What is Patient Safety in the Medical Home?

虽然大多数医疗保健发生在门诊环境中，但如何最好地在初级保健中实施患者安全 还没有被很好地理解。关键的门诊安全领域包括漏诊、延误适当的治疗、 用药错误和可预防的不良药物事件以及沟通、信息流和缺陷 护理协调。以患者为中心的医疗之家(PCMH)是改善初级保健的关键模式， 旨在解决全面、以患者为中心、协调和可访问的护理的核心属性 以及质量和安全。此前没有研究明确评估PCMH的安全性。这种伙伴关系 约翰霍普金斯大学和国家质量保证委员会(NCQA)之间的合作是一个独特的机会 评估PCMH如何最好地解决安全问题。这两个组织都有丰富的构建经验 和评估PCMH；NCQA作为美国PCMH认证机构，拥有广泛的数据和与PCMH的联系 社区对这一项目表示了强烈的兴趣。霍普金斯大学阿姆斯特朗患者研究所 安全和质量带来了患者安全各个方面的广泛专业知识，特别是关键领域，如 安全文化和人的因素。我们的总体目标是通过评估意义来提高门诊安全性 以及在PCMHs中实施安全。在这项混合方法研究中，我们将评估初级保健如何 实践(使用3级PCMH的最佳方案)正在解决跨 这四个关键领域通过来自多个角度的数据，包括患者输入。我们的特定 目标是：(1)使用已获得NCQA认可的实践和具有 参与电子健康记录有意义的使用报告，探索采用的趋势和变化 基于实践和区域特征的患者安全活动；(2)使用来自 访谈、观察和患者焦点小组，分析PCMH模式如何与患者安全相互作用 从不同的角度-患者、提供者和管理员-涵盖四个关键的门诊安全 以及(3)在以不同方式实施PCMH的实践样本中，评估 背景问题(例如，实践类型)和与患者安全措施相关的具体PCMH实施实践 采用定性对比分析的方法，对门诊安全的四个关键领域进行了研究。预期中的 结果将是关于PCMH和具体执行要素如何相互作用的重要调查结果 跨不同的门诊安全域和PCMH的患者安全和潜在影响安全结果 程序。这一结果将为公共和私营部门促进流动安全的努力提供参考， 提供关于评估非卧床安全结果的各种方法的可行性的重要信息 并提出了更好地将安全性融入PCMH等车型的方法。调查结果将被传播 通过NCQA标准和PCMH社区合作伙伴，并将提高对门诊安全的知识 以及如何最好地设计未来的干预措施来改善患者的结果。

Although most health care occurs in ambulatory settings, how best to implement patient safety in primary care is not well understood. Key ambulatory safety domains include missed diagnoses, delays in proper treatment, medication errors and preventable adverse drug events and defects in communication, information flow, and care coordination. The Patient-Centered Medical Home (PCMH), a key model for improving primary care, is designed to address core attributes of comprehensive, patient-centered, coordinated, and accessible care and quality and safety. No previous research has explicitly evaluated safety in the PCMH. This partnership between Johns Hopkins and the National Committee on Quality Assurance (NCQA) is a unique opportunity to evaluate how the PCMH can best address safety. Both organizations have significant experience with building and evaluating the PCMH; NCQA, as the US PCMH accreditor, has extensive data and links to the PCMH community, which has expressed strong interest in this project. The Hopkins Armstrong Institute for Patient Safety and Quality brings extensive expertise in all aspects of patient safety, particularly critical areas such as safety culture and human factors. Our overall goal is to improve ambulatory safety by evaluating the meaning and implementation of safety in PCMHs. In this mixed-methods study, we will evaluate how primary care practices (using the best-case scenario of Level 3 PCMHs) are addressing ambulatory safety across the four key domains through data from multiple perspectives, including patient input. Our specific aims are: (1) Using data on practices that have achieved NCQA recognition and providers that have participated in electronic health record meaningful use reporting, explore trends and variation in adoption of patient safety activities based on practice and regional characteristics; (2) using triangulated data from interviews, observation, and patient focus groups, analyze how the PCMH model interacts with patient safety from different perspectives-patient, provider, and administrator - across the four key ambulatory safety domains; and (3) in a sample of practices implementing the PCMH in diverse ways, evaluate the association of contextual issues (eg, practice type) and specific PCMH implementation practices with patient safety measures across the four key domains of ambulatory safety using qualitative comparative analysis. The expected outcomes will be important findings about how the PCMH and specific implementation elements interact with patient safety and potentially impact safety outcomes, across diverse ambulatory safety domains and PCMH programs. The results will inform public and private sector efforts to advance ambulatory safety, provide critical information on viability of various methods for evaluating ambulatory safety outcomes and suggest ways to better integrate safety into models such as the PCMH. Findings will be disseminated through NCQA standards and PCMH community partners and will improve knowledge about ambulatory safety and how best to design future interventions to improve patient outcomes.