Diabetes Treatments

context of type 2 diabetes in the United States among minority, diabetes programs in selected communities around the country. …

Merck Alliance Call for Proposals

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The Merck Alliance to Reduce Disparities in Diabetes Call for Proposals
The Merck Alliance to Reduce Disparities in Diabetes: Mission and Vision
To address the growing problem of health care disparities in the context of type 2 diabetes in the United States among minority, low-income, and underserved adult populations, The Merck Company Foundation the Foundation announces a new initiative, The Merck Alliance to Reduce Disparities in Diabetes the Alliance The Alliance aims to help decrease health care disparities and enhance the quality of health care by improving diabetes prevention and management services The Alliance will work with national, regional, and community partners to develop, implement, and evaluate comprehensive, evidence-based diabetes programs in selected communities around the country The Alliance will achieve the following: Apply program models that address health care disparities related to type 2 diabetes and its associated conditions or complications among minority, low-income, and underserved adult populations Enhance patient and health care provider communication, mobilize community partners, and assist health care
organizations to decrease disparities in diabetes care Improve the quality of health care for adults who have or are at risk for type 2 diabetes Decrease health care disparities related to diabetes and its associated conditions or complications eg, heart disease, hypertension, kidney disease, and stroke Increase public awareness of the problem of health care disparities and diabetes
Merck Company Foundation The Merck Company Foundation is a US-based, private charitable foundation Established in 1957 by the global research-driven pharmaceutical company Merck Co, Inc, the Foundation is funded entirely by the Company and is Mercks chief source of funding support to qualified nonprofit, charitable organizations The mission of the Foundation is to support organizations and innovative programs that expand access to medicines, vaccines, and quality health care; build capacity in the biomedical and health sciences; promote environments that encourage innovation in a fair and ethical context; and support communities where Merck has a major presence For more information, please visit wwwmerckcompanyfounda tionorg

Merck Alliance Call for Proposals
The Merck Company Foundation will
support this initiative with a commitment of up to 15 million during the next 5 years It is anticipated that up to five program sites will be supported over 5 years as part of the Alliance

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Through this initiative, the Foundation aims to contribute to the field of health care disparities and diabetes prevention and management by developing and supporting comprehensive, systems-based programs for chronic disease management These programs will incorporate patient-centered communication strategies, based on proven and promising practices in the field of chronic disease prevention and management This initiative is not intended to fund research projects, but grantees are encouraged to address implementation hypotheses and related outcome measures Grantees will be expected to design programs and specify objectives Grantees will also be expected to participate fully in a cross-site evaluation The aim of the individual site programs and the cross-site evaluation is to produce sufficient information to establish comprehensive program models to decrease health care disparities related to the prevention and management of diabetes among minority, low-income, and underserved adult
populations across the nation

Background
Health Care Disparities
In 2000, the US Department of Health and Human Services HHS launched its Initiative to Eliminate Racial and Ethnic Disparities in Health, with a public reaffirmation of the National Institutes of Healths NIHs commitment toward investing in research and training programs that seek to reduce and eliminate disparities NIH, 2000 Health care disparities were the focus of the Agency for Healthcare Research and Qualitys AHRQs National Health Care Disparities report for the last 3 years; these reports produced extensive national overviews of disparities in the care received among racial, ethnic, and socioeconomic groups AHRQ concluded that disparities exist in many aspects of health care, including all dimensions of quality of and access to care; across many levels and types of care, clinical conditions, and settings; and within many subpopulations Eliminating disparities is one of Healthy People 2010s two overarching goals

Diabetes among Minority and Underserved Populations
The Centers for Disease Control and Prevention CDC 2005 indicate that nearly 21 million people, or 7 of the US population, have diabetes and that the
prevalence of diabetes increases with age New cases of diabetes occur most frequently among those aged 40 to 59 Not only is diabetes increasing in prevalence, but adults with diabetes often experience limitations in function and quality of life de Rekeneire et al, 2003; Rubin Peyrot, 1999 The medical costs associated with managing and treating diabetes and its complications are substantial The American Diabetes Association 2008 estimates that in 2007 the direct and indirect costs of diabetes and its complications in the United States totaled 174 billion, with 116 billion estimated due to medical costs and 58 billion due to reduced national productivity Type 2 diabetes accounts for 90 to 95 of all diagnosed cases of diabetes; it usually begins as insulin resistance, a disorder in which the cells do not use insulin properly American Diabetes Association, 2005 The American Diabetes Association states that preventing the development of diabetes is possible through medication adherence and lifestyle changes,

Merck Alliance Call for Proposals
including proper nutrition and more physical activity Having diabetes increases the risk of serious complications, including heart disease,
blindness, nerve damage, and kidney damage

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In addition, many people who have diabetes also experience serious co-morbidities such as obesity and cardiovascular disease Appropriate disease self-management, gained through working collaboratively with a health care provider, can help people with diabetes prevent early onset of these conditions and thus help control both the disease and its associated complications Collaborative management and effective patient-centered communication take place in a system of care that comprehensively addresses health care disparities and diabetes The health care disparities for diabetes are significant AHRQ reports that a greater percentage of black and Latino patients receive poorer quality care than White patients For example, in 2004, the proportion of Latino patients who received three recommended clinical services was significantly lower than for non-Hispanic White patients 388 compared with 492 AHRQ also documents disparities in receiving clinical tests by socioeconomic status From 2002 to 2004, the gap between low-income and high-income populations remained the same In 2004, the proportion of patients who received three recommended clinical
services was significantly lower for poor 384, near poor 376, and middle-income people 419 than for highincome people 584 AHRQ, 2007 Rates of diabetes care services have been reported to be equal to or better than national averages among Native American patients Acton et al, 2001 This better care may be due to intensive interventions by the Indian Health Service However, diabetes rates and complications are still as high or higher among Native Americans than other population subgroups in the United States Acton et al, 2003; Young, 2003a; Young, 2003b These statistics are consistent with other research documenting racial disparities in some care processes and outcomes for diabetes Heisler et al, 2003

Reducing Disparities in Diabetes by Advancing Quality Care
To address the problem of health care disparities in the context of diabetes, the initiative will support multifaceted programs eg, those that include components for the patient, clinicians, and health system and involve community partnerships as depicted below in Figure 1 The Alliance will include comprehensive, multifaceted, and systems-based programs that are guided by the model in Figure 1 Research shows that
intensification of intervention effects takes place when a program includes multiple components that address, for example, aspects for clinicians, patients, or health care systems Institute of Medicine [IOM], 2003 Better communication between patients and health care providers should enhance diabetes selfmanagement behaviors Roter et al, 1998 This multifaceted and comprehensive approach is also consistent with the public health paradigm of addressing multiple determinants of a problem, patient and provider behavior, and systems of care to reduce health care disparities Stokols, 1992 Because of its cross-cutting nature, this multifaceted approach would likely have the collateral benefit of also addressing the associated conditions or complications of diabetes A key feature of the model shown in Figure 1 is an emphasis on patient-centered care and communication With patient-centered care, the focus is on understanding the patients experience of illness and health care and enhancing the systems and processes that support their needs IOM, 2001 Effective communication among providers, patients, and their family members is essential for achieving optimal care outcomes, enhancing
prevention and management of diabetes, and reducing health care disparities

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Reduced Health Care Disparities for Diabetes Improved Diabetes Outcomes
Figure 1 adapted from Wagner EH Chronic Disease Management: What Will It Take to Improve Care for
Chronic Illness? Effective Clinical Practice 1998; 1:2-4

In addition to emphasizing patients and clinicians communication, this model recognizes that people with diabetes receive care within a system that may include other professionals, such as nutritionists or pharmacists, and lay health advisors This model also extends outside the boundaries of the clinical setting to reach patients where they spend most of their time and make most of the decisions that affect their health, such as community settings and homes This multifaceted, systems-based approach is also consistent with the model developed by the American Association of Diabetes Educators AADE to understand quality of care related to diabetes and supporting behavior change Mulcahy et al, 2003 Specifically, it aligns with the AADE7 Self-Care Behaviors, including healthy eating, physical activity, monitoring, medication adherence, problem
solving, reducing health risks, and healthy coping Peeples et al, 2007

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Program Goals and Overview
Through this Call for Proposals, the Foundation will select highly qualified organizations to participate in the Alliance whose diabetes programs build on the model shown in Figure 1 The Alliance programs will focus on three core components and related goals: Patient Enhance patient education and empowerment Patients who are better educated and empowered may become more engaged in their health care overall; they may become better at managing their illnesses themselves, adopting behaviors that help prevent health problems, and communicating effectively with physicians and other clinicians o Examples: communication training or coaching; diabetes self-management education, monitoring, and problem-solving skills using appropriate vignettes Clinician Enhance clinician cultural competencies and communication skills Clinicians who are more skilled in communicating with diverse patient groups and aware of cultural beliefs are more effective in providing care and educating their patients, and they become more patient centered in their communication o
Examples: cultural competency training; patient-centered communication training; training in assessing patient beliefs that affect disease selfmanagement; teach-back methods System Implement health care system-level changes Health care organizations that implement and support clinical systems, policies, or practices related to disease management can reduce disparities in diabetes care o Examples: establishment and support of diabetes registries and policies and practices for registry usage; use of electronic medical records; multidisciplinary diabetes care teams; lay health advisor, promatoras, or navigator programs; cultural competency of the health care setting via interpreters or signage

The first phase of this initiative will be a 6-month planning period During this time, sites will develop program plans for how they will address health care disparities related to the prevention and management of diabetes in their health care setting Sites also will be required to complete an evaluability assessment to help them identify community, organizational, or clinical assets or barriers that may arise during the program and its evaluation Finally, during this period, sites will
participate in developing measures that will be required across all program sites and used in the cross-site evaluation At the completion of the planning period, each site will implement its proposed program with collection of baseline data The program will be ongoing for 4 years During this implementation phase, sites will participate in periodic data collection, collaborative learning with other sites, and sustainability planning At the end of 4 years, there will be a 6-month wrap up phase During this time, sites will collect their final data and present their findings and experiences from their program They will also implement final phases of sustainability plans

Expectations for Applicants in Developing Programs
1 Goals: Applicants should already be successfully addressing one of the three components abovepatients, clinicians, or systemsin their current setting You should propose to build on this success by addressing the other two goals, while maintaining

Merck Alliance Call for Proposals
the original component For instance, if your work previously has been largely with patients, then you should propose expansions to clinicians and systems You must document your previous
success in achieving one of the goals by providing data from previous evaluations or publications of data in peer-reviewed journals

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2 Target population: Programs should focus on target populations that experience disparities in the process or outcomes of care related to diabetes These can include minority, low-income, and underserved adult populations in the United States The target population can include combinations of these particular subgroups but need not address all subgroups 3 Community involvement and partnership: Applicants should involve community stakeholders and community organizations as partners in the program, or you must have community involvement in the program via program activities, outreach, or input to program development You are expected to demonstrate how you will create, support, and maintain critical linkages among different partners in coalitions or consortia that are developed as part of the program Applicants should demonstrate capacity for clinical community partnerships to address diabetes and disparities One lead organization and at least one other partner organization must be involved in the program Applicants and their partners must have clearly
delineated roles and responsibilities A history of partnership between the proposed organizations is strongly favored Organizations that serve as partners must meet the eligibility criteria described in a later section of this document 4 Program objectives: Applicants are expected to articulate specific and quantifiable objectives for their individual programs, wherever possible Your plan must also include measures of process such as fidelity to and deviations from the planned interventions Also, your objectives should address collateral benefits in preventing or managing the complications and conditions associated with diabetes 5 Participation in cross-site evaluation of the initiative: An independent organization using a cross-site evaluation approach will evaluate the Alliance programs Program sites will be required to collect and/or report a uniformly defined set of process and outcome measures and collaborate with the evaluating organization to ensure that patientreported data can be collected in accordance with relevant human subjects provisions and Institutional Review Board IRB approvals Both short- and long-term outcomes measures will be examined Measures will be selected
and refined during the initial planning period; Table 1 provides preliminary measures for each key program componentpatient, provider, and systemthat will be considered during the planning period 6 Sustainability: Applicants are expected to include preliminary plans for sustainability beyond the end of grant funding Plans for sustainability should include examples of institutional change such as changes in health care systems providing diabetes care, permanent employment of outreach staff or clinic staff, organizational policy changes, and so on Applicants should also provide details on sources of additional and continued funding, and in-kind support, and on resources already available in the health care setting, in the community, and from partners that may be part of the proposed program

Merck Alliance Call for Proposals
Table 1: Preliminary Cross-Site Evaluation Measures
Program Component Patient Outcomes Measures Process Measures Access to resources and supports for diabetes selfmanagement Participation in education classes, trainings, courses, related events Participation in and feedback on trainings and other resources offered as part of the program Participation in cultural
competency/other relevant training programs Organizational goals for the program; experiences with program planning; leadership support for the program; assessment of changes in infrastructure, policies, and procedures to support the program Short Term Use of resources and supports for diabetes selfmanagement Self-care behaviors from the American Association of Diabetes Educators AADE7 Hemoglobin A1c levels, cholesterol levels, blood pressure Providers perspectives on the program Provider-reported CME/CE training credits for relevant training Patient-reported feedback on care experiences in terms of patient-centeredness eg, communication experience, quality of care, selfmanagement enablement Experiences with program implementation; barriers and facilitators experienced and how they were addressed; assessment of changes in infrastructure, policies, and procedures to support the program Assessment of policies and/or procedures to address disease prevention, enhanced access to quality care, positive behavior activity of patients, and program sustainability Long Term Use of resources and supports for diabetes self-management Self-care behaviors from the American Association of Diabetes
Educators AADE7 Hemoglobin A1c levels, cholesterol levels, blood pressure Providers perspectives on the program Provider-reported CME/CE training credits for relevant training Patient-reported feedback on care experiences in terms of patient-centeredness eg, communication experience, quality of care, selfmanagement enablement

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Providers

Health Care Systems

Experiences with program implementation; barriers and facilitators experienced and how they were addressed; assessment of changes in infrastructure, policies and procedures to support the program Assessment of policies and/or procedures to address disease prevention, enhanced access to quality care, positive behavior activity of patients, and program sustainability Maintenance of policies and practices; sustainability implementation

Table note: AADE7 self-care measures focus on healthy eating, being active, monitoring, taking medication, problem solving, reducing risks, and healthy coping

7 Program components and interventions: The Foundation strongly encourages applicants to use interventions with proven or promising effectiveness see below Applicants can adopt or adapt interventions that they believe best address the
issue of health care disparities and the prevention and management of diabetes in their particular communities The evidence basis for proposed interventions should be clearly documented

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Interventions and Components of a Comprehensive Program
Applicants should propose comprehensive programs that are based on evidence from peerreviewed literature related to diabetes prevention and management, chronic illness management, health care disparities, and/or health care quality improvement The program components must be convincingly described as promising practices in these areas, or identified as evidenced-based models or programs Programs should build on previous success in one area patient, provider, or systems and propose to address two additional program component areas Funds are to be used to build on and enhance ongoing and successful programs that will further develop high-quality comprehensive diabetes prevention and management programs that help reduce health care disparities and improve diabetes outcomes Grantees should incorporate scientifically based and replicable interventions with proven or promising effectiveness Grantees are expected
to adopt or adapt the se interventions to create a model of health care with strong clinical and community linkages that can address health care disparities, diabetes, and its associated conditions or complications Table 2 illustrates the types of program components that grantees might use Table 2: Examples of Intervention Components
Patient Component Education about selfmanagement behaviors Education on the long-term consequences of uncontrolled diabetes Videos of effective patientprovider communication Help asking care-related questions Help working with an interpreter Role playing care encounters Education in proper nutrition and physical activity Instruction on using glucose monitoring equipment Patient coaching from more experienced patients or health educators Training in effective communication skills Provider Component Education in cultural beliefs Training in identifying acculturation levels Techniques for assessing beliefs and patient behavior Education in incidence and prevalence of diabetes among Latinos, African Americans, and Native Americans Patient elicitation techniques Education in systematic, culturally sensitive patient interviewing techniques Education in
listening skills Role playing of communication skills Education about how to connect patients to community resources Teach-back methods System of Care Component Diabetes registries Policy and practices for enforcing and using registries Appointment reminder systems Materials or personnel to improve cultural competency of the entire health care setting interpreters, patient materials Family member education and/or screening for diabetes Developing diabetes care teams Implementing lay health advisor, promatoras, or navigator programs Culturally appropriate patient materials on site Implementing group medical visits

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Eligible Organizations
Organizations that are eligible for support through this initiative are noted below, but they are subject to the exclusions noted in the list following the eligibility criteria: Nonprofit organizations in the United States designated as 501c3 organizations by the US Internal Revenue Service; Public or private institutions, such as universities, colleges, health care organizations including, but not limited to, hospitals, health centers, and clinics; Community-based or nongovernmental organizations; Units of
state and local governments Organizations that are not eligible for support through this initiative include the following: Political organizations, campaigns, and activities; Fraternal, labor, or veterans organizations and activities; Religious organizations or groups whose activities are primarily sectarian in purpose; Organizations that discriminate on the basis of race, color, sex, sexual orientation, marital status, religion, age, national origin, veterans status, or disability

Funding Available
Grants of up to 400,000 per year for up to 5 years can be provided Annual budgets for the proposed programs cannot exceed 400,000 in any single year; the longest period of a grant will be 5 years Funds cannot be used to displace any funding already used for diabetes or health care disparities programs; the intent is to build on and expand such programs or to create new ones The indirect rate for general administrative costs cannot include equipment cannot exceed 10: it is included in the total annual grant amount of up to 400,000

Allowable and Unallowable Use of Funds
Grant funds may be used for the following purposes: Project staff salaries and fringe benefits; Consultants;
Other essential direct costs, including data processing, travel to Alliance program activities or other relevant diabetes and health care disparities meetings, a limited amount of equipment, general office materials and supplies, educational materials, relevant training, printing and copying, telephone and fax, postage and delivery, rent and utilities, and maintenance; Subcontracts same allowable and unallowable costs as for the Alliance grant

Grant funds may not be used for the following purposes with very limited exceptions: Direct patient care; Medical screening or testing except as part of the evaluation plan; Purchase of medications, devices, or biologics; Fellowship/tuition support for training purposes intended for a specific individual or institution; Endowments, including academic chairs;

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Media eg, radio, TV, film, Web cast productions that are not integral parts of the diabetes program with clear objectives and measurable outcomes; Meetings/conferences or symposia that are not integral parts of the Alliance program with clear objectives and measurable outcomes; Fund-raising events, such as benefit dinners, galas,
concerts, or sporting events, and annual appeals or membership drives; Capital or building campaigns, including new construction or renovation of facilities or homes; Basic or clinical research projects, including epidemiological studies, clinical trials, or other pharmaceutical studies; Unrestricted general operating support; Financial support for political candidates; Grants to one organization to be passed to another, except under specific or approved subcontracting arrangements; Programs that directly support marketing and/or sales objectives of Merck Co, Inc

How to Apply
The application process has two stages The first involves submitting a Letter of Intent LOI Second, the Foundation will invite submission of full proposals from applicants whose LOIs best reflect the intent of the Alliance initiative and address the program goals Only electronic submission of LOIs and proposals will be accepted LOIs and Invited Full Proposals may be submitted by uploading files to http://merckalliancertiorg

Letter of Intent
Applicants must submit LOIs electronically as one PDF file at http://merckalliancertiorg All sections, including cover letter, the body of the LOI, citations, and any
appendices containing letters of agreement or support, need to be combined into one PDF document Only electronic LOIs uploaded to the site as one PDF file can be accepted No faxed or hard copies will be accepted LOIs should be received by 8:00 pm EDT on May 23, 2008 The LOI cover page should contain the title of the project; Principal Investigator information name, title, affiliation, mailing/shipping address, telephone number, fax number, and e-mail address; and contact person information, if different from Principal Investigator The LOI should have 1 margins; use a font no smaller than Arial 11 point; and should not exceed five single-spaced pages, excluding literature citations, attachments, or appendices It should briefly describe and discuss the following areas: 1 Project Goals and Objectives eg, short- and long-term goals for the project and changes and outcomes to be achieved Description and documentation of past success related to one of the program goals and how proposed program builds on this success and addresses additional goals 2 Problem to be Addressed and its Significance, including but not limited to: a Populations to be included eg, age, sex, ethnicity,
socioeconomic status, and size b Geographic area to be covered and relationship to the populations to be included, specifying population base where possible

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c Clinical, socioeconomic, or other issues eg, for these populations and geographic areas: incidence and prevalence; prevalence of health care disparities and/or diabetes; health resources available; and special issues that need to be considered d Health and health care disparities for diabetes 3 Project Plan, such as the following: a Specific tasks and activities b Program components and features, with specific reference to the interventions and components outlined above, supported by citations from peer-reviewed literature c Partnership, coalition, or consortia relationships, including publicprivate partnerships and formal linkages among them eg, memoranda of understanding or agreement, letters of participation or support from partner organizations or potential subcontractors should be included in appendix d Evaluation approach of local not across sites program, specifying objectives 4 Applicant Experience: a Past and current chronic illness management, and/or diabetes-related projects
or coalitions, with particular emphasis on type and level of involvement for type 2 diabetes and health care disparities b Relevant organizational experience 5 Key Personnel or Project Staff: a Principal Investigators from applicant organization and any collaborating organizations b Other core staff from applicant organization and collaborating organizations c Intended subcontractors, if any d Intended consultants, if any Appendices containing letters of support from potential partners can be included as part of the LOI, but must be part of the PDF Appendices or letters cannot be uploaded as separate documents We will notify eligible applicants to invite a full proposal on or before June 20, 2008 Electronic copies of the full proposals will be due by 8:00 pm EDT on August 29, 2008 All full proposals must be submitted by uploading a PDF to http://merckalliancertiorg

Invited Full Proposal
The proposal should have the following parts: Volume I: 1 Cover Page, 2 Table of Contents, 3 Project Plan Volume II: Appendices Volume III: Detailed Budget and Justification Volume 1: The cover page should contain the title of the project; Principal Investigator information name, title,
affiliation, mailing/shipping address, telephone number, fax number, and e-mail address; contact person information, if different from Principal Investigator; person responsible for grant and budget negotiations or administration, if different from Principal Investigator; period of performance; and amount requested total and for each year of funding separately The table of contents should be no longer than 1 page You must include a running header that includes the name of the Principal Investigator and consecutive page numbers covering all of Volume I Together the cover page, table of contents, and project plan should not exceed 27 pages

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The project plan should not exceed 25 single-spaced pages, should have 1 margins and type font no smaller than Arial 11 point, and should be printed on only one side of each page The project plan should describe and discuss the following topics 1-6: 1 Project Goals and Objectives: a Issues related to health care disparities and the prevention or management of type 2 diabetes to be addressed How this effort will build on past success and address additional program goals b Overarching purposes of your project
and the processes and outcomes that will be different by the end of the project or grant period Include information on both shortterm and long-term changes and improvements 2 Problem to be Addressed and its Significance, including but not limited to: a Populations to be included eg, age range, ethnicity, socioeconomic status, and size b Geographic area to be covered, specifying population base where possible c Clinical, social, economic, and other issues of particular concern for the target populations d Health and health care disparities 3 Project Plan details, including but not limited to: a Description of community resources and partnerships that can contribute to the program and/or outreach b Specific tasks and activities c Program components and their role in achieving site-specific and Alliance program goals, and how they will build on past success d Evaluation approach related to Alliance program and site goals, including specific objectives and measures of changes in processes and improvements in health outcomes e Capacity for collecting and reporting on process and outcomes measures for internal assessment and external evaluation f Partnerships, collaborators, and
coalition or consortia relationships and formal linkages among them g Timetable for implementation and milestones 4 Applicant Experience: a Previously and currently funded health care disparities, diabetes, and/or chronic illness prevention or management projects: brief description of projects and accomplishments and, if appropriate, how ongoing projects will be integrated with the proposed Alliance project b Past and current health care disparities or diabetes coalitions and relationship to proposed Alliance project c Other relevant experience of the organization d Current and pending funding sources and amount on the same or similar proposals related to health care disparities and diabetes 5 Personnel or Project Staff: Describe titles, affiliations, qualifications, and experience of the following categories of people; briefly describe responsibilities and note percentage time for each year on the project; describe lines of authority organization chart a Principal Investigator b Co-Investigators and component/task leaders c Key collaborators d Project administrator or manager e Other core staff, as appropriate

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6 Sustainability Demonstration
of past success with sustainability of interventions, explanation of what additional resources would be needed to continue the program over time eg, financial, staffing, partners, how applicant expects to secure these resources to support this project in the future, and a timetable for securing resources Volume II: Appendices can be included to cover the following, as needed: Brief resumes of core project staff, limited to 4 pages each in length Additional materials documenting success in addressing one of the Alliance program goals in past or current projects and/or coalitions Additional materials on collaborators, including letters of commitment or memoranda of understanding Additional materials on subcontractors, including letters of commitment Additional materials as needed, such as letters of support

Volume III: The budget, submitted as a separate Volume III, should contain enough information to allow proposal reviewers to understand the proposed cost, including detailed line items and adequate explanations of assumptions for line item estimates in the budget justification The budget should include: estimates for costs of labor staff salaries and fringe benefits,
materials and other direct costs, travel, subcontracts and consultants, indirect costs and rate limited to 10 and exclusive of equipment costs for each year of requested funding and for all years together, and other sources of grant funding or financial contributions and any in-kind support for this project

Each of the volumes should be uploaded as a separate PDF file to the submission Web site
http://merckalliancertiorg

Proposal Review and Evaluation Criteria
Proposals will be reviewed by an external Expert Advisory Committee, The Merck Company Foundation, and individuals representing RTI International, a nonprofit health research firm that is consulting with the Foundation on the Alliance initiative We cannot provide technical critiques of proposals or return proposals We reserve the right to contact applicants for further information Program proposals will be assessed using the following six criteria budgets will be reviewed separately: 1 Creativity and demonstrated significance of project goals and objectives eg, population needs, program reach, anticipated change as they relate to reducing health care disparities for diabetes 2 Scientific and empirical justification,
soundness, strength, and technical feasibility of the project plan; integration of critical program components and their relationship to site-specific and program goals; correspondence between financial proposal budget and the project plan

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3 Breadth and depth of collaborative relationships or partnerships and demonstrated ability to forge lasting linkages among collaborators/partners 4 Experience and qualifications of applicant, personnel, and organization 5 Evaluation plan 6 Sustainability plan Proposals will be strengthened by inclusion of one or more of the following three elements: 1 Discussion of how the applicants project will address complications or conditions associated with type 2 diabetes 2 Discussion of how the applicants project will foster broader and/or sustained community collaborations beyond those existing or planned for the project 3 Minimum 10 of total program budget that represents in-kind contributions from applicant and/or collaborating institutions Technical Evaluation Weights for Invited Full Proposals Creativity and significance of project goals as they relate to reducing health care disparities for diabetes
Scientific and empirical justification; feasibility of project plan and integration of program components Collaborative partnerships and linkages Experience and qualifications of applicant, personnel, and organization Sustainability and evaluation plans Total 10 40 15 25 10 100

For questions related to the Call for Proposals, please e-mail merckalliance@rtiorg with the term RFA question in the subject line or call 1-866-354-4943 and leave a message with details of your questions, your name, and e-mail address The Foundation reserves the right to answer similar questions with a common answer to all who inquire

References
Acton, K J, Shields, R, Rith-Najarian, S, et al 2001 Applying the diabetes quality improvement project indicators to the Indian Health Service primary care setting Diabetes Care, 241, 2226 Acton, K J, Burrows, N R, Geiss, L S, Thompson, T 2003 Diabetes prevalence among American Indians and Alaskan Natives and the overall population–United States, 19942002 MMWR, 5230, 702704 Agency for Healthcare Research and Quality AHRQ 2007 National healthcare disparities report, 2006–full report Rockville, MD: Agency for Healthcare Research and Quality Retrieved from
http://wwwahrqgov/qual/nhdr06/report/Chap2htmdiabetes

Merck Alliance Call for Proposals
American Diabetes Association 2005 National diabetes fact sheet, 2005 Retrieved from http://wwwdiabetesorg/uedocuments/NationalDiabetesFactSheetRevpdf American Diabetes Association 2008 Economic costs of diabetes in the US in 2007 Diabetes Care, 313, 120

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Centers for Disease Control and Prevention CDC 2005National diabetes fact sheet, United States 2005 Atlanta, GA: Centers for Disease Control and Prevention Retrieved from http://wwwcdcgov/diabetes/pubs/pdf/ ndfs_2005pdf de Rekeneire, N, et al 2003 Diabetes is associated with subclinical functional limitation in nondisabled older individuals Diabetes Care, 26, 32573262 Heisler, M, Smith, DM, Hayward, RA, Krein, SL, Kerr, EA 2003 Racial disparities in diabetes care processes, outcomes, and treatment intensity Medical Care, 41, 12211232 Institute of Medicine 2003 Unequal treatment: Confronting racial and ethnic disparities in healthcare Washington, DC: National Academies Press Mulcahy K et al 2003 Diabetes self-management education core outcomes measures Diabetes Educator, 295, 76870, 77384, 7878 passim Review No abstract available Murray,
CJL, Kulkarni, SC, Michaud, C, Tomijima, N, Bulzacchelli, MT, et al 2006 Eight Americas: Investigating mortality disparities across races, counties, and race-counties in the United States PLoS Med, 39, e260 Retrieved from http://medicineplosjournalsorg/perlserv/ ?requestgetdocumentdoi101371/journalpmed0030260 National Institutes of Health NIH 2000 NIH strategic research plan to reduce and ultimately eliminate health disparities Retrieved from http://ncmhdnihgov/our_programs/strategic/pubs/ Volumn1_031003EDrevpdf Peeples M, et al 2007 AADE Outcomes Project and AADE/UMPC Diabetes Education Outcomes Project: Evolution of the American Association of Diabetes Educators diabetes education outcomes project Diabetes Educator, 335, 794817 Roter, D, Hall, JA, Rolande, M, Nordstrom, B, Cretin, D, Svarstad, B 1998 Effectiveness of interventions to improve patient compliance: A meta-analysis Medical Care, 368, 11381161 Rubin, R R, Peyrot, M 1999 Quality of life and diabetes Diabetes/metabolism research and reviews, 153, 20518 Stokols, D 1992 Establishing and maintaining healthy environments: Toward a social ecology of health promotion American Psychologist 471, 622 Wagner, E H 1998 Chronic
disease management: What will it take to improve care for chronic illness? Effective Clinical Practice, 1, 24

Merck Alliance Call for Proposals
Young, B A, Maynard, C, Reiber, G, Boyko, E J 2003a Effects of ethnicity and nephropathy on lower-extremity amputation risk among diabetes veterans Diabetes Care, 262, 495501 Young, B A, Maynard, C, Boyko, E J 2003b Racial differences in diabetes nephropathy, cardiovascular disease, and mortality in a national population of veterans Diabetes Care, 268, 23922399

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Other Useful Sources
Centers for Disease Control and Prevention: http://wwwcdcgov/ CDC State Diabetes Prevention and Control Programs: http://wwwcdcgov/diabetes/states/indexhtmlist American Association of Diabetes Educators: http://wwwdiabeteseducatororg/ National Institute of Diabetes and Digestive and Kidney Diseases NIDDK: http://www2niddknihgov/ American Public Health Association: http://wwwaphaorg/ American Diabetes Association: http://wwwdiabetesorg/homejsp Directory of Diabetes Organizations: http://diabetesniddknihgov/resources/organizationshtm National Association of Chronic Disease Directors:
http://wwwchronicdiseaseorg/i4a/pages/Indexcfm?pageID3418

Source:merck.com