ARRAOS Recovery Act Limited Competition Behavioral Economics for Nudging the Implementation of Comparative Effectiveness Research Clinical Trials (RC4) | Apply Online

Opportunity Summary:

The ARRAOS Recovery Act Limited Competition Behavioral Economics for Nudging the Implementation of Comparative Effectiveness Research Clinical Trials (RC4) grant opportunity (Funding Opportunity Number RFA-OD-10-001) was a National Institutes of Health (NIH) funding announcement backed by American Recovery and Reinvestment Act of 2009 (ARRA) funds, with additional support tied to the Agency for Healthcare Research and Quality (AHRQ). Its central goal was to fund rigorous clinical trials that test whether behavioral economics based "nudges" can measurably increase how often health care providers actually use findings from comparative effectiveness research (CER) in day-to-day clinical practice. The motivation is straightforward: even when CER identifies treatments, procedures, or care pathways that appear superior, real-world adoption by clinicians and health systems is often slower and smaller than expected. This FOA treated that implementation gap as a practical, high-impact research problem and asked applicants to address it with experimentally tested behavioral interventions rather than relying only on education, guidelines, or financial incentive programs.

A defining requirement of the opportunity was that applicants propose controlled trials with random assignment, meaning the project needed to be designed as either a randomized clinical trial (RCT) or a cluster randomized trial (CRT). Randomization could occur at the individual level (for example, individual clinicians) or at a clustered level such as practices, hospitals, or even larger organizational units. In other words, this was not a request for observational research, descriptive implementation reports, or purely qualitative studies. The program was specifically focused on testing causal effects of behavioral economics strategies on provider behavior and uptake of CER-backed practices, using experimental designs strong enough to produce credible, decision-ready evidence.

The research theme centered on behavioral economics, described here as an interdisciplinary approach blending insights from psychology, decision science, and economics to reflect how people actually make decisions, rather than assuming perfectly rational behavior. The FOA explicitly linked this perspective to classic work like Kahneman and Tversky's Prospect Theory and later contributions emphasizing predictable decision biases, framing effects, defaults, and other features of real-world choice. For this grant, the practical implication was that provider decisions might be shifted by altering choice architecture: changing defaults in ordering systems, adjusting how options are framed, simplifying decisions, using timely prompts, leveraging social norms, or otherwise designing environments that make evidence-aligned actions easier and more likely. The announcement also pointed out that some nudges, particularly default-based approaches, could potentially deliver behavior change at lower cost than traditional strategies such as some pay-for-performance (P4P) arrangements, which can be expensive, administratively complex, and uneven in effectiveness.

On the CER side, the FOA required that the meaning of "comparative effectiveness research" follow the Federal Coordinating Council definition referenced in the HHS Recovery Act CER annual report. Practically, that meant the targeted behaviors and clinical decisions in the proposed trials needed to be tied to credible CER findings comparing interventions, tests, or delivery strategies, and the goal was to increase real implementation of what CER suggests works better for patients in relevant settings. The intended end result was higher-quality care driven by stronger alignment between everyday practice and the best available comparative evidence.

Administratively, this was a discretionary grant program under the Health category, using a grant funding instrument. The NIH anticipated making about 2 awards, with an estimated total funding level of $15,000,000. There was no cost sharing or matching requirement, which matters because it reduced barriers for applicants that might not have had institutional capacity to provide matching funds. Key dates reflected the Recovery Act timeline: it was posted and created on December 28, 2009, with an original and current closing date of April 7, 2010, and an archive date of May 8, 2010.

Eligibility was broad and inclusive across government, academic, nonprofit, and private sectors. Eligible applicants included state, county, city or township governments, special district governments, independent school districts, and U.S. territories or possessions. It also included public and state-controlled institutions of higher education, private institutions of higher education, nonprofits with and without 501(c)(3) status, small businesses, and other for-profit organizations (excluding small businesses in that specific category listing, though other for-profits were allowed). The opportunity also explicitly included tribal governments and tribal organizations, public housing authorities and Indian housing authorities, and a range of mission-focused institutions such as Historically Black Colleges and Universities (HBCUs), Hispanic Serving Institutions, Alaska Native and Native Hawaiian Serving Institutions, and Tribally Controlled Colleges and Universities (TCCUs). Faith-based and community-based organizations were listed as eligible, and certain federal entities were also included under "Eligible Agencies of the Federal Government." Taken together, the eligibility structure signaled an intent to fund trials in real clinical environments and delivery systems, not only in traditional academic medical centers.

In practical terms, a competitive application under this FOA would have been expected to identify a specific CER-supported practice change (for example, choosing a preferred medication, appropriate imaging use, evidence-aligned preventive care workflows, or other clinician behaviors), design a behavioral economics intervention that directly targets known decision frictions, and then evaluate it using a randomized design with appropriate outcomes. Outcomes would likely include measurable provider behaviors (ordering, prescribing, referral patterns, adherence to protocols) and potentially downstream patient or system outcomes when feasible, along with attention to scalability and cost-effectiveness given the FOA's emphasis on potentially lower-cost nudging approaches.

The complete announcement was hosted through the NIH grants guide (link provided in the source), and the contact listed for access or technical issues was the NIH Office of Extramural Research (OER) webmaster.

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