Ƶdefines patient safety as “freedom from accidental or preventable injuries produced by medical care.”2 Patient safety gained national attention in the late 1990’s with the publication of the Institute of Medicine’s report To Err is Human, which estimated that thousands of patients die each year due to preventable errors in U.S. hospitals.3 High-quality primary care plays a critical role in patient safety because it ensures that care is comprehensive, coordinated, and continuous. As described in The Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families (PDF 3.3 MB), Ƶlays out how the relationships developed in the primary care setting among clinicians, patients, and families are essential for ensuring that care is centralized, safe, and effective.4 Primary care helps to encourage active communication between clinicians and patients, as well as coordination and collaboration within and across clinical teams. This active communication and coordination prevents diagnostic delays and medication errors, avoids fragmentation of care, and facilitates transitions in care, thus reducing avoidable hospital admissions and readmissions.5,6
Ƶfunds research and implementation projects through its Center for Quality Improvement and Patient Safety (CQuIPS) to understand approaches to deliver safer patient care. This section provides information about patient safety grants, initiatives, and resources that are focused on primary care.
Grants
Across the AHRQ primary care research grants with active funding in FYs 2023 and 2024, 18 focus mainly on patient safety. This includes eight R01 grants (Research Projects), seven R18 grants (Research Demonstration and Dissemination), and three K08 grants (Mentored Clinical Scientist Development Awards).
An additional five grants with some focus on patient safety are described in other topic area sections, including one in Practice and Quality Improvement, one in Health Disparities, one in Digital Healthcare, one in Person-Centered Care, and one in Primary Care Workforce.
We summarize the 18 grants focused on patient safety below, organized by subtopic. The subtopics are:
- Medication Safety and Management.
- Improving Diagnostic Accuracy.
- Diagnostic Safety and Quality.
- Predictive Tools for Patient Safety.
- Safety of Telehealth and E-Health.
Medication Safety and Management
Seven grants focus on reducing adverse drug events and inappropriate use of antibiotics and improving medication management.
(R01)
PIs: Kimberly Gold Blumenthal; Alysse Gail Wurcel
Organization: Tufts Medical Center
Grant Start Date: May 1, 2023
Aims to understand the barriers and facilitators to removing inaccurate penicillin allergy labeling in primary care, which has been shown to decrease exposure to suboptimal antibiotics and has the potential to reduce multi-drug resistance and healthcare-associated infections. Long term, the study aims to increase implementation of penicillin allergy de-labeling in primary care and reduce infection-associated health disparities.
(R18)
PIs: Ryan J. Coller; Nicole E. Werner
Organization: University of Wisconsin – Madison
Grant Start Date: May 2, 2022
Develops an app (MedS@HOME) to improve medication safety for children with medical complexity who may receive care in pediatric primary care and from specialists. The app supports standardized medication management across caregivers to increase administration accuracy and reduce medication-related adverse events.
Learn more about this study in a recent NCEPCR webinar: Innovative Use of Technology in Primary Care Delivery.
(R18)
PI: Joel F. Farley
Organization: University of Minnesota
Grant Start Date: July 1, 2021
Evaluates the implementation of pharmacist-provided comprehensive medication management to coordinate care for high-need/high-cost patients when they transition between the hospital and primary care. In this program, a health information exchange’s automated electronic alert system notifies primary care clinics when patients need pharmacist-provided comprehensive medication management after a hospital visit.
(R01)
PI: James A. Feinstein
Organization: University of Colorado – Denver
Grant Start Date: April 1, 2023
Assesses the effectiveness of a pharmacist-led Pediatric Medication Therapy Management intervention compared with usual care (e.g., primary care or specialist provider) to reduce medication-related problems (such as inappropriate therapy, undertreated symptoms, or adverse drug events) for children with medical complexity in an outpatient complex care program.
(R01)
PIs: Jeffrey A. Linder; Julia E. Szymczak
Organization: Northwestern University at Chicago
Grant Start Date: September 30, 2023
Aims to reduce antibiotic overuse in ambulatory care settings, including primary care, by understanding and addressing the concerns and behaviors of patients known to frequently use antibiotics inappropriately. The mixed-methods study includes controlled cohort studies to develop patient categories by antibiotic usage; interviews and qualitative analyses to identify the social and behavioral factors that influence antibiotic use among patients with frequent inappropriate antibiotic use; and develops and tests a patient-centered behavioral nudge intervention to reduce inappropriate antibiotic use among these patients.
(R18)
PIs: Ranjit Singh; Heui-Yen Chen; David Jacobs
Organization: State University of New York at Buffalo
Grant Start Date: September 1, 2023
Aims to develop a learning lab for older adult patients and caregivers to decrease risk for medication harm during transitions of care. The learning lab encourages patients and their caregivers to work with their healthcare team to achieve safer medication use during this vulnerable time, which leads to the design, development, and testing of scalable human-centered interventions across the transition of care continuum, including in primary care.
(R01)
PIs: Barbara Wells Trautner; Larisa Grigoryan
Organization: Baylor College of Medicine
Grant Start Date: July 1, 2019
Examines factors at the patient, healthcare system, and clinician encounter levels that predict use of nonprescribed antibiotics by patients seen in safety net primary care clinics, who are predominantly uninsured and often have low incomes. Develops a communication tool to help clinics guide their patients toward safer antibiotic use.
Improving Diagnostic Accuracy
These five grants examine various approaches to improving diagnostic accuracy.
(K08)
PI: Irit R. Rasooly
Organization: Children’s Hospital of Philadelphia
Grant Start Date: September 30, 2022
Uses electronic health record (EHR) data and systems analysis to develop clinical decision support (CDS) strategies that can identify and help diagnose child abuse in primary care settings. The research team is using EHR data to detect and validate markers of physical abuse to help identify children experiencing abuse; using EHR simulations to identify abuse-related diagnostic errors; and working to develop feasible, acceptable, and appropriate CDS strategies for improved child abuse detection and diagnosis.
Learn more about this study in a NCEPCR Impact Story: Advancing Primary Care Research Careers (PDF, 1 MB).
(R01)
PIs: Patricia C. Dykes; Jin Chen
Organization: Brigham and Women’s Hospital
Grant Start Date: September 1, 2024
Develops an advanced, data-driven electronic clinical quality measure to measure timely, delayed, and missed venous thromboembolism (VTE) diagnoses in ambulatory and urgent care settings. Uses EHR data and stakeholder expertise to understand risk factors for VTE diagnostic errors, disparities in care, and health outcomes. Develops artificial intelligence and statistical learning tools to identify and address vulnerabilities in workflows to help reduce delayed and missed VTE diagnoses.
(R01)
PIs: Larisa Grigoryan; Barbara Wells Trautner
Organization: Baylor College of Medicine
Grant Start Date: August 1, 2023
Tests the effectiveness of a diagnostic stewardship intervention to improve the accuracy of urinary diagnostic testing by reducing the contamination of urine samples leading to inappropriate antibiotic use in primary care. Develops, assesses, and iteratively improves patient education on proper midstream clean-catch urine sample collection strategies, with input from stakeholders to address known barriers to accurate urine sample collection.
(R01)
PI: Gordon David Schiff
Organization: Brigham and Women’s Hospital
Grant Start Date: September 30, 2024
Analyzes the relationships between diagnostic quality (processes, communication with patients, and outcomes), time allotted for clinical visits, and clinician stress. Comparing primary care encounters from one clinic that allows 20 minutes per visit with one that allows 30 minutes per visit, the research team solicits patient feedback about processes and outcomes for diagnostic visits; uses EHR timestamp data to assess visit time and outcomes; and conducts qualitative analysis of diagnostic patient/clinician conversations during visits based on artificial intelligence–generated EHR notes.
(R18)
PIs: Jeffery A. Gold; Raj M. Ratwani
Organization: Oregon Health & Science University
Grant Start Date: September 30, 2019
Develops a library of validated EHR-based simulations to improve diagnostic safety in ambulatory care. The research team is using a combination of administrative and claims data to identify diagnoses at risk for diagnostic error in ambulatory care settings and the EHR use errors associated with those diagnostic errors. Uses this data to develop simulations for five ambulatory care settings, including primary care, and validates the use of the simulation activities as a training tool to change EHR use patterns and reduce diagnostic errors.
Diagnostic Safety and Quality Centers
These two grants are part AHRQ’s Diagnostic Safety Centers of Excellence grant initiative, which had the goal of collectively developing systems, measures, and new technology solutions to improve diagnostic safety and quality.
(R18)
PIs: Ramin Khorasani; Ronilda Lacson
Organization: Brigham and Women’s Hospital
Grant Start Date: September 30, 2022
Develops a Diagnostic Center of Excellence to reduce failures in timely performance of clinically necessary diagnostic imaging exams and interpretation errors. The team implements IT-enabled functions and workflows to enhance a clinical dashboard with improved EHR integration and monitoring as well as learning capabilities to help reduce diagnostic errors and health disparities across settings, including primary care. In addition, this project provides opportunities for peer learning to reduce interpretive errors and convenes a team of clinicians to develop consensus recommendations for the management of lung, prostate, pancreatic, and adrenal cancers and embed the recommendations into the EHR.
(R18)
PI: Hardeep Singh
Organization: Baylor College of Medicine
Grant Start Date: September 30, 2022
Develops a center that supports the implementation of surveillance and feedback systems to improve diagnostic safety in healthcare organizations. The center works to accelerate the uptake of electronic trigger (e-trigger) tools, which mine large sets of clinical and administrative data to identify signals for likely adverse events. E-trigger algorithms can efficiently identify patterns of care indicating missed or delayed diagnoses in primary care as well as other settings.
Predictive Tools for Patient Safety
These two studies use innovative approaches to understand and improve patient safety.
(K08)
PI: Caleb Ward
Organization: Children’s Research Institute
Grant Start Date: August 1, 2024
Refines and pilot tests the Pediatric Observation Priority Score (POPS) for use by Emergency Medical Services (EMS) technicians as a risk assessment tool to identify which children can be safely managed without going to an emergency department (ED). First, the study identifies factors associated with under triage of children who are not transported by EMS to an ED; then works to optimize the acceptability, appropriateness, and feasibility of the POPS tool with clinical end-users; and finally, uses simulations and field pilot studies to assess the refined POPS tool. Once validated, the POPS will be useful to study EMS innovations for caring for children, including treatment in pace, telemedicine, and integration of primary care.
(K08)
PI: Hsin-Hsiao Scott Wang
Organization: Boston Children’s Hospital
Grant Start Date: July 1, 2024
Aims to reduce the risk of renal injury from febrile urinary tract infection in children by developing and implementing prediction modeling to assist primary care clinicians and families in determining the most optimal timing for a voiding cystourethrogram. Develops the machine-learning prediction model using a combination of pediatric practice data and advice from experts in related fields and then piloted to further adapt the model to maximize adoption and sustainability.
Safety of Telehealth and E-Health
Two studies examine safety issues related to the use of telehealth and e-health.
(R01)
PI: Hamish SF. Fraser
Organization: Brown University
Grant Start Date: July 1, 2023
Evaluates the safety, usability, and diagnostic and triage accuracy of a symptom checker smartphone app used by patients to identify when urgent primary or emergency care is needed, such as a transient ischemic attack or stroke. Tests the symptom checker app with patients to assess impact on their intentions to seek care, collects patient feedback on the app’s usability, compares diagnostic and triage accuracy of the app compared with the assessment of a treating physician, and evaluates the impact on patient decision making of two options for presenting diagnosis and triage information through the app. Uses data collected in a community setting to evaluate the influence of patient characteristics, including age, sex, race, ethnicity, country, and socioeconomic group on the presentation of symptoms.
(R18)
PIs: Raj M. Ratwani; Ethan A. Booker
Organization: MedStar Health Research Institute
Grant Start Date: September 30, 2022
Aims to develop the SafE-T C2 Learning Laboratory, which will address issues related to chronic conditions, health disparities, and primary care. The laboratory will help identify safety issues for telehealth patients (particularly patients with chronic conditions) and guide the development and implementation of solutions. The laboratory uses the socio-technical system engineering framework, which underscores that technology, policies, processes, and people all play a role in patient safety issues. Implements identified solutions across multiple outpatient clinics.
Initiatives and Resources
A wide range of patient safety–related resources and information can be found on AHRQ’s Patient Safety and Quality Improvement webpage. , a searchable resource with information and tools related to patient safety is still available online—but is not currently funded, so the last update was in March 2025. The focus of these Ƶresources is broader than primary care, however, many resources available on these webpages are relevant for primary care settings. Below we share information about several primary care-related patient safety materials that were initially released or updated in 2023 and 2024.
ձշʱʳ®
In 2023, Ƶupdated Team Strategies & Tools to Enhance Performance & Patient Safety (ձշʱʳ®). ձշʱʳ® 3.0 is an evidence-based set of tools designed to improve patient outcomes by improving the communication and teamwork skills of healthcare teams and emphasizing patient engagement. Updated materials include welcome guides, curriculum materials with multiple modules, a pocket guide, patient videos, and training videos. Ƶnow offers the ձշʱʳ® training free of charge, with continuing education units available for a fee.
Diagnostic Safety Issue Briefs
Three recently published Diagnostic Safety Issue Briefs are specifically relevant to primary care:
- Reimagining Healthcare Teams: Leveraging the Patient-Clinician-AI Triad to Improve Diagnostic Safety. Provides a framework for how patients and clinicians can safely and effectively use artificial intelligence and machine learning when making diagnostic decisions.
- Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors:
- Volume 1: Why Patient Narratives Matter. Highlights the importance of collecting patient perspectives about the impacts of diagnosis-related events to help build clinician understanding and reduce patient harm.
- Volume 2: Eliciting Patient Narratives. Discusses the importance of using rigorous methods to collect patient experiences about diagnosis-related events and how this information can be used to advance learning about the diagnostic process.
Improving Healthcare Safety by Engaging Patients and Families
This report (PDF, 578 KB) summarizes research findings from across 53 Ƶgrants related to the importance of patient and family engagement to improve healthcare safety and quality.
