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37645

MondayJuly 14, 1997

Part II

Department ofEducation

National Institute on Disability andRehabilitation Research; Final FundingPriority for Fiscal Years 1997–1998 for aRehabilitation Research and TrainingCenter and Availability of Applications;Notices

37646

Federal Register

/Vol. 62, No. 134/Monday, July 14, 1997/Notices

DEPARTMENT OF EDUCATIONNational Institute on Disability andRehabilitation ResearchFinal Funding Priority for Fiscal Years1997–1998 for a RehabilitationResearch and Training Center

AGENCY

Department of Education.

ACTION

Notice of a Final FundingPriority for Fiscal Years 1997–1998 fora Rehabilitation Research and TrainingCenter.

SUMMARY

The Secretary announces afinal funding priority for theRehabilitation Research and TrainingCenter (RRTC) Program under theNational Institute on Disability andRehabilitation Research (NIDRR) forfiscal years 1997–1998. The Secretarytakes this action to focus researchattention on an area of national need toimprove rehabilitation services andoutcomes for individuals withdisabilities, and to assist in thesolutions to problems encountered byindividuals with disabilities in theirdaily activities.

EFFECTIVE DATE

This priority takes effecton August 13, 1997.

FOR FURTHER INFORMATION CONTACT

David Esquith. Telephone: (202) 205–8801. Individuals who use atelecommunications device for the deaf (TDD) may call the TDD number at (202)205–2742. Internet:David



Esquith@ed.gov

SUPPLEMENTARY INFORMATION

Thisnotice contains a final priority toestablish an RRTC for research related tomedical rehabilitation services andoutcomes. This final priority supportsthe National Education Goal that callsfor all Americans to possess theknowledge and skills necessary tocompete in a global economy andexercise the rights and responsibilitiesof citizenship.

Note:

This notice of final priority does

not

solicit applications. A notice invitingapplications under this competition ispublished in a separate notice in this issueof the

Federal Register

Analysis of Comments and Changes

On April 21, 1997, the Secretarypublished a notice of proposed priorityin the

Federal Register

(62 FR 19437–19438). The Department of Educationreceived 22 letters commenting on thenotice of proposed priority by thedeadline date. Technical and otherminor changes—and suggested changesthe Secretary is not legally authorized tomake under statutory authority—are notaddressed.

Rehabilitation Research and TrainingCenters

Priority: Medical Rehabilitation Servicesand OutcomesComment:

Three commenterssupported maintaining the priority’sconceptual framework of addressing thetopics of medical rehabilitative servicedelivery and functional assessment andoutcome measurement in one RRTC.Twelve commenters suggested thatNIDRR fund two centers instead of one.The commenters who supportedestablishing two centers indicated thatone center would not be able to organizesufficient expertise to address all thepriority’s purposes adequately and thatthe unique aspects of the two topicsrequire separate research activities.

Discussion:

The subject of the priorityis improving medical rehabilitationservices delivery and outcomes.Appropriate use of valid functionalassessment measures is one importantelement toward improving services aswell as justifying the availability,utilization, and financing of thoseservices. This is a dynamic field andlinking the assessment of functionaloutcomes with the medicalrehabilitation services in which theywill be used, while presenting manychallenges to the RRTC, reflects thechallenges that are occurring in the fieldof medical rehabilitation services.RRTCs conduct coordinated andadvanced programs of research targetedtoward the production of newknowledge to improve bothrehabilitation methodology andservices. In this priority, improvedmeasurement of outcomes is a vital areaof need for methodological research.There is a need for improved use of outcome measures to assess medicalrehabilitation services. The RRTC willneed to assemble and coordinate thework of experts from diverse fields.While this is a demanding undertaking,it is feasible and necessary in order tofulfill the purposes of the RRTC. NIDRRemphasizes the importance of involvinga range of disciplines and collaborativeefforts in centers of excellence.In regard to whether the uniqueaspects of the two topics requireseparate RRTCs, applicants have thediscretion to propose specific researchand training activities that will definethe parameters of the RRTC. Thepriority and application evaluationprocess are designed to provideapplicants with the freedom to addressunique aspects of one or more issues. Itis not necessary to establish two RRTCsin order to fulfill the purposes of thepriority.

Changes:

None.

Comment:

The third purpose shouldfocus on the development andvalidation of methods to evaluate thecost effectiveness and impact onfunctional performance of specificrehabilitation interventions in diversesettings and populations. The databaseelements and standards tasks that make-up part of the third purpose areindependent of the development of measures.

Discussion:

The RRTC is intended toimprove rehabilitation services andservice delivery, applying measures of functional outcomes as a key strategy inthis endeavor. Uniform databaseelements and standards areprerequisites to implementing anysystem of functional outcome measuresin service delivery systems.

Changes:

None.

Comment:

One commenter suggestedthat methods are needed that willprovide consumer perspectives onfunctional abilities and outcomes aswell as the effectiveness of interventions. The commenter alsoindicated that methods are also neededto support the consumer in decisionmaking about interventions includingchoices about appropriate rehabilitationsettings and timing of service delivery,accommodations in the physicalenvironment, and caregiver assistanceoptions. A second commenter suggestedthat the priority should connectmeasures of specific disabilities orperformances with the person’s ownvalues and perceptions.

Discussion:

All RRTCs are required toinvolve individuals with disabilitiesand, if appropriate, their familymembers, as well as rehabilitationservice providers, in planning andimplementing the research and trainingprograms, in interpreting anddisseminating the research findings, andin evaluating the Center. Thisrequirement is sufficient to ensure thatthe RRTC addresses consumerperspectives on functional abilities andoutcomes, the effectiveness of interventions, decision making aboutinterventions, and the connectionbetween measures of specificdisabilities or performances with theperson’s own values and perceptions.

Changes:

None.

Comment:

The sixth purpose shouldbe deleted from the priority because itis substantially different than thepriority’s main emphasis.

Discussion:

The emphasis of the sixthpurpose relates to medical rehabilitationservices system applications. The sixthpurpose is necessary because it connectsthe RRTC’s work on functional outcomemeasures to applied service settings.

37647

Federal Register

/Vol. 62, No. 134/Monday, July 14, 1997/Notices

Changes:

None.

Comment:

The RRTC should establisha health policy research fellowshipprogram targeted to people withdisabilities seeking to become proficientin health policy research at either themasters or doctoral level within thecontext of a university-based degree-granting program.

Discussion:

The priority does notprovide the RRTC with the authority toestablish a research fellowship programon the general subject of health policyresearch. An applicant could propose toestablish a research fellowship programrelated directly to medical rehabilitationservices and outcomes. The peer reviewprocess will evaluate the merit of theproposal.

Changes:

None.

Comment:

Many commenterssuggested numerous specific activitiesfor the RRTC to carry out. Thesesuggestions include, but are not limitedto, developing a theoretical orconceptual model of the disablementprocess, establishing aninterdisciplinary panel of experts toreview and author a series of paperssummarizing the state of science in theirarea of expertise and disseminate thepapers, studying and emphasizing therelationship between treatment processto patient outcomes, and creating acommon metric scale or platform for allfunctional disabilities.

Discussion:

Applicants have thediscretion to propose the specificactivities that the RRTC will undertakein order to fulfill the purposes of theRRTC as set forth in the priority.Providing this degree of discretion toapplicants is an acknowledgement of the wide range of approaches thatapplicants could take. The peer reviewprocess will determine the merits of thesuggested activities.

Changes:

None.

Comment:

The government shouldinsist that any instruments that aredeveloped through grant funds areplaced in the public domain.

Discussion:

According to theEducation Department GeneralAdministrative Regulations, the Federalgovernment has the right to obtain,reproduce, publish, or otherwise usedata first produced under an award, andauthorize others to receive, reproduce,publish, or otherwise use these data forFederal purposes. NIDRR is planning toconvene a public meeting to inform itsdecision making on this important issueas it relates to this and other grants.

Changes:

None.

Comment:

The terms ‘‘rehabilitationcenters’’ and ‘‘community-based’’appear in the background statement, butare not defined. It would be helpful if they were defined.

Discussion:

These terms, and manyothers that appear in the priority, arenot defined in order to provideapplicants with the option of proposingtheir own definitions if they consider itnecessary. The peer review process willdetermine the merits of any proposeddefinition.

Changes:

None.

Comment:

This Center, and others,should publish their research findingsin refereed journals.

Discussion:

The quality of anapplicant’s proposed disseminationactivities are evaluated in the peerreview process using applicableselection criteria. No furtherrequirements are necessary.

Changes:

None.

Comment:

The reference totelemedicine and multimediatechnology is overly prescriptive andshould be deleted from the firstpurpose.

Discussion:

Community-basedrehabilitation settings that usetelemedicine and multimediatechnology are increasingly common. If the RRTC did not include these settingsin their research, the applicability of theresearch that it carries out under thefirst purpose would be significantlyrestricted.

Changes:

None.

Comment:

The second purposeshould be revised to require the RRTCto develop and validate measures of social and physical environments, andevaluate the ways in which social andphysical environments limit or enhancethe community participation of medicalrehabilitation service recipients.

Discussion:

The essential differencebetween the commenter’s suggestionand the second purpose as set forth inthe priority is that the commenter’ssuggestion focuses on the ‘‘communityparticipation’’ of medical rehabilitationservice recipients. An applicant couldpropose to emphasize communityparticipation under the second purpose,and the peer review process willevaluate the merits of the emphasis.

Changes:

None.

Comment:

The third purpose shouldbe revised to address evaluationactivities rather than the development of the database elements and the fourthpurpose should be revised to addresshow accrediting bodies can serve toenhance routine measurement.

Discussion:

Applicants have thediscretion to propose to emphasizesundry aspects of a purpose. Anapplicant could propose to emphasizethe evaluation components of the thirdpurpose and propose to address howaccrediting bodies can serve to enhanceroutine measurement under the fourthpurpose. The peer review process willevaluate the merits of the proposals.

Changes:

None.

Comment:

Four commenters statedthat the required purposes under thepriority did not address sufficiently theproblems discussed in the backgroundstatement related to changes in theorganization and delivery of medicalrehabilitation services. For example, onecommenter suggested that the RRTCshould document trends in theconsolidation of medical rehabilitationservices and evaluate the impact of those trends.

Discussion:

NIDRR assumed that theseorganization and service delivery issueswould be addressed by applicants underexisting requirements in the priority.NIDRR agrees with the commenters thatthe priority as written does not ensurethat the RRTC will address theseimportant topics.

Changes:

A new purpose has beenadded to the priority that focuses onissues of the organization, financing,and delivery of services, the impact of managed care on the delivery of medicalrehabilitation services, consumer accessto services, and the capacity of the fieldof medical rehabilitation.

Comment:

Two commenters suggestedthat the priority should identify themost important gaps in current outcomemeasurement systems and the need forbetter measures or methods of estimation of severity and case mix.

Discussion:

Under the first andsecond purposes, respectively,applicants could propose to identify andaddress the most important gaps incurrent outcome measurement systemsand develop better measures or methodsof estimation of severity and case mix.The peer review process will evaluatethe merit of the activities.

Changes:

None.

Comment:

It is not necessary toconduct pilot projects in purpose four inorder to fulfill the purpose’s purpose.The RRTC should conduct research onobstacles to the use of validatedfunctional outcome measures andidentify strategies to overcome theseobstacles and enhance valid use of thesemeasures.

Discussion:

The commenter is correctthat pilot projects are not the onlymeans that could be used to identifyand evaluate strategies to evaluateobstacles in the use of validatedfunctional outcome measures.Applicants should be given thediscretion to propose means to evaluatethe strategies developed to identify