Ambulatory Patient Safety of Clients in Treatment for Substance Abuse

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DESCRIPTION (provided by the application): Numerous safety concerns surround outpatient substance abuse treatment for people with addictions. People in treatment for chemical dependency often have co-occurring mental and physical health problems. Multiple medications aimed at these disorders may be prescribed by assorted providers. Medication errors can easily occur when prescriptions are written by multiple providers acting with limited or no data in common. These considerations are important because more than a million people in the United States obtain substance abuse treatment each year chiefly in outpatient programs. Most substance abuse treatment services are delivered in public sector programs that typically lack sophisticated information technology. Moreover, priority populations such as minority group members and low-income individuals are greatly over-represented. However, proactive risk assessment methods have rarely if ever been applied to the systems serving substance abuse treatment clients. The proposed project will address risk assessment for clients who make transitions among addiction programs, mental health clinics, and primary care providers within a large public-sector academic health care system. First, a process map will be developed tracking patient transitions from entry into the addiction treatment program through follow-up at mental health facilities and primary care clinics. Second, the process map will be authenticated via interviews and focus groups with stakeholders in order to secure accurate representation of client information exchange and identification of nodes that represent threats to patient safety. Stakeholders will include clients, providers (addiction, mental health, and primary care), receptionists, clerical staff, billing personnel, and administrators. Third, key informant interviews and record reviews will generate examples of adverse events with emphasis on medication errors. Fourth, staff will conduct "walk-throughs" to validate the process map and pinpoint potential threats to patient safety. Fifth, the refined process map and the examples of adverse events will be examined using root cause analysis in order to understand sources of errors. Sixth, survey instruments will be modified to address substance abuse treatment and employed to measure the safety climate surrounding services for clients with chemical dependency. The proposed planning project will set the stage for interventions as well as methodology to determine whether they are successful.