AHRQ's contributions to diagnostic safety: past, present, and future

In the decade before and 10 years since the National Academies of Sciences, Engineering, and Medicine (NASEM) Improving Diagnosis in Health Care report, the U.S. Agency for Health Research and Quality (AHRQ) has played a major role in convening, coordinating and funding research and quality improvement efforts to learn from and prevent diagnostic errors. As part of a 10th Anniversary reflection of progress since the 2016 NASEM report, we review the historic diagnostic safety contributions of AHRQ and contemplate AHRQ's future at a critical time given recent staffing reductions and budget cuts. AHRQ contributions have included funding annual Diagnostic Error in Medicine conferences, studies on error epidemiology, projects to improve timeliness and accuracy of specific diagnoses (e.g. chest pain, dizziness), diagnosis improvement in various settings (ED, inpatient, primary care,) and disciplines (laboratory, radiology). In the past decade AHRQ has funded two major diagnosis improvement initiatives via a) its Patient Safety Learning Laboratories (PSLL) projects which take a systems engineering approach to improve clinical care processes, and b) 10 Diagnostic Centers of Excellence (DCE) working to develop systems, measures and new technologies to improve diagnostic safety and quality. Support for patient engagement has been a major strategic emphasis for AHRQ's projects, tools, and diagnosis safety information disseminated. While facing an uncertain future, federal funding and leadership is needed now more than ever given the extent of the problems that have been documented and need to build on progress to date. We project a bold vision for a bigger, better future AHRQ.