What is Patient Safety in the Medical Home?

点击翻译按钮获取中文摘要

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.