You are invited to submit a proposal to the Agency for Healthcare Research and Quality (AHRQ) for Request for Proposal (RFP) No. AHRQ-01-0006, entitled “National Quality Measures Clearinghouse,” formerly called the “National Measures Clearinghouse. Your proposal must be developed and submitted in accordance with the requirements and instructions of this RFP.
A Performance Based Cost Plus Award Fee Completion type of contract is contemplated for a period of four (4) years. The planned performance period of this contract is from September 17, 2001 to September 16, 2005.
NOTICE OF SMALL BUSINESS GOALS: All offerors (other than small businesses) must submit a complete subcontracting plan with their initial proposal. The requirement to submit a subcontracting plan also applies to colleges, universities, and non-profit organizations, as well as large business concerns. AHRQ recommended goal (as a percentage of total contract value for the base period) is 23% for Small Businesses, which shall include at least 5% (as a percentage of total contract value for the base period) for Small Disadvantaged Businesses, and at least 5% (as a percentage of total contract value for the base period) for Women-Owned Small Businesses, and at least 2% (as a percentage of total contract value) for HUBZone Small Businesses. These goals represent AHRQ’s expectation of the minimum level for subcontracting with small businesses at the prime contract level. Any goal stated less than the AHRQ recommended goal shall be justified and is subject to negotiation. A copy of the AHRQ model subcontracting plan is provided as an attachment to this solicitation. If the model is not used, all elements outlined must be addressed in the offeror’s format. If the offeror is not a small business and fails to submit a subcontracting plan with the initial proposal, the offeror will be considered non-responsive and their proposal will be returned without further consideration. The approved plan will be included in any resultant contract.
Offerors shall submit the following:
A. Technical Proposal (See Section L.9) Original and 11 copies
B. Past Performance Information (See Section L.10) Original and 3 copies
C. Small Disadvantaged Business Participation Plan (See Section L.11) Original and 1 copy
D. Business Proposal (See Section L.12) Original and 5 copies-set forth in Cost Plus Award Fee arrangement
Small Business Subcontracting Plan (See Section L.12.B.) Original and 5 copies (This does not apply to small business concerns)
Your technical proposal must be concisely written and should be limited to 150 typewritten pages (double-spaced), exclusive of personnel qualifications (i.e., resume, etc., see Section L.9 for additional details). This limitation is for administrative purposes only and exceeding the limitation shall not, of itself, be considered a basis for rejection of your proposal.
Your proposal must provide the full name of your company, the address, including county, Tax Identification Number (TIN), Dun and Bradstreet No., and if different, the address to which payment should be mailed.
YOUR ATTENTION IS CALLED TO THE LATE PROPOSAL PROVISIONS PROVIDED IN SECTION L.3 OF THIS RFP. YOUR ATTENTION IS ALSO DIRECTED TO THE TECHNICAL PROPOSAL INSTRUCTIONS PROVIDED IN SECTION L.9 OF THE SOLICITATION.
Questions regarding this solicitation shall be received in this office no later than June 6, 2001
(See Section L.6). Your questions should be submitted to the attention of Mary Haines, Contracting Officer, Agency for Healthcare Research and Quality, Suite 502, 2101 E. Jefferson Street, Rockville, Maryland 20852 and the envelope should be marked “Proposal Questions RFP No. AHRQ-01-0006.”
The proposal shall be signed by an authorized official to bind your organization and must be received in our Contracts Office no later than 12:00 noon,
local prevailing time, on July 6, 2001.
Your proposal must be mailed to the following address:
Agency for Healthcare Research and Quality
Division of Contracts Management
2101 E. Jefferson Street, Suite 502
Rockville, Maryland 20852
Hand carried proposals may be dropped off at the above location, at Room 5E108A. The Division of Contracts Management offices are located in Suite 502 in the East Wing of the 5th
Floor. Allow sufficient time for parking and delivery.
The RFP does not commit the Government to pay any cost for the preparation and submission of a proposal. It is also brought to your attention that the Contracting Officer is the only individual who can legally commit the Government to the expenditure of public funds in connection with the proposed acquisition.
Requests for any information concerning this RFP should be referred to Mary Haines,
TABLE OF CONTENTS
PART I Pages
Section A Solicitation 1-2
Table of Contents 3
Section B Supplies or Services & Prices/Costs 4-6
Section C Description/Specification/Work Statement 7-29
Section D Packaging and Marking 30
Section E Inspection and Acceptance 30
Section F Deliveries or Performance 30-33
Section G Contract Administration Data 34-36
Section H Special Contract Requirements 37-45
Section I Contract Clauses 46-50
Section J List of Attachments 51
Section K Representations and Instructions 52-70
Section L Instructions, Conditions & Notices to Offerors 71-93
Section M Evaluation Factors for Award 94-98
SECTION B-SUPPLIES OR SERVICES AND PRICES/COSTS
B.1 BRIEF DESCRIPTION OF SUPPLIES OR SERVICES
“National Quality Measures Clearinghouse.” See Section C for a complete description.
B.2. ESTIMATED COST
Note: The Government estimates the cost of this procurement at approximately $8.4 million, inclusive of all fees.
a. The estimated cost (exclusive of any fees) for performance of the work under the contract including direct and indirect costs for the four year period is
$ (TO BE COMPLETED UPON AWARD)
b. The base fee for the contract is $(TO BE COMPLETED UPON AWARD). The base fee shall be paid in installments based on the percentage of completion of work, as determined by the Contracting Officer
, and subject to the withholding provisions of the Clauses ALLOWABLE COST AND PAYMENT and FIXED FEE incorporated herein. Payment of the base fee shall not be made in less than monthly increments.
c. The maximum amount of Award Fee that may be earned for the contract period is$ (TO BE COMPLETED UPON AWARD).
d. The Government’s maximum obligation, represented by the sum of the Estimated Cost plus the Base Fee plus total award fee obtainable for the contract period is $ (TO BE COMPLETED UPON AWARD).
(1) The Contractor’s performance shall be evaluated on a semi-annual basis, during the period of the contract. The award periods and maximum amounts for each are listed in Section H, Special Contract Requirements, H.4., Award Fee
(2) The criteria set forth in the Quality Assurance Plan, Attachment 2 shall be used to evaluate the Contractor’s performance.
f. It is estimated that the amount currently allotted will cover performance of the contract through _____
g. The Contracting Officer may allot additional funds to the contract without the concurrence of the contractor. For further provisions on funding, see the LIMITATION OF COST/ LIMITATION OF FUNDS and the ALLOWABLE COST AND PAYMENT (AND FIXED FEE) clauses incorporated into the contract.
B.4 PROVISIONS APPLICABLE TO DIRECT COSTS
a. Items Unallowable Unless Otherwise Provided
Notwithstanding the clauses, ALLOWABLE COST AND PAYMENT
, and FIXED FEE, incorporated into this contract, unless authorized in writing by the Contracting Officer, the costs of the following items or activities shall be unallowable as direct costs:
(1) Acquisition, by purchase or lease, of any interest in real property;
(2) Rearrangement or alteration of facilities;
(3) Purchase or lease of any item of general purpose-office furniture or office equipment regardless of dollar value. (General purpose equipment is defined as any items of personal property which are usable for purposes other than research, such as office equipment and furnishings, pocket calculators, etc.);
(4) Accountable Government property (defined as both real and personal property with an acquisition cost of $1,000 or more, with a life expectancy of more than two years) and "sensitive items" (defined and listed in the Contractor's Guide for Control of Government Property, 1990,
regardless of acquisition value;
(5) Travel to attend general scientific meetings;
(6) Foreign Travel;
(7) Any costs incurred prior to the contract's effective date;
(8) Rental of meeting rooms not otherwise expressly paid for by the contract;
(9) Any formal subcontract arrangements not otherwise expressly provided for in the contract;
(10) Consultant fees in excess of $500/day; and
(11) ADP hardware or software.
b. This contract is subject to the provisions of Public Law (P.L.) 99-234 which amends the Office of Federal Procurement Policy Act to provide that contractor costs for travel, including lodging, other subsistence, and incidental expenses, shall be allowable only to the extent that they do not exceed the amount allowed for Federal employees.
The Contractor, therefore, shall invoice and be reimbursed for all travel costs in accordance with Federal Acquisition Regulations (FAR) 31.205-46.
National Quality Measures Clearinghouse (NQMC)
Independently and not as an agent of the Government, the Contractor shall furnish all the necessary services, qualified personnel, material, equipment, and facilities
, not otherwise provided by the Government as needed to perform the Statement of Work as described in the following sections.
The Agency for Healthcare Research and Quality (AHRQ) is interested in producing tools which will help translate evidence-based information on healthcare outcomes, quality, and cost, use, and access into healthcare practice. This procurement is one of a series that will ultimately result in the production of an integrated suite of Internet based tools for healthcare providers, managers, and policymakers. This suite of tools will initially be comprised of a significant enhancement of the Agency’s CO
ality Measurement E
em (CONQUEST) library of quality measures and the Agency’s highly successful National Guideline Clearinghouse™ (NGC). Feedback from NGC users indicates that some users desire a convenient mechanism to identify relevant measures to evaluate how well a guideline is being implemented and used. Similarly, some CONQUEST users have indicated that a linkage with NGC would be desirable so that the full, evidence-based guideline is accessible as a complete reference. As a result, AHRQ believes there would be significant added value in integrating the two clinical information tools such that users would have the choice to search one or both tools and retrieve an integrated result set.
An evaluation of CONQUEST also indicated that users would value a dynamic Internet based library of quality measures. Through this procurement the Agency will migrate the software-based CONQUEST library of quality measures to the Internet and rename that new tool the National Quality Measures Clearinghouse (NQMC). AHRQ also believes that standardizing the language of fields in the new NQMC is a desirable goal, should be a part of its migration to the Web, and will aid in the integration of the NQMC and NGC. In addition to the NQMC
, this procurement will design, develop, and maintain a database backbone (an “umbrella site”) to house the NQMC as one module and be expandable to include additional AHRQ clinical tools such as the NGC and others in subsequent modules. This database backbone must be designed to take advantage of what has worked well with the NGC and accommodate future NGC enhancements. In addition to enhancements with functionality, it is anticipated that NGC enhancements will include the addition of references (citations) used in the development of the guideline, linking the references to recommendations when provided by the developer, and linking references to PubMed when appropriate. It is also anticipated that NGC will have an on-line submission and review process. The NGC will be substantially enhanced through a separate but related procurement beginning FY 2003 and migrated to the database backbone in the fourth quarter of FY 2003.
The specific aims of this solicitation are to 1) establish and maintain an Internet-based National Quality Measures Clearinghouse (NQMC) containing detailed information on quality measures; 2) design, develop, and maintain a database backbone and “umbrella” Web site that will house the NQMC as one module and be expandable to include additional AHRQ clinical tool modules such as the National Guideline Clearinghouse™ and others in subsequent efforts; 3) provide appropriate and timely technical assistance to NQMC users; and 4) provide appropriate integration between different Internet-based AHRQ clinical information and decision modules.
The Agency for Healthcare Research and Quality (AHRQ) was established in 1989 as the Agency for Health Care Policy and Research. Re-authorizing legislation passed in November 1999 establishes AHRQ as the lead Federal agency charged with supporting research designed to improve the quality of healthcare, reduce its cost, improve patient safety, decrease medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on healthcare outcomes, quality, and cost; use and access. The information helps healthcare decisionmakers, patients and clinicians, health system leaders, and policymakers make more informed decisions and improve the quality of healthcare services.
Legislation re-authorizing AHRQ specifically directs it to support activities that:
Improve the quality of health care. AHRQ is to coordinate, conduct, and support research, demonstrations, and evaluations related to the measurement and improvement of health care quality. AHRQ is also to disseminate scientific findings about what works best and facilitate public access to information on the quality of, and consumer satisfaction with, health care.
Promote patient safety and reduce medical errors. AHRQ is to develop research and build partnerships with health care practitioners and health care systems and establish a permanent program of Centers for Education and Research on Therapeutics (CERTs). These initiatives will help address concerns raised in a 1999 report by the Institute of Medicine (IOM) that estimates as many as 98,000 patients die as a result of medical errors in hospitals each year. (IOM 1.)
Advance the use of information technology for coordinating patient care and conducting quality and outcomes research. AHRQ is to promote the use of information systems to develop and disseminate quality measures; create effective linkages between health information sources to enhance health care delivery and coordination of evidence-based health care services; and promote protection of individually identifiable patient information used in health services research and health care quality improvement.
AHRQ supports a variety of investigator-initiated and targeted projects focused on quality measurement and improvement, evidence-based medicine, and implementation of research into practice. For example, AHRQ is supporting twelve (12) Evidence-based Practice Centers to conduct rigorous, comprehensive reviews of the relevant scientific literature on selected topics and publish results in evidence reports and technology assessments2.
Particularly relevant to this solicitation, AHRQ has developed the National Guideline Clearinghouse™ (NGC), in partnership with the American Association of Health Plans (AAHP) and the American Medical Association (AMA). The NGC is an Internet-based repository of clinical practice guidelines3
allowing detailed comparisons across different guidelines4
. The contents of NGC include structured summaries of guidelines using controlled terms with descriptive free-text fields. The structured summaries capture information on each guideline in the following three areas: bibliographic
, clinical, and methodological and are available in brief and complete formats. Each summary contains a copyright statement created by the guideline developer. In most cases, the full-text of each guideline is available via hyperlink or on the NGC site. In instances where the guideline developer does not make the full-text available, ordering information is posted. The NGC database contains information on almost 1,000 clinical practice guidelines; new guidelines are added every week. The site has been operational since December 15, 1998 and has seen a steady increase in use. Currently, the site has approximately 30,000 to 33,000 visits per week. The design of the NQMC should take advantage of the success of the NGC model.
Additionally, the Agency supports research on clinical performance measurement5
and improvement that involves developing reliable6
clinical performance measures. The Expansion of Quality of Care Measures (Q-SPAN) project is designed to strengthen the science base of quality measurement while expanding the scope and availability of validated, ready-to-use measures. Q-SPAN builds on past work in quality measurement by public and private organizations through eight cooperative agreements to develop and test additional clinical performance measures for specific conditions, patient populations
, and health care settings8
. More recently the Agency has sponsored a joint project with the Health Care Financing Administration to develop measures of patient safety through the National Quality Forum. The Agency has also been charged by the Congress to develop a National Healthcare Quality Report by FY 2003. A recent report from the Institute of Medicine provides a vision for the development of that report and makes suggestions concerning the selection of appropriate quality measures.9
To address some of the quality measurement needs, AHRQ (then the Agency for Health Care Policy and Research [AHCPR]) sponsored several projects designed to develop, test, and refine a typology or classification scheme for understanding how to evaluate, select, and use clinical performance measures. The products from these two projects were documents entitled 1) Understanding and Choosing Clinical Performance Measures for Quality Improvement: Development of a Typology and Attachments (AHCPR publication numbers 95-N001 and 95-N002) and 2) the CO
ality Measurement E
em (CONQUEST 1.0) which was released to the public in April 1995, accompanied by a User’s Guide. CONQUEST 1.0 required the use of Microsoft Access 2.0®.
AHRQ has funded several projects related to improving CONQUEST. CONQUEST 1.1 was released to the public in mid-1996. It converted CONQUEST 1.0 into a more user-friendly application that operated in a Microsoft Windows® environment without the requirement to use a Microsoft Access-based application although it remained the platform upon which CONQUEST 1.1 was built. A User’s Guide also accompanied CONQUEST 1.1. In September 1996, the Agency sponsored the Quality Measurement Network (QMNet) project. The main objective of QMNet was to enhance and expand CONQUEST 1.1 by adding more clinical performance measures and related conditions and to assess the relational database software platform of CONQUEST 1.1. The most important products from QMNet were the release of CONQUEST 2.0 and the Final Report (March 12, 1998) which included procedures to code measures from raw data, procedures for mail validation of coded measures, time estimates for coding measures from raw data and for validating measures by mail, programming specifications for CONQUEST 2.0, a CONQUEST 2.0 User’s Guide, and a list of all gaps in CONQUEST 2.0's condition database by condition and type of gap - including recommendations for filling those gaps. The QMNet contract ended in March 1998. CONQuest 2.0 (which contains over 1100 measures), the User’s Guide, Fact Sheet, and Overview are available on the Internet at http://www.ahrq.gov/qual/conqix.htm.
A related activity funded by AHRQ was the Performance Measures Inventory (PMI). Its purpose was to collect all performance measures (e.g., clinical, population
, and system measures) in use nationally or under development and soon to be implemented nationally by Agencies and Departments within the Federal government. This work was completed by the Center for Health Policy Studies (CHPS) 10
. The purpose of the project was to provide an inventory of measures and to help identify areas for potential coordination and collaboration in the development and implementation of measures across Federal agencies and departments. The most relevant product of this project includes a CONQUEST-compatible database containing a limited subset of the measure-specific variables found in CONQUEST. This subset includes measure name, measure set name, numerator and denominator descriptions, measure type, applicable age range, level of care for which the measure was designed, current/planned use, and contact information such as Agency, Department, person, address, phone and fax numbers, e-mail address, date of measure entry
, and date of last update.
Two other related activities have direct relevance to this solicitation. The first activity is the CONQUEST 2.0 Evaluation project (Contract No. 290-96-0011, Task Order No. 5)11
which was awarded to the Research Triangle Institute and completed in June 2000. The results of the evaluation included five main conclusions.
Only a small number of end users requesting CONQUEST 2.0 had actually used the software.
A major reason for not using CONQUEST 2.0 was lack of time to load the program and/or to learn how to use it. Another barrier was lack of measures and typology data for conditions of interest for the end user.
Of those who used CONQUEST 2.0, they were genuinely pleased with the advances that CONQUEST 2.0 represented over earlier versions both in terms of interface and number of new measures.
Drawbacks and limitations of CONQUEST 2.0 were varied but pointed to limitations in the CD-ROM-based system. For example, it was perceived as being outdated shortly after release and users wanted more interactive capabilities not supported by the software.
Moving CONQUEST to an Internet-based system was viewed as highly desirable and would help keep it current, provide linkages to related information, and free up valuable hard drive space on users computers.
Another activity was a commissioned study to explore and detail the conceptual and technological issues, complexity, and cost implications involved in redesigning CONQUEST as a Web-based utility and integrating it with an enhanced NGC, in a way that will result in a seamless, integrated set of programs that are also capable of expansion12. The study made recommendations in three management areas: content, technology, and enterprise management. The study report in its entirety is attached as an appendix to this solicitation. AHRQ has considered recommendations and findings of this study and particular interests and needs of AHRQ and the Government, along with all previous activities in preparing this solicitation.
AHRQ has gained valuable experience in its sponsorship of CONQUEST and the National Guideline Clearinghouse™ and believes significant advantages for the health care community can result from the development of a National Quality Measures Clearinghouse™ and an integrated suite of quality and clinical information tool modules. AHRQ also believes that economies can be realized by developing a common database backbone to house the proposed NQMC
, NGC, and other clinical information and decision tool modules. While some of the audiences for NGC and the NQMC do not overlap, many users will be interested in both tools. The Agency would like to provide a mechanism for those users who wish to coordinate their search for information within both systems.
It is the intent of AHRQ that NQMC and NGC be accessible individually through unique Uniform Resource Locators (URLs), as well as through an umbrella Web site, also with a unique URL. The umbrella Web site would be capable of housing both information tools and potentially other clinical information tools while providing a user-friendly universal Web-based interface. Thus, the goal is to develop a suite of Internet-based tool modules with a common “look and feel.” Each tool will appear as an individual module and site to the user but will share a common information system infrastructure and backbone database system and have clear prompts to open the user’s searches to include materials from the other related tool modules. It is expected that each tool module, including the umbrella site, will utilize standard, common Web-based data query, database storage software and search engine tools, have consistent graphic and navigational features and controlled vocabularies, and share other technical database, software and computer specifications where content-appropriate and cost-effective.
Offerors should keep in mind that computer capabilities of users will differ significantly in their level of technological sophistication. For this reason, it will be necessary to provide a platform that will address the needs of users with either high-end or low-end capabilities. Pages that use table formatting must also be available in formats (i.e., plain text) for browsers that cannot render tables. Frames may be used as long as an option to turn off the frames is supported. Any recommendation for the use of persistent cookies must be justified and the rationale clearly described. All Web site development efforts under this contract must comply fully with the Section 508 provisions of the Americans with Disabilities Act (ADA). For example, ASCII text files must be made available to be in compliance with the Americans with Disabilities Act (ADA). The NQMC Web nonframes/text only site should be Bobby-approved13
and Lynx-compatible. Under no circumstances will personally identifiable information be gathered on NQMC users unless it is supplied voluntarily by the user (e.g., e-mail communication).
The objectives of project are to:
1) establish and maintain an Internet-based National Quality Measures Clearinghouse (NQMC) containing detailed information on quality measures;
2) design, develop, and maintain a database backbone and umbrella Web Site that will house the NQMC as one module and be expandable to include additional AHRQ clinical tool modules such as the National Guideline Clearinghouse™ (NGC) and others in subsequent efforts;
3) provide appropriate and timely technical assistance to NQMC users;
4) finalize and maintain the database structure that will house an enhanced NGC;
5) migration of an enhanced NGC consistent with a the new database environment in the fourth quarter FY 2003; and
6) provide appropriate integration between different Internet-based AHRQ clinical information and decision tool modules.
C. Specific Requirements
All work under this contract shall be monitored by the AHRQ Project Officer (PO) as authorized by the AHRQ Contracting Officer (CO).
The Contractor is expected to maintain such internal policies and procedures as may be required to ensure a high-quality, smooth operation of a project of this scope and complexity, including such training materials as may be necessary to introduce new employees to the project. The NQMC Contractor is expected to maintain a highly effective internal quality control process which assures that the deliverables developed under the contract accurately and consistently address the stated objectives and accurately portray substantive content. The Contractor is expected to ensure the accuracy of the content of the NQMC and its ability to correct contents, links, etc. quickly. The Contractor’s quality control policies, procedures, and materials are deliverables under this contract.
All report and document deliverables under the NQMC contract
, except routine memoranda, must be submitted in hard copy and electronically in a file format and to print specifications as instructed by the Project Officer and shall be in compliance with any Agency standardized contract reporting systems.
Specifically, the National Measures Clearinghouse Contractor shall perform tasks described in the following sections.