The John A. Hartford Foundation is soliciting grant applications for the establishment of new Hartford Centers of Excellence in Geriatric Medicine and Training. The Foundation seeks proposals that demonstrate both current strengths and future promise to increase our nation’s capacity to care for older adults in academic geriatrics. Hartford anticipates awarding $450,000 grants to be paid in amounts of approximately $150,000 per year for three years.

In 1988, building on recommendations of the Institute of Medicine, the Foundation created the Centers of Excellence (CoE) program to support the development of an ongoing infrastructure for geriatrics fellowship training and junior faculty development. Foundation Trustees have committed over $25 million nationwide to support this work to date, with the establishment of 22 Centers in medicine and two in geriatric psychiatry. The CoE program was highlighted in the Foundation’s 2005 Annual Report.

The Foundation’s goals for the CoE program are largely unchanged from its inception — to support the development of geriatrics faculty whose research, teaching, and service can help ensure that the nation can meet the health care needs of our older citizens.

Foundation support should be used primarily to recruit and support the development of advanced fellows and junior faculty in geriatrics for physicians who are pursuing careers as basic researchers, clinical and health outcomes researchers, or clinician educators. Proposals should address the full spectrum of medical training — including the medical student and residency years — as well as enhancing the geriatrics expertise of other specialties and subspecialties, either through use of grant funds or with concurrent activities.

The Foundation also welcomes proposals that seek to adopt or adapt innovations created elsewhere, and/or that address leadership development for advanced fellows and junior faculty. The strategy of the CoE initiative is to identify medical schools with the necessary components for training academic geriatricians, including:

• A history of success in producing academic geriatric faculty;
• Leadership and depth of faculty (basic science, clinical and multidisciplinary);
• Successful recruitment of geriatrics fellows and the pursuit of research/academic career training by a portion of them;
• The existence of a geriatrics department, division or section;
• Access to excellent geriatric clinical facilities across the continuum of care;
• Demonstrated success in obtaining competitive research funding;
• A strong and visible commitment to geriatrics by the institution.

Applications must demonstrate strength in each of these components, and will form the core criteria for advancement to finalist status. Proposals must include data that quantifies your program’s past successes — such as numbers of geriatrics fellows trained, production and support of junior faculty (both researchers and clinician educators), numbers of geriatrics-related publications or presentations, and outside funding such as Reynolds, Pepper, Hartford/RAND Interdisciplinary, or NIH awards — and sets evaluable targets for future training, research, and funding productivity. Additional criteria such as a relationship to academic nursing or other health professions, geographic location, population demographics, or national leadership visibility may also be weighed.

Proposals will be reviewed internally and by a national advisory board. The Foundation will not provide individual critiques of submitted letters of intent or proposals, although some editing of proposals may be requested of finalists. Finalist proposals will be considered by Trustees at the Foundation’s December 8, 2007 Board meeting.

Online Submission of Letter of Intent Due: February 23, 2007.
Invitations for Submission of Full Proposals Will be Sent by: March 23, 2007.
Full Proposals Due: May 25, 2007.
Site Visits to Select Institutions: June-September, 2007.
John A. Hartford Foundation Trustee Review: December 8, 2007.
Awardee Notification: December 11, 2007.
Anticipated Start Date: January 1, 2008.

Sample Proposals Available Online

Proposals from institutions that were granted CoE renewal awards in 2006 are currently available to serve as a resource in the development of new proposals. The non-financial portions of these proposals may be inspected at our secure website at: http://www.jhartfound.org/secure. The user I.D. is johnhartford and the password is huntington.

The following institutions are currently Centers of Excellence awardees:

Baylor College of Medicine: George Taffet, MD
Boston University Medical Center: Rebecca Silliman, MD, PhD
Cornell University: Cary Reid, MD, PhD
Duke University: Harvey Cohen, MD
Emory University (Southeast Center of Excellence): Joseph Ouslander, MD
Harvard University: Lewis Lipsitz, MD
Indiana University: Steven Counsell, MD
Johns Hopkins University: Linda Fried, MD, MPH
Mount Sinai School of Medicine: Rosanne Leipzig, MD, PhD
University of Alabama at Birmingham (Southeast Center of Excellence): Richard Allman, MD
University of California, Los Angeles: David Reuben, MD
University of California, San Diego (Geriatric Psychiatry): Dilip Jeste, MD
University of California, San Francisco: Seth Landefeld, MD
University of Chicago: Greg Sachs, MD
University of Colorado: Robert Schwartz, MD, and Andrew Kramer, MD
University of Hawaii: Patricia Blanchette, MD, MPH
University of Michigan: Jeffrey Halter, MD
University of North Carolina, Chapel Hill: Jan Busby-Whitehead, MD
University of Pennsylvania: Jerry Johnson, MD
University of Pittsburgh: Neil Resnick, MD
University of Pittsburgh (Geriatric Psychiatry): Charles Reynolds, MD
University of Rochester: William Hall, MD
University of Texas Health Science Center at San Antonio: David Espino, MD
University of Washington: Itamar Abrass, MD
Yale University: Mary Tinetti, MD

There are two stages in the competitive application process:

1. Submission of an online Letter of Intent (LOI) fill-in form and a brief 1500 word narrative, due by February 23, 2007.
2. If invited, submission of a full proposal and budget reflecting the required 100% match by May 25, 2007.
3. Site visits to select institutions will be arranged from June to September, 2007.

Foreign institutions are not eligible to apply. Programs in osteopathic medicine or geriatric psychiatry are not eligible to apply.

Letter of Intent Submission Information

The online letter of intent submission form may be found at http://www.jhartfound.org/coe_cfp/coecfp.htm. This form asks for specific information about your program on a fill-in form and requires a 1500 word narrative. The narrative should address in abbreviated form much of the information that a full proposal would require. Letters of intent are due by midnight, February 23, 2007. Invitations for submission of full proposals will be sent by March 23, 2007.

The following information will be most relevant to sites invited to submit full proposals after review of the required letters of intent, but may also be helpful background information during the letter preparation stage.

For those sites invited, full proposals will be due by May 25, 2007. The narrative portion of the proposal should be limited to 20 pages. Please detail overall goals, a plan to use CoE funds, and what measurable outcomes are expected over the life of the grant. Certain specific topics in the proposal must be covered in order to better benchmark the successes of the CoEs individually, and to quantify the success of the initiative as a whole.

All proposals should explicitly detail outcome goals for the period of the grant; use numbers and estimate if necessary. Proposals should summarize numbers and names of trainees where available in different tracks (research, clinician educator), levels (residents, 1st year fellows, advanced fellow/junior faculty), and disciplines (geriatrics or other specialties or subspecialties), numbers of those who will be supported in different activities, numbers who have won awards, and other metrics as appropriate. A statement indicating institutional support of the required 1:1 budget matching should be included, along with a sustainability plan. Proposals must specify activities and quantitative goals to be accomplished under the proposed CoE. Wherever possible, bring into narrative portions of the text summary counts, distributions, or illustrative details from the appendices.

Applications should describe how the CoE would fit into the institution, and what other resources, leveraging, or new opportunities might be made available. Candidates should address the potential benefits, challenges, and financial decision-making concerns of a Hartford CoE award.

Application Content

• A 1-2 page Executive Summary should include a brief overview of the institution and program,
  what Hartford money (if any) has been used for in the past, how this award will build geriatric
  capacity, and the expected impact from the funding.
• Describe the history of your program, listing the goals, activities, and accomplishments to date,
  a statement describing how geriatrics fits into your institution’s mission, and any recent or
  anticipated changes in your institution’s geriatric capacity. You may wish to refer to Appendices
  A–C (see below) here. You may include external indicators of national impact and standing,
  such as U.S. News & World Report or NIH research award rankings.
• Please describe your institution’s activities to attract, prepare, and mentor physicians in
  geriatrics and care for older persons at the college, medical student, residency, advanced
  training, and mid-career levels.
• Describe the proposed activities and work plans to help support the development of fellows
  and faculty whose research, teaching, and service can help ensure that the nation can meet the
  health care needs of our older citizens. “Lessons learned” from other CoEs may be referenced as
  a rationale to describe activities and desired outcomes.
• If clinical fellow year slots have not been filled over the previous five years, please include a
  plan to increase recruitment. For the upcoming three years forecast how many persons will
  be trained, in what year, and other such measurable outcomes. Also, list any complementary
  training support, such as Reynolds Foundation or federal awards, which will be utilized to help
  support the CoE.
• Describe the direct support to be provided to trainees (salary, research support, tuition, etc.) and
  any indirect support to be provided (career development and research skills workshops, access to
  research expertise, support of divisional research infrastructure and proposal administration, etc.).
  Note whether the support will be provided by the CoE grant, other funds, or both.

Terms

For all personnel to be supported under the grant, please specify the person’s home department or administrative division (i.e., which department or division makes decisions regarding their hiring and/ or promotion). If the home discipline is not geriatrics, please also state the specialty or subspecialty. In addition, we ask that you apply the following definitions to commonly used terms:

• “Clinical Fellow,” refers to the first year of fellowship (aka “CAQ” or “clinical” year).
• “Junior Faculty” refers to all years of support after the first clinical year up to promotion to
  associate professor and independence, and also refers to those called advanced fellow, instructor,
  lecturer, assistant professor, or others depending on local usage.
• “Senior Faculty” are at the associate professor level or higher, and may include persons in their
  first year as associate professor through senior faculty who are being supported as they train,
  re-train, or receive various enhancement experiences in geriatrics.

Appendix A: Clinical Fellow Development/Accomplishments

For each of the previous five years, please list the number and location of clinical fellow year slots available at your academic health center and affiliated medical school. Please indicate how many were filled, by whom, the type of training they received, whether they received direct or indirect support (or both), whether direct Hartford support, other source of support, type of support (e.g., salary, pilot grant, tuition), and if they were successful in obtaining their CAQ in geriatrics (pass, fail, unknown). Please also characterize their current career using the following categories (a) clinical practice, (b) clinical practice including mentoring/proctoring of medical students and/or residents, (c) academic career: basic research, (d) academic career: health services/clinical services research, (e) academic career: clinician educator, (f) other, or (g) unknown. If the home discipline is not geriatrics, please also state the specialty or subspecialty. For non-MDs, please list only those with direct Hartford support. This information should also be summarized in tabular or spreadsheet form in the beginning of this Appendix, and select summary statistics should be incorporated into the narrative.

Appendix B: Junior Faculty Development/Accomplishments

For each of the previous five years, please list the junior faculty members (typically MDs or PhDs) who have been directly and indirectly supported at your Center for training in geriatric medicine or topics related to the health of older patients. Please indicate how they were supported, whether they received direct or indirect support (or both), whether direct Hartford, other source of support, type of support (e.g., salary, pilot grant, tuition). Please also characterize their current career using the following categories (a) clinical practice, (b) clinical practice including mentoring/proctoring of medical students and/or residents, (c) academic career: basic research, (d) academic career: health services/clinical services research, (e) academic career: clinician educator, (f) other, or (g) unknown. If the home discipline is not geriatrics, please also state the specialty or subspecialty. This information should also be summarized in tabular or spreadsheet form in the beginning of this Appendix, and select summary statistics should be incorporated into the narrative.

Appendix C: Faculty Development/Accomplishments

For each of the previous five years, please list the faculty members (typically MDs or PhDs) who have been directly and indirectly supported at your Center for training in geriatric medicine or topics related to the health of older patients. Please indicate how they were supported, whether they received direct or indirect support (or both), whether direct Hartford, other source of support, type of support (e.g., salary, pilot grant, tuition). Please also characterize their current career using the following categories (a) clinical practice, (b) clinical practice including mentoring/proctoring of medical students and/or residents, (c) academic career: basic research, (d) academic career: health services/clinical services research, (e) academic career: clinician educator, (f) other, or (g) unknown. If the home discipline is not geriatrics, please also state the specialty or subspecialty. This information should also be summarized in tabular or spreadsheet form in the beginning of this Appendix, and select summary statistics should be incorporated into the narrative.

Additional Appendices

Please include letters of endorsement from your dean, department chair, or higher administrative officials, with specific references to the matching funds, additional support, and other resources they intend to provide to your work in advanced fellowship training and junior faculty development over the next three years. Please include “short-form” NIH-style CVs in the proposal for key personnel expected to work on this grant. (Regular “long-form” CVs may be requested at a later date.)

Proposal Format

If invited, three copies of the proposal unbound, and an electronic version are required for the final submissions. The electronic submission may be in MSWord/Excel or pdf format, but must include all parts in one file. Proposals should be single-sided, paginated, double-spaced, 12 point Arial font.

Site Visits

Site visits to select candidate programs are anticipated to be scheduled from June to September, 2007. This will generally entail a 3-4 hour opportunity for selection committee members to see the program and meet key personnel on site.

Matching Funds

One-to-one institutional matching funds should be described in the letter of intent, proposal, and budget documents. Please be attentive to our desire that institutional matching funds be of as high quality as is reasonably possible (e.g., unencumbered, flexible). Consistent with current CoE practice, institutional indirect costs (up to 10%) are permitted in the budget, but the annual budget with indirect costs as a line item may not exceed the total grant request of $150,000.

Proposal Review

Proposals will be reviewed internally and by a panel of current CoE awardees and external consultants. Additional budget formating instructions will be sent to those sites invited to submit full proposals. Draft budgets with justifications are also due by May 25, 2007 and detailed budgeting questions may be directed to Frank Doll at francisco.doll@jhartfound.org. Please ensure that the budget and justification reflect the work plan laid out in the proposal.

If invited, three hard copies and one electronic version of the full proposal with budget and all appendices should be sent to:

The John A. Hartford Foundation
Gavin W. Hougham, PhD
Senior Program Officer
55 East 59th Street
New York, NY 10022

Foundation Contact: Inquiries concerning this funding opportunity should be directed to:

Gavin W. Hougham, PhD
gavin.hougham@jhartfound.org
212.832.7788

The Foundation‘s 2004 Annual Report included a series of short “Action Briefs” on our programs across disciplines, including one specifically about the Centers of Excellence in Geriatric Medicine. “Medicine's Missing Resource: Geriatrics Faculty Needed to Prepare Doctors for Medical Care” may be found at: http://www.jhartfound.org/pdf%20files/medfaculty.pdf.

The CoE program was highlighted in the Foundation’s 2005 Annual Report.

Much of the discussion in, Mallon, William T. “Benefits and Challenges of Research Centers and Institutes in Academic Medicine.” Academic Medicine 81(6): 502-512, June 2006, and Mallon, William T., “The Financial Management of Research Centers and Institutes at U.S. Medical Schools.” Academic Medicine 81 (6): 513-519, June 2006, will be relevant to divisions considering competing for a Hartford Center of Excellence in Geriatric Medicine and Training.