Tracking - Add Item

CIPHR Brief Proposal

Briefly describe your proposed project:
User Information
	* Required fields
Date of Request:
Proposal Name:
User Requesting Information:
Principal Investigator(s):
Position/Title:
Dept:
Address:
Phone:
Fax:
*Email:
Other Co-Investigators or collaborators/mentors:
Complete list of users who may require access to the data or analytic files (co-Investigators/Post-docs/Students/analysts, etc):
Data Needed (Select all that apply.)	SEER-Medicare HPDS (Health Professionals Data System) CIPHR/NC linked Central Cancer Registry/Claims (CMS/private) Other:

Is the research question similar to any one of the following objectives? (Select all that apply.)	Identify trends in screening practices and diagnosis of cancer cases; characterization of patients' treatment experiences; Identification of population-level risk factors; or describe the distribution and practices of cancer care providers who deliver treatment to cancer patients in North Carolina. Assessment of the strenghts and weaknesses of Medicaid, Medicare, BCBS and SHP claims data to characterize patterns of cancer treatment and outcomes in North Carolina. Examine and characterize the oncology treatment provider workforce. Examine patient-level, provider-level, or health systems-level predictors of quality and cost of cancer treatment for multiple cancer types.
Brief Project Proposal / Abstract
Note: If the scope of the project is currently undefined, a member of the Operations Team will meet with you to help refine your research question.
Specific Aims:
Methods:
Timeline/Deadline/Goal to be met:
Data Being Requested
Specific Data Sets (SEER-Medicare, NC CCR, Medicare/Medicaid, Private Payer, NC SHP, Other):
Population description (demographics):
Other Selection Criteria (tumor info, staging, receptor status, etc):
Years of data / Time period of study:
Funding
Funding Sources (if applicable):
Funding Reference Grant # (if applicable):
Funding Period (if applicable)
Estimate of Anticipated CIPHR Staffing/Support (Report %FTE or $ allocated in budget):	Data Manager: Data Analyst: Data/Statistical Advising:
Anticipated Project Outcomes / Goals
Will this project/request be used to support any of the following?	Grant proposal/preparation (K-award, UCRF award, NCI, NIH, other) Abstract submission Manuscript
Other outcome/goal (please describe):

Version	8.2.9 - Updates to CIPHR NIP page with 2024 information. [Show Details]
System	Rhel / Apache / Tomcat / PHP / Pear / Pecl / Dojo / JpGraph
Browser	Default Browser 0.0 on unknown

Tracking - Add Item

CIPHR Brief Proposal

User Information

Brief Project Proposal / Abstract

Data Being Requested

Funding

Anticipated Project Outcomes / Goals