Advancing Safety Process Innovation in Rheumatology (ASPIRE)

项目概要 尽管人们普遍认识到美国医疗保健系统中普遍存在的患者安全问题，但研究 开发可行、可扩展的解决方案已经滞后，特别是在门诊环境中。需要新的 提高安全性的方法在护理使用高风险的门诊患者时尤为紧迫 免疫抑制药物，因为此类药物的使用急剧增加，并且有报告 可预防的不良事件有所增加。在上一个 AHRQ 资助期间，我们的研究团队产生了 患者安全风险和不良事件的新流行病学证据，并利用这些信息来制定 医疗保险和医疗补助中心基于电子健康记录的质量措施 (eMeasures) 服务质量付款计划。此外，我们还在美国全国范围内实施了这些电子措施 风湿病学院的 RISE 注册表，其中包括超过三分之一的电子健康记录数据 美国执业风湿病学家。在本提案中，我们的目标是在这项工作的基础上改善门诊患者 使用高风险免疫抑制药物的个人的安全。在目标 1 中，我们将使用来自 RISE 的数据 登记处与医疗保险索赔相关联，以识别新批准的新出现的患者安全错误 免疫抑制药物，并分析这些跨种族/民族、社会经济地位、医疗状况的错误 复杂性、获得护理的机会和实践特征。在目标2中，我们将进行综合评估 现行国家与免疫抑制药物相关的患者安全电子措施，评估可行性， 不同实践环境、电子健康记录系统和就诊类型的可靠性和有效性 （远程医疗与面对面医疗）。在目标 3 中，我们将使用基于实施科学的混合方法 确定门诊患者安全电子措施绩效关键驱动因素的理论。数据来自于此 研究将用于开发和传播第一个实施工具包，旨在改善患者 高风险免疫抑制药物的安全性。拟议的研究将对 国家基础设施，以改善数百万具有免疫能力的美国人的门诊患者安全 介导的疾病。

Project Summary Despite widespread recognition of pervasive patient safety problems in the U.S. health care system, research to develop feasible, scalable solutions has lagged, particularly in the ambulatory setting. The need for new approaches to improve safety is especially pressing in the care of ambulatory patients using high-risk immunosuppressive medications, as use of this category of medications has grown precipitously and reports of preventable adverse events have increased. In the last AHRQ funding period, our research team generated new epidemiological evidence of patient safety risks and adverse events and used this information to develop electronic health record-based quality measures (eMeasures) for the Centers for Medicare and Medicaid Services Quality Payment Program. In addition, we implemented these eMeasures nationally in the American College of Rheumatology's RISE registry, which includes electronic health record data from over one-third of U.S. practicing rheumatologists. In this proposal, we aim to build on this work to improve ambulatory patient safety for individuals using high-risk immunosuppressive drugs. In Aim 1, we will use data from the RISE registry linked to Medicare claims to identify emerging patient safety errors for newly approved immunosuppressive drugs and analyze these errors across race/ethnicity, socioeconomic status, medical complexity, access to care and practice characteristics. In Aim 2, we will perform a comprehensive evaluation of current national patient safety eMeasures related to immunosuppressive drugs, assessing feasibility, reliability, and validity across diverse practice settings, electronic health record systems, and visit types (telemedicine versus face-to-face). In Aim 3, we will use mixed-methods grounded in implementation science theory to determine key drivers of performance on ambulatory patient safety eMeasures. Data from this research will be used to develop and disseminate the first implementation toolkit designed to improve patient safety for high-risk immunosuppressive drugs. The proposed research will contribute significantly to the national infrastructure to improve ambulatory patient safety for the millions of Americans with immune- mediated diseases.