Request for Proposals (RFP 003) for Synthesis Research - July 20, 2001 Competition

Deadline: September 19, 2001

I. Introduction

Health Canada's Research Management and Dissemination Division (RMDD), situated within the Applied Research and Analysis Directorate of the Information, Analysis and Connectivity Branch, is pleased to announce on behalf of its Health Policy Research Program (HPRP) the first Request for Proposals (RFP) for Synthesis Research. The HPRP funds research and related activities that directly support Health Canada's policy and program functions through four components:

• research projects (original and secondary analyses as well as syntheses);
• Federal/Provincial/Territorial (F/P/T) health research partnerships;
• developmental projects (such as feasibility studies, assessment of pilot projects, development of policy research or knowledge transfer methodologies, or definition of the scope and parameters of a new policy research area); and
• policy-relevant workshops, seminars, and conferences.

II. Research and Policy Interface

The RMDD is committed to building a sustained collaboration between the research community and Health Canada's policy officials. As such, a key policy contact has been identified for each of the priority areas described in this document. This contact person is responsible for ongoing interaction with researchers to provide contextual guidance and advice to researchers on the policy interface at Health Canada. We encourage all applicants to contact the policy official identified for consultation prior to and during the drafting of a proposal.

Important Notes:

• Policy contacts are to be consulted on the policy issues and proposal content only. Formatting, eligibility/ineligibility, and other administrative questions (such as timeframes, budgets, etc.) should be directed to the RMDD Information Officer (see Section VII).
• Do NOT forward proposals (draft or otherwise) to policy contacts for their review at any time. Preliminary review of a proposal by a policy contact will be deemed a conflict of interest and may result in the disqualification of your proposal.

III. Important Information for Applicants

The HPRP is releasing two concurrent RFPs: (1) for synthesis research projects; and (2) for workshops, seminars and conferences. A combined funding envelope of $1 million has been dedicated for these two competitions. The HPRP expects to fund up to 10 - 12 proposals (synthesis projects and workshops, seminars and conferences combined). Funding will be distributed across both competitions and across the identified themes as required. The RFP for Workshops, Seminars and Conferences (#002) is available at : http://www.hc-sc.gc.ca/arad-draa.

IV. Scope of Competition

The purpose of this competition is to develop a better understanding of the present state of knowledge of policy issues of priority to Health Canada by soliciting proposals to synthesize the existing research, to provide critical assessment of the present knowledge level, and to identify future knowledge needs for the policy areas identified below. Project duration is expected to range from 8 - 14 months. Proposals must examine one of the following policy relevant themes:

• Community Capacity; or
• Integrated Health Systems.

Specific policy questions are outlined under each theme.

Important Note:

• Proposals must not exceed a budget of $100, 000.
• Applicants must refer to Eligibility Criteria and Ineligible Activities (Section 6 of the Guide) before developing a proposal. Note that each theme may specify additional criteria.

Community Capacity

This section is organized under two subcategories: (1) Measuring and Operationalizing Community Capacity; and (2) Social Capital and the Impact on Community Capacity. While policy questions are identified under each section, proposals may address a combination of questions from across both subcategories. Proposals must synthesize the existing research, provide critical assessment of the present knowledge level, and identify the future knowledge needs for at least one policy question identified within this document.

Measuring and Operationalizing Community Capacity

Policy Contact:

Ian Clark
Senior Research Analyst
Division of Aging and Seniors
Centre for Healthy Human Development
Population and Public Health Branch
Health Canada
8th Floor, Jeanne Mance Building
AL 1908A1, Tunney's Pasture
Ottawa, Ontario K1A 0K9
Telephone: (613) 954-1047
Fax: (613) 957-7627
E-Mail: ian_clark@hc-sc.gc.ca

Community capacity can be defined as "...the characteristics of communities that affect their ability to identify, mobilize, and address social and public health problems"¹. While building community capacity is one of Health Canada's objectives, and the purpose behind a number of community based programs, including the Community Action Plan for Children (CPAC) and the Canada Prenatal Nutrition Program (CPNP), the ability to measure or assess this capacity is limited.Several CAPC and CPNP projects, for example, have enlisted the help of university researchers and other evaluators to capture the impact of projects on participants and their community. The evaluation results indicated that CAPC and CPNP projects were successful at developing and maintaining partnerships, and that these partnerships had many benefits, including increased resources, referrals, visibility, exchange of information and levels of service for families. While this qualitative research has proven somewhat successful at measuring some aspects of community capacity, quantitative evidence is limited. In order to guide policy decisions and facilitate community capacity building programs, it is essential to build upon the available knowledge and evidence base. This requires the development or refinement of tools (1) to measure and assess, and (2) to operationalize community capacity. As a first step, a synthesis and analysis of the current status of research in this area is needed.1. Poole, D.L, "Building community capacity to promote social and public health: Challenges for universities." Health and Social Welfare, 22, 3 (1997): 163. Policy Questions

Measuring Community Capacity

1. What is the available knowledge on theoretical frameworks, statistical analyses and the evidence base on measuring community capacity and health? What are the gaps in the literature on measuring community capacity? What are the "best practices" of existing community based programs and how could these inform the development of assessment tools? What are the issues that need further investigation?
   
2. What indicators of community capacity have been tested, and how effective have the results been? Where are the gaps?
   

   a. What measurement or assessment methods are best suited to determining community capacity? Are quantitative and qualitative indicators sufficient to capture community capacity? Will surveys produce the desired measurement? Are there participatory action/research methods that are more appropriate? b. What are potential ingredients for a composite, broadly applicable indicator of community capacity? Is there something similar already being used across communities that could be assessed for relevance (e.g. quality of life indicators)?

3. What is known about models/best practices for accomplishing community capacity, and lessons learned that could contribute to the measurement question? This would include key research that has been done by other sectors on community capacity, and how much of this is transferrable to the health sector. Are there partnership opportunities across sectors for the research?
   
4. How can citizens and community organizations be engaged in determining how to best measure community capacity? What models of engagement have been found to be effective?

1. What key pieces of research are currently under way that illuminate the relationship between population health and community capacity? Why are some communities healthy and others not?
   
2. What community based programs are actually effective in terms of their effects in building better communities for different subpopulations (i.e. children, Aboriginals, etc.)?

Social Capital and the Impact on Community Capacity

Policy Contacts:

Solange van Kemenade
Research Analyst
Quantitative Analysis and Research Division
Strategic Policy Directorate
Population and Public Health Branch (PPHB)
Health Canada
A.L. 1917C1, Tunney's Pasture
Ottawa, Ontario K1A 0K9
Telephone: (613) 954-8035
Fax: (613) 954-5542
E-Mail: solange_van_kemenade@hc-sc.gc.ca

Éric Jenkins
Manager
Quantitative Analysis and Research Division
Strategic Policy Directorate
Population and Public Health Branch (PPHB)
Health Canada
A.L. 1917B1, Tunney's Pasture
Ottawa, Ontario K1A 0K9
Telephone: (613) 946-5676
Fax: (613) 954-5542
E-Mail: eric_jenkins@hc-sc.gc.ca

Since the 1990s, some determinants of health have been shown to be related to dimensions previously little measured and for which the link with health has not been clearly identified. These include the link between the health of individuals and the effects of : immediate social environment (family, friends), social networks, trust between individuals, citizen participation, and community commitment. These indicators relate for the most part to a microsocial scale (the community) and constitute an effort to link the individual to his/her social environment. The recent rapprochement of sociologists and epidemiologists explains in part the growing interest in the new determinants of health on the part of those in the health sciences (Wilkinson, 1996).Although the concepts referred to are different, they are based on a common idea. Whether we are speaking of "social cohesion," "social capital" or "community capacity," there is a fundamental certainty that intangible elements act on individuals and communities, either by strengthening them or by making them more vulnerable to adversity. Studies are increasingly showing that communities supported by a large stock of social capital perform better economically and socially (Putnam, 2000). These communities have lower crime rates and less tax fraud, their citizens show greater tolerance and are in better moods, and the children have a higher level of well-being and succeed better in school. The beneficial effects of social capital on health have also been shown by certain research projects. In government, there is a desire to better understand the effects of different social factors on Canadian society, communities, and individuals in order to develop policies that better reflect the new realities. The initiative for interdepartmental research on social cohesion in Canada and the establishment of the Social Cohesion Network are evidence of that concern. At Health Canada, the Quantitative Analysis and Research Division (Strategic Policy Directorate, PPHB) began research on social capital in February 2001. In connection with this research, certain initiatives were identified, such as the survey on social capital done by a group of researchers at the University of British Columbia. In addition, in the fall, Health Canada will be collaborating with Statistics Canada on development of Cycle 17 of the General Social Survey, which will be on social cohesion and social capital.Policy QuestionsProposals addressing the following policy questions should focus on methodologies, policies, and comparative research.

1. Research has shown that communities behave differently in the face of a natural disaster, depending on whether or not their stock of social capital is large. What are the factors that promote social cohesion in a community? What Canadian towns, cities, villages and communities are richer in social capital/community capacity? How should we develop policies that strengthen social capital in the most disadvantaged towns/cities/communities/groups?
   
2. Research in the United States shows that some groups of immigrants succeed better than others at integrating into the host society. Their stock of social capital is apparently greater. Are similar differences to be found in Canadian society? What existing policies generate/strengthen social capital for these new arrivals? What new policies should be implemented?
   
3. Are there policies or programs that have positive effects on social cohesion/social capital? What specific evaluations or empirical analyses of the policies and programs have been conducted?

Integrated Health Systems (IHS)

Policy questions are outlined under two subcategories: (1) Integration of Care from a Health Systems Perspective; and (2) Integration of Care at the End of Life. While policy questions are identified under each section, proposals may address a combination of questions from across both subcategories. Proposals must synthesize the existing research, provide critical assessment of the present knowledge level, and identify the future knowledge needs for at least one policy question identified within this document.

Integration of Care from a Health Systems Perspective

Policy Contact:

Diane Lugsdin
Manager, Acute Care and Technology Unit
Health Services Division
Health Care Strategies and Policy Directorate
Health Policy and Communications Branch
Health Canada
A.L. 0910D, Tunney's Pasture
Ottawa, Ontario K1A 0K9
Telephone: (613) 957-0730
Fax: (613) 957-3233
E-Mail: diane_lugsdin@hc-sc.gc.ca

Integration of the components of health care is viewed in some countries as a solution to many of the problems faced by national health systems. The impetus for this trend has a basis in efficiency and effectiveness concerns, consumer demand for choice and access, and broader issues of quality of care (including redundancies/gaps and a desire to promote outcomes-based practice). Existing definitions and models focus on the coordination of health services across the continuum of care, as well as the collaboration among providers and provider organizations in the delivery of health services. In the September 2000 Communique on Health, First Ministers committed jointly to improved access to and greater integration of hospital, primary, home and community care.IHS concepts include: 1) system focussed integration seen as vertical, in which affiliated organizations provide different levels of care under one management umbrella, or horizontal, involving organizations providing similar care; 2) functional integration (the value added coordination of administrative functions); 3) physician integration, necessitating both economic and leadership involvement; 4) clinical integration, reflecting continuity and coordination of care (more from a consumer perspective), disease management, communication and information transfer; and 5) at a macro level of governance, to include the broad funding and policy making structures. Literature reviews appear to indicate that functional integration is most readily achieved and a body of knowledge exists on the Health Maintenance Organization (HMO) model and on 'needs-based' funding approaches, primarily capitation. Identified characteristics of successful integrated care include on the individual patient/client/user i.e. patient centred focus and a system that builds upon primary health care, shared information through use of technology, 'virtual' coordination, practical need-based funding models, and monitoring mechanisms.A number of models with elements of integration have evolved in the Canadian health delivery system, including: Regional Health Authorities, hospital networks, coordinated access systems and information/technology-based integration. Comprehensive synthesis reports on the following policy questions are required to build on the experience of the Health Transition Fund Integrated Service Delivery projects, to support essential policy development throughout Health Canada and may also be useful to inform research undertaken by Health Canada's principle research partners, eg. Canadian Institute for Health Information (CIHI), Canadian Institutes for Health Research (CIHR).

Policy Questions

Proposals should synthesize the existing research, provide critical assessment of the present knowledge level, and identify the future knowledge needs for one or more of the following policy questions. In addressing the questions, successful applicants will develop a synthesis of current care/ service delivery models, and highlight those models/approaches that best foster care integration from a consumer perspective, while meeting the system needs of the complete continuum of care.

1. Given existing knowledge of models of continuity of services, what are the objectives/achievable goals of an integrated system of health care (from the perspective of health services management, client populations, health system providers/policy decision-makers)?

a. Given these objectives, what are the characteristics of an integrated system from the perspective of:

information systems;
relational aspects, i.e. patient and provider(s); and with other sectors;
care planning; and
financing and governance.

b. What are the policy implications of these objectives and characteristics at the federal, provincial, funder, and the regional health system delivery levels?

2. What IHS funding/governance models have: (1) had demonstrable contributions to both the integration and costeffectiveness of the health care system as a whole, and (2) have applicability to the Canadian context?

3. What mechanisms are required to ensure that the health system, as a whole and for each of its components, has the capacity to respond to changes in demand and service delivery elsewhere in the system (e.g. impact on long-term care of changes in the acute care sector, impact on acute care/home care of advances in technology)?

b. In particular, information is sought on effective funding models, including needs-based funding models, that contribute to flexibility and the ability to move among system components, from the perspective of the patient/consumer, while contributing to the sustainability of all system sectors, and human resource retention.

4.What do we know about the direct and indirect costs of the failure to integrate health service systems (costs to the health and broader health/community system), including but not limited to impacts on:

timely access to various care sectors, including specialized/tertiary care; the consequent need for prolonged use of alternative health services/sectors; inappropriate use of resources; health outcomes; impact on quality of life; social support requirements; and lost productivity years.

In addressing the above cost factors, successful applicants will highlight approaches that foster care integration while 1) prioritizing access to those most in need/most able to benefit, and/or 2) facilitating simultaneous/sequential access to different service sectors (i.e. out-patient hospital care combined with home care) in non-traditional settings.

Integration of Care at the End of Life

Policy Contact:

Sue Morrison
Manager, Palliative Care Secretariat
Health Services Division
Health Care Strategies and Policy Directorate
Health Policy and Communications Branch
Health Canada
A.L. 0904A , Tunney's Pasture
Ottawa, Ontario K1A 0K9
Telephone: (613) 946-9851
Fax: (613) 941-5258
E-Mail: sue_morrison@hc-sc.gc.ca

Although we do not have Canadian population-based data on the use of health care services by individuals near the end of life, existing evidence indicates that a significant portion of the lifetime use of health care services of an individual typically is attributable to care in the last months of life. As the population ages, it is increasingly the case that the trajectory toward death involves a period of months which has been referred to as "chronic living-dying" (Committee on Care at the End of Life, 1997) between the diagnosis of an incurable illness and the stage of imminent death. During this stage of "chronic living-dying", the individual may use a wide range of services across the spectrum of sites for health service delivery. He or she may move in and out of hospital, home care, and residential long-term care. He/she may make use of specialist physicians as well as maintain an ongoing and longstanding relationship with a family physician and receive palliative nursing care in the home. The person may move from a community hospital to a specialist tertiary care facility, and back again. A wide range of support services may be utilized, including: those provided as volunteer community-based services; publicly subsidized services offered through a community agency or provincial or regional home care program; or those provided and paid for privately on a for-profit basis.

Policy Questions

Proposals should synthesize the existing research, provide critical assessment of the present knowledge level, and identify the future knowledge needs for one or more of the following policy questions:

1. How have recent developments toward increased system integration (in the sense of any/all of the concepts outlined above) affected the care, and particularly the continuity and quality of care, of patients nearing the end of life?

   a. Do some types of system integration approaches have more favourable (or less favourable) effects on the experienced continuity of care, quality of care, or effective level of support to the family of the dying individual?b. Are there differential effects of system integration efforts on dying individuals according to: characteristics of the individual (age, family status, living arrangements); specific disease or disorder experienced; the patient's point of entry into the system?

2. How have integrated systems reforms in the health system affected the potential for the development of effective surveillance systems related to end-of-life care?

V. Application Process

Applicants are invited to submit a proposal before 5:00 p.m. E.S.T. on September 19, 2001 in one of the priority areas identified in this document. Applicants must complete the Application for Research Project Funds - HC/SC HPRP-1 (06-2001). OR an application form may be obtained from:

• the HPRP Information Officer who may be reached by telephone at (613) 954-8549, by fax at (613) 954-7363 or by e-mail at rmddinfo@hc-sc.gc.ca.

• the HPRP Guide;
• Application instructions; and
• this Request for Proposals.

VI. Review Process

The review process will consist of:

1. screening within the HPRP for eligibility;
2. review by departmental officials for policy relevance and suitability to Health Canada's needs;
3. external peer review for policy priority and scientific quality; and
4. approval by the Minister of Health (based on reviews and subject to availability of funds).

Health Canada will provide advice to applicants in the development of proposals and throughout the life of funded projects to facilitate the connection between research and policy/program development. ** Please note that scientific review may also be applied to deliverables submitted upon completion of the research.

VII. Inquiries and Submission of Proposals

Inquiries should be directed to:

RMDD Information Officer
E-mail: rmddinfo@hc-sc.gc.ca
Telephone: (613) 954-8549
Fax: (613) 954-7363

Five copies of each proposal must be submitted to the Health Policy Research Program by:

Mail/Courrier:

Health Policy Research Program
Research Management & Dissemination Division
Information, Analysis and Connectivity Branch
Health Canada, 15th Floor, Jeanne Mance Building
Tunney's Pasture, Ottawa, Ontario K1A 0K9
Address Locator: 1915A

References

Putnam, Robert (2001) "Social Capital Measurement and Consequences". ISUMA, Canadian Journal of Policy Research, Volume 2 No 1 - Spring, pages 41-51.

Wilkinson, Richard G. (1996) Unhealthy Societies. The afflictions of Inequality, Routledge, London.