Problem Density, Mental Workload and Medical Error in Primary Care Practice

初级保健实践中的问题密度、脑力负荷和医疗错误

• 批准号: 7025331
• 负责人: JONATHAN L TEMTE
• 金额: $ 10万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-06-01 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7025331
• 关键词: allied health personnel; behavioral /social science research tag; clinical research; health care model; health care personnel performance; health care quality; health services research tag; human subject; interview; longitudinal human study; medical appointment; model design /development; patient care management; patient care personnel relations; patient oriented research; patient safety /medical error; primary care physician; problem solving; psychic activity level; psychological stressor

DESCRIPTION (Provided by the Applicant): The provision of healthcare services to patients in primary care practices is a highly chaotic and complex process, which is poorly understood. On average, family physicians deal with 3.05 problems during each encounter; the specific number of problems is highly variable and related to patient age and the presence of underlying medical conditions. Furthermore, the average encounter lasts 17 minutes. Medical errors can thrive in an environment of inattention, competing demands and time stress. Hypothesis: It is hypothesized that the competing demands of multiple patient problems and limited time have a significant effect on clinician mental workload, which, in turn, affects quality of care and propensity for medical error. Goals and Objectives: We will conduct a pilot study to better define the relationships between encounter problem density (number of problems per unit time), clinician mental workload (as ascertained by the NASA Task Load Index), perceived medical error, and quality indicators. The feasibility of collecting this data using physician-medical assistant teams within busy WREN practices will be explored. Methods: Each of 30 recruited WREN physicians will collect data on 20 routine adult patient visits over a four-week period, thus resulting in a sample of 600 visits. Specific data collected will include patient age and gender, the patient's anticipated number of medical issues to be discussed during the visit, clinician mental workload as measured by the post-visit NASA TLX, physician reported number and types of problems addressed, face-to-face time spent during the visit, physician estimated likelihood of error, patient reported extent to which concerns were addressed, and a copy of the resulting clinical note for assessment of quality indicators around blood pressure and tobacco use. Correlations between encounter problem density, clinician mental workload, and perceived medical error will be evaluated. Structured interviews will be conducted with physicians on a subset (n~30) of outlying encounters (i.e., high problem density and low mental workload). Significance: Results of this pilot study will be used to refine a systems model developed by industrial engineers to better define the process of primary healthcare delivery. This will serve as a basis for additional studies of the relationship between complexity and error in family practice and primary care. As this model is better developed, enhancements made at critical points may result is more efficient delivery of care with a reduction in error and improvement in quality.

描述（由申请人提供）：在初级保健实践中向患者提供医疗保健服务是一个高度混乱和复杂的过程，人们对此知之甚少。平均而言，家庭医生在每次就诊中处理3.05个问题;具体问题数量差异很大，与患者年龄和基础医疗条件有关。此外，平均相遇持续17分钟。医疗差错可能在注意力不集中、相互竞争的需求和时间压力的环境中大量发生。假设：据推测，多个病人的问题和有限的时间的竞争需求有显着的影响，临床医生的心理工作量，这反过来又影响护理质量和医疗差错的倾向。目的和目标：我们将进行一项试点研究，以更好地定义遇到的问题密度（每单位时间的问题数量），临床医生的心理工作量（由NASA任务负荷指数确定），感知医疗差错和质量指标之间的关系。将探讨在忙碌的WREN实践中使用医生-医疗助理团队收集这些数据的可行性。研究方法：招募的30名WREN医生将在四周内收集20名常规成人患者访视的数据，从而产生600次访视的样本。收集的具体数据将包括患者年龄和性别、患者在访视期间要讨论的医疗问题的预期数量、由访视后NASA TLX测量的临床医生精神工作量、医生报告的解决问题的数量和类型、访视期间花费的面对面时间、医生估计的错误可能性、患者报告的解决问题的程度，以及由此产生的临床记录的副本，用于评估血压和烟草使用的质量指标。将评估遇到的问题密度，临床医生的心理工作量和感知的医疗错误之间的相关性。将与医生进行结构化访谈，以确定一个子集（n~30）的外围接触（即，高问题密度和低脑力负荷）。重要性：这项试点研究的结果将用于完善由工业工程师开发的系统模型，以更好地定义初级保健服务的过程。这将作为进一步研究家庭实践和初级保健的复杂性和错误之间的关系的基础。随着该模型的更好发展，在关键点进行的增强可能会导致更有效地提供护理，减少错误并提高质量。