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

The Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services, issued a Notice of Funding Opportunity (NOFO) titled "AHRQ Improving Diagnostic Safety in Ambulatory Care: Strategies and Interventions (R18)." The agency’s overarching mission is to produce evidence that enhances the safety, quality, accessibility, equity, and affordability of healthcare in the United States. This funding opportunity is part of AHRQ's long-standing investment in diagnostic safety, specifically aimed at the often-overlooked ambulatory care setting. Diagnostic errors in this domain are a leading cause of patient harm, responsible for a significant proportion of deaths and malpractice claims annually. This NOFO reflects AHRQ’s ongoing commitment to addressing diagnostic challenges through health services research and applied interventions. This opportunity seeks projects that will develop, test, and evaluate strategies and interventions designed to improve diagnostic accuracy and safety in outpatient settings. Projects may include method demonstrations, such as processes that reduce diagnostic uncertainty, or result demonstrations, such as the implementation of algorithms that enhance diagnostic precision. Eligible research should also aim to identify and reduce disparities in diagnosis, particularly for populations historically underserved or at higher risk for misdiagnosis. These include older adults, racial and ethnic minorities, and those with atypical presentations of disease. The AHRQ specifically highlights the importance of addressing risk factors such as age, race/ethnicity, and gender through thoughtful intervention design. This R18 funding mechanism supports demonstration and dissemination projects. The scope of work may include, but is not limited to, initiatives focused on health IT systems to reduce diagnostic noise, multi-rater diagnostic consensus methods, interdisciplinary diagnostic team approaches, and educational interventions to improve clinician decision-making. Applicants are encouraged to consider models and methods derived from other industries, such as aviation safety, and to recruit investigators with expertise beyond hospital-based disciplines. The funding also promotes early dissemination planning and encourages stakeholder engagement, including patients and families. Eligible applicants include a wide range of U.S.-based institutions such as higher education institutions (both public and private), non-profit entities, local and state governments, and other public organizations. For-profit and foreign organizations may only participate as subcontractors or consortium members but cannot serve as the primary applicant. Applications from minority-serving institutions and organizations addressing health disparities are encouraged. The opportunity does not require cost sharing, but institutional support may enhance project sustainability. Applications were first accepted on January 25, 2024, and followed the NIH standard submission dates. While the NOFO was originally set to expire in 2028, it was updated to expire early on March 17, 2026. As of the analysis date, the opportunity is closed, but NIH late submission policies may allow for case-by-case exceptions. This NOFO is recurring and historically aligned with similar R18 programs issued annually or biennially. Based on the original pattern and current expiration, the next expected cycle is anticipated in Spring 2027. Applicants were instructed to use the SF424 (R&R) application forms and submit via the NIH ASSIST system, Grants.gov Workspace, or institutional systems. Key application components include adherence to AHRQ’s page limits, a data management plan, and detailed research strategy. Projects may propose budgets up to $500,000 per year and a total of $2 million over a four-year period. AHRQ generally makes award decisions four months after the peer review stage. Contact information for submission and technical support is provided, including Dr. Karen Cosby at AHRQ for scientific inquiries and Nicole Williams for grants management.