Targeting Interventions to Reduce Errors

在患者安全运动中形成的势头为突出问题和合作改善患者结果提供了一个重要机会。然而，可能很难就何时发生错误达成一致，更难制定出可行的、具有成本效益的系统方法来预防错误。为了响应医疗研究和质量机构的RFA，我们提议成立一个患者安全评估和研究发展中心(DCERPS)。我们中心名为“针对性干预以减少差错”(TITRE)，这凸显了一个共同的重点，即通过目标确定减少差错的有效方法。目标定位这一术语体现了我们的奉献精神，即确保我们将有限的时间和精力花在影响最大、干预措施可能起到最大作用的问题上。作为推论，这种方法需要能够在研究问题时确定既具体又常见的模式，并确保改善问题的干预措施不会使系统的反应能力饱和。DCERPS包括具有广泛研究技能的研究人员，包括卫生服务研究、临床流行病学、医学社会学、运筹学和高可靠性系统、认知心理学、伦理学、医学教育和经济学。我们有八个附属研究单位和组织，包括密歇根大学医学中心、退伍军人管理局国家患者安全中心、加州太平洋健康系统和圣约瑟夫医学中心。我们的规划阶段涉及几个战略和倡议，包括围绕特定项目的“征求建议书”组织的一系列务虚会，以及与我们的研究目标特别相关的一系列与患者安全相关的主题。我们将包括来自行业和非临床学术领域的医疗内容专家和减少错误的专家。前者将提出问题，后者将提出解决方案。我们还将成立一个多学科规划委员会，成员来自医学以外的多个学科的代表。我们相信，我们确定的研究人员和组织以及提案中概述的战略和倡议将使我们能够显著提高我们在患者安全方面的研究能力。

The momentum developed in the patient safety movement presents an important opportunity to highlight problems and work cooperatively to improve patient outcomes. It may be difficult, however, to agree when errors occur, and even more difficult to develop workable and cost- effective systematic approaches to their prevention. In response to an RFA from the Agency for Healthcare Research and Quality, we are proposing a Developmental Center for Evaluation and Research in Patient Safety (DCERPS). The name of our center "Targeting Interventions to Reduce Errors" (TITRE) highlights a common focus on identifying efficient approaches to reduce errors through targeting. The term targeting captures our dedication to ensuring that we spend our limited time and energy on problems that have the greatest impact and where interventions are likely to do the most good. As a corollary, this approach requires the ability to identify patterns that are both specific and common when studying problems and ensuring that interventions to ameliorate problems do not saturate the ability of the system to respond. The TITRE DCERPS includes investigators with a wide variety of research skills including health services research, clinical epidemiology, medical sociology, operations research and high reliability systems, cognitive psychology, ethics, medical education, and economics. We have eight affiliated research units and organizations including the University of Michigan Medical Center, the VA National Center for Patient Safety, the California Pacific Health System, and St. Joseph's Medical Center. Our planning phase involves several strategies and initiatives, including a series of retreats organized around project-specific "Requests for Proposals" and a series of patient safety related topics that are particularly relevant to our research objectives. We will involve both medical content experts and error-reduction specialists from industry and non-clinical academic areas. Problems will be presented by the former and solutions proposed by the latter. We will also have a multi-disciplinary planning committee with representatives from a wide variety of disciplines outside of medicine. We believe that the researchers and organizations that we have identified along with the strategies and initiatives outlined in the proposal will allow us to significantly enhance our research capacity in patient safety.