Presentation Slides - Montana AHEC & Office of Rural Health

Healthcare Grants:
Are they worth pursuing?
Doris T. Barta, Director Telehealth Services
Partners in Health Telemedicine Network
St. Vincent Healthcare
Challenges in writing healthcare grants
• Competition is greater –
less grant opportunities
– TNPG grants – funded 80
1 year ago; 5 this year
• A lot less money – with
high expectations for
– $200k/year versus
• More emphasis on
outcomes (e.g. evaluation)
and less focus on need
Office of Rural Health Policy Grants
• ORHP Grants have a rural focus –
• Montana is a rural (frontier) state
• ORHP tends to have annual grant cycles for some grants
• Application document remains consistent year after year
• ORHP grants are one of the easiest federal grants to write
• Explicit instructions on how to develop grant narrative
I. Funding Opportunity Description
1. Purpose
This announcement solicits applications for the Telehealth Network Grant
Program (TNGP). The primary objective of the TNGP as noted in Section
330I(D)(1) is to demonstrate how telehealth programs and networks can
improve access to quality health care services in rural, frontier, and underserved
communities. TNGP networks are used to:
(a) expand access to, coordinate, and improve the quality of health care
(b) improve and expand the training of health care providers; and/or
(c) expand and improve the quality of health information available to health
care providers, and patients and their families, for decision-making.
The St. Vincent Healthcare Foundation is submitting this Telehealth
Network proposal to provide pediatric outreach services to rural and
frontier Montana communities. We request the following
administrative funding priorities: (b) provision of clinical mental health
services; (d) network of rural health care providers whose sites are
located in frontier areas; (e) participation of a HRSA-funded community
health center; and the following legislative preferences: (a) the
applicant is a faith-based organization and (b) will provide pediatric
mental and preventive health services through this project. St. Vincent
Healthcare (SVH) is one of the two largest healthcare providers in
Montana, and is located in the state’s largest city, Billings. SVH is home
to the Partners in Health Telemedicine Network (PHTN), a partnership
of healthcare sites in Montana, Idaho, and Wyoming, which offers
telemedicine, teleconferencing, and continuing medical education to
member sites.
Montana Has Critical Gaps in Pediatric Care
37 in
26 in
21 in
13 in
11 in
73% of Pediatricians in Montana are located in
5 urban communities – all of which are on two
freeways that cross the state
Healthcare is hard to access in most of the state’s counties, and pediatric care is
nearly non-existent in rural/frontier Montana. In-state transfers of emergency care
cases to urban areas such as Billings are frequent and expensive. Numbers of
pediatric outpatient ER admissions at St. Vincent (children admitted to the ER,
treated, and released without hospitalization) from outside Yellowstone County are
significant. The chart below shows numbers of pediatric patients from outside our
county who are admitted to the ER, treated, and released without an overnight stay.
This indicates numbers of children who could be served in their local area, without
the stress and expense of travel.
By enhancing rural communities’ access to
Pediatric ER Admits outside Yellowstone County
pediatric specialty services through
without hospitalization
telehealth consults, we will help our rural
communities keep more pediatric cases
closer to home – providing the most cost
effective and appropriate level of care –
where and when needed. Finding a way to
keep more pediatric cases in-state and
closer to home—treated locally, where
possible, or, for cases requiring more
intensive care, sent to larger medical
centers in state – is better financially for the
state, the children and the parents.
Criterion 2: RESPONSE (maximum 16 points)
This Criterion is comprised of two parts:
a. Goals and Objectives (maximum 8 out of 16 points) - The application will be
evaluated based on the extent to which the project Goals and Objectives:
• Facilitate collection of data on the impact of telemedicine on improving health care
outcomes (e.g., improved access, productivity, dollars saved) as well as improved
quality of clinical services (e.g., reduction of medical errors).
• Correspond to identified problems, needs, and community demand.
• Are achievable, measurable, time-limited, and clearly stated.
• Are compatible with the applicant organization’s goals and objectives, including
quality of care, and cost-effective delivery of services.
• Responds to TNGP program goals.
b. Benefits (maximum 8 out of 16 points) The application will be evaluated based on the extent to which the project benefits:
• evidence of effective results in terms of quality of care, efficiency, and cost savings.
• Relate to the project’s goals and objectives.
• Are quantifiable, and justify the costs (both equipment and human) of the project.
• Are assessed by the applicant to monitor project effectiveness.
• Evidence the project’s value to the community and most effective use of technology
Writing Goals and Objectives:
What Funders want to see
Goal: What is the problem, and what would the
world look like if you solved it
• What do you want to accomplish
Objectives: How will you address the
Evaluation: How will you know if it worked?
Activities: What steps do you have to take
to get there?
• Think through the objectives
and activities that will help
you reach your goal, and start
jotting down your budget
needs as you go.
• Your goals, objectives and
action plans become your
work plan.
Any questions so far . . .?
Criterion 3: EVALUATIVE MEASURES (maximum 18 points)
The effectiveness of the method proposed to monitor and evaluate the project
results. Evaluative measures must be able to assess 1) to what extent the program
objectives will be met and 2) to what extent the outcomes can be attributed to the
• Evidences the experience and/or ability in evaluating health care outcomes
attributable to the telehealth program (e.g., improved quality of care, productivity
and efficiency, expanded access.
• Addresses the specific data planned for collection, the specific data collection
strategies and tools to be used, the types of analyses to be performed on the data,
and provides baseline data for those clinical services and/or diseases addressed for
this proposed project.
• Will be able to collect and provide data on costs, utilization, patient and
practitioner satisfaction, improved health care outcomes, reduction of medical errors,
and network organizational factors such as staffing, administration, etc.
• Has developed a plan to carry out evaluation activities and provides resources for
evaluation activities.
• Indicates how assessment data might be used to modify the project as appropriate.
• Evidences experience in dissemination of technical information to a wide audience.
How will you know if it worked?
• How will you measure your results?
• How will you demonstrate that the grant
project caused the results?
• Applications will be reviewed based on the
strength of the approaches used to measure
success in achieving project goals, objectives
and outcomes.
– Many applicants do not have this expertise in
house, and are hiring an outside evaluator
The Evaluator will be responsible for process and outcome
evaluation, selection of valid and reliable measures, development
and testing of new measures as needed. She will also participate in
monthly meetings with the Project Director and the Advisory
Group as needed. Baseline data will be used where available. The
Evaluator will prepare and deliver quarterly and annual reports that
will be available to the Advisory Group and the Network of
Providers. The consistent sharing of information regarding the
program activities will allow for changes in development and/or
implementation of program activities dependent upon the results of
evaluation information presented. Quarterly meetings will assure
ample opportunity for program adjustments should the need arise.
The Evaluator will also assist the Project Director to disseminate
results through local publications, refereed international
publications, and national presentations. In summary, the external
Evaluator’s role will be to monitor progress, measure successes,
ensure fidelity of the project, and assist or take the lead role in
disseminating results.
Tools used to assess the goals and activities: We are using
standardized tools for patient outcomes (e.g., clinical and
behavioral measures) and will be designing brief tools to estimate
cost, describe reasons for telehealth consultations, count the
number of telehealth consultations, and so forth. The tools for this
project will use nominal, ordinal, interval, and ratio levels of
measurement. Each tool is described in the Evaluation Plan below.
In addition, data will be collected to confirm process outcomes,
such as compliance with the terms of the proposal and timely
execution of project objectives. Evaluative strategies including
both outcome and process objectives are incorporated into the table
“Evaluation Plan,” which follows this section.
Criterion 4: IMPACT (maximum 13 points) – The extent to which project results may
be replicated nationally; the extent and effectiveness of plans for dissemination of
project results; and the sustainability of the program beyond the Federal Funding.
Specifically, this Criterion is comprised of two parts:
a. Project Impact and Information Dissemination (maximum 5 out of 13 points)
• Serves as an experienced model for telehealth networks that provide specific,
quantifiable and measurable outcomes for: 1) quality of care; 2) efficiency; 3) cost
savings; or 4) the integration of the telehealth information system into the electronic
health information systems (e.g., electronic medical record) used by the applicant and
network members.
• Plans and strategies for marketing, promotion, and information dissemination
b. Sustainability (maximum 8 out of 13 points)
How the project will be sustained during and after federal grant funding:
• Plans to measure the contribution of the project to the goals of each project partner and
how these goals contribute to the long-term success of the project.
• Has integrated the project into its strategic plan, core business, and clinical practices
• Documents how cost-savings to be realized and measured, as applicable.
• Evidences acceptance of partner financial responsibility, participation and commitment
• Outlines a realistic plan for sustainability
• Evidences local community/provider involvement
Criterion 5: RESOURCES/CAPABILITIES (maximum 25 points) – The extent to which
project personnel is qualified by training and/or experience to implement and carry out
the projects. The application will address the capabilities of the applicant organization,
and quality and availability of facilities and personnel to fulfill the needs and
requirements of the proposed project.
This Criterion is comprised of three parts:
a. Network Experience/ Network Member Sites including, as applicable, Network
Partner Rural Spoke sites and Hub site(s) and Network Organization (maximum 9 out of
25 points)
b. Project Management and Work Plan (maximum 11 out of 25 points)
c. Clinician Acceptance and Support (maximum 5 out of 25 points)
Applicants failing to submit verifiable information with respect to the
commitment of network partners [i.e., all Partner Rural Spoke sites and Hub
site(s) at the time of application will receive 0 out of 25 points.
a. Existing Network Experience/ Network Member Sites and Network
b. Project Management and Work Plan
c. Clinical Acceptance and Support
Criterion 6: SUPPORT REQUESTED (maximum 15 points) –
The application will be evaluated based on the extent to which the budget,
including the cost projections, and budget justification:
• Is realistic and justified in terms of the project goal(s), objectives, and
proposed activities.
• Documents that the budgeted costs are realistic, necessary, and justifiable to
implement and maintain the project, including the human and technical
• Documents a realistic, necessary, and justifiable full-time equivalents (FTEs)
and expertise necessary to implement and maintain the project.
• Is complete and detailed in supporting each line item and allocating
• Documents demonstrable experience with regard to technical costs of
hardware and software, and telecommunication charges.
• Conforms to the use of grant dollars permitted by the grant program.
The budget and the narrative should tell
the same story!
You should be able to
read the text and
estimate the cost
You should be able to review
the budget and understand
what is being done.
What is an allowable cost?
Know your funding source
• They will publish what they fund
and what they do not fund
• Some federal funding sources will
not cover operating costs, but will
allow you to include that in your
match (RUS)
• The ORHP funds both operating
costs and equipment (equipment
can only be up to 40% of the project
• Funding sources can and will change
their priorities
In-kind and matching requirements
• In-kind contributions: the “stuff,”
time, and material you bring to the
• Hard match: the cash dollars you
set aside from your budget toward
the grant
Budget Development
• Many times the Funding Source will give you a
sample budget form to follow
• Make sure you provide a thorough budget –
don’t leave the reviewer guessing
• Make sure you provide a detailed budget and
a detailed budget narrative
Sample Budget
Project Director
Billings 1000mi/
@ .51/mile
Planning for sustainability
• Avoid building salaries
into grants
• Can the project sustain
• Can your budget absorb
the costs?
CLINICAL SYSYTEMS (maximum 8 points) – The extent to which the application
demonstrates knowledge of technical requirements and rationale for costeffective deployment and operation.
• Have the ability to integrate administrative and clinical information systems with the
proposed telehealth system.
• Will utilize “open architecture” (interoperable) technologies or demonstrate why
proprietary solutions are preferable.
• Will integrate the proposed system into each provider’s normal practice.
• Employs technologies that are upgradeable and scalable.
• Justifies the technology as the optimum and most efficient technology to meet the
identified need.
• Explain how the project will ensure the privacy of patients and clinicians using the
system and the confidentiality of information transmitted via the system, including
compliance with Federal and State privacy and confidentiality, including HIPAA
• Evidence knowledge of telecommunications transmission services available in the
project service area, and justify the deployment at each site considering the range of
choices available.
This project will provide fifteen rural spoke sites with the
peripheral equipment to support the telepresentation of pediatric
patients to urban pediatricians and pediatric specialists. Based
upon currently available technology, this equipment will include
the following peripherals, which are easily incorporated into the
selected codec:
•TR-1/EF Telephonic Stethoscope, which consists of a Chest
Piece Assembly, a standard audio Headset, a wall-mount power
adapter and electronics Module containing amplifiers, filters,
CODEC, UART and RS232 interface. The power adapter, Chest
Piece Assembly and Headset are detachable and can plug into
the electronics Module. The electronics Module is capable of
operating as a transmitting unit sending digitized auscultation
signals fro the attached Chest Piece, or as a receiving unit
accepting the digitized auscultation signals, converting them to
analog audio and presenting them to the attached Headset. This
stethoscope will provide the ability to assess heart and lung
•AMD 2500 General Exam Camera, which is an analog camera
that combines power zoom (1-50x), auto focus, freeze frame
capture, and electronic image polarization in one diagnostic
device. It provides fluorescent lighting feature with auto white
balance and output signals of composite and S-Video. This
equipment allows for the presentation of patients when the
Polycom codec is not adequate, and operations are easily
presented and coached for unfamiliar users.
•AMD 2015 ENT/Otoscope with Pediatric Adapter, which is a tool
that combines the functionality of a high performance otoscope
and an oral exam scope in a single diagnostic device. It contains
pneumatic otoscopy for easy assessment of outer-ear canal, ear
drum and middle ear. It permits excellent imagery for lower sinus
and upper throat examinations and connects to the AMD-400
camera platform (included in the purchase). This device with the
pediatric adapters allows for the full examination of the ear, nose
and throat.

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