What is Patient Safety in the Medical Home?

什么是医疗之家的患者安全？

• 批准号: 9355591
• 负责人: SYDNEY MORSS DY
• 金额: $ 49.88万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9355591
• 关键词: What; Patient; Safety; Medical; Home

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.

尽管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 不太了解。关键的门诊安全领域包括遗体诊断，适当治疗的延迟， 药物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），这是改善初级保健的关键模型， 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。先前的研究没有明确评估PCMH的安全性。这个合作伙伴关系 约翰·霍普金斯（Johns Hopkins）和国家质量保证委员会（NCQA）之间是一个独特的机会 评估PCMH如何最好地解决安全性。这两个组织都在建设方面都有丰富的经验 并评估PCMH； NCQA作为美国PCMH的认可者，具有广泛的数据，并链接到PCMH 社区对该项目表达了强烈的兴趣。霍普金斯·阿姆斯特朗病人研究所 安全和质量在患者安全的各个方面都具有广泛的专业知识，尤其是关键领域，例如 安全文化和人为因素。我们的总体目标是通过评估含义来提高门诊安全 和PCMHS安全性的实施。在这项混合方法的研究中，我们将评估初级保健 实践（使用3级PCMHS的最佳情况）正在解决各个方面的门诊安全 通过多个角度的数据，包括患者输入，这四个关键域。我们的具体 目的是：（1）使用实现NCQA识别的实践的数据，以及 参加了电子健康记录有意义的使用报告，探索趋势和采用的差异 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模型如何与患者安全相互作用 从不同的角度来看，患者，提供商和管理员 - 在四个关键的门诊安全范围内 域； （3）在以各种方式实施PCMH的实践样本中，评估 通过患者安全措施的上下文问题（例如，实践类型）和特定的PCMH实施实践 使用定性比较分析，在卧床安全的四个关键领域。预期 结果将是有关PCMH和特定实现元素如何与之相互作用的重要发现 患者安全性并可能影响安全结果，跨不同的卧床安全域和PCMH 程序。结果将为公共部门和私营部门提供努力，以提高门诊安全， 提供有关各种方法的可行性的关键信息，以评估卧床安全结果 并建议将安全更好地整合到PCMH等模型中。调查结果将被传播 通过NCQA标准和PCMH社区合作伙伴，将提高有关门诊安全的知识 以及如何最好地设计未来的干预措施以改善患者的预后。