Rationale

Research has demonstrated that diagnostic errors are the most common, catastrophic and, costly of all causes of preventable medical harm. In fact, errors in diagnosis are the most frequent cause of medical error reported by patients. In total, it’s estimated that 12 million US adults experience a diagnostic error every year in outpatient settings alone. It has also been reported that failures of diagnosis result in as many as 80,000 preventable deaths every year in US hospitals. Through a grant from the Gordon and Betty Moore Foundation, researchers from John Hopkins University and CRICO Strategies found that one in three malpractice cases that result in death or permanent disability stem from an inaccurate or delayed diagnosis and resulted in $1.8 billion in malpractice payouts over 10 years. Three quarters of diagnostic error malpractice claims were attributable to just three categories of conditions: cancer (37.8 percent), vascular events (22.8 percent) and infection (13.5 percent), referred to as the “Big 3.”

Important Dates
  • Informational Webinar: Feb. 21, 2020
  • Application Deadline: March 30, 2020
  • Award Announcement: By June 5, 2020
  • Cohort 1 Grant Period: June 2020 - May 2021

Given the magnitude of diagnostic error burden, SIDM advocates for increased attention by health systems to improving the quality of their diagnostic process. This goes beyond avoiding errors and includes consideration of accuracy, timeliness, cost, and patient convenience. Designing an optimal diagnostic process will require a careful balancing among these competing demands. Given the dearth of solutions, we believe catalyzing a "bottom up" approach, whereby frontline health professionals and patients are engaged to develop and test plausible solutions, will most likely produce the best outcomes.

Program Overview

Twenty grantees will be awarded grants of up to $50,000 to carry out 12-month diagnostic quality and safety improvement projects. Grantees will be asked to identify opportunities for improvement and potential interventions, evolve the interventions through small tests of change to increase their effectiveness, build the level of evidence supporting the intervention’s effectiveness, and, where appropriate, increase impact through further opportunities to “scale and spread” utilization. There will be three distinct award cycles (annual cohorts).

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Who is eligible to apply?**

Care-delivery systems* are eligible to apply and will typically come from the following:

  • Office-based primary care
  • Office-based specialty care
  • Clinic (e.g., Urgent, Acute)
  • Other ambulatory centers (e.g., Surgical, Imaging)
  • Community Hospital
  • Academic Medical Center
  • Psychiatric Hospital
  • Rehab Facility
  • VA & Military Centers
  • Skilled Nursing Facility
  • Federally Qualified Health Center
  • Safety Net Hospitals

*PLEASE NOTE: Organizations that do not provide direct care are not eligible to apply as the lead on a DxQI project, but may partner with an eligible organization, not as the applicant, but as part of the team.

**FOR INTERNATIONAL APPLICANTS: While international locations are eligible to receive a grant, you will be asked to address the importance of the problem and its potential solution to the US healthcare system in your proposal. Failure to demonstrate problem importance and intervention applicability will result in a denial.

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Areas for Improvement

While any topic related to improving diagnosis is eligible for an improvement award, two areas in particular will receive increased attention and a minimum allocation of awards. They are:

  • Diagnostic Quality Disparities: proposals focused on how and when the visible factors of age, race/ethnicity, and/or sex, as well as other social determinants of health, influence the risk of diagnostic error. 20% of awards

Up to 30% of awards will be awarded to the OPEN category, i.e. not one of the priority areas.

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Program Support

  • SIDM will moderate an online community established for grantees to:
    • Support shared learning across sites as challenges and barriers are identified by individual QI teams
    • Allow participating sites to share documents and engage with the SIDM QI Program Manager who will act as a virtual improvement advisor to the community for the lifecycle of the program.
  • Educational webinars on QI techniques applied to the diagnostic field will be made available
  • Limited support will be made available through ad hoc calls to help grantees overcome potential QI barriers

Program Requirements

Each organization selected will be expected to:

  • Designate appropriate team members to be part of the QI Core Project Team
  • Attend a cohort kick-off webinar
  • Submit bi-monthly status reports describing:
    • What barriers/challenges have you faced?
    • What unanticipated consequences did you encounter with this month’s tests?
    • How did you overcome those?
  • Submit formal mid-project and year-end final reports
  • Participate in quarterly calls
  • Participate in the online Community
  • Attend two designated QI Summits at future SIDM International Conferences
  • Recruit an Executive Sponsor who will be required to submit a letter of support
  • Confirm no additional external funding is available to do this work
  • Ensure the IRB is aware of the proposed project, if required, and appropriate authorization will be obtained prior to the start of the project

What are we looking for?

A qualifying proposal will meet the following criteria:

1. The project lead represents a facility where health care is delivered.

2. The proposed intervention can be described by one of the four categories below:

a. A well-defined problem and discovery period followed by adequate time for a to-be defined intervention that will be tested and improved.

b. A well-defined intervention that will be tested and improved.

c. An implemented, but unevaluated intervention with a well-defined evaluation plan and an opportunity to improve.

d. An implemented, evaluated intervention that will be tested and improved in a novel setting or with a novel population.

3. We are looking for interventions to reduce important sources of diagnostic error that might include (but are not limited to) cognitive interventions in patient care settings such as checklists or decision support; systems interventions to change diagnostic processes or workflow in practice; or educational interventions where the targeted outcomes of the study are practice change in diagnosis. We are NOT looking for studies that measure the burden or causes of diagnostic error without an intervention; that develop new interventions in “lab” setting without testing them for patient care outcomes; or that are limited to studying new diagnostic tests without an emphasis on reducing error.

4. The team includes meaningful stakeholder involvement including patient or family input or an adequate explanation of why the team would not benefit from patient or family input on this proposed project.

5. The executive sponsor provides a letter of support that confirms:

a. There is organizational support for the project aims.

b. The team is appropriate to meet the project aims.

c. The budget is sufficient to meet project aims on time and within scope.

d. Required people and resources to meet project aims will be available.

e. Data necessary for project completion will be accessible and available.

f. The sponsor will assist in overcoming unanticipated barriers/challenges that pose a threat to project completion.

6. Short bibliography of key articles that support the importance of the problem and/or the suitability of the intervention, if available.

Download the Request for Proposals

Scoring Criteria

Note that a technical review by a limited number of people will be performed to ensure that the submission is complete, that the core project team is appropriate, and that the budget is sufficiently described. If a proposal passes this initial review, a deidentified version will be submitted to peer review using the criteria below.

Content Review

1. Aims, Background, and Approach

a. Do the aims utilize SMART goal attributes (Specific, Measurable, Achievable, Realistic, Timely)?
b. Does the proposal explicitly and, where possible, quantifiably justify the problem selection, i.e. describe the magnitude of the problem and establish its importance to the diagnostic process?
c. Does the proposal clearly address the importance of addressing this problem for the nation-at-large?
d. Is the proposed intervention supported by a compelling rationale (theory of change or logic model) justifying the linkage between the intervention and the problem’s root causes using literature to add strength to the proposal? If an international location, is the applicability of the intervention to the US health system demonstrated?

2. Project Plan

a. Is the population receiving the intervention specified and is that population appropriate for the aims?
b. Is the process for testing and improving the intervention clearly described (and if utilized, is the discovery process preceding the testing of the intervention clearly described and limited in time?)
c. Is the study design (e.g. pre/post, control group) adequately described and does it include an appropriate comparator (measure) defined to help assess improvement?
d. Does the proposal adequately describe the operational requirements including access to needed data and required participation, if any, from non-core team members?
e. Does the proposal describe short-term outcomes and how the intervention measures are related to these outcomes? Does it describe how the applicant will ultimately evaluate the project’s impact?
f. Does the proposal describe the setting(s) for the intervention?
g. Does the proposal describe the potential unintended negative consequences and the balancing measures they will use to evaluate whether those negative consequences occur?
h. Does the proposal list major milestones including deliverables in all three phases: pre-intervention, intervention and assessment?

3. Organizational Rationale (assessed in preliminary review)

a. Does the project lead have the proper training or experience to lead the QI team?
b. Does the identified core project team exemplify an interdisciplinary approach and address the skills, competencies, and authority needed to execute the project plan?
c. Is there meaningful patient or family involvement in this project, or where deemed to add no value, is that position justified?

4. Risks and risk mitigation

a. Does the proposal adequately address access to data resources?
b. Does the proposal describe other potential project operational challenges and strategies to address those challenges?

How to Apply

Step 1:

Interested applicants are encouraged to participate in a webinar on February 21, 2020 at 12 pm EST. To be answered, questions must be submitted by February 26, 2020. All received questions and answers will be posted on the DxQI site by March 2, 2020. Questions submitted by 12:00 pm EST on February 20 will be given priority on the webinar.

Step 2:

Applications must be submitted online by March 30, 2020 before midnight EST. To begin an application, you will be asked to sign in to an existing SIDM account or create a new account. Once you have logged in and started an application, you will be able to save and log in at a later date to complete unfinished questions.

Submission must include:

  • Completion of online application
  • Two letters of support:
    • One from an executive sponsor e.g., department chair or an equivalent senior leadership role within your organization
    • One from any third-party partner that is deemed critical to the success of the project (if applicable).

Applications should also include complete responses to application questions, project team roster and roles, budget explained in the narrative and an uploaded Letter of Support (PDF format).

For additional guidance on the application view the application/instruction guide.

For additional questions, please e-mail us at dxqiseedgrant@ImproveDiagnosis.org.

Frequently Asked Questions

Eligibility
Grant Decisions and Notification
Applicant Considerations and Process
The Application

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