AHRQ Understanding and Improving Diagnostic Safety in Ambulatory Care: Incidence and Contributing Factors (R01)

The Agency for Healthcare Research and Quality (AHRQ), operating within the U.S. Department of Health and Human Services, is soliciting applications under the funding opportunity titled "Understanding and Improving Diagnostic Safety in Ambulatory Care: Incidence and Contributing Factors (R01)." This grant opportunity reflects AHRQ’s ongoing commitment to enhancing the quality, safety, accessibility, equity, and affordability of healthcare in the United States. AHRQ emphasizes the critical nature of diagnostic safety in ambulatory care and seeks to advance foundational knowledge around the incidence and contributing causes of diagnostic errors. The grant supports original health services research projects (R01 mechanism), specifically targeting diagnostic challenges in diverse outpatient care environments, such as urgent care, mobile clinics, dental care, and telehealth. The focus of this funding opportunity is to support research that explores diagnostic errors in outpatient settings, where more than 860 million visits occur annually across the United States. Although the ambulatory environment comprises most diagnostic services today, current diagnostic safety research has been predominantly centered on hospital settings. AHRQ acknowledges that the heterogeneity of ambulatory care—in terms of service types, patient populations, and technology systems—poses unique challenges. Diagnostic inaccuracies in these settings are not only prevalent but also have serious consequences, contributing to approximately 10% of patient deaths annually and 12 million affected individuals per year. The grant encourages applicants to study the complexity and frequency of diagnostic errors and associated harms in outpatient care. Priority research areas include identifying causes of diagnostic disparities by demographic factors (e.g., age, gender, race/ethnicity), understanding system-wide contributors to diagnostic inaccuracies, and evaluating diagnostic performance metrics such as bias, noise, and precision. AHRQ especially encourages research aligned with the six NASEM priority areas: error identification and reduction; patient engagement; professional training; use of health IT; work system improvements; and the broader regulatory environment. Applicants may propose projects assessing EHR utilization, educational effectiveness, or quality improvement systems like TeamSTEPPS for estimating and reducing diagnostic errors. Applicants can request up to $500,000 per year in total costs, with a maximum project total of $2 million over a four-year period. Only direct and necessary expenses are allowable, and all proposed costs must comply with federal cost principles. Cost sharing is not required under this NOFO, though institutional support may enhance project viability. Applications proposing clinical trials are allowed but not required. The opportunity is open to a wide range of U.S.-based entities, including academic institutions, nonprofits, tribal governments, local and state governments, and public housing authorities. However, foreign and for-profit entities may not serve as the primary applicant, though they may participate as partners or subcontractors. This opportunity is structured around standard NIH and AHRQ application systems, with submissions to be completed via ASSIST, Grants.gov Workspace, or institutional system-to-system interfaces. The next due date for applications is February 5, 2024, with standard review and award timelines applying. AHRQ anticipates peer review to occur four months after the application deadline, with funding decisions shortly thereafter. The NOFO was posted on August 22, 2023, and remains open until March 10, 2026, replacing the original expiration date of July 6, 2028. The program accepts new and resubmission applications but not renewals or revisions, and awards are contingent upon federal appropriations and merit review. Key contacts for this opportunity include Dr. Karen Cosby, Medical Officer at AHRQ’s Center for Quality Improvement and Patient Safety, and Kathryn Woolridge in the AHRQ Division of Grants Management. Applications must be fully compliant with AHRQ and NIH submission guidelines, including data sharing plans, and human subject protections when applicable. Priority populations—including racial and ethnic minorities, rural and low-income individuals, the elderly, and LGBTQ+ communities—must be considered in project design and recruitment.