CRICO Risk Management Grant Program 2021 RFA Announcement

Advance patient safety in your practice.

Boston, MA, August 7, 2020—CRICO, a recognized leader in evidence-based risk management, owned by and serving the Harvard medical community, is pleased to announce a Request for Applications (RFA) to advance our commitment to patient safety. This RFA is designed to support identification, evaluation, and implementation of patient safety solutions aligned with identified areas of malpractice risk. Priority will be given to proposals that are original, evidence-based, aimed at improving patient safety and reducing malpractice risk, and designed for operational sustainability within the investigator’s organization. This includes proposals that:

1. Examine specific domains of malpractice risk and patient harm while assessing the factors at various levels that contribute to such risks.

2. Investigate strategic interventions at individual, systems, and organizational levels to help reduce and eliminate specific patient harm and malpractice risk.

3. Disseminate proven solutions to reduce malpractice risk. It is anticipated that knowledge gained from these projects will positively affect care delivery and promote risk reduction.
   
   

Focus Areas

Applications must also match one of the specified focus areas. Please note in your Letter of Intent which area you plan to address and which type of grant (i.e., a, b, or c from above) best defines your proposal’s intent. CRICO is interested in funding projects that examine patient safety risks, investigate strategic interventions for those risks, and/or disseminate proven solutions in the following areas:

1. Patient Assessment: We are interested in proposals that address “clinical situations which present vulnerabilities to front-line clinicians and predispose them to diagnostic errors” (Reyes, 2016). Issues to be addressed include:
   
   
   • Factors (system or individual) that contribute to a provider’s failure or inability to identify, address, or synthesize relevant clinical information—e.g., symptoms, history, physical findings, diagnostic tests, imaging results—leading to missed or delayed diagnosis. This category also includes failures or delays in ordering or interpreting diagnostic studies.
   • Factors related to narrow diagnostic focus (includes reliance on previous assessment or diagnosis, atypical presentations, and inadequate patient assessment).
   • Failure to rescue, defined as a clinician’s or provider’s delay in or lack of appropriate and timely response to a patient’s deteriorating clinical condition.
     Factors (system or individual) that contribute to a provider’s failure or inability to provide equitable patient care. The Institute of Medicine (IOM) defines health equity as “providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.”
   • Risks associated with medical documentation, including insufficient or incomplete documentation, use of medical scribes, use of templates, use of voice recognition.
   
   We are interested in applications that explore risks in Patient Assessment for the following clinical domains: Emergency Medicine, Radiology, General and Internal Medicine, Medicine Sub-specialties, and Advanced Practice Clinicians (i.e., Physician Assistants and Nurse Practitioners)
   
   
2. Management and Performance of Medical Treatment/Procedural Safety: (i.e., procedures performed outside the operating room): We are interested in proposals that address the management and performance of medical treatment (procedures performed outside the operating room) by Emergency Medicine, General and Internal Medicine, Interventional Radiology, Radiology, and Nursing. Issues to be addressed include:
   
   
   • Ways to reduce the risk of improper technical performance of specific procedures or treatments, e.g., cardiac catheterization, endoscopy, and procedures performed in interventional radiology.
   • Risks associated with improper management of a patient’s medical treatment course before, during, or after a procedure, e.g., delays, failure or mismanagement of acute and/or chronic conditions, improper medication management, improper monitoring.
   • Risks associated with a failure or inability to provide equitable patient care. The Institute of Medicine (IOM) defines health equity as “providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.”
   • Risks associated with medical documentation, including insufficient or incomplete documentation, use of medical scribes, use of templates, use of voice recognition.
3. Other Areas of Clinical Focus:
   • Emergency Medicine
     We are interested in proposals that address risks and challenges associated with patient throughput, capacity management (patient surge), clinical processes for the management of complex patients, and the clinical responsibilities and associated risks of Advanced Practice Clinicians (i.e. Physician Assistants and Nurse Practitioners).
   • OB/GYN
     We are interested in proposals that include the design, evaluation or dissemination of interventions aimed at addressing risks associated with the recognition and management of fetal distress, and the clinical responsibilities and associated risks of Advanced Practice Clinicians (i.e., Physician Assistants and Nurse Practitioners).
   • Surgery
     We are interested in proposals that address risks associated with, and potential interventions for, the technical performance of general, orthopedic, neuro, and plastic surgery. We are also interested in proposals that address risks associated with and the clinical responsibilities and associated risks of Advanced Practice Clinicians (i.e. Physician Assistants and Nurse Practitioners).
   • Emerging Health Care Delivery Models
     We are interested in proposals that examine and evaluate the application of innovative health care delivery models including the impact of telehealth and virtual visits.
   • Data Analytics
     We are interested in proposals that investigate new and innovative ways to leverage internal malpractice data with external data sources such as administrative data, billing data, EHR data, clinical data repositories, and other referential data sets to identify leading indicators of safety and malpractice risk.
   • Employment Practices Liability
     We are interested in proposals that identify the underlying contributing factors of, address risks associated with, and establish potential risk mitigating interventions for Employment Practices Liability, which includes but is not limited to, claims of discrimination (based on sex, race, age or disability, for example), retaliation, harassment, sexual harassment, wrongful termination, and other employment-related issues, such as failure to promote.

The RFA is offered to CRICO-insured members at all levels of experience. Partnerships across CRICO-insured organizations are encouraged. Submissions that contain designs to further impact enterprise risk and emerging patient safety issues are also encouraged.

RFA Timeline

Dates with deadlines: materials due no later than 5 p.m.

August 7, 2020 RFA announcement
September 17, 2020 Deadline for Letter of Intent
October 9, 2020 Invitations for full applications
November 12, 2020 Deadline for full applications
March 2021 Final proposals for Board Approval
April 2021 Notice of Grant Award

Project Duration and Funding

Support will be provided for no more than two years, with a total budget not to exceed $200,000 per award. CRICO principal investigators must agree to dedicate at least five percent annualized effort to approved projects during the grant cycle. All research is to be conducted at CRICO member health care organizations, with written notification from these organizations acknowledging their support and approval. Applicants with proposals requiring greater than $200,000 to meet the project’s aims will need to demonstrate proof of co-funding.

Letters of Intent will be reviewed to determine alignment with CRICO’s mission and targeted areas of funding interest. Proposals deemed most congruent with CRICO’s objectives will be invited to submit a full-length, detailed proposal for peer review. Institutional subject matter experts within each target area will serve as reviewers. Final proposals selected by the review committee will be submitted to the CRICO Board of Directors in March 2021 for funding consideration and approval.

For More Information

If you have any questions regarding this announcement, please contact Jeff Timperi, Grants Manager, at [email protected] or 617.450.6887, or Fred Essien, Grants Administrator, at [email protected] or 617.450.5517. The grants team can also be reached by email at [email protected].

Reference

Reyes, H. Diagnostic Pitfalls: A New Approach to Understand and Prevent Diagnostic Error. Society to Improve Diagnosis in Medicine 9th International Conference. Hollywood, CA. 2016.