Advancing Safety Process Innovation in Rheumatology (ASPIRE)

项目摘要 尽管人们普遍认识到美国医疗保健系统中普遍存在的患者安全问题， 制定可行的、可扩展的解决方案的工作已经滞后，特别是在流动环境中。需要新 提高安全性的方法在使用高风险药物的非卧床患者的护理中尤其紧迫。 免疫抑制药物，因为这类药物的使用急剧增加， 可预防的不良事件有所增加。在上一个AHRQ资助期间，我们的研究团队产生了 患者安全性风险和不良事件的新流行病学证据，并使用此信息开发 医疗保险和医疗补助中心基于电子健康记录的质量措施（eMeasures） 服务质量付款计划。此外，我们在美国全国范围内实施了这些电子措施， RISE登记处，其中包括来自超过三分之一的电子健康记录数据， 美国执业流变学家在这项建议中，我们的目标是在这项工作的基础上， 使用高危免疫抑制药物的个体的安全性。在目标1中，我们将使用来自RISE的数据 与医疗保险索赔相关的登记处，以识别新批准的患者安全性错误 免疫抑制药物，并分析这些错误的种族/民族，社会经济地位，医疗 复杂性，获得护理和实践特点。在目标2中，我们将进行全面评估 当前国家患者安全措施与免疫抑制药物相关，评估可行性， 在不同的实践环境、电子健康记录系统和访问类型中的可靠性和有效性 （远程医疗与面对面）。在目标3中，我们将使用基于实施科学的混合方法 理论，以确定非卧床患者安全eMeasures性能的关键驱动因素。数据从该 研究将用于开发和传播第一个实施工具包，旨在改善患者 高风险免疫抑制药物的安全性。这项研究将大大有助于 国家基础设施，以改善流动病人的安全，为数百万美国人与免疫- 介导的疾病。

Project Summary Despite widespread recognition of pervasive patient safety problems in the U.S. health care system, research to develop feasible, scalable solutions has lagged, particularly in the ambulatory setting. The need for new approaches to improve safety is especially pressing in the care of ambulatory patients using high-risk immunosuppressive medications, as use of this category of medications has grown precipitously and reports of preventable adverse events have increased. In the last AHRQ funding period, our research team generated new epidemiological evidence of patient safety risks and adverse events and used this information to develop electronic health record-based quality measures (eMeasures) for the Centers for Medicare and Medicaid Services Quality Payment Program. In addition, we implemented these eMeasures nationally in the American College of Rheumatology's RISE registry, which includes electronic health record data from over one-third of U.S. practicing rheumatologists. In this proposal, we aim to build on this work to improve ambulatory patient safety for individuals using high-risk immunosuppressive drugs. In Aim 1, we will use data from the RISE registry linked to Medicare claims to identify emerging patient safety errors for newly approved immunosuppressive drugs and analyze these errors across race/ethnicity, socioeconomic status, medical complexity, access to care and practice characteristics. In Aim 2, we will perform a comprehensive evaluation of current national patient safety eMeasures related to immunosuppressive drugs, assessing feasibility, reliability, and validity across diverse practice settings, electronic health record systems, and visit types (telemedicine versus face-to-face). In Aim 3, we will use mixed-methods grounded in implementation science theory to determine key drivers of performance on ambulatory patient safety eMeasures. Data from this research will be used to develop and disseminate the first implementation toolkit designed to improve patient safety for high-risk immunosuppressive drugs. The proposed research will contribute significantly to the national infrastructure to improve ambulatory patient safety for the millions of Americans with immune- mediated diseases.