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Toward Canadian Benchmarks for Health Services Wait Times - Evidence, Application and Research Priorities (Archived)

Rapid Response - Request for Applications

CIHR Institute of Health Services and Policy Research

In partnership with:

Conference of Provincial / Territorial Deputy Ministers of Health
CIHR Institute of Cancer Research
CIHR Institute of Musculoskeletal Health and Arthritis

Summary

The purpose of this Request for Applications (RFA) is to fund initiatives designed to inform the work of Provincial/Territorial Deputy Ministers of Health in meeting those commitments in the Ten-Year Plan to Strengthen Health Care related to establishing evidence-based benchmarks for medically acceptable wait times, in five priority areas: cancer, heart, diagnostic imaging, joint replacement, and sight restoration.

Timeline

March 15, 2005	Abbreviated Registrations must be courier stamped by this date (see How to Apply section)
March 31, 2005	Full applications must be courier stamped by this date
May 2, 2005	Anticipated Notification of decision
May 3, 2005	Anticipated start date.

Value and Duration

Duration of projects	Up to 1 year.
Funds Available	For this initiative: Minimum of $500,000 (subject to sufficient fundable applications) Per grant: Maximum of $100,000.

Summary
Background
Partners
Objectives and Eligible Research Areas
Funding Information
Eligibility
Evaluation Criteria and Process
Guidelines and Conditions of Funding
Communications Requirements
Monitoring, Performance Measurement and Evaluation
How to Apply
Contact Information
Description of Partners

Background

Canadians are passionate about their health care system. Most Canadians visit at least one health care provider during the course of a year, and individual experiences with the health care system are mostly positive. Yet, people are becoming less confident that health care will be there when they need it. Tension between public expectations regarding timely access to appropriate health services and current wait times for some services has not gone unnoticed by health care managers and policy-makers in Canada.

In 2004, a national consultation exercise (Listening for Direction II) was undertaken to identify research priorities among health services administrators and policy-makers.¹ Ten priority research themes emerged and "timely access to quality care for all" was a significant and recurring priority among those who attended consultations. CIHR's Institute of Health Services and Policy Research (IHSPR) subsequently became the lead national organization responsible for funding research and knowledge translation activities in this area. For more information visit the Listening for Direction II page.

In September 2004, First Ministers agreed to build on past efforts to reduce wait times and improve access by making the following commitments in the Ten-Year Plan to Strengthen Health Care:

Each jurisdiction agrees to establish comparable indicators of access to health care professionals, diagnostic and treatment procedures with a report to their citizens to be developed by all jurisdictions by December 31, 2005.
Evidence-based benchmarks for medically acceptable wait times starting with cancer, heart, diagnostic imaging procedures, joint replacements, and sight restoration will be established by December 31, 2005 through a process to be developed by Federal, Provincial and Territorial Ministers of Health.
Multi-year targets to achieve priority benchmarks will be established by each jurisdiction by December 31, 2007.
Provinces and territories will report annually to their citizens on their progress in meeting their multi-year wait time targets.

The full text of the Ten-Year Plan is available as a [ PDF | Help ].

A crucial step in developing evidence-based benchmarks is to understand the existing body of research and learn from the experiences of jurisdictions in Canada and abroad. A second important step is having a clear picture of where further work is needed by identifying gaps where there is currently insufficient evidence to support such benchmarks.

The work conducted in response to this RFA will complement parallel work already underway by the Canadian Health Services Research Foundation that is intended to:

Evaluate what is generally considered as "evidence" by researchers and those involved in health system decision-making (e.g., patients, clinicians, managers, and policy-makers); and
Outline the deliberative processes used to combine "evidence" with other inputs to arrive at health system guidance.

Research evidence on the relationship between waits, health and quality of life will rarely be sufficient, alone, to point to an obvious benchmark. Nevertheless, evidence on these relationships is critically important information for decision-makers to take into account in developing wait time benchmarks in priority areas. The availability of evidence of this nature varies widely, across broad clinical areas, and across different procedures and services within any given clinical area. For example, there are broadly accepted, evidence-based norms regarding when some diagnostic or clinical services are most appropriate (e.g. prenatal screening). But these represent the exception. For other procedures, the amount of relevant evidence on any one particular relationship (e.g. between wait time and independence in activities of daily living for hip replacement candidates) varies considerably. The body of evidence may reflect work from many different venues, using different methods, based on different populations, over different time periods, and so on. In such situations, syntheses become important tools for translating a body of evidence into a form and format useful to decision-makers.

Partners

CIHR's IHSPR is dedicated to identifying and developing collaborations with other CIHR institute(s), branch (es) or office(s), to enhance the availability of funding for this strategic initiative, and to create, where appropriate, opportunities for knowledge exchange and translation related to the scope of this particular initiative.

Applicants are invited to visit the Descriptions of Partners to find a list of partners and their respective mandates and/or strategic interests.

Objectives and Eligible Research Areas

Synthesize research evidence regarding the relationships between patient characteristics (e.g. age, clinical severity or stage of illness, co-morbidities, etc.), health service wait times, and mortality, health status or quality of life;
Summarize wait time benchmarks that are currently used nationally or internationally, and research evidence (if any) that was used to support their selection;
Identify areas/procedures where there is currently sufficient evidence, and general consensus exists, regarding wait time benchmarks; indicate the benchmarks being used, and the range of settings where such benchmarks are currently applied;
Identify priority areas and questions for future research (particularly with respect to the types of relationships between wait times and health status/quality of life described in objective #1 above) that are likely to yield research evidence of use to provinces and territories in considering additional wait time benchmarks;
Support knowledge translation/exchange between the funded applicant(s) and Provincial/Territorial Deputy Ministers of Health through, at a minimum, the creation of three reports;
Support knowledge translation and dissemination activities regarding new knowledge generated through this initiative.

The ONLY eligible projects under the present RFA include those focused on subsets or combinations of the following five clinical priority areas:

Cancer
Heart
Diagnostic imaging
Joint replacements
Sight restoration

In order to meet the information needs of Provincial/Territorial Deputy Ministers of Health, funded applicants will be expected to deliver three reports to CIHR; on or before July 22, 2005 (Report 1), October 15, 2005 (Report 2) and April 30, 2006 (Report 3). The content of these reports is outlined in the "Guidelines and Conditions of Funding" section.

Funding Information

Mechanism of Support

This RFA is funded as a strategic initiative and is designed to solicit research synthesis grant applications with duration of up to one year. The General Guidelines for All Research Grants apply.

Allowable Costs

Applicants should review Use of Grant Funds and Eligibility of Expenses, Employment under Grants within the General Guidelines for All Research Grants for a complete listing and description of allowable costs and activities.

The full application must provide a detailed budget and justification of all costs.

Allowable costs for these research synthesis grants also include:

Release time for clinical experts or health system decision-makers, more specifically up to 25% for applicant(s) salary(ies). The dollar amount awarded may be used only for the actual replacement costs of the designated recipient and may not be reallocated to other research or related expenses. Funds granted for other purposes may not be reallocated to a release time stipend. Recipients of release time stipends are not considered employees of CIHR.
Consulting fees, provided that such costs are well justified.
The salary(ies) of research assistants.
Knowledge translation related costs, such as:
- Costs of networking activities, including collaboration, planning, and research exchange activities directly related to the proposed project, and extra travel funds required for members and trainees separated by a significant distance. Eligible activities must involve substantive and meaningful interaction between research and system policy/ management personnel
- Costs associated with the creation and distribution of communication tools (e.g. plain language summaries or other user driven methods)
Purchase and maintenance of research equipment and other research tools, maintenance grants for common services and shared facilities.

Grants should NOT be used as bridging or emergency funding; or, to support ongoing studies.

Funds Available

The maximum amount awarded for a single grant will be $100,000 for up to one year, including equipment.
The total amount available for this initiative will be a minimum of $500,000. The final available amount will be dependent on the ability to secure additional partner funding, and on the nature and range of applications submitted, and deemed at review to be fundable.
Separate funding pools will be established to ensure that at least one meritorious application (top-ranked and deemed relevant by the funding partners) is funded in each of the five priority clinical areas.
If additional funds are available for this program, consideration may be given to funding more than one application in a priority area, provided the applications are not duplicative of the applications approved for funding within each pool.
Applications receiving a score of less than 3.5 will not be considered for funding, even if this means that no work is supported for one or more of the priority clinical areas listed above.

Eligibility

Eligibility Criteria

Eligibility criteria for all CIHR research funding programs apply. The business office of the institution of an eligible Nominated Principal Applicant generally administers CIHR funds. Please refer to the Eligibility Requirements for CIHR Grants and Awards regarding the eligibility requirements for individuals and institutions.

Evaluation Criteria and Process

Criteria for Merit Review

The following general criteria will be used to evaluate the full application:

Relevance and Potential Impact:

How important (potential health impact, incidence/prevalence), and widely encompassing of the clinical area(s) in question, are the procedures and/or services for which the synthesis/scoping work will be undertaken? What is the potential for important new observations or knowledge?
Have the applicants identified key (clinical and/or policy) collaborators and stakeholders, where relevant, as well as methods for engaging/consulting with them?
Above/beyond the three required reports outlined in the "Guidelines and Conditions of Funding" section of this RFA, how realistic, appropriate and potentially effective, is the overall plan for knowledge translation/exchange during, and after, the granting in light of the critical time path for the work, and the resources available?

Scientific Merit:

How appropriate and rigorous is the proposed approach to the synthesis work? How well have the applicants anticipated difficulties in their approach and considered alternatives? How clearly have the applicants outlined their proposed methods for the review of evidence, including methods for identifying, selecting and appraising peer reviewed literature and grey literature?
How appropriate to the research proposed is the training or track record of the applicant(s) in terms of research, research synthesis and knowledge translation and exchange? How relevant is the recent research of the applicant (s)?
What is the likelihood that this team can complete the research and required reports in a timely fashion?
How appropriate is the proposed critical time path?
What experience does the research team have in research synthesis and the development of research summary documents for senior policy-makers?
How realistic is the proposed methodology relative to the reporting requirements of the work?

Evaluation Process

Full applications will be initially screened by CIHR staff to ensure that: (a) reporting requirements are acknowledged; (b) all proposed expenditures are eligible; (c) all materials comply with format requirements and include appropriate documentation and (d) research falls within the scope of at least one of the five eligible priority clinical areas.

Prior to merit review, the Provincial/Territorial Deputy Ministers and the appropriate CIHR Institute representatives will review proposals for relevance to their strategic interests. This information will be used for decisions regarding financial commitments to this RFA. To conduct this work, representatives will have access to anonymized project titles and summaries (page 9 of the Research Module). This review will be conducted independently of and will have no impact on the merit review process.

A merit review panel comprised of relevant research peers, and decision makers will review full applications deemed eligible by CIHR staff. The merit review panel will be created specifically for this program. CIHR staff responsible for the administration of the merit review will select panel members, and this process will be informed by suggestions put forward by Provincial/Territorial Deputy Ministers of Health, CIHR Institutes and the research community. Names of panel members will be published on the CIHR website after the competition results are announced.

Full applications will be assessed and rated by the merit review panel using the evaluation criteria listed above. Relevance and potential impact, relative to the objectives of the RFA, and scientific merit, will be given equal weight in the assessment of the applications reviewed by the panel. The panel will then rate each application, using the CIHR Merit Review scale.

CIHR's Merit Review Scale:

	Relevance & Potential Impact		Scientific Merit
Fundable:	enormous extremely significant very significant	4.5-4.9 4.0-4.4 3.5-3.9	outstanding excellent very good
Seldom funded:	significant	3.0-3.4	acceptable, but low priority
Not fundable:	acceptable limited negligible	2.5-2.9 2.0-2.4 0-1.9	needs revision needs major revision seriously flawed

On completion of the merit review, the Provincial/Territorial Deputy Ministers and the appropriate CIHR Institute representatives will receive an anonymized ranking list, merit scores (ratings), and recommendations of the merit review panel, with regards to funding level, for the submitted applications that fall in the fundable range.

All personal information collected by CIHR about applicants is used to review applications, to administer and monitor grants and awards, to compile statistics, and to promote and support health research in Canada. Consistent with these purposes, applicants should also expect that information collected by CIHR may be shared as described in Use and Disclosure of Personal Information Provided to CIHR for Peer Review.

Access to Information Act and Privacy Act, and the Personal Information Protection and Electronic Documents Act (PIPEDA)

CIHR as a federal entity is subject to the Access to Information Act and the Privacy Act, therefore the requirements of these two statutes will apply to all information located in CIHR's premises including, without limitation, cost-sharing agreements related to this Request for Applications and all matters pertaining thereto.

The Parties, while respecting the application of the Privacy Act to federal entities, will also be bound by the PIPEDA. All personal information (as identified by the PIPEDA) collected, used or disclosed in the course of any commercial activity under cost-sharing agreements related to the Request for Applications will be collected, used and disclosed in compliance with the PIPEDA.

Guidelines and Conditions of Funding

All conditions specified in CIHR General Grants and Awards Policies shall apply to applications funded through this RFA. Conditions cover areas such as Applicant and Institutional Responsibilities, Ethics, Official language policy, Access to Information and Privacy Acts, and Acknowledgement of CIHR Support. Successful applicants will be informed of any special financial conditions prior to the release of funds or when they receive CIHR's Authorization for Funding (AFF) document.
In addition to CIHR standard guidelines and requirements, the following special conditions shall apply:

In order to meet the information needs of Provincial/Territorial Deputy Ministers of Health, funded applicants will be expected to deliver three reports to CIHR; on or before July 22, 2005 (Report 1), October 15, 2005 (Report 2) and April 30, 2006 (Report 3). CIHR will forward these reports to officials reporting to Provincial/Territorial Deputy Ministers of Health. All reports should be in a form and format suitable to these audiences.

Report 1 (July 22, 2005) is intended to provide information on objective #3 above, that is the identification of areas/procedures where there is currently sufficient evidence, and general consensus exists, regarding wait time benchmarks, a description of the benchmarks being used, for what purposes and by whom, and the range of settings where such benchmarks are currently applied. In addition, this first report will briefly summarize progress toward the other four objectives outlined above.

Report 2 (October 15, 2005) will contain the results of work on objectives #1 and #2 above, specifically the synthesis of evidence regarding:
Wait time benchmarks that are currently used nationally or internationally and research evidence (if any) that has been used to support them.
Relationships between patient characteristics (e.g. age, clinical severity or stage of illness, co-morbidities, etc.), health service wait times, and mortality, health status or quality of life.

Report 3 (April 30, 2006) will contain the results of work addressing objective #4 above, specifically:
The gap analysis and identification of priority areas and questions for future research (particularly with respect to the types of relationships between wait times and health status/quality of life described in objective #1) that are likely to yield research evidence of use to provinces and territories in considering additional wait time benchmarks.
Conversely, and importantly, in order to complete the work relevant to objective # 2 (i.e. to describe wait time benchmarks that are currently used nationally and research evidence that was used to support their selection), the provinces and territories agree to provide funded researchers with relevant information in a timely way. CIHR's IHSPR will undertake to facilitate linkages between funded researchers and designated representatives in these jurisdictions.

Communications Requirements

Grant recipients are required to acknowledge the financial assistance received from the Provincial/Territorial Deputy Ministers of Health and CIHR Institutes in any communication or publication related to the project. However, all acknowledgements should confirm that the conclusions and opinions found in the reports or other publications are solely those of their authors and that no official endorsement by CIHR or Provincial/Territorial Deputy Ministers of Health is intended or should be inferred.

The intellectual property rights in all works produced as a result of these grants will belong to the grant recipients. More specifically copyright to Reports 1-3 above will belong to the authors of those reports, but the authors will grant the Provincial/Territorial Deputy Ministers of Health free, irrevocable and unlimited sole licences to use, copy, publish, and translate those reports throughout the world. Grant recipients will not publish any of the Reports 1, 2 or 3 mentioned above, nor the information contained in those reports, for a period of 30 days from their actual dates of receipt by the Provincial/Territorial Deputy Ministers of Health.

See CIHR General Grants and Awards Policies, Acknowledgement of CIHR's Support for details on CIHR's communication requirements. The contributing Institutes / partners will be identified on the Authorization for Funding and decision letter.

Monitoring, Performance Measurement and Evaluation

CIHR is committed to demonstrating results to Canadians for the money invested in health research. Therefore, processes for monitoring progress and appropriate use of funds, as well as for performance measurement and program evaluation are in place. As a result, funding recipients must:

Adhere to the reporting requirements articulated above
Contribute to the monitoring, review and evaluation of CIHR's programs, policies and processes by participating in evaluation studies, surveys, workshops, audits and providing data or reports as required for the purpose of collecting information to assess progress and results
Encourage their associates, trainees and administration to participate in the monitoring, review and evaluation of CIHR's programs, policies and processes as required

How to Apply

The application process is comprised of two steps: 1) Abbreviated Registration and 2) Full Application.

Review the application instructions provided in How to Apply for a Grant or Award.

1) Abbreviated Registration:

Intent to respond to this RFA MUST be indicated by submitting the attached Abbreviated Registration Form: [PDF (52 KB) | PDF (65 KB, fillable) | Help]. Two copies [original plus one copy] must be courier stamped no later than March 15th, 2005 (late registration will not be accepted) and sent to the following address:

Marie-Lynne Boudreau
Program Delivery Officer
Canadian Institutes of Health Research
160 Elgin Street, Room 97
Address Locator 4809A
Ottawa, ON
K1A 0W9

2) Full Application:

Complete the Full Application using the CIHR Operating Grants application package, which consists of the CIHR Research Module, the CIHR Operating Budget Module and the Common CV. Select Operating Grants (Application) from the Research Funding Programs Application Packages.

Additional instructions must be followed for this RFA:
a) Research Module:

In the Research Funding Program section of the Research Module (page 7 of the web form printed report), select "Strategic Initiative/RFA" and enter the title of this RFA.

The research proposal section of the Research Module for this initiative is limited to a maximum of 6 pages, including figures and tables and the Summary of Research Proposal (p. 9). References may be listed in additional pages.

You must clearly indicate in the Summary of Research Proposal (p. 9), which of the following five clinical priority areas your project is addressing:

Cancer
Heart
Diagnostic imaging
Joint replacements
Sight restoration

Any team wishing to apply to undertake syntheses for more than one priority clinical area should submit a separate registration and application for each clinical area.

b) Common CV Module

You must submit full common CV modules for the Nominated Principal Applicant, Principal Applicants and one Co-Applicant. Only abbreviated CVs (2 pages) are required for any additional Co-Applicants. The abbreviated CV should use the CIHR common CV Module as a guide for content and must include at a minimum, the contact information of the Co-applicant including mailing address, telephone number and e-mail address, information on current grants held, relevant publications from the last five years, and expertise keywords. Full CVs will not be considered.

Courier the 6 copies [original, plus five copies] of the full application by the full application deadline of March 31st, 2005 to the address below:

Marie-Lynne Boudreau
Program Delivery Officer
160 Elgin Street, Room 97
Address Locator 4809A
Ottawa, ON
K1A 0W9

Contact Information

For questions on CIHR funding guidelines, how to apply, and the review process contact:

Marie-Lynne Boudreau
Program Delivery Officer
Canadian Institutes of Health Research
Telephone: (613) 941-0861
Fax: (613) 954-1800
Email: mboudreau@cihr-irsc.gc.ca

For questions about this initiative and research objectives contact:

Michèle O'Rourke
Associate, Strategic Initiatives
CIHR Institute of Health Services and Policy Research and
CIHR Institute of Population and Public Health
Telephone: (613) 952-4539
Fax: (613) 954-1800
E-mail: morourke@cihr.gc.ca

Description of Partners: CIHR Institutes and Partner Organizations

Canadian Institutes of Health Research (CIHR)
CIHR is Canada's major federal funding agency for health research. Its objective is to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system.

CIHR - Institute of Health Services and Policy Research (IHSPR)
CIHR's IHSPR is dedicated to supporting innovative research, capacity-building and knowledge translation initiatives designed to improve the way health care services are organized, regulated, managed, financed, paid for, used and delivered, in the interest of improving the health and quality of life of all Canadians.

CIHR - Institute of Cancer Research (ICR)
One of the clinical priority areas that this RFA covers is Cancer. CIHR's ICR supports research to reduce the burden of cancer on individuals and families through prevention strategies, screening, diagnosis, effective treatment, psycho-social support systems, and palliation. ICR is specifically interested in funding evidence to support decisions regarding medically acceptable wait times in the following areas: diagnosis, surgery, radiation therapy and chemotherapy. ICR will contribute up to $200,000 in support of this RFA.

CIHR- Institute of Musculoskeletal Health and Arthritis (IMHA)
CIHR's IMHA supports research across its three research themes: 1) Physical Activity, Mobility & Health, 2) Tissue Injury, Repair & Replacement, and 3) Pain, Disability & Chronic Diseases of the Musculoskeletal, Skin or Oral Health Systems - which encompass the six foci of the mandate: oral health, skin, MSK rehabilitation, skeletal muscle, bone and arthritis. IMHA is specifically interested in funding evidence to support decisions regarding medically acceptable wait times in the area of joint replacements. IMHA will contribute up to $100,000 in support of this RFA.

Conference of Provincial / Territorial Deputy Ministers of Health
The Conference of Provincial/Territorial Deputy Ministers of Health provides leadership on a wide range of health care issues important to all Canadians. As the members of the Conference, Canada's thirteen Provincial/Territorial Deputy Ministers of Health address common challenges facing all jurisdictions, share information and innovative practices to improve the operation of health care services, and work collaboratively to reform health care in Canada. Currently chaired by Ontario, the Conference reports to Provincial/Territorial Ministers of Health. The Conference of Provincial/Territorial Deputy Ministers of Health will contribute up to $500,000 in support of this RFA.

Organizations that partnered to conduct this consultation include: Canadian Health Services Research Foundation, CIHR's - Institute of Health Services and Policy Research, the Canadian Institute for Health Information, the Canadian Coordinating Office for Health Technology Assessment, the Advisory Committee on Governance and Accountability of the Federal/ Provincial/ Territorial Conference of Deputy Ministers of Health, and the Health Statistics Division of Statistics Canada.

Created: 2005-02-25
Modified: 2005-04-15
Reviewed: 2005-02-25
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