Improving the Safety of Primary Care by Measuring Adverse Events and Improvement

描述（由申请人提供）：来自贝勒医疗保健系统(BHCS)/医疗保健改善研究所门诊触发工具（BI-OTT）大规模本地部署的数据表明，在门诊初级保健中存在大量不良事件（ae）负担（13.5 ae /100 pt年）。采用这种测量策略本身就是一种与改善门诊初级保健质量有关的干预措施。基于BI-OTT工具和流程的改进以及第二次大规模部署，有机会为更广泛的使用做好准备，并测试其作为改善干预本身的效用，评估特定患者安全干预对不良事件发生率的影响，并对门诊初级保健中发生的不良事件的影响进行经济分析。拟议工作的具体目标是：1)制定一套培训材料和实施工具的传播包，供其他组织采用，使他们能够有效地使用BI-OTT来衡量ae的比率；2)测试传播包在其开发环境之外为ae提供可靠、有效的测量系统的有效性；3)从患者、初级保健提供者、付款人、雇主和社会的角度评估门诊ae的经济影响；4)测试BI-OTT检测已知导致住院和/或使用ED的门诊初级保健源性ae的能力；5)使用BI-OTT来量化部署动态电子健康记录对药物不良事件发生率的影响。BHCS将与三角研究所合作开发和部署传播包，包括培训视频、网站和BI- OTT电子数据收集工具的可下载版本。传播将在帕克兰健康和医院系统（德克萨斯州达拉斯的一个安全网提供者）、中大西洋凯撒永久医疗集团和普罗维登斯卫生服务中心进行测试。假设可证明的有效性，这项工作将促进标准化可靠工具的广泛传播，以检测和表征初级保健不良事件，证明该工具在更广泛地评估其他安全干预措施方面的效用，并提供有关初级保健不良事件相关成本的宝贵信息。这些数据可能有助于在提供者层面（与改善患者安全的潜在投资有关）和在政策层面（与安全举措的优先级和潜在的补偿策略的重新调整有关）为决策提供信息，以更好地分配成本和由此节省的投资，以改善患者安全。

DESCRIPTION (provided by applicant): Data from a large-scale local deployment of the Baylor Health Care System (BHCS)/Institute for Healthcare Improvement Outpatient Trigger Tool (BI-OTT) indicate the presence of a substantial burden of adverse events (AEs) in ambulatory primary care (13.5 AEs/100 pt years). Deployment of this measurement strategy represents, itself, an intervention related to improving the quality of ambulatory primary care. Based upon refinement of the BI-OTT tool and process and a second large scale deployment, an opportunity exists to ready this intervention for broader use and to test its utility as an improvement intervention itself, to evaluate the impact of a specific patient safety intervention upon the rate of AEs, and to initiate an economic analysis of the impact of AEs taking place in ambulatory primary care. Specific aims of the proposed work are: 1) To develop a dissemination package of training materials and implementation tools for adoption by other organizations to enable them to effectively use the BI-OTT to measure the rate of AEs; 2) To test the effectiveness of the dissemination package in providing a reliable and valid measurement system for AEs outside of its development environment; 3) To evaluate the economic impact of identified ambulatory AEs from the perspectives of the patient, primary care provider, payer, employer, and society; 4) To test the ability of the BI-OTT to detect ambulatory primary care-derived AEs known to result in hospitalization and/or ED use; and 5) To use the BI-OTT to quantify the effects of deploying an ambulatory electronic health record on the rate of adverse drug events. BHCS will collaborate with Research Triangle Institute to develop and deploy the dissemination package, to include a training video, Web site, and downloadable version of the BI- OTT electronic data collection tool. Dissemination will be tested within the Parkland Health and Hospital System (a safety-net provider in Dallas, Texas), the Mid-Atlantic Kaiser Permanente Medical Group, and Providence Health Services. Presuming demonstrable effectiveness, this work will facilitate widespread dissemination of a standardized reliable tool to detect and characterize primary care AEs, demonstrate the utility of this tool for evaluating other safety interventions more broadly, and provide valuable information regarding the costs associated with primary care-derived AEs. These data may help to inform decision-making at the provider level (related to potential investments to improve patient safety) and at the policy level related both to prioritization of safety initiatives and potential realignment of reimbursement strategies to better apportion both cost and resultant savings of investments to improve patient safety. PUBLIC HEALTH RELEVANCE: Although ambulatory care accounts for the majority of health care encounters in the United States, relatively little attention has been paid to patient safety and adverse events (AEs) in this setting. The proposed project will provide a means of broadly disseminating a measurement tool to track and characterize primary care-derived AEs, demonstrate the utility of this tool in evaluating effectiveness of patient safety initiatives in the primary care setting, and contribute valuable information regarding costs associated with primary care-derived AEs to inform provider and policy decisions regarding prioritization of safety initiatives and potential realignment of reimbursement strategies to better apportion costs and resultant savings related to investments in safety initiatives. This work has significant implications for public health, as all of the project aims address vital steps in reducing the risk of patient harm in the most frequently utilized health care setting.