Department of Health and Human Services

Part 1. Overview Information
Participating Organization(s)

Agency for Healthcare Research and Quality (AHRQ)

NOTE: The policies, guidelines, terms, and conditions stated in this announcement may differ from those used by the NIH. Where this Funding Opportunity Announcement (FOA) provides specific written guidance that may differ from the general guidance provided in the grant application form, please follow the instructions given in this FOA. Also note that AHRQ has different page limits than NIH for the application Research Strategy, which can be found within each individual FOA.

Components of Participating Organizations

Agency for Healthcare Research and Quality (AHRQ)

Funding Opportunity Title

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

Activity Code

R01 Research Project Grant

Announcement Type


Related Notices
  • December 18, 2018 - Notice of PA Cancellation: PA-15-180. See Notice NOT-HS-19-006.
  • February 7, 2018 - AHRQ Notice of Extension of PA-15-179 and PA-15-180. See Notice NOT-HS-18-004.
  • NOT-HS-18-003 - Reminder: FORMS-E Grant Application Forms and Instructions Must be Used for AHRQ Due Dates On or After January 25, 2018.
  • May 10, 2017 - New AHRQ "FORMS-E" Grant Application Forms and Instructions Coming for Due Dates On or After January 25, 2018. See NOT-HS-17-015.
  • NOT-OD-16-004 - NIH & AHRQ Announce Upcoming Changes to Policies, Instructions and Forms for 2016 Grant Applications (November 18, 2015)
  • NOT-OD-16-006 - Simplification of the Vertebrate Animals Section of NIH Grant Applications and Contract Proposals (November 18, 2015)
  • NOT-OD-16-011 - Implementing Rigor and Transparency in NIH & AHRQ Research Grant Applications (November 18, 2015)
Funding Opportunity Announcement (FOA) Number


Companion Funding Opportunity

PA-15-179, R18 Research Demonstration and Disseminations Projects

Catalog of Federal Domestic Assistance (CFDA) Number(s)


Funding Opportunity Purpose

Despite the growing interest and rapid pace of recent achievements, not much is known with a high degree of confidence about the prevalence of diagnostic failure in its various manifestations. This Funding Opportunity Announcement (FOA) solicits applications from research institutions and their investigators to conduct Health Services Research Projects (R01) to gain a better understanding of the complexity and incidence of diagnostic failure and its associated costs and harms.

Key Dates
Posted Date

April 8, 2015

Open Date (Earliest Submission Date)

September 5, 2015

Letter of Intent Due Date(s)

Not Applicable

Application Due Date(s)

Standard dates apply, by 5:00 PM local time of applicant organization.

Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.

AIDS Application Due Date(s)

Not Applicable

Scientific Merit Review

Generally, four months after receipt date.

Advisory Council Review

Not Applicable

Earliest Start Date

Generally, four months after peer review date

Expiration Date

New Date February 8, 2019 per issuance of NOT-HS-19-006 . (Original Expiration Date: November 6, 2020 )

Due Dates for E.O. 12372

Not Applicable

Required Application Instructions

It is critical that applicants follow the instructions in the SF424 (R&R) Application Guide, except where instructed to do otherwise (in this FOA or in a Notice from the NIH Guide for Grants and Contracts). Conformance to all requirements (both in the Application Guide and the FOA) is required and strictly enforced. Applicants must read and follow all application instructions in the Application Guide, follow the AHRQ Grants Policy and Guidance found on the AHRQ website at, and follow any program-specific instructions noted in Section IV of the FOA. When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions. Applications that do not comply with these instructions may be delayed or not accepted for review.

Table of Contents

Part 1. Overview Information
Part 2. Full Text of the Announcement

Section I. Funding Opportunity Description
Section II. Award Information
Section III. Eligibility Information
Section IV. Application and Submission Information
Section V. Application Review Information
Section VI. Award Administration Information
Section VII. Agency Contacts
Section VIII. Other Information

Part 2. Full Text of Announcement
Section I. Funding Opportunity Description

AHRQ Mission

The mission of the Agency for Healthcare Research and Quality (AHRQ) is to produce evidence to make health care safer, higher quality, and more accessible, equitable, and affordable. AHRQ achieves this mission by working within the U.S. Department of Health and Human Services and with other partners to make sure the evidence is understood and used.

AHRQ s Role in Patient Safety and Diagnostic Safety

The release of the Institute of Medicine’s (IOM) seminal report, To Err is Human: Building a Safer Healthcare System in 1999 quickly elevated awareness of long-standing risks and patient harms occurring in the U.S. health care system. A major take-home message was that preventable adverse events arose from problems inherent in a complex and fragmented health care system that providers inherit. While the U.S. provides some of the best health care in the world, it is not distributed evenly throughout the nation and is not always available at the particular hour, setting, or locale when and where needed. The report called for systematic change and cited safety improvements made in other hazardous industries through the use of reporting systems, information technology, human factors considerations, process redesign, simulation and teamwork, and cultures of open communication and learning. The report also recommended a center for patient safety be created. AHRQ was subsequently directed to lead a national effort to improve patient safety through appropriately targeted research.

Although the IOM report cited problems associated with diagnosis among the most common types of preventable failure, the topic was not discussed further in the report. However, by 2002 concerned investigators started to draw attention to diagnostic failure in journal opinion pieces. Workshops and retreats devoted to the topic soon followed and investigators applied to AHRQ for conference grants to harness and bring together the available expertise. Over the past eight years, annual conferences were held, helping to shape the way we think of diagnostic work today. During the same period, AHRQ posted a Special Emphasis Notice on its web site, soliciting research on diagnostic performance in ambulatory health care settings. Building upon the success of the conferences, a new professional society, The Society to Improve Diagnosis in Medicine, was launched in 2012 by the emerging discipline s thought leaders to increase awareness, research, and education. To further advance the field, consolidate the expanding interest, and provide a publication hub for researchers and stakeholders, a new journal, Diagnosis, was launched in 2013.

Despite the growing interest and rapid pace of recent achievements, not much is known with a high degree of confidence about the prevalence of diagnostic failure in its various manifestations. Relatively little is known about the host of provider, patient, and socio-technical factors and their interactions that can adversely impact or facilitate diagnostic performance. Even less seems to be known about strategies and interventions that might reduce diagnostic failures and patient harms or enhance the resilience and safety of diagnostic work. Recent discussions of diagnostic performance have become more nuanced and have benefitted from conceptual development and different perspectives on measurement, priority setting, and future directions. Amid the diverse voices and intellectual vigor is a shared and humbled appreciation of how little is actually known. Yet gaining a better understanding of the known unknowns is progress. For these reasons and to provide a more committed and sustained vehicle to encourage diagnostic safety research, the present Funding Opportunity Announcement is issued.

Specific Objectives of the FOA

This Funding Opportunity Announcement (FOA) solicits applications from research institutions and their investigators to conduct Health Services Research Projects (R01) in response to the first or second of three related specific objectives identified below. A separate program announcement is available to investigators whose research interests predominately are closer matched to the third specific objective.

  • 1) Gain a better understanding of the complexity and incidence of diagnostic failure and its associated costs and harms,
  • 2) Expand the depth and breadth of knowledge of contributing factors that underlie diagnostic failure and that facilitate diagnostic improvement, and
  • 3) Evaluate strategies and interventions for reducing diagnostic failures and patient harms, including approaches that enable organizations, providers and patients to better anticipate and mitigate emerging diagnostic risk before failure and harm occurs.

For the purpose of this FOA, ambulatory care refers to health care provided in emergency departments, large and small clinicians offices and practices, clinics, community health centers, urgent care centers, home care, and outpatient surgery centers, including the transitions that occur across the continuum of care settings. Researchers from in-patient settings with an interest in fostering high quality and safe diagnostic services are welcome to participate, but must do so in partnership with an ambulatory care organization as the primary entity.

Challenges in Establishing Incidence

A number of studies going back to the early 1990s support the claim that diagnostic failure comprises a significant and costly fraction of all medical failures and has resulted in devastating consequences for patients, families, and health care professionals. The prevalence of ambulatory diagnostic failure is difficult to determine for a host of reasons, including challenges in thinking about and bounding the problem space, varying definitions and study methods with their strengths and weaknesses giving rise to differences in what is detected, and variations in problem manifestations of selected diseases across individuals and time. The level of coordinated diagnostic activity across multiple episodes of care, and the delayed, difficult-to-track consequences of upstream diagnostic failures on downstream patient outcomes are added challenges. A large number of estimates using varying approaches find that the diagnosis is wrong in 5-20% of the cases. Even higher percentages are reported in certain specialty areas. A 2014 study concluded that such errors affect approximately 12 million US adults every year (or at least 1 out of 20 adults), half of which potentially could be harmful.

Diagnostic failures and misuse of diagnostic testing also carry a high-cost burden for health care organizations and patients alike. The leading cause of malpractice claims in the U.S. those that are the most difficult to defend and that result in the highest payouts stem from diagnostic failures. Diagnostic failures result too frequently in delay of appropriate treatment, disability, death and other harms. At the same time, the overuse of diagnostic testing fuels the excessive costs of defensive medicine, conservatively estimated to be in the $45-60 billion range. When unnecessary diagnostic tests are ordered, there can be both a squandering of costly health care resources and a denial of the opportunity of receiving a timely diagnosis and appropriate treatment. More needs to be known about the conditions under which diagnostic tests are overused, underused, and appropriately used. In brief, what questions need to be asked and researched to realize better diagnostic value and safety?

Challenges in Understanding Contributing Factors

The ambulatory diagnostic landscape is quite vast and understanding the factors that can impede or facilitate diagnostic performance is likely to be dependent on the clinical setting or medical specialty. Among clinical settings and medical specialties serving as fertile ground for a deeper understanding are internal and family medicine, emergency medicine, urgent care centers, pediatrics, surgery, laboratory medicine, radiology, pathology, and psychiatry. Emergency medicine is a specialty where instances of flesh and blood diagnostic failure come quickly to mind, given its chaotic mix of system-based, cognitive, affective, and variable, unknown patient factors. The gatekeeping functions of internal and family medicine with its high-volume stream of patients might conjure up less compelling instances of diagnostic failure, but routine and familiar cases can give rise to insidious consequences if physicians and their assistants become too comfortable in relying on heuristics in their encounters with patients. The uncritical use of heuristics can lead to faulty diagnoses, but the affective state of diagnosticians their aversion or liking for certain patients also can influence the diagnostic work-up. Likewise, the disciplines of radiology, pathology, and dermatology are vulnerable to perceptual dispositions; that is, ways in which underlying perceptual processes interact with the visual field to influence where one looks and what gets noticed. Perceptual dispositions are intricately interwoven with cognitive and affective dispositions. This bundle of inherent response tendencies is influenced, in turn, by a host of contextual and system-related factors that influence diagnostic outcomes. Despite the inventorying and rich descriptions of these dispositions that one finds in the literature, there has been very little empirical work experimental or otherwise that attempts to tease apart and demonstrate the causal factors that underline these dispositions and determine their relation to diagnostic outcomes and patient harms.

Some investigators have chosen to focus on system-based factors and approaches that might be considered as more amenable to empirical efforts. Here, one finds efforts to understand the impact of health IT and computerized aids in recording and updating the patient’s evolving medical history. Such information can be useful assuming providers have sufficient time to examine the information and are not burdened by information overload. Checklists have started to receive attention to curb overconfidence and reliance on memory. What can be learned about their effective uses and limitations? Other investigators have focused on system glitches and vulnerabilities that occur during different stages of the diagnostic work-up. The absence of follow-up and feedback mechanisms that would otherwise enable diagnosticians to track patient outcomes better and recalibrate their diagnostic processes where needed has received repeated mention in the literature. Still others note that diagnostic work, like other clinical work, takes place in a greater socio-technical system, involving more than the physician-patient encounter. A more encompassing view holds that diagnostic work is distributed across time and place, subject to the direct and indirect effects of multiple interactions among providers, specialists, technicians, patients, shifting health policy as well as local contextual factors. Clearly, the diagnostic safety literature is expanding rapidly, revealing richness and complexity characteristic of the patient safety literature writ large.

Challenges in Operationalizing Strategies and Interventions

Ideas for strategies and interventions that could potentially improve diagnostic performance are not difficult to find. Strategies have included realigning financial incentives to address the overuse of diagnostic testing; the active recruitment of the patient perspective via patient-based reporting systems and assignment of patients to substantive quality improvement committees; development of dashboard and data visualization techniques as a way of putting more knowledge in the world rather than relying on knowledge in the head; and promoting early education and training of all providers engaged in diagnostic processes, among other approaches. All stakeholders patients, physicians, specialists and other providers, researchers, medical educators, laboratory testing and imaging groups, payers and malpractice insurers, health care purchasers and employers, credentialing organizations, foundations and funding agencies have active roles to play as part of efforts to develop a more unified and strategic diagnostic safety plan.

Ideas for targeted interventions have included risk assessment procedures, algorithms to identify high-risk patients, checklists, predefined red-flags for don t-miss signs and test results, independent second reads, participative diagnosis, de-biasing techniques, evaluation tools to counter over-reliance on heuristics, vignette creation and simulation as a diagnostic test-bed, use of unannounced standardized patients, EHR reminders, electronic trigger tools that catch unscheduled hospitalizations after primary care or emergency room visits, decision support tools, and feedback mechanisms that enable recalibration of diagnostic performance, among others. Despite the abundance of ideas, recent reviews of the literature have found few efforts that actually operationalize the ideas and test them empirically whether in actual clinical or simulated settings. Clearly there is a need for innovative and disciplined approaches for the testing of these ideas.

Further Guidance and Comment

Various settings and processes offer their own diagnostic challenges such as laboratory-related failures that can occur across the total testing process with its extended pre-analytic, analytic, and post-analytic phases involving multiple clinical, laboratory, and support personnel. Conducting diagnostic work can be more problematic with certain diseases or conditions such as cancer and depression, in diseases of rare occurrence, and with diverse patient populations presenting with variations in language, health literacy, and cultural norms. Diagnostic failure impacts all populations regardless of age, gender, ethnicity, or socio-ethnic background. However, these factors may underlie missed diagnoses, disparities in diagnostic work-ups, and level of care received. These are just a few areas of diagnostic vulnerability, but not all of the areas of potential interest to AHRQ. Applications addressing diagnostic challenges and issues not addressed above also are welcomed.


The preparation of this announcement has benefitted from the conceptual acumen and hard work of many investigators who have played active roles in moving the emerging discipline of diagnostic safety forward. Many will recognize their thinking and areas of interest in what appears in the announcement. In the interest of maintaining an open research environment for all interested parties, AHRQ encourages the exploration of new ground.

Section II. Award Information
Funding Instrument

Grant: A support mechanism providing money, property, or both to an eligible entity to carry out an approved project or activity.

Application Types Allowed


The OER Glossary and the SF424 (R&R) Application Guide provide details on these application types.

Funds Available and Anticipated Number of Awards

The number of awards is contingent upon AHRQ appropriations and the submission of a sufficient number of meritorious applications. Future year amounts will depend on annual appropriations.

Award Budget

The total costs (direct and indirect) for a project awarded under this FOA will not exceed $350,000 in any given year or $1,750,000 for the entire project period.

Award Project Period

The project period may not exceed five years.

These projects are authorized by 42 U.S.C. 299a, which provides that AHRQ shall conduct and support research, support demonstration projects, and disseminate information on health care and on systems for the delivery of such care, including activities with respect to the quality, effectiveness, efficiency, appropriateness, and value of health care services.

All applications submitted and AHRQ grants made in response to this FOA are subject to the Office of Management and Budget's (OMB's) "Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards," (the "Uniform Grant Guidance") at 2 CFR part 200, et seq, the HHS Grants Policy Statement (see and, and the terms and conditions set forth in the Notice of Award.

Section III. Eligibility Information
1. Eligible Applicants
Eligible Organizations

You may submit an application(s) if your institution/organization is a (an):

  • Public or non-profit private institution, such as a university, college, or a faith-based or community-based organization;
  • Unit of local or State government;
  • Eligible agency of the Federal government.
  • Indian/Native American Tribal Government (Federally recognized)
  • Indian/Native American Tribal Government (Other than Federally recognized);
  • Indian/Native American Tribally Designated Organization.

AHRQ’s authorizing legislation does not allow for-profit organizations to be eligible to lead applications under this research mechanism. For-profit organizations may participate in projects as members of consortia or as subcontractors only. Because the purpose of this program is to improve healthcare in the United States, foreign institutions may participate in projects as members of consortia or as subcontractors only. Applications submitted by for-profit organizations or foreign institutions will not be reviewed. Organizations described in section 501(c) 4 of the Internal Revenue Code that engage in lobbying are not eligible.

HHS grants policy requires that the grant recipient perform a substantive role in the conduct of the planned project or program activity and not merely serve as a conduit of funds to another party or parties. If consortium/contractual activities represent a significant portion of the overall project, the applicant must justify why the applicant organization, rather than the party(s) performing this portion of the overall project, should be the grantee and what substantive role the applicant organization will play. Justification can be provided in the Specific Aims or Research Strategy section of the PHS398 Research Plan Component sections of the SF424 (R&R) application. There is no budget allocation guideline for determining substantial involvement; determination of substantial involvement is based on a review of the primary project activities for which grant support is provided and the organization(s) that will be performing those activities.

Foreign Institutions

Non-domestic (non-U.S.) Entities (Foreign Institutions) are not eligible to apply.
Non-domestic (non-U.S.) components of U.S. Organizations are not eligible to apply.

Required Registrations

Applicant Organizations

Applicant organizations must complete and maintain the following registrations as described in the SF 424 (R&R) Application Guide to be eligible to apply for or receive an award. All registrations must be completed prior to the application being submitted. Registration can take 6 weeks or more, so applicants should begin the registration process as soon as possible. The NIH Policy on Late Submission of Grant Applications states that failure to complete registrations in advance of a due date is not a valid reason for a late submission.

  • Dun and Bradstreet Universal Numbering System (DUNS) - All registrations require that applicants be issued a DUNS number. After obtaining a DUNS number, applicants can begin both SAM and eRA Commons registrations. The same DUNS number must be used for all registrations, as well as on the grant application.
  • System for Award Management (SAM) (formerly CCR) Applicants must complete and maintain an active registration, which requires renewal at least annually. The renewal process may require as much time as the initial registration. SAM registration includes the assignment of a Commercial and Government Entity (CAGE) Code for domestic organizations which have not already been assigned a CAGE Code.
  • eRA Commons - Applicants must have an active DUNS number and SAM registration in order to complete the eRA Commons registration. Organizations can register with the eRA Commons as they are working through their SAM or registration. eRA Commons requires organizations to identify at least one Signing Official (SO) and at least one Program Director/Principal Investigator (PD/PI) account in order to submit an application.
  • Applicants must have an active DUNS number and SAM registration in order to complete the registration.

Program Director/Principal Investigator (PD/PI)

The PD/PI must have an eRA Commons account. The PD/PI should work with their organizational officials to either create a new account or to affiliate their existing account with the applicant organization in eRA Commons. If the PD/PI is also the organizational Signing Official, he/she must have two distinct eRA Commons accounts, one for each role. Obtaining an eRA Commons account can take up to 2 weeks.

Eligible Individuals (Program Director/Principal Investigator)

Any individual(s) with the skills, knowledge, and resources necessary to carry out the proposed research as the Program Director/Principal Investigator (PD/PI) is invited to work with his/her organization to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for AHRQ support.

Only one PD/PI may be designated on the application.

2. Cost Sharing

While there is no cost sharing requirement included in this FOA, AHRQ welcomes applicant institutions, including any collaborating institutions, to devote resources to this effort. An indication of institutional support from the applicant and its collaborators indicates a greater potential of success and sustainability of the project. Examples of institutional support would include: donated equipment and space, institutional funded staff time and effort, or other resource investments. Applicant institutions should indicate institutional support by outlining the specific contributions to the project and providing assurances that their organization and any collaborators are committed to providing these funds and resources to the project. This information can be included at the end of the budget justification section of the application, but institutional support dollars are not to be shown/included in the detailed budget request.

3. Additional Information on Eligibility
Number of Applications

Applicant organizations may submit more than one application, provided that each application is scientifically distinct.

AHRQ will not accept duplicate or highly overlapping applications under review at the same time. This means that AHRQ will not accept:

  • A new (A0) application that is submitted before issuance of the summary statement from the review of an overlapping new (A0) or resubmission (A1) application.
  • A resubmission (A1) application that is submitted before issuance of the summary statement from the review of the previous new (A0) application.
  • An application that has substantial overlap with another application pending appeal of initial peer review (see NOT-OD-11-101).
Section IV. Application and Submission Information
1. Requesting an Application Package

Applicants must download the SF424 (R&R) application package associated with this funding opportunity using the Apply for Grant Electronically button in this FOA or following the directions provided at

2. Content and Form of Application Submission

It is critical that applicants follow the instructions in the SF424 (R&R) Application Guide, including Supplemental Grant Application Instructions except where instructed in this funding opportunity announcement to do otherwise. Conformance to the requirements in the Application Guide is required and strictly enforced. Applications that are out of compliance with these instructions may be delayed or not accepted for review.

For information on Application Submission and Receipt, visit Frequently Asked Questions Application Guide, Electronic Submission of Grant Applications.

Page Limitations

All page limitations described in the SF424 Application Guide and the Table of Page Limits must be followed.

Instructions for Application Submission

The following section supplements the instructions found in the SF424 (R&R) Application Guide and should be used for preparing an application to this FOA.

SF424(R&R) Cover

All instructions in the SF424 (R&R) Application Guide must be followed.

SF424(R&R) Project/Performance Site Locations

All instructions in the SF424 (R&R) Application Guide must be followed.

SF424(R&R) Other Project Information

All instructions in the SF424 (R&R) Application Guide must be followed.

SF424(R&R) Senior/Key Person Profile

All instructions in the SF424 (R&R) Application Guide must be followed.

R&R or Modular Budget

All instructions in the SF424 (R&R) Application Guide must be followed, with the following additional instructions:

Budget Component: Special Instructions for AHRQ applications

AHRQ is not using the Modular Grant Application and Award Process. Applicants for funding from AHRQ are to ignore application instructions concerning the Modular Grant Application and Award Process, and prepare applications using instructions for the Research and Related Budget Components of the SF 424 (R&R). Applications submitted in the Modular format will not be reviewed.

R&R Subaward Budget

All instructions in the SF424 (R&R) Application Guide must be followed.

PHS 398 Cover Page Supplement

All instructions in the SF424 (R&R) Application Guide must be followed.

PHS 398 Research Plan

All instructions in the SF424 (R&R) Application Guide that are not otherwise specified within this Funding Opportunity Announcement must be followed.

Appendix: Do not use the Appendix to circumvent page limits. Follow all instructions for the Appendix as described in the SF424 (R&R) Application Guide.

Planned Enrollment Report

When conducting clinical research, follow all instructions for completing Planned Enrollment Reports as described in the SF424 (R&R) Application Guide.

PHS 398 Cumulative Inclusion Enrollment Report

When conducting clinical research, follow all instructions for completing Cumulative Inclusion Enrollment Report as described in the SF424 (R&R) Application Guide.

3. Submission Dates and Times

Part I. Overview Information contains information about Key Dates. Applicants are encouraged to submit applications before the due date to ensure they have time to make any application corrections that might be necessary for successful submission.

Organizations must submit applications to (the online portal to find and apply for grants across all Federal agencies). Applicants must then complete the submission process by tracking the status of the application in the eRA Commons, NIH’s electronic system for grants administration. NIH and systems check the application against many of the application instructions upon submission. Errors must be corrected and a changed/corrected application must be submitted to on or before the application due date. If a Changed/Corrected application is submitted after the deadline, the application will be considered late.

Applicants are responsible for viewing their application before the due date in the eRA Commons to ensure accurate and successful submission.

Information on the submission process and a definition of on-time submission are provided in the SF424 (R&R) Application Guide.

4. Intergovernmental Review (E.O. 12372)

This initiative is not subject to intergovernmental review.

5. Funding Restrictions

For efficient grant administration, AHRQ grant administration procedures will be used and conducted in accordance with the terms and conditions, cost principles, and other considerations described in the HHS Grants Policy Statement. The Grants Policy Statement can be found at

Pre-award costs are allowable. A grantee may, at its own risk and without AHRQ prior approval, incur obligations and expenditures to cover costs up to 90 days before the beginning date of the initial budget period of a new award if such costs are necessary to conduct the project and would be allowable under the grant, if awarded, without AHRQ prior approval. If specific expenditures would otherwise require prior approval, the grantee must obtain AHRQ approval before incurring the cost. AHRQ prior approval is required for any costs to be incurred more than 90 days before the beginning date of the initial budget period of a new award.

The incurrence of pre-award costs in anticipation of a competing or non-competing award imposes no obligation on AHRQ either to make the award or to increase the amount of the approved budget if an award is made for less than the amount anticipated and is inadequate to cover the pre-award costs incurred. AHRQ expects the grantee to be fully aware that pre-award costs result in borrowing against future support and that such borrowing must not impair the grantee's ability to accomplish the project objectives in the approved time frame or in any way adversely affect the conduct of the project.

6. Other Submission Requirements and Information

Applications must be submitted electronically following the instructions described in the SF424 (R&R) Application Guide. Paper applications will not be accepted.

Applicants must complete all required registrations before the application due date. Section III. Eligibility Information contains information about registration.

For assistance with your electronic application or for more information on the electronic submission process, visit Applying Electronically. If you encounter a system issue beyond your control that threatens your ability to complete the submission process on-time, you must follow the Guidelines for Applicants Experiencing System Issues.

Important reminders:

The PD/PI must include the eRA Commons ID in the Credential field of the Senior/Key Person Profile Component of the SF424(R&R) Application Package. Failure to register in the Commons and to include a valid PD/PI Commons ID in the credential field will prevent the successful submission of an electronic application to AHRQ. See Section III of this FOA for information on registration requirements.

The applicant organization must ensure that the DUNS number it provides on the application is the same number used in the organization s profile in the eRA Commons and for the System for Award Management. Additional information may be found in the SF424 (R&R) Application Guide.

See more tips for avoiding common errors.

Upon receipt, applications will be evaluated for completeness by the Center for Scientific Review, NIH, and for responsiveness by AHRQ. Applications that are incomplete, non-compliant, or non-responsive will not be reviewed.

In order to expedite the review, applicants are requested to notify the AHRQ Referral Office by email when the application has been submitted. Please include the FOA number and title, PD/PI name, and title of the application.

Institutional Review Board (IRB) approval of human subjects is not required prior to peer review of an application (see However, initiation of IRB review, if necessary or applicable, is strongly encouraged to assure timely commencement of research.

Although there is no immediate acknowledgement of the receipt of an application, applicants are generally notified of the review and funding assignment within eight (8) weeks.

Priority Populations

AHRQ supports research, evaluations, and demonstration projects concerning the delivery of health care in inner-city and rural areas (including frontier areas), and health care for priority populations. Priority populations include low income groups; minority groups; women; children; the elderly; and individuals with special health care needs, including individuals with disabilities and individuals who need chronic care or end-of-life health care. 42 USC 299(c). Women and members of minority groups are included in all AHRQ-supported research projects involving human subjects, unless a clear and compelling rationale and justification is provided that inclusion is inappropriate, e.g. because of the lack of connection between the study and the health of women or particular minorities. Investigators should review the document entitled, AHRQ Policy on the Inclusion of Priority Populations, which is available Applicants under this FOA should consider and discuss including priority populations in the research design as specified in this Notice.

Plan for Sharing Research Data

The precise content of the data-sharing plan will vary, depending on the data being collected and how the investigator is planning to share the data. Applicants who are planning to share data may wish to describe briefly the expected schedule for data sharing; the format of the final dataset; the documentation to be provided; whether or not any analytic tools also will be provided; whether or not a data-sharing agreement will be required and, if so, a brief description of such an agreement (including the criteria for deciding who can receive the data and whether or not any conditions will be placed on their use); and the mode of data sharing (e.g., under its own auspices by mailing a disk or posting data on its institutional or personal website or through a data archive or enclave). Investigators choosing to share under their own auspices may wish to enter into a data-sharing agreement. References to data sharing may also be appropriate in other sections of the application.

The reasonableness of the data sharing plan or the rationale for not sharing research data will be assessed by the reviewers. However, reviewers will not factor the proposed data sharing plan into the determination of scientific merit or the priority score.

Data Confidentiality

The AHRQ confidentiality statute, 42 USC 299c-3(c), requires that information that is obtained in the course of AHRQ supported activities and that identifies individuals or establishments be used only for the purpose for which it was supplied. Information that is obtained in the course of AHRQ-supported activities and that identifies an individual may be published or released only with the consent of the individual who supplied the information or is described in it. There are civil monetary penalties for violation of the confidentiality provision of the AHRQ statute. 42 USC 299c-3(d). In the Human Subjects section of the application, applicants must describe procedures for ensuring the confidentiality of the identifying information to be collected. The description of the procedures should include a discussion of who will be permitted access to this information, both raw data and machine readable files, and how personal identifiers and other identifying or identifiable data will be restricted and safeguarded. Identifiable patient health information collected by grantees under this FOA will also be obtained and managed in accordance with the HIPAA Privacy Rule, 45 CFR Parts 160 and 164.

The grantee should ensure that computer systems containing confidential data have a level and scope of security that equals or exceeds that established by the HIPAA Security Rules, if applicable, and that established by the Office of Management and Budget (OMB) in OMB Circular No. A-130, Appendix III - Security of Federal Automated Information Systems. The applicability and intended means of applying these confidentiality and security standards to subcontractors and vendors, if any, should be addressed in the application.

Sharing Research Resources: Rights in Data

Unless otherwise provided in grant awards, AHRQ grantees may copyright, or seek patents for, as appropriate, final and interim products and materials developed in whole or in part with AHRQ support, including, but not limited to, methodological tools, measures, software with documentation, literature searches, and analyses. Such copyrights and patents are subject to a royalty-free, non-exclusive, and irrevocable AHRQ license to reproduce, publish, use or disseminate for any purpose consistent with AHRQ’s statutory responsibilities and to authorize others to do so for any purpose consistent with AHRQ’s statutory responsibilities. In accordance with its legislative dissemination mandate, AHRQ purposes may include, subject to statutory confidentiality protections, making project materials, databases, results, and algorithms available for verification or replication by other researchers. In addition, subject to AHRQ budget constraints, final products may be made available to the health care community and the public by AHRQ or its agents if such distribution would significantly increase access to a product and thereby produce substantial or valuable public health benefits. Ordinarily, to accomplish distribution, AHRQ publicizes research findings but relies on grantees to publish research results in peer-reviewed journals and to market grant-supported products. AHRQ's Office of Communications and Knowledge Transfer (OCKT) wishes to be consulted in advance of publication in order to coordinate announcements of new AHRQ-supported research results with other AHRQ dissemination activities. Important legal rights and requirements applicable to AHRQ grantees are set out or referenced in the Uniform Grant Guidance (available in libraries and on the website of the Office of the Federal Register at

Post Submission Materials

Applicants are required to follow our Post Submission Application Materials policy.

Section V. Application Review Information

Important Update: See NOT-OD-16-006 and NOT-OD-16-011 for updated review language for applications for due dates on or after January 25, 2016.

1. Criteria

The mission of AHRQ is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with the U.S. Department of Health and Human Services (HHS) and other partners to make sure that the evidence is understood and used.

AHRQ's priority areas of focus are:

  • Improve health care quality by accelerating implementation of patient-centered outcomes research (PCOR).
  • Make health care safer.
  • Increase accessibility by evaluating Affordable Care Act (ACA) coverage expansions.
  • Improve health care affordability, efficiency, and cost transparency.

As part of this mission, applications submitted to AHRQ to support health services research are evaluated for scientific and technical merit through the AHRQ peer review system.

Applications that are complete and responsive to the FOA will be evaluated for scientific and technical merit by an appropriate peer review group convened in accordance with standard AHRQ peer review procedures that are described in 42 CFR Part 67, Subpart A. Incomplete and/or non-responsive applications or applications not following instructions given in this FOA will not be reviewed. Only the review criteria described below will be considered in the review process.

Administrative Criteria: Upon receipt, applications will be evaluated for completeness by the Center for Scientific Review, NIH, and for responsiveness by AHRQ.

Merit Review Criteria: Merit Review Criteria, as described below, will be considered in the review process.

Overall Impact

Reviewers will provide an overall impact score to reflect their assessment of the likelihood for the project to exert a sustained, powerful influence on the research field(s) involved, in consideration of the following review criteria and additional review criteria (as applicable for the project proposed).

Scored Review Criteria

Reviewers will consider each of the review criteria below in the determination of scientific merit, and give a separate score for each. An application does not need to be strong in all categories to be judged likely to have major scientific impact. For example, a project that by its nature is not innovative may be essential to advance a field.


Does the project address an important problem or a critical barrier to progress in the field? If the aims of the project are achieved, how will scientific knowledge, technical capability, and/or clinical practice be improved? How will successful completion of the aims change the concepts, methods, technologies, treatments, services, or preventative interventions that drive this field?


Are the PD/PI, collaborators, and other researchers well suited to the project? Is the work proposed appropriate to the experience level of the PD/PI and other researchers? Do the PD/PI and investigative team bring complementary and integrated expertise to the project (if applicable)? Is the leadership approach, governance and organizational structure appropriate for the project?


Is the project original and innovative? For example: Does the project challenge current research or seek to shift clinical practice paradigms; address an innovative hypothesis or critical barrier to progress in the field? Does the project develop or employ novel concepts, approaches or methodologies, tools, or technologies for this area?


Are the overall strategy, methodology, and analyses well-reasoned and appropriate to accomplish the specific aims of the project? Are potential problems, alternative strategies, and benchmarks for success presented? If the project is in the early stages of development, will the strategy establish feasibility and will particularly risky aspects be managed?


Will the scientific environment in which the work will be done contribute to the probability of success? Are the institutional support, equipment and other physical resources available to the investigators adequate for the project proposed? Will the project benefit from unique features of the scientific environment, subject populations, or collaborative arrangements?

Additional Review Criteria

As applicable for the project proposed, reviewers will evaluate the following additional items while determining scientific and technical merit, and in providing an overall impact score, but will not give separate scores for these items.

Protections for Human Subjects

For research that involves human subjects but does not involve one of the six categories of research that are exempt under 45 CFR Part 46, the committee will evaluate the justification for involvement of human subjects and the proposed protections from research risk relating to their participation according to the following five review criteria: 1) risk to subjects, 2) adequacy of protection against risks, 3) potential benefits to the subjects and others, 4) importance of the knowledge to be gained, and 5) data and safety monitoring for clinical trials.

For research that involves human subjects and meets the criteria for one or more of the six categories of research that are exempt under 45 CFR Part 46, the committee will evaluate: 1) the justification for the exemption, 2) human subjects involvement and characteristics, and 3) sources of materials. For additional information on review of the Human Subjects section, please refer to the Guidelines for the Review of Human Subjects.

Degree of Responsiveness

Reviewers will assess how well the application addresses the purpose and objectives of this FOA. How responsive is the application to the special eligibility criteria, including the project requirements, noted in the FOA?

Inclusion of Priority Populations

Reviewers will assess the adequacy of plans to address the needs of both genders, racial and ethnic minorities (and subgroups). Reviewers will assess the adequacy of attention to AHRQ priority populations (see above discussion on Priority Populations in section IV.6 Other Submission Requirements ).

Budget and Period of Support

The committee will evaluate whether the proposed budget is reasonable and whether the requested period of support is appropriate in relation to the proposed research.

Privacy and Security Protections for Patients

Reviewers will assess the resources and processes to be used to address privacy and security issues in the development and implementation of the intervention.


For Resubmissions, the committee will evaluate the application as now presented, taking into consideration the responses to comments from the previous scientific review group and changes made to the project.


Not Applicable

Additional Review Considerations

As applicable for the project proposed, reviewers will consider each of the following items, but will not give scores for these items, and should not consider them in providing an overall impact score.

Not Applicable

2. Review and Selection Process

Applications will be evaluated for scientific and technical merit by (an) appropriate Scientific Review Group in accordance with AHRQ review policy and procedures, using the stated review criteria. Assignment to a Scientific Review Group will be shown in the eRA Commons.

As part of the scientific peer review, all applications:

  • May undergo a selection process in which only those applications deemed to have the highest scientific and technical merit (generally the top half of applications under review) will be discussed and assigned an overall impact scores.
  • Will receive a written critique.

Applications will be assigned on the basis of AHRQ referral guidelines to the appropriate AHRQ Office or Center. Applications will compete for available funds with all other recommended applications submitted in response to this FOA. The following will be considered in making funding decisions:

  • Scientific and technical merit of the proposed project as determined by peer review.
  • Availability of funds.
  • Responsiveness to goals and objectives of the FOA.
  • Relevance and fit within AHRQ research priorities, as well as overall programmatic and geographic balance.
3. Anticipated Announcement and Award Dates

After the peer review of the application is completed, the PD/PI will be able to access his or her Summary Statement (written critique) via the eRA Commons.

Generally, applicants should anticipate eight months between the application submission date and the earliest possible start date.

Section VI. Award Administration Information
1. Award Notices

If the application is under consideration for funding, AHRQ will request "Just-In-Time" information from the applicant. Just-In-Time information generally consists of information on other support, any additional information necessary to address administrative and budgetary issues, and certification of IRB approval of the project's proposed use of human subjects. For details regarding IRB approval, applicants may refer to the "AHRQ Revised Policy for Institutional Review Board (IRB) Review of Human Subjects Protocols in Grant Applications" (

If all administrative and programmatic issues are resolved, a formal notification in the form of a Notice of Award (NoA) will be provided to the applicant organization for successful applications. The NoA signed by the AHRQ grants management officer is the authorizing document and will be sent via email to the grantee’s business official.

Awardees must comply with any funding restrictions described in Section IV.5. Funding Restrictions.

Selection of an application for award is not an authorization to begin performance. Any costs incurred before receipt of the NOA are at the recipient’s risk. These costs may be reimbursed only to the extent considered allowable pre-award costs. See also Section IV.5., Funding Restrictions.

Any application awarded in response to this FOA will be subject to the DUNS, SAM Registration, and Transparency Act requirements as noted on the AHRQ web site at

2. Administrative and National Policy Requirements

All AHRQ grant and cooperative agreement awards are subject to OMB's Uniform Grant Guidance, the HHS Grants Policy Statement (see, and the terms and conditions set forth in the Notice of Award.

A standard term and condition of award will be included in the Notice of Award (NOA) that states: in any grant-related activity in which family, marital, or household consideration are, by statute or regulation, relevant for purposes of determining beneficiary eligibility or participation, grantees must treat same-sex spouses, marriages, and households on the same terms as opposite-sex spouses, marriages, and households, respectively. By same-sex spouses, HHS means individuals of the same sex who have entered into marriages that are valid in the jurisdiction where performed, including any of the 50 states, the District of Columbia, or a U.S. territory or in a foreign country, regardless of whether or not the couple resides in a jurisdiction that recognizes same-sex marriage. By same-sex marriages, HHS means marriages between two individuals validly entered into in the jurisdiction where performed, including any of the 50 states, the District of Columbia, or a U.S. territory or in a foreign country, regardless of whether or not the couple resides in a jurisdiction that recognizes same-sex marriage. By marriage, HHS does not mean registered domestic partnerships, civil unions or similar formal relationships recognized under the law of the jurisdiction of celebration as something other than a marriage.

All applicants will be subject to a term and condition that applies the terms of 48 CFR section 3.908 to the award, and requires that grantees inform their employees in writing of employee whistleblower rights and protections under 41U.S.C. 4712 in the predominant native language of the workforce.

As necessary, additional Terms and Conditions will be incorporated into the NoA.

3. Reporting

When multiple years are involved, awardees will be required to submit the Research Performance Progress Report (RPPR) annually unless specified otherwise in the terms of the award. Grantees are required to submit expenditure data on the Federal Financial Report (FFR; SF 425) annually.

For details regarding progress report submission, refer to If instructions on the AHRQ website are different from the RPPR Instructions, follow the instructions on the AHRQ website. Progress reports are due 3 months before the anniversary of the award. In addition to the annual progress report, recipients may be required to submit quarterly progress reports to AHRQ. If applicable, detailed instructions on additional reporting requirements will be provided with the grant award.

Expenditure data is to be reported on the Federal Financial Report (FFR; SF 425). AHRQ requires annual financial expenditure reports for ALL grant programs as described in the HHS Grants Policy Statement ( AHRQ implementation of the FFR retains a financial reporting period that coincides with the budget period of a particular project. However, the due date for annual FFRs is 90 days after the end of the calendar quarter in which the budget period ends. For example, if the budget period ends 4/30/2015, the annual FFR is due 9/30/2015 (90 days after the end of the calendar quarter of 6/30/2015).

A final Progress Report, final Federal Financial Report, and Final Invention Statement are required when an award ends. All final reports are due within 90 days of the project period end date. For further details regarding grant closeout requirements, refer to

The Federal Funding Accountability and Transparency Act of 2006 (Transparency Act), includes a requirement for awardees of Federal grants to report information about first-tier subawards and executive compensation under Federal assistance awards issued in FY2011 or later. All awardees of applicable AHRQ grants and cooperative agreements are required to report to the Federal Subaward Reporting System (FSRS) available at on all subawards over $25,000. See the HHS Grants Policy Statement ( for additional information on this reporting requirement.

Section VII. Agency Contacts

We encourage inquiries concerning this funding opportunity and welcome the opportunity to answer questions from potential applicants.

Application Submission Contacts

eRA Service Desk (Questions regarding ASSIST, eRA Commons registration, submitting and tracking an application, documenting system problems that threaten submission by the due date, post submission issues)
Telephone: 301-402-7469 or 866-504-9552 (Toll Free)
Finding Help Online:
Email: Customer Support (Questions regarding registration and submission, downloading forms and application packages)
Contact CenterTelephone: 800-518-4726

Scientific/Research Contact(s)

Direct your questions about general FOA issues, including information on the inclusion of priority populations to:

Kerm Henriksen, Ph.D.
Agency for Healthcare Research and Quality (AHRQ)
Telephone: 301-427-1331

Peer Review Contact(s)

Direct your questions about peer review issues of grant application made in response to this FOA to:

Kishena Wadhwani, Ph.D.
Agency for Healthcare Research and Quality (AHRQ)
Telephone: 301-427-1556

Financial/Grants Management Contact(s)

Direct your questions regarding fiscal matters to:

Nicole Williams
Agency for Healthcare Research and Quality (AHRQ)
Telephone: 301-427-1015

Section VIII. Other Information

Recently issued AHRQ policy notices may affect your application submission. A full list of policy notices published by AHRQ is provided in the NIH Guide for Grants and Contracts. Notices can also be found at AHRQ Grants Policy Notices. All awards are subject to the terms and conditions, cost principles, and other considerations described in the HHS Grants Policy Statement.

Authority and Regulations

This program is described in the Catalog of Federal Domestic Assistance at and is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. Awards are made under the authority of 42 USC 299 et seq., and in accordance with the OMB Uniform Grant Guidance and other referenced applicable statutes and regulations. All awards are subject to the terms and conditions, cost principles, and other considerations described in the HHS Grants Policy Statement. The HHS Grants Policy Statement can be found at

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