AgencyforHealthcare Research and Quality, Diviision of Contracts Management, Executive Office Center, Suite 601, 2101 East Jefferson Street, Rockville, MD 20852

A -- BIOTERRORISM INITIATIVE SOL AHRQ-00-0009 POC Sharon Williams, (301) 594-7192 The Agency for Healthcare Research and Quality (AHRQ) is seeking potential sources from qualified small business firms under Standard Industrial Classification (SIC) Code 8733 ($5.0 million) that have the capability 1) to describe and evaluate approaches to preparedness for bioterrorism that are based upon information systems and 2) to determine the best ways to train clinicians to manage rare events, specifically including the possible consequences of bioterrorism, in order to fulfill the legislative mandate of AHRQ. The threat of bioterrorist attacks has stimulated broadly-based planning by the Department of Health and Human Services (DHHS). DHHS plans involve various elements of the public health and medical care systems in preparing for and responding to weapons of mass destruction. If an episode of bioterrorism were to occur, health professionals on the front line would see patients presenting in many varied and dispersed clinical settings, including emergency rooms, physicians' offices, and walk-in clinics. Health-care providers represent an essential component of a comprehensive response, but without proper training and tools they might become unwitting obstacles to rapid identification of a response to the release of a bioterrorist weapon. An initially localized dispersal of a transmissible biological agent might be followed by scattering of those exposed among multiple geographical sites, so that each patient sought care from a different provider, none of whom might appreciate the significance of the initial nonspecific clinical findings. All involved might thus fail to recognize the epidemic. For health professionals in the front lines of emergency departments and primary care settings, the difficulty of accurately diagnosing a patient's illness and the lack of a direct connection to the public health infrastructure might prevent their recognizing the implications of their clinical observations and taking appropriate action. Information systems that enhance the clinician's ability to diagnose infectious diseases caused by biological weapons, to inform public health authorities, and to treat the individual patient are essential. Because most medical care in the United States is provided in the private sector, the nation's capacity to detect and respond to a bioterrorist attack or to any other major health crisis will depend heavily upon the service capacity, clinical preparedness, information technology (IT), and communication capabilities of emergency departments, managed care and integrated delivery systems, and private physicians' offices. Administrative and patient encounter data currently collected by such entities can provide a baseline fo research and illuminate decision-making on appropriate policies and programs. In FY 2000, AHRQ will develop an initiative that complements current federal efforts to respond to bioterrorism and that includes at least three components: 1) AHRQ will sponsor a research initiative with federal and private collaborators to develop and evaluate information systemsto detect sentinel events and provide rapid information to clinicians regarding appropriate management. A specific focus of interest will be the development and evaluation (through simulations) of artificial intelligence technology for early detection of the release of a bioterrorist weapon. Research that addresses the role of human factors in early detection and that evaluates the extent to which such detection can be integrated with other sentinel event detection efforts (e.g., medical errors) will also be solicited. The highest priority will be given to collaborative efforts among academic health centers, emergency departments, local, and federal agencies. 2) AHRQ will support developing a broad research agenda to identify important areas related to the role of clinicians, emergency departments, hospitals, and private practices; to evaluate the current data capacity and needs of hospitals, clinical practices and emergency departments; convenes regional and national groups of clinicians, hospitals, and emergency departments to assess current and future research agendas, specifically focusing upon primary care practice networks, and to consult with national experts in bioterrorism and clinical practice; and 3) AHRQ will assess and improve the capacity of integrated delivery systems and managed care organizations to detect and respond to bioterrorist attacks. Using task orders with the Agency's new Integrated Delivery System Research Network (currently being solicited)and working closely with the Centers for Disease Control and Prevention (CDCP) and the Office of Emergency Preparedness (OEP), AHRQ will study the feasibility of using managed care data to monitor sentinel events such as patients presenting with symptoms suggestive of exposure to bioterrorist agents and to identify specific IT requirements that should be met to enhance early detection and response. The bioterrorism initiative at AHRQ is managed by the Center for Primary Care Research in collaboration with the Center for Outcomes and Effectiveness Research. The primary objective of this bioterrorism task order contract is to secure targeted research of the highest quality from experienced investigators of established competence to determine reliable answers to six research questions: 1) What is the current capacity of surveillance and detection systems to mine data for rare events?; 2) What is the experience with surveillance and detection systems in other industries?; 3) What is the current state of the art of on-line decision-support systems?; 4) What can be learned from other industries about decision-support systems?; 5) What is the best way to train clinicians to deal with rare events?; and 6) Are there innovative approaches to training clinicians for rare events like bioterrorist attacks? Following are examples of topics which may result in a task order. These are provided as examples only and are not necessarily indicative of actual topics which may be used in the award of task orders under this proposed contract. 1) Assessing what can be learned about internet-based decision-support systems in other fields in order to illuminate the development of decision-support systems for clinical care in general and bioterrorism response in particular; 2) Delineating a model prototype for preparing a state to respond to a bioterrorist threat or attack; 3) Developing and evaluating clinical surveillance and detection systems to detect rare events, with particular emphasis on the adaptation of existing clinical systems to detect possible bioterrorism; 4) Evaluating existing systems of surveillance and decision support (e.g., poison-control centers, CDC botulism surveillance, ProMed, and military systems) to support detection and management of unusual clinical events; 5) Supporting development of decision-support systems that could be used to aid clinicians at the point of care with special emphasis on the requirements of the system for reconfiguration to deal with bioterrorism; 6) Determining the utility, effectiveness, and cost-effectiveness of training simulations, including review of the experience in other industries; 7) Reviewing and evaluating the effectiveness of current programs of training and education about bioterrorism; and 8) Identifying the best approaches to reaching front-line clinicians with appropriate training about bioterrorism. Performance of these task orders will require not only technical expertise in clinical medicine, public health, medical microbiology, and educational psychology, but also knowledge of the fundamental techniques of health services research, including cost-effectiveness analysis, IT, meta-analysis, outcomes research, quality measurement and improvement, and technology assessment. The task orders for this initiative are not of a routine nature, but require innovation and sophistication in design, documentation, and execution to approach a threat in which the risk of catastrophic morbidity and mortality is very high; the ability to predict the etiology, timing, and location of the event is by no means assured; and the fund of accumulated practical experience available is minimal. For these reasons, ivestigators will need to be able to draw upon a very broad range of sources of information to make inferences about what practices can be recommended for transfer to the clinical setting. The offeror must have permanent staff with demonstrated experience in the areas set out above. That is, qualified offerors will have a project director and subordinate personnel who among them have at least 5 years of experience in each of the following disciplines; 1) primary care and/or emergency medicine; 2) public health; 3) medical education; 4) IT; and 5) cost-effectiveness analysis. In addition, organizations must demonstrate prior experience collaborating with academic medical or public health institutions. The project director must also have experience exhibiting 1) excellent overall skills in project management that include substantive and technical areas, teamwork, budget management, cost control, flexibility, and the ability to produce deliverables on time, within budget, and with exceptionally high technical quality; 2) excellent verbal communication skills with the project officer and in meetings and presentations; and 3) excellent written English. The qualified offeror should demonstrate an appropriate organizational structure and management systems, including the management of the personnel assigned to each task and the labor hours proposed, the plan for ensuring the availability of adequate staff, the plan for reporting the required technical and cost information to the Government, the system for maintaining efficient use of resources, the plan for responding to special requests on short notice, and planned methods for assuring the successful completion of all tasks within the time and budget allocated. Potential offerors must also show sufficient staff with the skills and experience to be fully operational within 30 days of the start of a contract. Potential offerors will be evaluated as well on the degree to which they demonstrate anunderstanding of the requirements and objectives of this initiative and the problems that are likely to be encountered. There will be periodic interaction between agency research staff and the offeror's staff, so suitable logistical plans to facilitate communications and meetings must be addressed. Potential offerors must demonstrate that they have suitable, high quality and cost-efficient computers and other facilities and equipment available for the performance of all requirements of this acquisition. This is not a formal solicitation. Concerns that respond to this notice must furnish concise responses directed specifically to the requirements mentioned above. Sources possessing experience and demonstrated capability to accomplish the above are to supply pertinent information in sufficient detail to demonstrate the ability to perform the required services. In particular, information about the number of staff currently employed by the firm who are available and are qualified to meet AHRQ's requirements should be provided on all personnel. Information furnished must include background informaton, resumes, and proof of employment of qualified staff; a description of general and specific facilities; a description of corporate experience with similar projects (including title, sponsoring agency, contract number, and project officer name and telephone number); a list of publications and reports from those projects; and other available information needed for AHRQ staff to perform a proper evaluation. Interested small businesses may submit these tailored capability statments in an original and four (4) copies to the attention of the Contracting Officer at the address above no later than 3:00 p.m. local prevailing time on April 26, 2000. Posted 04/11/00 (W-SN443649). (0102)

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