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 Notice of Funding Opportunity (NOFO) may differ from those used by the NIH. Where this NOFO provides specific written guidance that may differ from the general guidance provided in the grant application form, please follow the instructions given in this NOFO. Also note that AHRQ may have different page limits than NIH for the application Research Strategy, which can be found within each individual NOFO.

Components of Participating Organizations

None

Funding Opportunity Title

Systems-Based Approaches to Improve Patient Safety by Improving Healthcare Worker Safety and Well-Being (R01 Clinical Trial Optional)

Activity Code

R01 Research Project Grant

Announcement Type

New

Related Notices

May 8, 2023 - Special Emphasis Notice: AHRQ Announces Interest in Health Services Research to Advance Health and Healthcare Equity. See NOT-HS-23-013.

January 6, 2023 - Salary Limitation on AHRQ FY2023 Grants, Cooperative Agreements, and Contracts. See NOT-HS-23-005.

May 11, 2022 - Competitive Revision Supplements to Existing AHRQ Grants and Cooperative Agreements to Enhance Workforce Diversity in Health Services Research. See PA-22-175

January 11, 2019 - AHRQ Announces Change in Grant Recipient Purchasing of Identifiable CMS Data, effective FY2019. See NOT-HS-19-007.

October 5, 2016 - AHRQ Policy Guidance Regarding Inflationary Increases (aka, cost-of-living adjustments, or COLAs) beginning in Fiscal Year 2017. See NOT-HS-17-001.

Funding Opportunity Number (FON)

PA-24-093

Companion Notice of Funding Opportunity

None

Assistance Listing Number(s)

93.226

Funding Opportunity Purpose

The purpose of this Notice of Funding Opportunity (NOFO) is to advance system-level approaches to improve patient safety by improving healthcare worker safety and well-being. Patient safety cannot be fully achieved without healthcare worker safety and well-being. This NOFO will contribute to AHRQ s goal of reinvigorating the patient safety movement by adding fresh perspectives and insights of healthcare professionals to efforts to improve patient safety.

Patient safety requires a foundation of safe and healthy healthcare workers. Healthcare workers' well-being depends, in part, on their ability to provide high-quality, safe care, and to have control and empowerment to impact the systems that affect this ability. Healthcare delivery systems can support or limit the ability of healthcare workers to provide such care, and healthcare workers have unique insights into the capabilities and hazards of healthcare delivery systems, along with varying opportunities to improve them.

Healthcare delivery involves dynamic interactions between various groups of healthcare workers (e.g., actions of hospital healthcare workers may impact emergency department healthcare workers) as well as interactions between different types of healthcare providers, and different organizational or administrative levels. AHRQ encourages grant applications that are designed to improve the interrelated systems and processes embedded in healthcare delivery in various healthcare settings (e.g., ambulatory, prehospital, emergency, various inpatient services, post-acute or long-term care, including medical, surgical, and mental health care settings) in order to support healthcare worker safety and well-being, and, ultimately, patient safety. Grant applications must include licensed healthcare professionals (e.g., physicians, nurses, pharmacists, social workers, therapists) affiliated with eligible organizations as PIs, Co-PIs, Senior and/or Key Personnel in the application's proposed development and implementation activities.

Key Dates
Posted Date

December 5, 2023

Open Date (Earliest Submission Date)

January 5, 2024

Letter of Intent Due Date(s)

30 days prior to the application due date

Application Due Date(s)

Standard dates apply. The first standard application due date for this NOFO is February 5, 2024.

All applications are due by 5:00 PM local time of the 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 the receipt date

Advisory Council Review

Not Applicable

Earliest Start Date

Generally, four months after the peer review date

Expiration Date

January 20, 2029

Due Dates for E.O. 12372

Not Applicable

Required Application Instructions

It is critical that applicants follow the Research (R) Instructions in the SF424 (R&R) Application Guide, except where instructed to do otherwise (in this NOFO or in a Notice from the NIH Guide for Grants and Contracts). Conformance to all requirements (both in the Application Guide and the NOFO) is required and strictly enforced. Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV and follow the AHRQ Grants Policy and Guidance found on the AHRQ website at http://www.ahrq.gov/funding/policies/nofoguidance/index.html.

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.


There are several options available to submit your application through Grants.gov to NIH and Department of Health and Human Services partners. You must use one of these submission options to access the application forms for this opportunity.

  1. Use the NIH ASSIST system to prepare, submit and track your application online.
  2. Use an institutional system-to-system (S2S) solution to prepare and submit your application to Grants.gov and eRA Commons to track your application. Check with your institutional officials regarding availability.

  3. Use Grants.gov Workspace to prepare and submit your application and eRA Commons to track your application.


  4. Table of Contents

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

    Section I. Notice of 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. Notice of Funding Opportunity Description

    Background

    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, and to work within the U.S. Department of Health and Human Services and with other partners to make sure the evidence is understood and used.

    Many factors and conditions must align effectively to enable patient safety, including access to capable, motivated and healthy healthcare workers. However, the safety and well-being of healthcare workers, and therefore their ability to provide safe care for patients is challenged by many conditions, including limited resources, conflicting clinical goals (e.g., taking the best care of each patient versus being the best steward of healthcare resources, being efficient versus being thorough, caring for patients despite personal risk of injury or illness), changing priorities (e.g., emergencies can necessitate rapid changes in prioritization, with cascading effects on other patients and other providers), poorly designed or implemented technologies, tools and processes, time pressures, shift work and changing schedules, and lack of personal physical and psychological safety.

    Numerous studies have documented that lack of healthcare worker safety and well-being are important current problems, with measurable adverse effects not only on healthcare workers, but also on patient care, patient experiences, and patient outcomes. In recognition of the important consequences of these relationships, improving healthcare worker safety and well-being are pillars of both the Quadruple Aim and the National Action Plan to Advance Patient Safety. Systems-based approaches to improve healthcare worker safety and well-being are essential and are expected to provide valuable benefits for both healthcare workers and patients. Research is urgently needed to better understand the effectiveness of systems-based interventions designed to improve healthcare worker safety and well-being, and to explore their impacts on healthcare workers and on patients.

    The overarching goal of this NOFO is to improve healthcare worker safety and well-being so as to improve patient safety. Providing safe care for patients in all care delivery settings is not just about avoiding harm and attempting to prevent errors. Safe care should also be considered from a resilience engineering perspective as attempting to ensure "as many things as possible go right" so that healthcare delivery achieves outcomes that are successful for healthcare workers as well as patients and their families.

    Healthcare worker safety and well-being

    The National Academy of Medicine states that healthcare workers are among the most educated and dedicated workers in any industry. However, many healthcare workers struggle with burnout, moral injury, emotional exhaustion, depersonalization, and low levels of personal accomplishment. Burn-out is an occupational syndrome resulting from chronic workplace stress that has not been successfully addressed, characterized by 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one s job, or feelings of negativism or cynicism related to one's job; and 3) reduced professional efficacy. Moral distress, which can progress to moral injury, can manifest when healthcare workers are unable to provide the ethically driven quality of care they were trained to provide because of structural barriers and challenges. Sustained moral distress can lead to moral injury, which has been linked to feelings of profound guilt, shame, anger, and other psychological impacts.

    In contrast, definitions of healthcare worker well-being are evolving. A proposed conceptual definition suggests that well-being (wellness) is defined by quality of life, which includes the absence of ill-being and the presence of positive physical, mental, social, and integrated well-being experienced in connection with activities and environments that allow healthcare workers to develop their full potentials across personal and work-life domains.

    Poor healthcare worker well-being is often associated with medical errors and patient safety incidents (which may or may not involve errors). Patient safety and healthcare worker safety and well-being are synergistic, and excessive workload, long hours, burgeoning bureaucracy, physical hazards, bullying, and burnout experienced by healthcare workers have adverse effects on patient outcomes. Accordingly, efforts to minimize harm and provide safe care for patients must include efforts to address healthcare worker safety and well-being.

    Factors that threaten healthcare worker safety and well-being extend beyond physical hazards and include moral distress, pandemic-related exhaustion, time pressure, lack of psychological safety, shortages of staff, equipment and supplies, poorly designed or poorly implemented technology, workflow, tools and processes, increasing patient acuity and complexity, structural racism and health inequities, conflicting clinical goals, excessive clerical and administrative burdens, and financial pressures. Furthermore, challenges with work life balance, the healthcare worker's own illness or disability, caregiving responsibilities for children, older adults, and other family members, and lack of sensitivity to each of these factors can also contribute to burnout. Although these challenges were exacerbated during the COVID-19 pandemic, the issues are not new. These factors impact individual healthcare workers, care teams, and entire healthcare delivery organizations.

    While the importance of healthcare worker well-being is frequently recognized, efforts to achieve well-being often focus on supporting the individual healthcare worker s use of coping mechanisms such as yoga, physical exercise, and meditation. While these interventions may be helpful, they do not address the systemic factors that challenge healthcare worker safety and well-being.

    Applications responding to this NOFO must test strategies to improve healthcare delivery system safety by addressing the factors that weaken healthcare worker safety and well-being and/or by making systemic changes to improve healthcare worker safety and well-being. Applications must include an operational definition of healthcare worker safety or well-being.

    Healthcare delivery system safety

    Several organizations, including AHRQ, the National Academy of Medicine, the World Health Organization, and the Institute for Healthcare Improvement, as well as the US Surgeon General and others, have recommended system approaches to improve patient safety through efforts targeting healthcare worker safety and well-being. This NOFO encourages applications focused on improving healthcare worker safety and well-being as a path to improving patient safety.

    Healthcare delivery occurs in systems that are simultaneously complex and adaptive. Healthcare delivery is affected by the difficulty, urgency and resource requirements of the intended task, and the availability, accessibility, capabilities and characteristics of patients and the care team, technology, tools and devices, and medications, diverse patient care settings, physical plants and organizational cultures, and the environment, processes, policies, and expectations within the healthcare organization, as well as the requirements and expectations placed on the organization from owners, payers and payment structures, regulators, and others. Relationships, resources, and patient care goals change over time - sometimes slowly and sometimes abruptly. Each of these factors impacts healthcare worker and patient experiences, and each, in turn, is impacted by healthcare worker and patient experiences. In complex systems, the consequences of decisions and actions may emerge in unpredictable, non-linear ways. Although subsystem analysis may provide rich insights, the whole of healthcare delivery cannot be completely understood by deconstruction into subsystem components.

    Because of the complexity and adaptive nature of healthcare delivery, and to ensure that healthcare worker well-being enhancements are effective and sustainable, the input and unique insights of healthcare workers must be included in the development and implementation of system level improvements. Involving licensed healthcare professionals in the development and implementation of interventions to support healthcare worker safety and well-being will take advantage of their lived experiences, address competing priorities, and increase their investment in improvement processes and sustainable outcomes. AHRQ requires applications to include licensed healthcare professionals in project planning and the development of interventions or strategies, including those who deliver care in ambulatory, prehospital, emergency, inpatient, post-acute or long-term care settings, including medical, surgical, and mental health care, to patients of any age.

    Objectives

    AHRQ encourages research projects that address more effective ways to improve healthcare worker safety and well-being and promote the wide-scale adoption of evidence-based approaches. This NOFO will support Large Research Projects (R01) in areas of healthcare worker safety and well-being focused on healthcare delivery system processes and informed by the participation of licensed healthcare professionals.

    This NOFO invites applications that seek to improve healthcare worker safety and well-being by:

    1) improving healthcare delivery systems with collaboration at multiple levels, which may include some combination of unit, specialty, department, facility and/or organizational systems, and

    2) requiring licensed healthcare professional participation as project PIs, Co-PIs, Senior and/or Key Personnel, to benefit from their input, experience and insights in the development and implementation of improvements, to optimize both healthcare worker capabilities and patient outcomes.

    The involvement of many other people who provide essential contributions to patient safety, such as executive leaders, administrators, healthcare delivery support staff (e.g., staff providing environmental and security services, and information technology, biomedical, equipment, and supply resources), and patients, families, and their communities, may also be components of applications responding to this NOFO.

    Healthcare workers, as individuals and members of teams, fulfill a variety of roles with a range of responsibilities, thus affording diverse insights into hazards and latent safety threats, first-hand understanding of work-as-done, and invaluable perspectives about potential interventions to enhance patient safety through interventions targeting healthcare worker safety and well-being.

    Examples of activities responsive to this NOFO

    In the following examples, the first list includes processes or qualities that may be desirable, and the second list includes processes or qualities that can be problematic. Researchers may address one or more items from one or both lists. The lists are not intended to be exclusive.

    Examples of factors relevant to this NOFO include, but are not limited to, processes, interventions or insights related to understanding, developing, improving, assessing, or maintaining:

    1) healthcare worker safety, well-being, satisfaction, joy, recognition, engagement, respect, management of work-home relationships

    2) healthcare worker autonomy, flexibility, agency, control

    3) organizational resilience, reliability, learning

    4) care planning, transitions (e.g., anticipatory planning or transfers of responsibility such as discharges, handoffs, consultations)

    5) adaptation, margin (e.g., capacity for adaptive response), or graceful degradation (e.g., ability to prioritize, and defer less essential tasks, but not collapse under pressure)

    6) value, priority alignment (e.g., ability to address or resolve conflicting patient care goals)

    7) collegiality, fairness, respect

    8) user-friendly/user-informed processes (e.g., clinical decision support, or other electronic or non-electronic processes), user-friendly/user-informed technology

    9) meaningful documentation

    Processes, interventions or insights related to understanding, assessing, preventing, managing, or mitigating the following healthcare worker concerns are also examples of factors relevant to this NOFO:

    1) moral injury

    2) goal conflicts, such as between efficiency and thoroughness

    3) gridlock, brittleness (e.g., propensity for processes to collapse under pressure)

    4) resource limitations

    5) fragmented care delivery

    6) non-productive work effort

    7) administrative burden

    Grant applications may address conditions and circumstances such as patient care surges, acute or chronic crises, and resource limitations as well as ordinary and/or successful work. Grant applications may address, but are not limited to, cognitive, physical, or social/ behavioral processes.

    Research, measurement, and practice improvement to enhance healthcare worker safety and well-being may address adverse events and harms or may encompass approaches that support learning from how and why things go right and how to anticipate, recognize, monitor, and respond to hazards and opportunities. Projects can be designed from a Safety-I or a Safety-II lens. The Safety-I perspective typically addresses what went wrong and attempts to prevent future occurrences of similar adverse events, generally by means of constraints. Grant applications may address preventing or mitigating conditions or processes that adversely impact healthcare worker well-being. The Safety-II perspective seeks a deep understanding of what went well with an appreciation of the importance of adaptability in both ordinary and extraordinary healthcare delivery. Healthcare workers doing complex everyday work are successful more often than they are unsuccessful. Studying how healthcare workers constantly adapt to create successful outcomes despite dynamic environments, incomplete information and limited resources may help define and further improve the factors and conditions that underpin that success.

    Methods may include the use of simulation and/or debriefing as interventions or research methodologies. A variety of surveys are available, addressing burnout, fulfillment, work environments, and healthcare worker and organizational safety, such as components of AHRQ s Surveys on Patient Safety Culture (SOPS). Less traditional research methods, such as stepped wedge cluster randomized trial, statistical process control, adaptive trials, agile design, implementation, mixed methods or solely qualitative research methods (e.g., interviews, observation, ethnography) may be appropriate. All research methods must be justified and include a theoretical or conceptual justification.

    To increase the consideration of scientific principles from diverse sciences or industries that design or implement methods to improve safety for humans, applicants must include collaboration with safety experts outside of surgery, internal medicine, pediatric, pathology or other traditional medical fields. Examples of collaborators include, but are not limited to, engineers with human factors, systems or industrial safety expertise, design or implementation scientists, informatics experts, social scientists such as anthropologists and sociologists, architects, economists, and psychologists with expertise in safety for humans.

    All projects must:

    Seek to improve healthcare delivery systems to improve healthcare worker safety and well-being;

    Include an operational definition of healthcare worker safety or well-being;

    Include at least one PI, Co-PI, Senior and/or Key Person who is a licensed healthcare professional in project planning and the development of interventions or strategies,

    Include at least one PI, Co-PI, Senior and/or Key Person from outside of traditional medical fields who has unique knowledge relevant to healthcare worker safety and well-being.

    See Section VIII. Other Information for award authorities and regulations.

    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

    New

    The OER Glossary and the SF424 (R&R) Application Guide provide details on these application types. Only those application types listed here are allowed for this NOFO.

    Clinical Trial?

    Optional: Accepting applications that either propose or do not propose clinical trial(s)

    Need help determining whether you are doing a clinical trial?

    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 funding is contingent upon the availability of funds for each year of support.

    Because the nature and scope of the proposed research will vary from application to application, it is anticipated that the size and duration of each award will also vary.

    Award Budget

    The total costs (direct and indirect) for a project awarded under this NOFO will not exceed $500,000 in any given year and $2 million for the entire project period. An application with a budget that exceeds $500,000 total costs in any given year will not be reviewed.

    Funds may be used only for those expenses that are directly related and necessary to the project and must be expended in compliance with applicable Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR Part 75) and the HHS Grants Policy Statement.

    Award Project Period

    The project period may not exceed 4 years.

    These projects are being funded pursuant to 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 NOFO are subject to 45 CFR Part 75 (Uniform Administrative Requirements, Cost Principles and Audit Requirements for HHS Awards; https://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75), the HHS Grants Policy Statement (see https://www.ahrq.gov/funding/policies/hhspolicy/index.html), and the terms and conditions set forth in the Notice of Award.

    Section III. Eligibility Information
    1. Eligible Applicants
    Eligible Organizations

    Higher Education Institutions

    • Public/State Controlled Institutions of Higher Education
    • Private Institutions of Higher Education

    The following types of Higher Education Institutions are always encouraged to apply for NIH support as Public or Private Institutions of Higher Education:

      • Hispanic-serving Institutions
      • Historically Black Colleges and Universities (HBCUs)
      • Tribally Controlled Colleges and Universities (TCCUs)
      • Alaska Native and Native Hawaiian Serving Institutions
      • Asian American Native American Pacific Islander Serving Institutions (AANAPISIs)

    Nonprofits Other Than Institutions of Higher Education

    • Nonprofits with 501(c)(3) IRS Status (Other than Institutions of Higher Education)
    • Nonprofits without 501(c)(3) IRS Status (Other than Institutions of Higher Education)

    Local Governments

    • State Governments
    • County Governments
    • City or Township Governments
    • Special District Governments
    • Indian/Native American Tribal Governments (Federally Recognized)
    • Indian/Native American Tribal Governments (Other than Federally Recognized)

    Federal Governments

    • Eligible Agencies of the Federal Government
    • U.S. Territory or Possession

    Other

    • Independent School Districts
    • Public Housing Authorities/Indian Housing Authorities
    • Native American Tribal Organizations (other than Federally recognized tribal governments)
    • Faith-based or Community-based Organizations
    • Regional Organizations

    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 recipient 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 Organizations

    Non-domestic (non-U.S.) Entities (Foreign Organizations) 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.

    • System for Award Management (SAM) 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.
      • NATO Commercial and Government Entity (NCAGE) Code Foreign organizations must obtain an NCAGE code (in lieu of a CAGE code) in order to register in SAM.
      • Unique Entity Identifier (UEI)- A UEI is issued as part of the SAM.gov registration process. The same UEI must be used for all registrations, as well as on the grant application.
    • eRA Commons - Once the unique organization identifier is established, organizations can register with eRA Commons in tandem with completing their Grants.gov registration; all registrations must be in place by time of submission. 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.
    • Grants.gov Applicants must have an active SAM registration in order to complete the Grants.gov registration.

    Program Directors/Principal Investigators (PD(s)/PI(s))

    All PD(s)/PI(s) must have an eRA Commons account. PD(s)/PI(s) 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, they 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)

    At least one PI, Co-PI, Senior and/or Key Person must be a licensed healthcare professional.

    At least one PI, Co-PI, Senior and/or Key Person must have unique knowledge outside of traditional medical fields that will contribute to the research program.

    Program Directors/Principal Investigators (PD(s)/PI(s))

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

    For institutions/organizations proposing multiple PDs/PIs, visit the Multiple Program Director/Principal Investigator Policy and submission details in the Senior/Key Person Profile (Expanded) Component of the SF424 (R&R) Application Guide. The AHRQ multiple PDs/PIs policy can be found at https://grants.nih.gov/grants/guide/notice-files/NOT-HS-16-018.html.

    2. Cost Sharing

    This NOFO does not require cost sharing.

    While there is no cost sharing requirement included in this NOFO, 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 per NIH Grants Policy Statement 2.3.7.4 Submission of Resubmission Application. This means that the 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.

    Section IV. Application and Submission Information
    1. Requesting an Application Package

    The application forms package specific to this opportunity must be accessed through ASSIST, Grants.gov Workspace or an institutional system-to-system solution. Links to apply using ASSIST or Grants.gov Workspace are available in Part 1 of this NOFO. See your administrative office for instructions if you plan to use an institutional system-to-system solution.

    2. Content and Form of Application Submission

    It is critical that applicants follow the Research (R) Instructions in the How to Apply - Application Guide, except where instructed in this notice of funding opportunity 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.

    Letter of Intent

    Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows AHRQ staff to estimate the potential review workload and plan the review.

    By the date listed in Part 1. Overview Information, prospective applicants are asked to submit a letter of intent that includes the following information:

    • Descriptive title of proposed activity
    • Name(s), address(es), and telephone number(s) of the PD(s)/PI(s)
    • Names of other key personnel
    • Participating institution(s)
    • Number and title of this funding opportunity

    The letter of intent should be emailed to:

    Name: Ellen S Deutsch, MD, MS
    O/C Division: General Patient Safety
    Telephone: 301-648-3028
    Email: ellen.deutsch@ahrq.hhs.gov

    Page Limitations

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

    For this specific NOFO, the Research Strategy section is limited to 12 pages.

    Instructions for Application Submission

    The following section supplements the instructions found in the How to Apply Application Guide and should be used for preparing an application to this NOFO.

    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.

    Budget Component: Special Instructions for AHRQ applications

    AHRQ is not using the Modular Grant Application and Award Process. Applicants applying 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 must be followed, with the following additional instructions:

    Resource Sharing Plan:

    Individuals are required to comply with the instructions for the Resource Sharing Plans as provided in the SF424 (R&R) Application Guide, with the following modification:

    Submission of a data management plan is required. AHRQ applicants are reminded to refer to NOT-HS-20-011: The Agency for Healthcare Research and Quality Data Management Plan Policy (https://grants.nih.gov/grants/guide/notice-files/NOT-HS-20-011.html) for additional information on how to incorporate their data management plan into the resource sharing plan.

    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.

    PHS Human Subjects and Clinical Trials Information

    When involving human subjects research, clinical research, and/or clinical trials (and when applicable, clinical trials research experience) follow all instructions for the PHS Human Subjects and Clinical Trials Information form in the SF424 (R&R) Application Guide, with the following additional instructions:

    If you answered Yes to the question Are Human Subjects Involved? on the R&R Other Project Information form, you must include at least one human subjects study record using the Study Record: PHS Human Subjects and Clinical Trials Information form or Delayed Onset Study record.

    Study Record: PHS Human Subjects and Clinical Trials Information

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

    Delayed Onset Study

    Note: Delayed onset does NOT apply to a study that can be described but will not start immediately (i.e., delayed start).

    All instructions in the SF424 (R&R) Application Guide must be followed. 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" (https://grants.nih.gov/grants/guide/notice-files/not-hs-00-003.html). Applicant should also be aware of the AHRQ policy for use of single IRB for cooperative research, 45 CFR 46.114 (b) https://grants.nih.gov/grants/guide/notice-files/NOT-HS-20-005.html.

    PHS Assignment Request Form

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

    3. Unique Entity Identifier and System for Award Management (SAM)

    See Part 1. Section III.1 for information regarding the requirement for obtaining a unique entity identifier and for completing and maintaining active registrations in System for Award Management (SAM), NATO Commercial and Government Entity (NCAGE) Code (if applicable), eRA Commons, and Grants.gov

    4. Submission Dates and Times

    Part I. Overview Information contains information about Key Dates and times. 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. When a submission date falls on a weekend or Federal holiday, the application deadline is automatically extended to the next business day.

    Organizations must submit applications to Grants.gov (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 Grants.gov 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 Grants.gov on or before the application due date and time. If a Changed/Corrected application is submitted after the deadline, the application will be considered late. Applications that miss the due date and time are subjected to the NIH Grants Policy Statement Section 2.3.9.2 Electronically Submitted Applications.

    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 How to Apply Application Guide.

    5. Intergovernmental Review (E.O. 12372)

    This initiative is not subject to intergovernmental review.

    6. 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 HHS Grants Policy Statement can be found at http://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf.

    Pre-award costs are allowable. A recipient 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 recipient 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 recipient to be fully aware that pre-award costs result in borrowing against future support and that such borrowing must not impair the recipient's ability to accomplish the project objectives in the approved time frame or in any way adversely affect the conduct of the project.

    7. 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 How to Apply Application Guide.. If you encounter a system issue beyond your control that threatens your ability to complete the submission process on-time, you must follow the Dealing with System Issues guidance. For assistance with application submission, contact the Application Submission Contacts in Section VII.

    Important reminders:

    All PD(s)/PI(s) must include their eRA Commons ID in the Credential field of the Senior/Key Person Profile form. 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 NOFO for information on registration requirements.

    The applicant organization must ensure that the unique entity identifier provided on the application is the same identifier 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.

    The applicant should pay particular attention to the SF424 (R&R) application guide instructions https://grants.nih.gov/grants/how-to-apply-application-guide/forms-f/general-forms-f.pdf) concerning letters of support. Letters of support, recommendation, or affirmation from any entity or individual not directly participating in the project should not be included.

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

    Institutional Review Board (IRB) approval of human subjects is not required prior to peer review of an application (see https://grants.nih.gov/grants/guide/notice-files/NOT-HS-00-003.html). 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.

    Please be sure that you observe the total cost, project period, and page number limitations specified above for this NOFO. Application processing may be delayed or the application may be rejected if it does not comply with these requirements

    Post Submission Materials

    Applicants are required to follow the instructions for post-submission materials, as described in the policy. Any instructions provided here are in addition to the instructions in the policy.

    Priority Populations

    AHRQ is committed to the inclusion of priority populations in health services research. The overall portfolio of health services research that AHRQ conducts and supports shall include the populations specifically named in AHRQ s authorizing legislation: inner city; rural; low income; minority; women; children; elderly; and those with special health care needs, including those who have disabilities, need chronic care, or need end-of-life health care. 42 U.S.C. 299(c)(1). AHRQ also includes in its definition of priority populations those groups identified in Section 2(a) of Executive Order 13985 as members of underserved communities: Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.

    AHRQ will broadly implement this inclusion policy across the research that AHRQ supports and conducts so that the portfolio of research is inclusive of all populations. AHRQ intends that these populations be included in studies such that the research design explicitly allows conduct of valid analyses. The policy applies to all grant applications. Investigators should review the document entitled, AHRQ Policy on the Inclusion of Priority Populations, which is available at https://grants.nih.gov/grants/guide/notice-files/NOT-HS-21-015.html. Applicants under this NOFO must consider and discuss including priority populations in research design as specified in this Notice.

    Public Access to AHRQ-Funded Scientific Publications

    Investigators should review the document titled AHRQ Announces new Policy for Public Access to AHRQ-Funded Scientific Publications , which is available at (http://grants.nih.gov/grants/guide/notice-files/NOT-HS-16-008.html). For all research arising from AHRQ support, this policy requires that AHRQ-funded authors submit an electronic version of the author s final peer-reviewed accepted manuscript to the National Library of Medicine's PubMed Central (PMC) to be made publicly available within 12 months of the publisher s date of publication.

    AHRQ Data Management Plan Policy

    Investigators should review the document titled AHRQ Data Management Plan (DMP) Policy, which is available at (https://grants.nih.gov/grants/guide/notice-files/NOT-HS-20-011.html). This policy requires applicants for AHRQ new/competing grants and research contracts to include a DMP for managing, storing and disseminating the primary data, samples, physical collections, and other supporting materials created or gathered in the course of research funded by AHRQ, or state why data management is not possible, as a component of their grant application or research contract proposal.

    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 should 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 (see NOT-HS-18-012: Confidentiality in AHRQ-Supported Research). 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 recipient under this NOFO will also be obtained and managed in accordance with the HIPAA Privacy Rule, 45 CFR Parts 160 and 164.

    The recipient 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 (see HIPAA website in prior paragraph) 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 recipients 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 recipients to publish research results in peer-reviewed journals and to market grant-supported products. AHRQ requests that recipients notify the Office of Communications (OC) when an AHRQ-funded research article has been accepted for publication in a peer-reviewed journal. Researchers should submit manuscripts that have been accepted for publication in a peer-reviewed journal to JournalPublishing@ahrq.hhs.gov at least four to six weeks in advance of the journal s expected publication date.

    Regulations applicable to AHRQ recipients concerning intangible rights and copyright can be found at 45 CFR 75.322.

    Section V. Application Review Information
    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 detailed here: https://www.ahrq.gov/funding/policies/nofoguidance/index.html.

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

    Applications that are complete and responsive to the NOFO will be evaluated for scientific and technical merit by an appropriate objective 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 NOFO will not be reviewed. Only the review criteria described below will be considered in the review process.

    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.

    Significance

    Does the project address an important problem or a critical barrier to progress in the field? Is the prior research that serves as the key support for the proposed project rigorous? 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? How will the knowledge gained improve healthcare worker safety and well-being?

    Investigator(s)

    Are the PD(s)/PI(s), collaborators, and other researchers well suited to the project? If Early Stage Investigators or those in the early stages of independent careers, do they have appropriate experience and training? If established, have they demonstrated an ongoing record of accomplishments that have advanced their field(s)? If the project is collaborative or multi-PD/PI, do the investigators have complementary and integrated expertise; are their leadership approach, governance, and organizational structure appropriate for the project? Does the PI team have unique knowledge outside of traditional medical fields that will contribute to the research program? Are licensed healthcare professionals - such as physicians, nurses, pharmacists, social workers, therapists, or other healthcare professionals who provide direct patient care - participating as PIs, Co-PIs, Senior and/or Key Personnel?

    Innovation

    Does the application challenge and seek to shift current research or clinical practice paradigms by utilizing novel theoretical concepts, approaches or methodologies, instrumentation, or interventions? Are the concepts, approaches or methodologies, instrumentation, or interventions novel to one field of research or novel in a broad sense? Is a refinement, improvement, or new application of theoretical concepts, approaches or methodologies, instrumentation, or interventions proposed?

    Approach

    Are the overall strategy, methodology, and analyses well-reasoned and appropriate to accomplish the specific aims of the project? Have the investigators included plans to address weaknesses in the rigor of prior research that serves as the key support for the proposed project? Have the investigators presented strategies to ensure a robust and unbiased approach, as appropriate for the work proposed? 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? Have the investigators presented adequate plans to address relevant biological variables, such as sex, for studies in vertebrate animals or human subjects?

    Do the investigators seek to improve healthcare delivery systems to improve healthcare worker safety and well-being?
    Have the investigators provided an operational definition of healthcare worker safety or well-being?

    Environment

    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.

    Data Management Plan

    The reviewers will comment on whether the Data Management Plan is reasonable.

    Protections for Human Subjects

    If the project involves human subjects and/or clinical research, are there plans to address

    1) the protection of human subjects from research risks, and

    2) inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion or exclusion of individuals of all ages (including children and older adults), justified in terms of the scientific goals and research strategy proposed?

    For research that involves human subjects but does not involve one of the 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 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.

    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" (https://grants.nih.gov/grants/guide/notice-files/not-hs-00-003.html).). Applicant should also be aware of the AHRQ policy for use of single IRB for cooperative research, 45 CFR 46.114 (b) https://grants.nih.gov/grants/guide/notice-files/NOT-HS-20-005.html.

    Inclusion of Priority Populations

    Peer reviewers will assess the adequacy of plans to address the needs of AHRQ priority populations.

    Peer reviewers must include their assessment of the proposed inclusion plan for priority populations in evaluating the overall scientific and technical merit of the application and assigning the impact score.

    In evaluating the overall impact of the application, the review groups will:

    • Evaluate the application for the presence or absence of the inclusion plan based on the proposed research objectives.
    • Evaluate the adequacy of the proposed plan for the inclusion of priority populations.
    • Evaluate the proposed justification for the exclusion of priority populations when a requirement for inclusion is described as inappropriate with respect to the purpose of the research.
    • Evaluate the plans for outreach and recruitment of study participants, including priority populations, where appropriate.
    • Evaluate the proposed plan for study design, execution, and outcome assessments so that study results will be relevant to one or more priority populations, where appropriate.
    • Assess the plan as being acceptable or unacceptable with regard to the appropriateness of the inclusion or exclusion of priority populations in the proposed research.
    Degree of Responsiveness

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

    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.

    Resubmissions

    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.

    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.

    Resource Sharing Plans

    Not Appliable

    2. Review and Selection Process

    Applications that are complete and responsive to the NOFO will be evaluated for scientific and technical merit by an appropriate Scientific 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 NOFO will not be reviewed.

    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 score.
    • Will receive a written critique.

    The following will be considered in making funding decisions:

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

    After the peer review of the application is completed, the PD/PI will be able to access their Summary Statement (written critique) via the eRA Commons. Refer to Part 1 for dates for peer review, advisory council review, and earliest start date.

    Information regarding the disposition of applications is available in the HHS Grants Policy Statement (see https://www.ahrq.gov/funding/policies/hhspolicy/index.html).

    Section VI. Award Administration Information
    1. Award Notices

    If the application is under consideration for funding, AHRQ Division of Grants Management staff 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" (https://grants.nih.gov/grants/guide/notice-files/not-hs-00-003.html). Applicant should also be aware of the AHRQ policy for use of single IRB for cooperative research, 45 CFR 46.114 (b) https://grants.nih.gov/grants/guide/notice-files/NOT-HS-20-005.html".

    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 e-mail address designated by the recipient organization during the eRA Commons registration process.

    Recipients must comply with any funding restrictions described in Section IV.6. 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.

    Any application awarded in response to this NOFO will be subject to the UEI, SAM Registration, and Transparency Act requirements.

    2. Administrative and National Policy Requirements

    All AHRQ grant and cooperative agreement awards are subject to HHS s Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, (http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75, and the HHS Grants Policy Statement (see http://www.ahrq.gov/funding/policies/hhspolicy/index.html), and the terms and conditions set forth in the Notice of Award.

    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 recipients inform their employees in writing of employee whistleblower rights and protections under 41 U.S.C. 4712 in the predominant native language of the workforce.

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

    If you are successful and receive a Notice of Award, in accepting the award, you agree that the award and any activities thereunder are subject to all provisions of 45 CFR Part 75, currently in effect or implemented during the period of the award, other Department regulations and policies in effect at the time of the award, and applicable statutory provisions.

    If you receive an award, HHS may terminate it if any of the conditions in 2 CFR 200.340(a)(1)-(4) are met. No other termination conditions apply.

    There is a prohibition on certain telecommunications and video surveillance services or equipment that became effective on or after August 13, 2020.

    If you receive an award, you must follow all applicable nondiscrimination laws. You agree to this when

    you register in SAM.gov. You must also submit an Assurance of Compliance (HHS-690). To learn more, see the HHS Office for Civil Rights website.

    • Health Literacy Below are available HHS resources.
    • HHS Health.gov: Health Literate Care Model
    • AHRQ: Health Literacy Universal Precautions Toolkit

    For additional guidance regarding how the provisions apply to AHRQ grant programs, please contact the Scientific/Research Contact that is identified in Section VII under Agency Contacts of this NOFO.

    In accordance with the statutory provisions contained in Section 872 of the Duncan Hunter National Defense Authorization Act of Fiscal Year 2009 (Public Law 110-417), AHRQ awards will be subject to the Federal Recipient Performance and Integrity Information System (FAPIIS) requirements. FAPIIS requires Federal award making officials to review and consider information about an applicant in the designated integrity and performance system (currently FAPIIS) prior to making an award. An applicant, at its option, may review information in the designated integrity and performance systems accessible through FAPIIS and comment on any information about itself that a Federal agency previously entered and is currently in FAPIIS. The Federal awarding agency will consider any comments by the applicant, in addition to other information in FAPIIS, in making a judgement about the applicant s integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 45 CFR Part 75.205 Federal awarding agency review of risk posed by applicants. This provision will apply to all AHRQ grants and cooperative agreements except fellowships.

    3. Reporting

    For details regarding annual progress report submission, refer to https://www.ahrq.gov/funding/grant-mgmt/noncomp.html. If instructions on the AHRQ website are different from the RPPR Instructions, follow the instructions on the AHRQ website. Annual progress reports are due 3 months before the start date of the next budget period of the award.

    Recipients are required to submit expenditure data on the Federal Financial Report (FFR; SF 425) annually.

    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 (https://www.ahrq.gov/funding/policies/hhspolicy/index.html). 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 4/30/2023, the annual FFR is due 9/30/2023 (90 days after the end of the calendar quarter of 6/30/2023).

    A final Progress Report, final Federal Financial Report, and Final Invention Statement are required when an award ends. All final reports are due within 120 days of the project period end date. For further details regarding grant closeout requirements, refer to http://www.ahrq.gov/funding/grant-mgmt/index.html#Closeout.

    The Federal Funding Accountability and Transparency Act of 2006 (Transparency Act), includes a requirement for recipients of Federal grants to report information about first-tier subawards and executive compensation under Federal assistance awards issued in FY2011 or later. All recipients of applicable AHRQ grants and cooperative agreements are required to report to the Federal Subaward Reporting System (FSRS) available at www.fsrs.gov on all subawards over the threshold. See the 2 CFR Part 170 (https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-170) for additional information on this reporting requirement.

    In accordance with the regulatory requirements provided at 45 CFR 75.113 and 2 CFR Part 200.113 and Appendix XII to 45 CFR Part 75 and 2 CFR Part 200, recipients that have currently active Federal grants, cooperative agreements, and procurement contracts from all Federal awarding agencies with a cumulative total value greater than $10,000,000 for any period of time during the period of performance of a Federal award, must report and maintain the currency of information reported in the System for Award Management (SAM) about civil, criminal, and administrative proceedings in connection with the award or performance of a Federal award that reached final disposition within the most recent five-year period. The recipient must also make semiannual disclosures regarding such proceedings. Proceedings information will be made publicly available in the designated integrity and performance system (currently FAPIIS). This is a statutory requirement under section 872 of Public Law 110-417, as amended (41 U.S.C. 2313). As required by section 3010 of Public Law 111-212, all information posted in the designated integrity and performance system on or after April 15, 2011, except past performance reviews required for Federal procurement contracts, will be publicly available. Full reporting requirements and procedures are found in Appendix XII to 45 CFR Part 75 and 2 CFR Part 200 Award Term and Condition for Recipient Integrity and Performance Matters.

    Recipient performance will be measured based on success in the following Program goals:

    Program Planning and Performance reporting requirements:

    The overarching objectives of these projects should be addressed through this reporting including progress with respect to:

    • Reach: Who was reached by this project?
      • Performance measures: Number or variety of practices, facilities, healthcare workers, and/or patients reached by the implementation.
      • Timeline: reach target by year 4.
    • Process: What processes were evaluated, implemented or improved as a result of this project?
    • How were processes implemented?
      • Performance measures: number, types, or magnitude of processes evaluated, implemented, or improved.
      • Implementation of processes based in Safety-II principles.
      • Healthcare worker participation in leadership in event analysis committees
    • Timeline: reach target by year 4.
    • Impact: Do the safety or well-being targets as represented by process measures or by other patient or licensed healthcare professional safety or well-being outcomes improve?
      • Performance measures: Impact of healthcare worker safety and well-being solution on select healthcare worker or patient safety process or outcome measures.
        Impact of healthcare worker safety or well-being solution on select healthcare worker or patient safety or well-being outcome measures.
        Increased satisfaction, capacity for resilience, efficiency, adaptability, margin, autonomy, agency, collaboration.
        Decreased brittleness, burnout, moral distress, administrative burden, stress, production pressure.
        Improved healthcare worker well-being, patient outcomes
    • Timeline: report on impact target by year 4.
    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, application errors and warnings, documenting system problems that threaten submission by the due date, and post-submission issues)

    Finding Help Online: https://www.era.nih.gov/need-help (preferred method of contact)
    Telephone: 301-402-7469 or 866-504-9552 (Toll Free)

    Grants.gov Customer Support (Questions regarding Grants.gov registration and Workspace)
    Contact Center Telephone: 800-518-4726
    Email: support@grants.gov

    Scientific/Research Contact(s)

    Ellen S Deutsch, MD, MS
    General Patient Safety
    Telephone: 301-648-3028
    Email: ellen.deutsch@ahrq.hhs.gov

    Peer Review Contact(s)

    Examine your eRA Commons account for review assignment and contact information (information appears two weeks after the submission due date).

    Robyn Sagatov, PhD, MHS, RDN
    Division of Scientific Review
    Office of Extramural Research, Education, and Priority Populations
    Agency for Healthcare Research and Quality
    Email: DSR@ahrq.hhs.gov

    Financial/Grants Management Contact(s)

    Kathryn Woolridge
    Office of Management Services
    Division of Grants Management
    Agency for Healthcare Research and Quality
    Telephone: 301-427-1025
    Email: kathryn.woolridge@ahrq.hhs.gov

    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 (https://www.ahrq.gov/funding/policies/hhspolicy/index.html).

    Authority and Regulations

    This program is described in the Assistance Listings (formerly called the Catalog of Federal Domestic Assistance) at https://sam.gov/content/home 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 45 CFR Part 75 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 http://www.ahrq.gov/funding/policies/hhspolicy/index.html

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