Application Form for TRIC

Level One (up to $3,000 over one year)

Title Page

Title:

Name and title of Scientific Co-Principal Investigator: (five-page CV attached):

Contact Information for Scientific Co-Principal Investigator:

Address:

Phone:

E-mail:

______

Signature of Scientific Co-Principal Investigator

Name and title of Administrative Co-Lead: (five-page CV attached)

Contact Information for Administrative Co- Principal Investigator:

Address:

Phone:

E-mail:

______

Signature of Administrative Co- Principal Investigator

Name and titles of Co/Sub-Applicants: (five-page CV attached)

1) Institution(s) where the research will be carried out:

QEII IWK

Other NSHA (please specify zone, facility, location):

2) Budget requested: $

Operational costs to be covered by the health system: $

Note: the TRIC research grant will support research costs. Operational costs must be supported by the health system. Please provide no more than one-half page of detail. These costs must be approved and signed by the Administrative Co-Principal Investigator:

3) Does your proposal involve:

Humans Yes No

Animals Yes No

Biohazards Yes No

4) Did a member of your team attend a TRIC application preparation workshop OR review one of the TRIC PowerPoint presentations on the Research Services Website?

Yes No Name:

5) Patient Engagement: Has your team considered patient engagement and determined how to include the patient voice?

Yes No Describe:

6) Did you apply elsewhere for grants/funding for this project?

Yes No Where?:

7) Is this project a resubmission to the TRIC program?

Yes No

8) Does this project build on a previously funded TRIC grant?

Yes No

Title of previously funded grant:

Competition date:

Co-PI Names:

9) If your application receives funding, would your team be willing to share your TRIC application with other potential TRIC applicants as an example of a successful proposal?

Yes No Maybe—Please contact me for permission.

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Co-PI’s Names:

Title of Project:

Level One

TRIC Checklist

This TRIC project will (check all that apply):

Improve patient reported outcomes

Improve the safety of healthcare

Improve wait times for healthcare

Reduce the need for healthcare

Improve access for under-served populations

Identify and reduce unnecessary costs

Reduce unnecessary interventions. We strongly encourage applicants to consider a focus on de-adoption of unnecessary tests, interventions or clinical practices that are of low value.

Lay Summary

Provide a 250-word description of how the proposed project will improve health care.

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Nova Scotia’s Healthcare Improvement Research Program Revised March 1, 2018

Follow the format outlined below in the development of your proposal for a Level One TRIC.

Project Description:

Three pages maximum. Note: this half page of instructions does not count as part of the allowable pages).

A. Background (Describe the healthcare problem, research question, improvement strategy to be explored and the existing evidence to support it)

B. Implementation Plan and Impact (Describe the expected findings of the developed research project, what viable evidence-based solution/treatment will be explored, how the implementation plan will be developed and how this will impact healthcare)

C. Development Plan (Describe the plan that will be used to develop the subsequent level 2 or 3 TRIC grant application)

D. Patient Engagement (Describe how patients or the patient voice will be included in the project)

E. Team Members and Roles (Describe the role of each member of the team in the project)


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Nova Scotia’s Healthcare Improvement Research Program Revised March 1, 2018

A. Background

B. Anticipated Findings, Implementation Plan and Impact

C. Development Plan

D. Patient Engagement

E. Team Members and Roles

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Nova Scotia’s Healthcare Improvement Research Program Revised March 1, 2018


Budget Template: Please complete the budget template below including:

A. Research budget—includes costs to be covered by TRIC award and

B. Operational budget—in kind costs that will be absorbed by the healthcare system.

Budget Justification: In addition to the budget template, on separate pages provide a detailed budget justification (no page limit). The budget justification pages are not considered part of the appendices. Please refer to the Budget Guidelines on the next page for eligible expenses.

Administrative Co-PI’s Letter of Commitment must be included to demonstrate commitment to supporting the operational budget, the overall project and sustainability.

A. Research budget (to be funded by TRIC) / Year 1
Research staff (i.e, research assistant, coordinator) / $
Materials and supplies / $
Equipment / $
Consulting services / $
Knowledge translation / $
Other / $
Total research budget / $
B. Operational budget (to be absorbed by the health system, in-kind or other)
Inpatient care
Staff
Materials
Equipment
Other / $
$
$
$
Outpatient care
Staff
Materials
Equipment
Other / $
$
$
$
Community-based care
Staff
Materials
Equipment
Other / $
$
$
$
Implementation / $
Total operational budget / $
Total budget (A+B) / $

Budget Guidelines

Eligible expenses include, but are not limited to, the following examples:

·  remuneration for work performed by research personnel that contributes to the direct cost of the research for which the funds were awarded, in accordance with institutional employment pay scales, contracts or collective agreements, where applicable

·  consulting fees

·  research equipment and supplies as related to the research project

·  costs of developing web-based information

·  IT costs (please elaborate on details such as: who will set up, monitor and maintain websites/online surveys, who will collect and store data?)

·  costs of holding a workshop or seminar, the activities of which relate directly to the funded research

Ineligible expenses include, but are not limited to, the following examples:

·  compensation to investigators

·  administrative or management charges or fees

·  release time allowance for clinicians

·  insurance costs for equipment and research vehicles

·  costs of the construction, renovation or rental of laboratories or supporting facilities

·  travel expenses (conference travel is not an allowable expense. Travel costs associated with team development, workshops or seminars are eligible but should be clearly justified.)

·  conference registration fees

·  open access publication fees: while we encourage the publication of TRIC research project findings in an open access journal, publication costs should not be included as part of your TRIC budget. However, once you have an accepted manuscript from an open access journal, please contact Research Development for information about funding support to offset the open access publication fee.

Checklist for TRIC grant submission

Scientific Co-PI has a valid NSHA or IWK appointment (appointment must be at the Health Centre where the research will take place and for the duration of the proposed project)

Title Page with signatures

TRIC Checklist

Lay Summary (250 words maximum)

Project Description: three pages maximum

Budget Template

Budget Justification (no page limit)

Appendix: one page maximum (e.g., figure, chart, table, questionnaire, etc)

References: one page maximum

Administrative Co-PI letter of commitment, signed

CV’s (maximum five pages each) for Scientific and Administrative Co-PI’s and all other Co/Sub-Investigators

Electronic application was sent on time as PDF to (NSHA) or (IWK)

(please combine application and all supporting documents into one PDF file)

There is no need to submit a paper copy.

Receipt of your application will be confirmed.

Additional details are available in the TRIC Application Guidelines document posted on the websites:

IWK: http://www.iwk.nshealth.ca/research/translating-research-care-tric-healthcare-improvement-research-program

QEII: http://www.cdha.nshealth.ca/discovery-innovation/qeii-fdn-tric-grants

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Nova Scotia’s Healthcare Improvement Research Program Revised March 1, 2018