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Health Equity Research Network (HERN) on Improving Access to Care and other Health Inequities in Rural America
Compared to urban populations, the health of those living in rural communities in the United States has significantly worsened over the past several decades. To help bring forward possible solutions for the disparity in health of rural populations, the American Heart Association (AHA) recently released a Presidential Advisory Call to Action1 to prioritize rural populations in programming, research, and policy. As a next step in addressing this critical issue, the AHA is releasing this Request For Applications (RFA) that propose novel solutions to meaningfully impact rural health disparities.
In the U.S., 15-20% of the population lives in rural counties, as defined by the Office of Management and Budget. While these rural counties are predominantly White (80%), there are significant race and ethnicity differences in parts of the country. For example, the rural South has a large population of non-Hispanic Black individuals, the rural Southwest is home to many Hispanic individuals, and rural Oklahoma, Alaska, the Great Plains, and the Southwest are home to high percentages of American Indian/Alaska Native individuals.2 Rural areas also have a higher percentage of elderly individuals and experience lower population growth and higher rates of poverty compared to urban and suburban populations.
Data going back to 1970 show that through the 1980s, mortality rates for rural and urban populations were comparable. Over the past three decades, however, mortality rates have differentially shifted, such that the mortality rate is now 20% higher in rural populations compared to urban populations.3 Life expectancy has followed a similar pattern, with urban populations living more than three years longer than individuals in rural areas.4 These disparities are especially prominent for indigenous people, whose life expectancy is 5.5 years lower than the general population.5
Cardiovascular conditions are among the disparities in health now present between rural and urban populations. Rural populations have a higher prevalence of heart disease as compared to urban populations, as well as an increased risk for cardiovascular and stroke mortality. The differences in risks have been reported to be 30-40% on average for cardiovascular conditions, and it appears the gap in cardiovascular health outcomes between rural and urban populations is growing.
The HERN on Rural Health will be a single network that will include multiple projects. An overall project plan will be developed by self-identified sites and submitted to the AHA as a coordinated submission. Proposed projects are expected to have a common fundamental theme that will assess intervention(s) and/or approaches that address rural health disparities. All aspects of the network application (each project and the Coordinating Center) will be reviewed as a collective program. The successful network application will be one wherein each project and the Coordinating Center are judged to be exemplary, and thus all components will be funded -- either the entire network (with some possible budgetary adjustments) will be funded, or the entire network will not be funded.
Each network application will include five projects. Each project will be at a distinct institution, and each will be led by a project principal investigator (PI). Each project must have the necessary research team, required infrastructure and ability to recruit and retain a diverse group of study participants, if applicable.
|Pre-proposal deadline:||Thursday, January 26, 2023|
Areas of Interest
The AHA encourages applicant teams to submit innovative intervention or investigative projects that can prevent or reduce poor rural health outcomes. Whereas studies focused specifically on disparities in cardiovascular health and outcomes are of interest, it is recognized that studies with an exclusive cardiovascular focus may not be feasible in all cases or for all study designs. Thus, studies that address potential solutions to rural health disparities more broadly are also acceptable, provided that improvements in cardiovascular health can reasonably be inferred. Below are examples of general themes that are research areas of opportunity; this list is not exhaustive and is not meant to direct applicants to a particular approach.
- Research on the effectiveness of digital medicine or other technological approaches in different rural areas and/or populations
- Studies to understand the most effective types and configurations of clinicians and community-based practitioners to support the needs of one or more distinct rural populations
- Development and assessment of rural-specific quality and outcome measures to inform value-based reimbursement models
- Development and assessment of a ‘Levels of Care’ (similar to Levels of Maternal Care) or other care regionalization approach to identify the best location for patient care based on individual risk level
A network may address a single research approach using one or more study populations or study targets with possible inclusion of comparator study arms. Alternatively, a network may propose to address multiple approaches that are closely aligned thematically. Regardless of the study approach, successful applications will clearly convey the ability to address rural health disparities.
Eligibility of Coordinating Center PI
- Must hold a doctoral-level degree.
- Must hold a faculty-rank position of any level. This award is not intended for trainees.
Eligibility of Project PIs
- Must hold a doctoral-level degree, or comparable credentials and experience documenting the ability to effectively lead the proposed project.
- Must hold a faculty-rank position of any level, or comparable research-related position from any project application originating from a non-academic institution.
Award Amount: The maximum budget amount that may be awarded to the network is $20 million, including funds to support the Coordinating Center responsibilities, and indirect costs of 10% maximum for all projects and the Coordinating Center. The AHA reserves the right to determine the final award amount for competitive projects based on need and potential impact.
There is no requirement that all sites receive an equal allocation of the total available budget. However, all sites must meaningfully contribute to the overall network outcomes. As such, it is expected that all sites will have a reasonable portion of the total funds available to the network.