AHRQ Improving Diagnostic Safety in Ambulatory Care: Strategies and Interventions (R18)

The Agency for Healthcare Research and Quality (AHRQ), part of the U.S. Department of Health and Human Services, has released a Notice of Funding Opportunity (NOFO) titled "AHRQ Improving Diagnostic Safety in Ambulatory Care: Strategies and Interventions (R18)." This program is designed to support research demonstration and dissemination projects that aim to develop, test, and evaluate strategies to improve diagnostic safety and quality in ambulatory care settings. AHRQ’s mission is to produce evidence that makes health care safer, higher quality, more accessible, equitable, and affordable, and this funding opportunity aligns with that mission by addressing diagnostic errors, which are a significant source of patient harm and medical liability. The purpose of the R18 program is to fund projects that evaluate strategies and interventions to reduce and eliminate diagnostic errors in ambulatory care. Ambulatory care includes outpatient settings such as primary care, urgent care, emergency medicine, telemedicine, and other non-hospital-based diagnostic services. Diagnostic errors are defined as the failure to provide an accurate and timely explanation of a patient’s health problem or to communicate that explanation to the patient. These errors occur frequently, affecting at least 12 million Americans annually, and contribute significantly to patient mortality and malpractice claims. Applicants are encouraged to propose projects that demonstrate and disseminate interventions to mitigate these risks and improve diagnostic processes. AHRQ highlights six priority research areas identified by the National Academies of Sciences, Engineering, and Medicine: identification and reduction of diagnostic errors, patient and family engagement, professional education and training, health information technology, work system improvements, and external environmental factors. Within this NOFO, AHRQ especially encourages proposals that address disparities in diagnosis among priority populations, including minority groups, women, children, the elderly, individuals with disabilities, rural populations, and those adversely affected by poverty or inequity. The agency emphasizes that strategies should not only reduce diagnostic errors but also prevent inequities in diagnostic care. The program provides awards of up to $500,000 in total costs per year, with a maximum of $2 million for the entire project period, which may last up to four years. The number of awards depends on AHRQ appropriations and the submission of a sufficient number of meritorious applications. Funds may be used only for project-related expenses that comply with federal cost principles. Applications exceeding the stated funding limits will not be reviewed. Clinical trials are optional under this opportunity, and applications may include new or resubmission types, provided they are not duplicates or overlapping with existing submissions. Eligible applicants include a broad range of U.S.-based entities such as public and private higher education institutions, nonprofits, state and local governments, federally recognized and non-recognized tribal governments, independent school districts, public housing authorities, and regional organizations. For-profit organizations may not serve as the lead applicant but may participate as consortium members or subcontractors. Foreign institutions are not eligible to apply, though they may participate as part of U.S.-led consortia. Applicants must also ensure they are properly registered in federal systems such as SAM.gov, eRA Commons, and Grants.gov before submission. Applications must be submitted electronically through ASSIST, Grants.gov Workspace, or an institutional system-to-system solution. Standard application due dates apply, with the first due date set on January 25, 2024, and recurring standard dates thereafter. Applications are due by 5:00 PM local time of the applicant organization. Review typically occurs four months after submission, with the earliest possible project start date four months after peer review. The current NOFO is active through May 26, 2028, following its update on March 31, 2025, to align with agency priorities. Applicants should carefully follow AHRQ-specific instructions, as they may differ from NIH guidance, particularly in page limits and formatting requirements. Applications will be evaluated on significance, investigator qualifications, innovation, approach, and environment, with additional consideration given to the inclusion of AHRQ priority populations and health equity strategies. Successful applications will proceed through peer review and administrative review, and funding decisions will be based on scientific merit, program priorities, and available funds. Key contacts include Dr. Karen Cosby for scientific and research questions, Dr. Koyeli Banerjee for peer review matters, and Nicole Williams for grants management inquiries. This program provides an opportunity for institutions to contribute to improving diagnostic safety in outpatient care while advancing equity and patient safety outcomes across diverse populations.

Applicants must strictly follow AHRQ-specific NOFO instructions, as they differ from NIH guidelines. Non-compliance may result in applications being rejected without review