AHRQ Announces Interest in Research About the Epidemiology of Patient Safety Risks and Harms in Ambulatory Health Care Settings

Notice Number: NOT-HS-15-006

Key Dates
Release Date: February 10, 2015

Related Announcements

Issued by
Agency for Healthcare Research and Quality (AHRQ)


The mission of the Agency for Healthcare Research and Quality (AHRQ) is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with the Department of Health and Human Services (HHS) and other partners to make sure that the evidence is understood and used. To further this mission, AHRQ is interested in funding health services research grants designed to (1) identify appropriate methods to conduct research studies about the epidemiology of safety events and harm in ambulatory settings; (2) test and evaluate these methods; and (3) apply proven approaches that provide useful information about the nature and extent of patient harm in ambulatory settings and ways to prevent it.

AHRQ's Patient Safety Research Program focuses on the risks and harms inherent in the delivery of health care in all health care settings, including hospitals, ambulatory and long-term care settings, and the home. Understanding care delivery in these settings and the factors that contribute to patient safety events (adverse events) is vital to preventing such events and improving care.

Since the publication of the Institute of Medicine landmark study, "To Err Is Human," AHRQ has supported the development of a substantial portfolio of scientific evidence and tools to make hospital inpatient care safer. But patients experience harm in many clinical settings, including ambulatory settings, and while it is critical to continue work that focuses on inpatient safety, there is a need to establish a more robust evidence base in order to achieve a similar scale of improvements in ambulatory settings. Currently, we lack sufficient evidence about the extent and nature of harms that occur in ambulatory settings, and still less is understood about how to prevent them. In some cases, risks and harms in ambulatory settings are similar to those associated with inpatient care, but methods used to estimate and understand them must be adapted to circumstances and needs specific to the ambulatory setting.

Research Areas of Interest

AHRQ will support research that expands knowledge of the adaption, refinement, or development of methods aimed at understanding the epidemiology of safety events and harm in ambulatory settings. AHRQ is interested in projects that (1) propose an adaption or refinement to an existing method or propose the development of a new method for studying the epidemiology of safety and harm in ambulatory settings, including approaches to validate and assess the proposed method, or (2) apply a proposed method for conducting epidemiologic studies of patient safety in ambulatory settings.

Proposed adaption of or refinement to an existing method or proposed development of a new method could address issues such as:

  • ways the proposed method can address specific challenges to conducting patient safety research and measurement in ambulatory settings;
  • operational considerations such as the feasibility and costs of various methods to collect information relative to the value of the information they provide about patient risks and harms or how to prevent those risks and harms; and/or
  • strengths, advantages, disadvantages, and limitations of the proposed method, including costs and other resource constraints.

Conduct of epidemiologic studies about patient safety in ambulatory settings might include a focus on:

  • aims that would reveal information about a broad and comprehensive or more targeted group of patient safety risks in a patient population;
  • measurement and analysis of the epidemiology from the perspective of various levels within the health care system, such as provider, practice/clinic, health care system, state/local/community, or national level; and,
  • epidemiology of patient risk and harms related to specific topics such as diagnostic error, medication safety, transitions of care, and/or patient factors that affect ambulatory safety.

Progression to Subsequent Activities Associated with Epidemiologic Studies and Findings

The overarching goal of AHRQ's Patient Safety Program is to improve care and prevent patient harm. In pursuit of this goal, the Agency will consider the anticipated value of proposed epidemiologic projects and their findings in light of their likelihood of filling important gaps in the scientific evidence base and offering the greatest potential to guide and support subsequent improvements in care delivery. AHRQ remains interested in the link between epidemiologic information and actions that will make care safer. Proposed project plans should take into account this linkage and subsequent activities that would effectively apply epidemiologic findings, and, where feasible, should describe the potential to apply epidemiologic information in real-world settings, through strategies to prevent and mitigate patient harm.

Further Guidance

Priority Populations. Priority populations continue to be an area of interest to AHRQ. For purposes of this Notice, priority populations include racial and ethnic minorities and low-income patients and settings serving these patients as well as AHRQ's other priority populations (children, women, elderly, and individuals with special health care needs).

Use of funding mechanisms. AHRQ will use standing grant mechanisms such as the R01, R03, and R18 funding mechanisms to support this research. The relevant general AHRQ Funding Opportunity Announcements for R01, R03 and R18 mechanisms can be found at: http://www.ahrq.gov/funding/research/announcements/index.html.

Application Submission. Applications focused on areas identified in this SEN should be submitted on regular R01, R03, and R18 grant application receipt dates. We encourage applicants to indicate in their applications that they are responding to this notice by including the Special Emphasis Notice title and number. We also encourage applicants to include a cover letter in their application package stating their interest in this SEN. Applications will be reviewed by AHRQ's standing study sections.


Please direct all inquiries to:

Richard Ricciardi, Ph.D., N.P.
Agency for Healthcare Research and Quality (AHRQ)
Center for Evidence and Practice Improvement
Telephone: 301-427-1637
Email: richard.ricciardi@ahrq.hhs.gov