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DxQI Seed Grant Overview

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.”

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.

The call for proposals for the DxQI Seed Grant Program will open in January 2021. Organizations interested in the program may sign up to receive notifications when the request for proposal is issued.

Grantee Projects

SIDM has issued the first of three grant rounds, totaling $3 million, as part of the DxQI Seed Grant Program. The initial awards are up to $50,000 for 17 organizations testing interventions to improve the quality, accuracy, and timeliness of diagnoses. The DxQI grantees will identify and implement small, practical tests of change, then begin to build evidence supporting interventions that could reduce harm due to diagnostic error if replicated and spread across other hospitals and health systems.

Learn more about the projects.

Meet the DxQI Grantees

SIDM has issued the first of three grant rounds that will total $3 million, as part of the DxQI Seed Grant Program. Learn more about the 17 organizations testing interventions to improve the quality, accuracy, and timeliness of diagnoses.

Eligible Grantees**

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

Over the course of three years, grants will be awarded in the following categories:

  • 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
  • Open: topics that do not address one of the previous two areas. Up to 30% of awards

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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?

Grant Review Committee

*Organizations are shown for identification purposes only.

Doug Salvador, MD, MPH – Committee Chair
Senior Vice President and Chief Quality Officer, Baystate Health

Anne Marie Benedicto, MPPA, MPH
Vice President, Joint Commission Center for Transforming Healthcare

Jeff Brown, MEd
Principal, Safer Healthcare

Brian Mittman, PhD
Research Scientist III, Division of Health Services Research & Implementation Science, Kaiser Permanente

Sarah Sampsel, MPH
Healthcare Quality Consultant, SLSampsel Consulting, LLC

Lucy Savitz, PhD, MBA
Vice President, Health Research, Kaiser Permanente Northwest

Gordy Schiff, MD
Associate Director, Center for Patient Safety Research and Practice, Brigham and Womens Hospital

Suz Schrandt, JD
Senior Patient Engagement Advisor, Society to Improve Diagnosis in Medicine

Ron Wyatt, MD, MHA
VP and Patient Safety Officer, MCIC-Vermont

Thank You to Our Peer Judge Committee

*Organizations are shown for identification purposes only.

Vonda Vaden Bates
CEO 10th Dot, Patient Safety Advocate

Daniel L. Berg
Philanthropic Advisor, The Minneapolis Foundation

Kristie Burnette, RN, MSN, CPHQ, CPPS
Director, Patient Safety and Quality, Virginia Hospital and Healthcare Association

Claudia Butler, MBA, CPC, ELI-MP, CPHQ, CSSMBB
Consultant and Leadership Coach, Core Connections LLC

Fred M. Castello, MD, MBA (retired)
Pediatrician and Former VP Medical Affairs and Chief Medical Officer, Augusta Health

Karen Harris, RN, MSN, CPHQ, CPPS
Division Director Clinical Quality, HCA Capital Division

Harry Hoar, MD
Pediatric Hospitalist, Director of Clinical Reasoning Education, Baystate Health

Karen M Johnson, BSN, RN, CCMSCP
Sr. Director Patient Safety, Baystate Health

Kirti Joshi, M.D. FACP
Academic Hospitalist and Medical Director, Patient Safety, Baystate Medical Center

G. Michael Lynch, M.D., FAAFP, CPXP, CPHQ
Principal, G. Michael Lynch, M.D. HealthCare Consulting, L.L.C.

Timothy J. Mosher, MD
Chair, Department of Radiology, Penn State Health Milton S Hershey Medical Center

Suz Schrandt, JD
Senior Patient Engagement Advisor, Society to Improve Diagnosis in Medicine

Nelson Toussaint
President, Tamarac LLC

Divvy Kant Upadhyay, MD, MPH
Scientist and Program Manager, (Quality, Safety & Patient Experience), Geisinger