Improving Individual and Family Outcomes through Continuity and Coordination of Care in Hospice (R21 Clinical Trial Optional) | PA 18 166

Opportunity Information: Apply for PA 18 166

The National Institutes of Health (NIH) grant opportunity titled Improving Individual and Family Outcomes through Continuity and Coordination of Care in Hospice (R21 Clinical Trial Optional), Funding Opportunity Number PA-18-166, supports early-stage, exploratory research aimed at strengthening how hospice care is coordinated and how care transitions are handled near the end of life. The central goal is to reduce negative outcomes for patients and families that can happen when transitions are unwanted, poorly managed, or disruptive, and to improve outcomes when continuity and coordination of care are done well. In practice, this means the FOA is looking for research that can identify, test, or refine approaches that help hospice patients and their family caregivers experience smoother care, fewer avoidable moves between settings, and better alignment between care delivered and the patient and family preferences.

A key emphasis of the announcement is the problem of transitions at the end of life, especially transitions that are not desired by the patient or family. These can include moves from home to hospital, from a nursing facility to the emergency department, or from one care setting to another due to symptom crises, communication breakdowns, gaps in after-hours coverage, medication issues, or lack of clarity about goals of care. The FOA encourages research that examines why these transitions occur, how they affect patients and caregivers emotionally and physically, and what health system or care-team changes could prevent unnecessary disruptions. Alongside reducing unwanted transitions, the announcement also focuses on optimizing positive outcomes through high-quality care coordination, meaning better communication across providers and settings, clearer care plans, more consistent symptom management, improved caregiver support, and better continuity as needs change.

The target population is individuals enrolled in hospice and their family caregivers, across any place hospice care is delivered. The FOA explicitly includes hospice provided in the patients home, a relatives home, hospice inpatient facilities, assisted living facilities, short- or long-term care facilities, and hospitals. This wide range of settings signals that NIH is interested in problems that arise when multiple organizations, clinicians, and systems interact, and where coordination failures are common, such as when hospice intersects with hospital care, long-term services and supports, or facility-based care. Projects can be designed to reflect the realities of hospice care in different environments, including rural areas, underserved communities, and settings with limited specialty palliative resources.

The mechanism is an NIH R21, which is generally used for exploratory or developmental research. That typically fits projects that are building preliminary evidence, developing and piloting interventions, testing feasibility, refining measures, or generating data needed for a later-stage, larger clinical or pragmatic trial. The label Clinical Trial Optional means applicants may propose studies that include a clinical trial component, but they are not required to do so. This allows a broad range of research designs, including observational studies of care transitions, intervention development and pilot testing, implementation-oriented feasibility work, or small-scale trials depending on the aims.

From an administrative standpoint, the opportunity is a discretionary grant in the Education and Health activity category and is listed under CFDA 93.361. The source data shows an award ceiling of $200,000, which is consistent with the smaller, early-phase nature of an R21 project. The opportunity was created on 2017-11-07, and the original closing date listed is 2020-01-07, indicating that the posted record reflects a specific receipt date window in that period (applicants should always verify current availability and active due dates in NIH and Grants.gov systems, since NIH FOAs can be reissued, expired, or updated).

Eligibility is broad and includes a wide range of domestic and certain non-domestic organizations. Eligible applicants include state, county, city or township governments; special district governments; independent school districts; public and state-controlled institutions of higher education; private institutions of higher education; Native American tribal governments (federally recognized); tribal organizations other than federally recognized tribal governments; public housing authorities/Indian housing authorities; nonprofits with and without 501(c)(3) status (other than institutions of higher education); for-profit organizations (other than small businesses); and small businesses. The FOA also highlights additional eligible applicant types such as Alaska Native and Native Hawaiian Serving Institutions, Asian American Native American Pacific Islander Serving Institutions (AANAPISISs), Hispanic-serving Institutions, Historically Black Colleges and Universities (HBCUs), Tribally Controlled Colleges and Universities (TCCUs), eligible federal agencies, faith-based or community-based organizations, regional organizations, U.S. territories or possessions, Indian/Native American tribal governments other than federally recognized entities, and non-U.S. entities (foreign organizations). This breadth suggests NIH is encouraging participation from diverse institutions and community partners, which can be especially important in hospice research where access, cultural factors, and caregiver supports vary widely.

Overall, this FOA is best understood as a call for research that improves the real-world experience of hospice at the end of life by strengthening continuity and coordination of care, reducing avoidable and unwanted transitions, and improving outcomes for both patients and family caregivers. It supports projects that can clarify what drives problematic transitions, develop and test practical strategies to improve coordination across settings and providers, and generate evidence that can ultimately improve quality of care, caregiver well-being, and alignment with patient goals during one of the most vulnerable periods of life.

• The National Institutes of Health in the education, health sector is offering a public funding opportunity titled "Improving Individual and Family Outcomes through Continuity and Coordination of Care in Hospice (R21 Clinical Trial Optional)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.361.
• This funding opportunity was created on 2017-11-07.
• Applicants must submit their applications by 2020-01-07. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $200,000.00 in funding.
• Eligible applicants include: State governments, County governments, City or township governments, Special district governments, Independent school districts, Public and State controlled institutions of higher education, Native American tribal governments (Federally recognized), Public housing authorities/Indian housing authorities, Native American tribal organizations (other than Federally recognized tribal governments), Nonprofits having a 501 (c) (3) status with the IRS, other than institutions of higher education, Nonprofits that do not have a 501 (c) (3) status with the IRS, other than institutions of higher education, Private institutions of higher education, For-profit organizations other than small businesses, Small businesses, Others.

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