This FOA solicits Large Research (R01) Project applications that focus on AHRQ's mission and/or any aspect of its specific priority areas, described in detail below.. The Research Project Grant (R01) is an award made by AHRQ to an institution/organization to support a discrete, specified health services research project. The R01 research plan proposed by the applicant institution/organization must be related to the mission and portfolio priority research interests of AHRQ. Although the PD/PI is responsible for conducting and supervising the research, the actual applicant is the research institution/organization legally accountable for the performance of the award and the expenditure of funds.

The AHRQ mission is to produce evidence to make health care safer, higher quality, more ac­cessible, equitable and affordable, and to work with HHS and other partners to make sure that the evidence is understood and used. Within the mission, AHRQ’s specific priority areas of focus are:

Research to improve health care patient safety.
Harnessing data and technology to improve health care quality and patient outcomes and to provide a 360-degree view of the patient.
Research to increase accessibility and affordability of health care by examining innovative market approaches to care delivery and financing.
Research to Improve Health Care Patient Safety
Patient safety is defined as the freedom from accidental or preventable injury produced by health care as well as the practices that create a safe environment of care. The ultimate goal of AHRQ-supported Patient Safety research is to improve the safety of health care delivery. Patient safety research initiatives that lead to this goal can be considered in three different stages:

Identification of risks, hazards, and patient harm.
Design, implementation, dissemination and spread, and evaluation of interventions to improve patient safety.
Establishment of strategies to sustain patient safety improvements such as culture, incident/event reporting, measurement, monitoring, and surveillance.
AHRQ's Patient Safety Research Program: (1) identifies specific areas of focus through targeted grant funding announcements (i.e., Program Announcements, Requests for Applications, and Special Emphasis Notices) and (2) encourages investigators to utilize the Agency's general funding announcements to apply this research framework in response to other patient safety threats and opportunities for improvement.

The Patient Safety Portfolio will support research projects to create new knowledge by identifying the risks, hazards, and harm encountered by patients as a result of health care. The Portfolio will also support projects that mitigate those risks, hazards, and harm including the design, implementation and evaluation of strategies (patient safety practices) and the adaptation, refinement, and sustainment of those strategies. These initiatives are part of the Agency's overall mission to improve the quality of health care.

Projects may address important topics such as: the surveillance, measurement, detection, and reporting of patient safety events; the impact of human performance, work flow, and working conditions on patient safety; the patients' role and contribution to patient safety; health care safety culture, leadership, communication, teamwork, and simulation; prevention and control of healthcare-associated infections (HAIs); diagnostic safety and quality; the safe use of medical devices and medications, including safely prescribing opioids; the role of Patient Safety Organizations; and the challenges inherent in transitions of care in the same setting and between settings and handoffs between health care providers.

AHRQ’s focus of interest in HAI research include the following broad areas:

Determination of the clinical efficacy and effectiveness of preventive interventions, including unintended adverse consequences.
Characterization and assessment of relevant epidemiological aspects of HAIs, including but not limited to patient risk factors, clinical presentation, and sources of antibiotic-resistant organisms involved in the development of HAIs.
Demonstration, dissemination, and evaluation of strategies and approaches for prevention and reduction of HAIs.
Research regarding adoption and implementation (including sustainment, spread, and scale-up) of evidence-based approaches for prevention of HAIs.
The HAI research portfolio also encompasses a generation of knowledge for combating antibiotic resistant bacteria. AHRQ is interested in studies to promote appropriate antibiotic use, reduce the transmission of resistant bacteria, and prevent HAIs in the first place. The last contributes to antibiotic stewardship by avoiding the need for antibiotic therapy and precludes the possibility of a resistant infection.

Clinical investigations that seek to establish the efficacy or effectiveness of preventive interventions, as noted above, typically involve a comparison of the intervention in question to routine care or, less frequently, to a placebo (when the latter is ethical). Such clinical studies are included in the scope of AHRQ’s HAI research portfolio. The HAI Portfolio does not fund comparisons of two interventions of known efficacy or effectiveness to determine which is more efficacious or effective. Such studies are comparative effectiveness research, which is more appropriately funded by other funding sources.

The Portfolio supports research in all health care settings including the hospital, long-term care, ambulatory care, home health care, pharmacy, and transitions of care between settings.

Patient safety research involves many stakeholder groups including patients, families, clinicians, non-clinical health care staff, policymakers, payers, and health care organizations including providers and accreditors, local and State governments, the Federal Government, Patient Safety Organizations, and many others.

Projects in this area may also address patient characteristics that might influence the risk of experiencing a patient safety event, for example, attributes of AHRQ's priority populations that can impact patient safety and address strategies to address barriers to safe care.

Harnessing Data and Technology To Improve Health Care Quality and Patient Outcomes and To Provide a 360-Degree View of the Patient
AHRQ is interested in research to: advance the methods of evidence synthesis to ensure scientific rigor and unbiased reviews, make evidence-based recommendations on clinical preventive services, conduct research on how health information technology can improve the quality of health care, advance the science of clinical practice improvement, evaluate and support innovative models of practice transformation in primary care and other ambulatory settings, and facilitate communities of learning to promote the implementation of evidence for practice improvement. Further, AHRQ is interested in studying and improving upon the process by which health systems and ambulatory care practices select evidence to implement and how to determine what strategies are used to implement the evidence into everyday practice. The study of implementation strategies and processes is critical because interventions developed in the context of publically funded efficacy and effectiveness trials are rarely scalable without adaptations to specific settings and additional tools and guidance to support uptake and implementation. AHRQ is also interested in research that advances whole-person, 360-degree care especially those with multiple chronic conditions and/or socioeconomic disadvantage. Whole person, 360-degree care is defined as the coordination of health, behavioral health, intellectual/developmental disabilities, and social services in a person-centered manner with the goals of improved health outcomes and more efficient and effective use of resources in the context of people’s lives and the communities they live in. Emphasis is on the orientation of the health care team to consider all domains of a person’s life when assessing and addressing needs. The following lists examples of AHRQ research priorities:

Improving health care quality outcomes by providing integrated, coordinated whole-person, 360-degree care to optimize individual and population health outcomes:

Generation of knowledge about how clinical teams can most effectively elicit and use a patient’s values; preferences; and personal, social, and clinical context to formulate and use plans of care in partnership with patients, caregivers, and families. Preferences, values, and context may be specific to the situation and also can change over time. Therefore, proposals that address how the process of care planning and the care plans themselves will identify and respond to the specific and dynamic nature of patients’ circumstances are of interest.
Development of information and data to create/foster/support partnerships and linkages between health care and human service systems (community-based organizations and public health) to improve whole-person care. These could be focused on improving care coordination and strengthening care transitions, ensuring that care is fully integrated to support the whole person and family.
Improvement of health care quality through the use of information systems and data resources that both provide meaningful clinical decision support to health care professionals and patients and families at the point of care and that capture important actions and outcomes of health care to increase evidence on effective practices and support clinical and organizational improvement.
Implementation of clinical prevention guidelines into learning health systems with innovative ways to include patients’ preferences and values in order to empower whole person-centered care.
Development and study of models of shared decision making that are tailored to the needs of disadvantaged populations.
Development of whole-person care research to improve health and health services efforts in persons with multiple chronic conditions.
Development, implementation, and evaluation of models of primary care for individuals with complexity, including multiple chronic conditions, disability, and socioeconomic disadvantage that improve individual and population health while reducing disparities.
Implement research findings in order to accelerate the spread of evidence-based practices by:

Implementation of evidence-based approaches to identify, understand, and overcome barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions, tools, policies, and guidelines.
Research on de-implementation of the use of health system procedures and clinical practices that are ineffective, have been prematurely widely adopted, or are harmful or wasteful.
Development of a parsimonious set of meaningful measures to evaluate implementation and impact of whole-person care.
Development of innovative ways to use data and health information technology (IT) in primary care practices in order to increase uptake and implementation of preventive services, especially those involving behavioral change (e.g. obesity prevention, substance use prevention).
Development of methods underlying the fields of evidence synthesis, stakeholder and patient engagement, decision making, and practice improvement.
Accelerating the ability of health care organizations to evolve as learning health systems that effectively apply data and evidence to improve patient outcomes by:

Synthesizing, translating, and communicating complex scientific evidence to facilitate informed care planning and health care decision making by patients, families, and health care professionals at the individual level and informed policy decision making at the health system and population level.
Discovering, testing, and spreading methods and strategies for health care practice improvement to improve health care quality, including accelerating the sustainable implementation of evidence-based practice. AHRQ has particular interest in practice improvement in primary care and ambulatory settings.
Demonstrating the effectiveness of synthesizing, translating, and communicating complex scientific evidence to facilitate informed care planning and health care decision making by patients, families, and health care professionals at the individual level and informed policy decision making at the health system and population level.
Research to Increase Accessibility and Affordability of Health Care by Examining Innovative Market Approaches to Care Delivery and Financing
Producing evidence that can be used to increase the affordability and efficiency of health care for all Americans is a major AHRQ priority. Potential research areas and questions include but are not limited to the following:

Reducing Cost Growth: In order to make health care more affordable, we must understand the drivers of those costs and their growth, as well as the relationship between cost and quality.

Comparing Performance of Systems and Providers: AHRQ is interested in research that will allow comparison of delivery system and provider performance by health care stakeholders such as consumers, providers, payers, insurers, and policymakers.

Incentives for Improving Performance: Public and private payers have provided a variety of financial and nonfinancial incentives to improve the performance of health care providers and systems. AHRQ is interested in research on the impacts of these changes—both intended and otherwise—as well as how to improve incentive programs.

Interventions to Improve Performance: While alignment with external incentives is very important, it is the provider or system that implements interventions to increase performance. AHRQ is interested in research on how interventions to improve quality or cost are best implemented within and spread across providers and systems.

Understanding how changes in policy affect the evolution of health insurance markets and the health insurance landscape is an important area for study. For example, innovations in health insurance markets, such as the increasing use of high-deductible health plans or changes in the cost-sharing structure of plans, are important developments to be analyzed. Other issues of interest include the relationship between changing health insurance markets and structural changes in the American workplace; analyses to improve our understanding of the impact of health care reform on coverage, access, and affordability; and evaluating the effects of changes in health insurance benefits on consumers' financial burdens and access to care.

AHRQ is engaged in efforts to provide evidence related to topics such as health insurance coverage, access to care and health care costs.

AHRQ is interested in funding research that will have an important impact on health care practice and policy.