For your application to be considered “complete”, please make sure you have submitted the following:

• Response to all online application questions
• A letter of support from an executive sponsor that demonstrates organizational support for the project and the project team by addressing all seven required elements as specified in the RFP
• A letter of support from a 3rd party partner if one is involved
• A bibliography of relevant citations that support the project rationale and intervention plan

Interested applicants are encouraged to participate in a webinar on Wednesday, February 24, 2021 at noon EST. Questions submitted by noon EST on February 22nd will be given priority on the call. All questions received by February 26th will be posted with answers on the DxQI site by March 2, 2021.

• Register for webinar
• Submit a question for webinar

Information on the webinar and additional resources on characteristics of a good application will also be made available. Check the DxQI website periodically for updates.

The DxQI website contains a downloadable step-by-step application guide.

Download the Application

We will score your application on the following elements:

• Aims statements (i.e., SMART Aims);
• Importance of problem selection to the diagnostic process and its local and national applicability;
• Proposed QI intervention and rationale;
• Prior QI experience of the project lead, appropriateness, and experience of the team;
• Applicability to one of the “Areas for Improvement” in diagnostic quality specified in the RFP;
• Strategy and measures of effectiveness;
• Appropriate patient and family engagement;
• Access to necessary organizational resources such as IT, data infrastructure, or other operational support;
• Project plan and timing for planning, implementing (or testing), evaluating, and improving the intervention; and
• Potential risks and mitigation strategies.

Patient and family engagement can be a confusing concept because it has been defined in multiple ways and in various contexts. For the purposes of the Seed Grant program, there are two types of patient and family engagement for you to keep in mind. The first, which is most well-known, is the idea that patients, who are empowered and supported to be active partners in their own care, tend to do better and feel better (James J, 2013). Therefore, patients and families should be looked to as key members of the care (and diagnostic) team and involved in decision-making and goal setting. The other type of engagement focuses not on a given patient’s own clinical management, but rather on drawing from the lived experience of patients and families to improve and design the healthcare system that serves them (Sheridan S, et al., 2017 and Carman KL, et al., 2013). In QI, this means partnering with patients and families in the planning, development, and evaluation of QI interventions whenever possible.

It is important to include enough details to provide a clear picture of how patients and families will be involved in the use or facilitation of the intervention and in the planning, development, and/or evaluation of the intervention—or why this involvement is not possible or not believed to be beneficial. An example is provided in Figure 1.

This project is centered on communication of [the issue] with the patient and family. Because the project is focused on pediatric patients, involvement of the patient and the family is essential to this project. A core outcome of the project will be the assessment of how communication of [the issue] is received and understood by the family. A primary objective is to increase the involvement of the family in the diagnostic process from the very beginning and throughout. In addition, patient and family members who have dealt with [the issue] will be involved in the process and development of all tools, interventions, and [the issue] curriculum intended for all level clinicians. Feedback from the family is vital to the planned process improvement and education development and will be critical for the PDSA cycles. In terms of measuring [the issue] and its impacts on the patient and family, the interaction with families and their reaction will be measured through a survey methodology. Data obtained will inform future iterations and change ideas.

We do not stipulate a minimum or a maximum number. The core team should be interdisciplinary and include meaningful stakeholders with the skills, competencies, and authority to execute the project plan. The team should also include members who have appropriate training and/or experience in quality improvement and/or change management. Projects involving IT should include a representative core team member.

A bibliography on disparities in diagnosis can be found on the SIDM webpage "Foundational Readings – Disparities in Diagnosis." Proposals to improve diagnostic outcomes related to health disparities explicitly identify one or more vulnerable populations where the quality improvement will be demonstrated, i.e. populations differentiated by age, race/ethnicity, gender and/or other social determinants of health. Ideally, there will be quantitative evidence of disparate outcomes that will be described in the background and be used as a basis for measuring improvement. Alternatively, an applicant can focus on a setting that primarily serves vulnerable populations, e.g. Federally Qualified Health Centers or Safety Net hospitals. Proposals that meet the criteria for both disparities and “Big 3” would maximize your chances assuming a high-quality proposal.

SMART is an acronym for Specific, Measurable, Attainable, Realistic, Timely. Your project Aim should succinctly incorporate each of these elements. Below are some examples:

• Reduce adverse drug events (ADEs) in critical care by 75 percent within 1 year.
• Reduce waiting time to see a physician to less than 15 minutes within 9 months.
• Reduce incidence of ventilator-associated pneumonia by 25 percent.
• Increase the number of surgical cases between cases with a surgical site infection by 50 percent within 1 year.
• Reduce waiting time to see a urologist by 50 percent within 9 months.
• Reduce the average length of stay for Medical ICU patients by 50 percent within 9 months.

For additional guidance, you can refer to the Institute for Healthcare Improvement’s “Science of Improvement: Setting Aims” webpage.

Peer Reviewers sign a confidentiality non-disclosure agreement with SIDM. They will also be instructed to explicitly identify conflicts of interest and recuse themselves from scoring an application where conflict of interest exists.

We are NOT looking for studies that:

• Measure the burden or causes of diagnostic error without an intervention;
• Develop new interventions in a “lab” setting without testing them for patient care outcomes;
• Focus on new diagnostic tests without a QI intervention that emphasizes reduction in diagnostic error;
• Are retrospective case studies with no planned QI Intervention;
• Evaluate the efficacy of a medical treatment or modality; or
• Are primarily scientific research with no direct impact on patient outcomes.

Check the DxQI website for information on currently funded grant projects and organizations. Additionally, Newman-Toker D, et al. (2019) identifies several contributing and causal factors in each of the Big Three disease categories that are opportunities for improvement (see table on next page). Literature reviews on system-related and cognitive interventions to reduce diagnostic errors by Singh H, et al. (2012) and Graber et al. (2012), respectively, offer further guidance.