Application Form for TRIC:

Level Two (up to $30,000 over one or two years)

Level Three (up to $60,000 over two years)

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:

QEIIIWK

Other NSHA (please specify zone, facility or 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:

HumansYesNo

AnimalsYesNo

BiohazardsYesNo

4) Did a member of your team review the TRIC Guidelines document, attend a TRIC workshop and/or review the resource materials on the Research Services Website?

Yes NoName:

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

Yes NoDescribe:

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

Yes NoWhere?:

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.

Co-PI’s Names:

Title of Project:

Level 2: Level 3:

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 ProgramRevised July 24, 2018

Follow the format outlined below in the development of your proposal for a Level Two or Three TRIC grant.

Project Description:

(Level Two—five pages maximum; Level Three—eightpages maximum) Note: this half page of instructions does not count as part of the allowable pages.

  1. Background and Evidence(Describe the healthcare problem, research question, the improvement strategy to be explored and the quality/strength of the evidence to be implemented)
  2. Implementation Procedure (Describe the health system change that your project will implement. Describe in detail how the anticipated research findings will be integrated into the healthcare system)
  3. Sustainability Plan (Describehow the anticipated healthcare improvement and healthcare impact of your project will be sustainable over the long term, describe your plan for knowledge translation)
  4. Methods and Procedures (Including timelines, team member roles,data collection and analysis plan,and performance indicators for success)
  5. Patient Engagement (Describe how patients or the patient voice will be included in theproject)

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Nova Scotia’s Healthcare Improvement Research ProgramRevised July 24, 2018

A. Background and Evidence

B. Implementation Procedure

C. Sustainability Plan

D. Methods & Procedures

E. Patient Engagement

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Nova Scotia’s Healthcare Improvement Research ProgramRevised July 24, 2018

BudgetTemplate: 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 / Year 2
Research Personnel / $ / $
Professional/Technical Services / $ / $
Materials and Equipment / $ / $
Knowledge Translation / $ / $
Other / $ / $
Other / $ / $
Total research budget / $ / $
B. Operational budget(to be absorbed by the health system, in-kind or other)
Inpatient care
Personnel, Professional & Technical Svcs
Materials and Equipment
Knowledge Translation (Travel/Meetings)
Other – misc. / $
$
$
$ / $
$
$
$
Outpatient care
Personnel, Professional & Technical Svcs
Materials and Equipment
Knowledge Translation (Travel/Meetings)
Other – misc. / $
$
$
$ / $
$
$
$
Community-based care
Personnel, Professional & Technical Svcs
Materials and Equipment
Knowledge Translation (Travel/Meetings)
Other – misc. / $
$
$
$ / $
$
$
$
Implementation / $ / $
Total operational budget / $ / $
Total budget (A+B) / $ / $

Budget Guidelines

Expenses related to personnel and professional/technical services must align with the HR and procurement policies of the administering institution.

Travel expenses must align with the travel policies of the institution administering funds.

All unused funds must be returned to the TRIC Grant program at the end of the grant/award funding period.

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

  • research assistant wages and benefits (outline details of hourly wage, work hours per week, number of weeks of work for each personnel position. Ensure CPP, EI and other related deductions/benefits are included, if required)
  • consulting fees, technician costs
  • purchase or lease of 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
  • travel costs associated with team development, workshops, seminars (please justify)
  • meeting room rental fees and catering costs for the purposes of data collection, partnership development and research dissemination
  • honoraria paid to research participants, such as modest incentives, as approved by an ethics committee

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

  • compensation to investigators, team member salaries or consulting fees
  • administrative or management charges or fees
  • release time allowance for clinicians
  • insurance costs for equipment and research vehicles
  • discretionary severance and separation packages
  • costs of the construction, renovation or rental of laboratories or supporting facilities
  • conference 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, professional training or education tuition and course fees, membership fees to professional associations or societies
  • entertainment and alcoholic beverages
  • 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
  • gifts.

Checklist for TRIC grant submission

Scientific Co-PI has a validNSHA 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 Descriptionwith the appropriate number of pages for level of award requested

Level 2: five pages maximum

Level 3:eight pages maximum

Budget Template

Budget Justification (no page limit)

Appendices(e.g., figure, chart, table, questionnaire, etc):

Level 2:two pages maximum

Level 3:three pages maximum

References:

Level 2: two pages maximum

Level 3: two pages 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:

QEII:

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Nova Scotia’s Healthcare Improvement Research ProgramRevised July 24, 2018