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

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DESCRIPTION (provided by applicant): 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 plan 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.