Investigating Failures of Notification and Monitoring in Outpatient Care: the Safety Promotion Action Research and Knowledge (SPARK) Network

 描述(由申请人提供)：确保患者安全仍然是医疗保健系统的一个关键问题。特别是，门诊(门诊)卫生保健环境容易受到患者安全顾虑的影响。大多数医疗保健是在门诊环境中提供的，美国每年有12亿人次的门诊就诊。在监控失败之间，以及 在漏诊和延误诊断的情况下，门诊患者的安全问题会导致严重的发病率和死亡率。虽然在识别和预防不良事件方面取得了很大进展，但对门诊护理环境中患者安全的流行病学以及导致这些差异的因素知之甚少。这项建议的总体目标不是审查照顾不同低收入人群的门诊护理环境中患者安全的流行病学情况：(1)根据种族/民族和语言熟练程度确定特定安全差距的发生率和流行率；(2)收集关于可以改善安全的战略的深入、定性的证据，并确定患者安全方面的差异；(3)在五个安全网医疗系统的不同样本中试行患者安全监测方法；以及(4)开发一个测量和错误调查工具包，以便在安全网医疗系统中传播。具体地说，我们将确定可操作检测结果的漏报程度和高危人群的漏报程度。这两个过程差距--定期监测高危情况和通知可提起诉讼的异常检测结果--都会导致可预防的患者伤害。虽然这些护理缺口已被记录在案，但伤害差异的程度和处于最高风险的人群仍然不清楚。为了进一步加深这些知识，我们将阐明这些安全差距的根本原因，重点是我们在数据中发现的差距。最后，我们的目标是为参与这项研究的安全网卫生系统提供方法论工具，以测量这些安全差距并进行事件调查，以便为未来的改进和创新工作奠定基础，以缩小差距。我们建议建立一个协作式安全促进行动研究和知识网络(SPARK Network)，以实现以下具体目标：1)为高危人群开发可行、及时和准确的患者安全通知和监测缺口的电子测量方法，并表征患者安全方面的差异程度；2)对五个公共门诊医疗环境中的患者安全通知/监测缺口进行根本原因分析，以找出导致这些差异的因素；以及3)评估根据目标1和2制定的患者安全监测方法在五个不同的门诊医疗环境中的试点实施情况。我们预计，该项目的试点结果将产生一个患者安全监测方法的测量和根本原因分析工具包，可以在照顾不同人群的医疗保健系统中广泛传播。

 DESCRIPTION (provided by applicant): Ensuring patient safety remains a critical issue for health care systems. In particular, ambulatory (outpatient) health care settings are vulnerable to patient safety concerns. The majority of health care is delivered in ambulatory settings, with 1.2 billion outpatient visits annually in the United States (U.S.). Between failures of monitoring, and missed and delayed diagnosis, there is significant morbidity and mortality from patient safety problems in outpatient care. Although strides have been made in recognizing and preventing adverse events, little is known about the epidemiology of patient safety in ambulatory care settings and factors that contribute to these disparities. The overall goals of this proposal are t examine the epidemiology of patient safety in ambulatory care settings that care for diverse, low-income populations as follows; (1) to characterize the incidence and prevalence of specific safety gaps, by race/ ethnicity and language proficiency; (2) to gather in- depth, qualitative evidence about strategies that can improve safety and characterize disparities in patient safety; (3) to pilot-test patient safety monitoring methodologies in a diverse sample of five safety net health care systems; and (4) to develop a measurement and error investigation toolkit for dissemination amongst safety-net health care systems. Specifically, we will identify the extent of missed notification for actionable test results and extent of missed monitoring for high-risk populations. These two process gaps, periodic monitoring of high-risk conditions and notification of actionable abnormal test results, both lead to preventable patient harm. While these care gaps are documented, the extent of disparities in harm and the populations at highest risk remain unclear. To further deepen this knowledge, we will elucidate underlying causes for these safety gaps, focusing on disparities we identify in the data. Finally, we aim to give safety-net health systems participating in this study the methodological tools to conduct measurement of these safety gaps and perform event investigation, in order to set the stage for future improvement and innovation work to close gaps in disparities. We propose a collaborative Safety Promotion Action Research and Knowledge Network (SPARK Network) to achieve the following specific aims: 1) to develop feasible, timely, and accurate electronic measures of patient safety notification and monitoring gaps in an ambulatory care setting for high-risk sub- populations and characterize the extent of disparities in patient safety; 2) to conduct a root cause analysis of patient safety notification/ monitoring gaps in five public ambulatory care settings to identify factors contributing to these disparities; and 3) to evaluate the pilot implementation of patient safety monitoring methodologies developed from Aims 1 and 2 across five diverse ambulatory health care settings. We envision that pilot findings from this project wil result in a measurement and root cause analysis toolkit of patient safety monitoring methodologies that can be widely disseminated across health care systems that care for diverse populations.