Measuring and Improving Ambulatory Patient Safety with an Electronic Dashboard

描述(申请人提供)：患者安全问题，如不良药物事件，监测失败，以及缺乏对异常测试的跟进，在门诊环境中经常发生，很少有健康信息技术(HIT)启用的方法来解决这些门诊安全差距的评估。为了有效，用于检测和缓解患者安全问题的HIT工具需要检测整个“医疗之家”人群的问题，而不是专注于去门诊就诊的个人。此外，这种以HIT为重点的方法在资源不足的安全网卫生保健环境中是最迫切需要的，这些环境照顾的是健康差距较大的人群，而且缺乏HIT基础设施。这项研究的长期目标是识别和减轻患者在整个Safet-Net医疗保健系统中使用HIT的门诊安全风险。该应用程序的目标是开发一个HIT界面，该界面综合来自电子健康记录的数据，以创建以门诊患者为中心的安全仪表板(安全措施的可视摘要)，并在以患者为中心的安全网医疗之家(PCMH)环境中对该工具进行试点测试。中心假设是，使用这个仪表盘将识别普遍存在的安全风险，并允许使用跨学科护理团队实时缓解风险。该工具将允许检测整个人口的风险模式，以向卫生系统流程变化提供信息，以降低风险。流程变更的一个例子是对选定的高风险异常测试进行进一步的自动化/警报，但未完成后续工作。这项研究的基本原理是，HIT支持的方法可以有效地识别患者的安全风险，并且在基于团队和基于人群的初级保健的背景下，这些风险可以实时采取行动，而不是通过定期的、基于访问的初级保健。根据仪表板方法的经验和表明存在重大安全问题的初步数据，我们提出了两个具体目标：(1)开发一种用于初级保健环境的流动安全电子仪表盘。仪表板将使用存储在电子健康记录和行政数据库中的数据，向护理团队通报门诊环境中选定的、以证据为基础的高度优先的安全风险；以及(2)：进行一项试点研究，以评估将仪表板的使用纳入PCMH模式的可行性。我们将在旧金山总医院的一家初级保健诊所进行这项试点研究。除了支持 为了评估可行性，这项试点研究将使我们能够收集关于其在改善选定的高度优先的安全问题方面的“现实世界”效用的初步数据。这种方法是创新的，因为卫生保健仪表板以前从未被用来解决患者安全风险或告知卫生系统流程变化，而且它们也没有在PCMH交付的背景下进行测试。这项拟议的研究具有重要意义，因为它有望告知整合到基于团队的护理中的以人群为重点的HIT工具可以在多大程度上识别和缓解门诊初级护理中的不安全情况。归根结底，社会保障网络的进步有可能更有效地提供医疗服务，减少医疗差距。 公共卫生相关性：在美国，患者安全不足已被认为是一项重大的公共卫生挑战，由于大多数医疗保健发生在门诊环境中，因此改善患者安全的努力必须包括门诊护理环境。这项提议是设计一种健康信息技术创新，即患者安全仪表盘，定义为对安全差距的交互式、可视化总结。我们选择了4个高优先级的安全差距进行调查，包括两个选定的高风险药物类别用于监测，对异常结肠癌筛查结果的不完全随访，以及因心力衰竭住院后缺乏门诊护理。然后，我们计划试行测试该工具的能力，以有效地识别和解决安全网门诊医疗系统中选定的高优先级患者安全问题。

DESCRIPTION (provided by applicant): Patient safety problems such as adverse drug events, monitoring failures, and lack of follow-up of abnormal tests, occur commonly in outpatient settings, and few health-information-technology (HIT)-enabled approaches to addressing these outpatient safety gaps have been evaluated. To be effective, HIT tools to detect and mitigate patient safety problems need to detect problems across the population of a "medical home", rather than focusing on individuals attending outpatient visits. Moreover, such HIT-focused approaches are most urgently needed in under-resourced safety-net health care settings that care for populations with health disparities and that lack HIT infrastructure. The long-term goal of this research is to identify and mitigate patient outpatient safety risks using HIT across safet-net health care systems. The objective of this application is to develop an HIT interface that synthesizes data from the electronic health record to create an outpatient- focused ambulatory safety dashboard (visual summary of safety measures) and to pilot-test this tool in a safety-net patient-centered medical home (PCMH) setting. The central hypothesis is that using this dashboard will identify prevailing safety risks and permit mitigation of risks in real-time using a interdisciplinary care team. This tool will allow detection of patterns of risk across the populatin to inform health system process changes to alleviate risk. An example process change is further automation/alerting for selected high-risk abnormal tests with incomplete follow-up. The rationale for this research is that HIT-enabled approaches can efficiently identify patient safety risks and in the context of team-based and population-based primary care, these risks can be acted upon in real-time rather than through periodic, visit-based primary care. Guided by experience with the dashboard approach and preliminary data indicating significant existing safety problems, we propose two specific aims: (1) To develop an ambulatory safety electronic dashboard for use in primary care settings. The dashboard will use data stored in the electronic health record and administrative databases to inform the care team about selected, evidence-based, high-priority safety risks in the outpatient setting; and (2): To conduct a pilot study to assess the feasibility of incorporating use of the dashboard in a PCMH model. We will conduct the pilot study in a primary care clinic at San Francisco General Hospital. In addition to enabling us to assess feasibility, this pilot study will enable us to collect preliminary data on its "real world" utility in ameliorating selected high-priority safety problems. The approach is innovative i that health care dashboards have not been previously used to address patient safety risks or to inform health systems process changes, and they have not been tested in the context of PCMH delivery. The proposed research is significant because it is expected to inform the extent to which a population-focused HIT tool integrated into team-based care can identify and mitigate unsafe situations in outpatient primary care. Ultimately, HIT advances in the safety net have the potential to deliver care more efficiently and reduce healthcare disparities. PUBLIC HEALTH RELEVANCE: Inadequate patient safety has been recognized as a major public health challenge in the U.S., and because the majority of medical care occurs in the outpatient setting, efforts to improve patient safety must include outpatient care settings. This proposal is to design a health-information technology innovation, a patient safety dashboard, defined as an interactive, visual summary of safety gaps. We have chosen 4 high-priority safety gaps to investigate, including two selected high-risk medication classes for monitoring, incomplete follow-up of abnormal colon cancer screening results, and lack of outpatient care following hospitalization for heart failure. We then plan to pilot-test the tool's ability to efficently identify and address selected high-priority patient safety problems within a safety-net outpatient health system.