Detecting, Addressing and Learning From Patient-Perceived Breakdowns in Care

检测、解决患者感知到的护理故障并从中学习

• 批准号: 8642914
• 负责人: KATHLEEN Michele MAZOR
• 金额: $ 49.54万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8642914
• 关键词: Detecting; Addressing; Learning; Patient; Perceived

Project Summary/Abstract There is a growing recognition that patients and family members have critical insights into care experiences, including information about adverse events and how they might be prevented, but many are hesitant to speak up about their concerns. There are multiple reasons for this, including feeling poorly, the belief that reporting would not lead to change, or fear that reporting their concern might disrupt their therapeutic relationship. As a result, many patients who believe something may have gone wrong "suffer in silence", impairing their experience of care, and limiting the ability of providers and health plans to address their concerns and to prevent similar breakdowns from recurring. Providing truly patient-centered care will require that healthcare organizations and providers create effective means to encourage patients to report their concerns about care breakdowns, respond to these concerns in real time, and use patient reports to prevent recurrences. Ongoing AHRQ-sponsored work is creating portals for patients to report patient safety events. Yet to be most effective, patient reporting systems will need to be highly proactive and coupled with mechanisms to respond to patient concerns in real time. Therefore, building on our prior work, and in partnership with MedStar Health (MSH), we propose to develop, implement, disseminate and evaluate a program for detecting, addressing and preventing patient-perceived breakdowns in care. The program will include a proactive, multi-modal, intensive campaign entitled "We Want to Know" which builds trust and encourages patients and family members to report on their care experiences. The campaign will include active telephone outreach to patients, reinforcing the We Want to Know message. A Real Time Response Navigator will coordinate responses to patient-identified care breakdowns and will facilitate system-based learning. The project will occur in two phases. In Phase I the program will be implemented in medical/surgical units of two hospitals. Working within the RE-AIM framework, we use a variety of evaluation methods, focusing primarily on program Reach, Adoption, and Implementation. In Phase II, we will use the lessons learned to refine and enhance the program before implementing it system- wide throughout all ten MSH hospitals. Phase II will entail a continuing evaluation of program Reach, Adoption, and Implementation. We will also examine Maintenance, focusing on leadership plans for sustaining the program. Phase II will provide a strong evaluation of program Effectiveness utilizing an interrupted time series design. Key outcomes will include the frequency and nature of patient reports and the health system's ability to respond to these reports. MedStar hospitals serve a socio-economically, racially, ethnically and linguistically diverse patient population, providing an ideal environment for examining whether the program's impact is moderated by these patient characteristics. Our mix of qualitative and quantitative methods will provide insights into how to generalize the program and optimize reach and effectiveness for all patients.

项目摘要/摘要 人们越来越认识到患者和家人对护理经历有关键的见解， 包括有关不良事件及其如何预防的信息，但许多人不愿说话 关于他们的担忧。造成这种情况的原因有多种，包括感到不好的信念，即报告 不会导致变化，或者担心报告他们的关注会破坏他们的治疗关系。作为 结果，许多认为某些事情可能“沉默遭受痛苦”的患者损害了他们的 护理经验，并限制提供者和健康计划的能力，以解决他们的关注和 防止重复出现类似的崩溃。提供真正以患者为中心的护理将需要医疗保健 组织和提供者创造有效的手段来鼓励患者报告他们对护理的担忧 分解，实时应对这些问题，并使用患者报告防止复发。正在进行 AHRQ赞助的工作正在为患者报告患者安全事件创建门户。但是最有效， 患者报告系统将需要高度主动，并与机制相结合以应对患者 实时关注。因此，建立我们先前的工作，并与MedStar Health合作（MSH），我们 建议开发，实施，传播和评估一个用于检测，解决和预防的程序 患者感知的护理中的细分。该计划将包括一个主动，多模式，密集的运动 题为“我们想知道”，该题为“我们要建立信任并鼓励患者和家人报告他们的 护理经验。该活动将包括对患者的积极电话推广，并加强我们想要的 知道消息。实时响应导航器将协调对患者识别的护理的响应 分解并将促进基于系统的学习。该项目将分为两个阶段。在第一阶段 计划将在两家医院的医疗/外科单元中实施。在Re-Aim框架中工作， 我们使用各种评估方法，主要关注计划范围，采用和实施。 在第二阶段，我们将使用学到的教训来完善和增强计划，然后再实施系统 - 遍及所有十个MSH医院。第二阶段将需要对计划范围进行持续评估， 采用和实施。我们还将检查维护，重点是维持领导计划 该程序。第二阶段将利用中断时间对程序有效性进行强有力的评估 系列设计。关键结果将包括患者报告的频率和性质和卫生系统的频率和性质 能够回应这些报告。 Medstar医院在社会经济，种族，种族和 语言上多样化的患者人群，为检查该计划的是否是研究的理想环境 这些患者特征会减轻影响。我们的定性和定量方法的混合 提供有关如何推广该计划并优化所有患者覆盖范围和有效性的见解。