Novel IT to Create Patient-Integrated Quality Improvement

摘要 在国际移民组织的开创性报告《犯错是人的》发表十多年后，患者安全方面的失败率仍然存在 在医院里居高不下。以前为提高医院质量所做的努力收效甚微，部分原因是 到对及时质量改进数据的有限访问。我们的长期目标是利用现有技术 向住院病人及其家属发声，改善医院安全和 质量。这个应用程序的总体目标是创建和评估一个收集患者和家属的工具 成员反馈并使其快速提供给提供商，从而实现灵活且响应迅速的安全和 质量改进的努力。基于联合制作理论的中心假设是，观察 来自患者和家属的信息，以结构化的方式收集，将提供有关患者的可行信息 安全和质量。做这个项目的基本原理是测试一种创新的新方法来创建 向致力于具体改进工作的提供商提供快速可用的数据流，以及 创建一种本质上以患者为中心的质量改进方法。我们计划测试我们的中央 假设，从而通过关注以下领域来实现本应用程序的目标 卫生信息技术研究：在研究类型“试点和”下，使用、实施和影响结果 可行性“，追求三个具体目标：目标1.确定患者数据的可行性和可接受性 收集和提供商仪表板工具(使用和实施)。我们将在进行可用性测试之前 研究开始，测量随时间推移的用户(患者和提供者)参与度，并收集有关该工具的反馈 在学习结束时。我们假设，患者和护理者的特征将预测工具的使用。目标2.评估 向提供者报告患者和护理人员观察到的护理过程是否会随着时间的推移而发生变化 (实施)。我们假设感兴趣的结构化项目的性能将随着时间的推移而提高 提供给提供商的快速可用的数据。目标3.评估工具实施效果的大小，使用预估 职位设计，关于医疗差错(对结果的影响)。在我们看来，拟议的研究是创新的， 基于以患者为主体的质量改进的范式转换概念模型，并且因为它 利用技术以前所未有的方式收集和呈现数据。预期的贡献 拟议的研究将是一种适当的工具，将收集关于患者安全的有意义和重要的数据 并以可操作的方式将其提供给提供商和医院领导，从而产生强大的数据流 患者安全的快速改善。这项提案的试点数据将为未来集群的设计提供参考- 在多个医院系统中对新工具进行随机试验。这一贡献将是重大的，因为它 代表着朝着改善医院患者安全的新方法迈出的关键一步。

Abstract More than a decade after the seminal IOM report, “To Err is Human”, failure rates in patient safety remain stubbornly high in hospitals. Prior efforts to improve hospital quality have had relatively little impact, in part due to limited access to timely quality improvement data. Our long-term goal is to leverage existing technologies to give voice to hospitalized patients and their family members, leading to improvements in hospital safety and quality. The overall objective in this application is to create and evaluate a tool that gathers patient and family member feedback and makes it rapidly available to providers, enabling nimble and responsive safety and quality improvement efforts. The central hypothesis, based on the theory of co-production, is that observations from patients and families, gathered in a structured way, will provide actionable information regarding patient safety and quality. The rationale for doing this project is to test an innovative new approach to creating a rapidly available data stream to providers who are working on specific improvement efforts, and a mechanism for creating a quality improvement approach that is inherently patient-centered. We plan to test our central hypothesis and thereby accomplish the objective of this application by focusing on the following areas of research for Health IT: Use, Implementation, and Impact on Outcomes, under the study type “Pilot and feasibility”, pursuing three specific aims: Aim 1. Determine feasibility and acceptability of the patient data collection and provider dashboard tool (Use and Implementation). We will conduct usability testing prior to study start, measure user (patients and providers) engagement over time, and gather feedback about the tool at study end. We hypothesize that patient and caregiver characteristics will predict tool use. Aim 2. Assess whether reporting patient- and caregiver- observed processes of care to providers leads to changes over time (Implementation). We hypothesize that performance on structured items of interest will improve over time with rapidly available data presented to providers. Aim 3. Estimate tool implementation effect sizes, using a pre- post design, on medical errors (Impact on outcomes). The proposed research is innovative, in our opinion, based on a paradigm-shifting conceptual model of patient-engaged quality improvement, and because it leverages technology to gather and present data in an unprecedented manner. The expected contribution of the proposed research will be an adapted tool that will gather meaningful and important data on patient safety and present it in an actionable way to providers and hospital leaders, resulting in a powerful data stream to fuel rapid improvements in patient safety. Pilot data from this proposal will inform the design of a future cluster- randomized trial of the new tool across multiple hospital systems. This contribution will be significant because it represents key steps towards a new approach to improving patient safety in the hospital.