BRIDGE-C2 RFA - Pilot Questionnaire

As part of your application, please complete this form as an introduction to the pilot study you wish to conduct as part of the BRIDGE-C2 Research Program. This will help the Center better understand the needs, objectives and outcomes you wish to achieve with this pilot study.

 
 

 

Basic Pilot Information

 

Please include degree(s)

 
 
 
 
 
 
 
 
 

 

Pre-Pilot/IRB Information

Please indicate for the following whether they are: Complete, Not Complete, Not Complete but you would like assistance in doing so, Not Applicable to this study, or you Don't Know their status

 
 
 
 
 
 
 
 
 

List below any recruitment materials you already have, or anticipate needing to use in the future

 

 

Detailed Pilot Information

 
 
 
 

If EHR, please also include dataset source e.g. "EHR, OCHIN" Write-in "Do Not Know" if data source currently unknown

 

e.g. patient-level, Clinic-level, etc.

 

Please indicate if your pilot study will include primary data collection

 

Please indicate if your pilot study will include secondary data analysis

 

Please list the date range for your pilot study. (e.g. 1/1/19-12/31/21)

 

Please list the analysts you wish to include on your pilot study, if known

 

 

Post-Pilot and Dissemination Information

 

Please indicate the main deliverable/product(s) of this pilot study (e.g. Manuscript, data for future grant)

 
 

If your main deliverable is a manuscript, please list the Target Journal(s)

 
 

Who is the target audience for your deliverable?

 

Please list any additional comments you would like to provide that this form may not have captured.

 
 

Pilot Abstract

 

GENERAL PROBLEM: 1 SENTENCE RESEARCH QUESTION OR PURPOSE: 1 SENTENCE

 
 

DESIGN, PARTICIPANTS/SITES, OUTCOME MEASURES, ANALYSIS: 2-3 SENTENCES

 
 

ANTICIPATED: 1-2 SENTENCES

 
 

SUMMARY OF THE MAIN TAKE-HOME LESSON EMERGING FROM THE DATA: 1 SENTENCE IMPLICATIONS FOR PRACTICE, POLICY OR SPECIFIC RESEARCH (ANSWER TO THE 'SO WHAT?' AND 'WHO CARES?' QUESTIONS: 1 SENTENCE

 
 

 

Full Application Document

 

Please upload your full application document as a single PDF here.

Drop your files here