Adverse Event Directed Analysis in Ambulatory Primary Care

描述（由申请人提供）：在门诊护理中发生的不良事件（ae）的危害的性质和程度受到的监管和改进关注远远少于住院护理中观察到的ae。因此，贝勒医疗保健系统修改了IHI门诊触发工具（I-OTT）的内容和流程，以评估由德克萨斯健康提供者网络（HTPN）雇用的初级保健医生所看到的患者所接受的护理。2006年使用了一种修订后的工具- Baylor/IHI门诊触发工具（Bl-OTT）来评估2005年期间接受179名初级保健医生护理的5246名患者的护理。本综述初步估计了2005年期间与护理相关的不良事件的范围、模式和性质。主要发现包括：经审计的成人患者每100患者年护理中存在25.6个不良事件，符合需要一些额外护理/监测水平的标准。大约54%的ae具有一定程度的可预防性，80%与所提供的护理有关（20%与未提供的指示性护理有关），63%与PCP的护理有关（46%与患者责任有关，25%与PCP执业外提供的护理有关）。这些数据表明，门诊初级保健存在相当大的患者风险，并强烈鼓励提出与以下广泛目标相关的具体目标：a)改进和表征BI-OTT仪器/审计过程，以便更广泛地使用，以更准确地估计初级保健患者的伤害负担；b)使用这种相对无偏见的方法来选择事件进行深入研究，以评估导致观察到的威胁/风险的性质

DESCRIPTION (provided by the applicant): The nature and extent of harm from adverse events (AEs) taking place in ambulatory care has received considerably less regulatory and improvement attention than AEs observed as part of inpatient care. Accordingly, the Baylor Health Care System has modified in content and process the IHI Outpatient Trigger Tool (I-OTT) to evaluate care received by patients seen by primary care physicians employed by HealthTexas Provider Network (HTPN). A revised instrument - the Baylor/IHI Outpatient Trigger Tool (Bl-OTT) was used in 2006 to evaluate the care of 5,246 patients who received care from 179 primary care physicians during 2005. This review has allowed initial estimates of the extent, pattern and nature of AEs related to care during 2005. Major findings include the existence of 25.6 adverse events per 100 patient years of care for audited adult patients that met the criterion of requiring some additional level of care/monitoring. Approximately 54% of AEs had some level of perceived preventability, 80% were associated with the care that was provided (vs. 20% related to indicated care that was not provided) and 63% were associated with the PCP's care (46% were associated with patient responsibility and 25% with care provided outside the PCP's practice). These data indicate that there is considerable patient risk in ambulatory primary care and strongly encourages the proposed specific aims related to the broad goals of: a) refining and characterizing the BI-OTT instrument/audit process for broader use to more accurately estimate the burden of harm to primary care patients; and b) using this relatively nonbiased approach to select events for in depth study to evaluate the nature of the threats/risks that contribute to the observed AEs. The results of the proposed research will: 1) generate a mature audit instrument/process (including electronic data collection tools and training manuals) that can be used to quantify AEs in ambulatory environments broadly; 2) provide a large scale estimate of the extent, nature and source of AEs with sufficient generalizability to begin to estimate this burden upon adult patients in the US; 3) establish the underlying high risk care processes that contribute to the development of AEs that do NOT depend upon more biased ways to identify them; 4) estimate the burden of AEs that are amenable to prevention or amelioration as a result of risk mitigation. The more mature BI-OTT2 audit instrument / process will provide the opportunity to: a) measure the effectiveness of interventions designed to improve patient safety in ambulatory primary care; b) permit longitudinal evaluation of the experience of patients with an identified AE (related to their clinical and economic outcomes); c) permit evaluation of similar patient outcomes that derive from care in practices that demonstrate higher vs. lower rates of AEs as identified through use of the Bl-OTT2.