Advancing Safety Process Innovation in Rheumatology (ASPIRE)

项目摘要 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 开发可行的、可扩展的解决方案已经落后，特别是在非卧床环境中。对新技术的需求 在护理使用高危患者的门诊患者时，提高安全性的方法尤其紧迫。 免疫抑制药物，因为这类药物的使用急剧增长，而且有报道称 可预防的不良事件有所增加。在上一个AHRQ资助期，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，并利用这些信息开发 医疗保险和医疗补助中心基于电子健康记录的质量衡量(EMeasures) 服务质量付款计划。此外，我们在美国全国范围内实施了这些电子测量 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 美国执业风湿科医生。在这项提案中，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体的安全性。在目标1中，我们将使用来自上升的数据 与联邦医疗保险索赔挂钩的登记表，以识别新批准的新出现的患者安全错误 并分析这些错误在种族/民族、社会经济地位、医疗 复杂性、可获得性和可护性的特点。在目标2中，我们将进行全面评估 当前与免疫抑制药物相关的国家患者安全电子措施，评估可行性， 跨不同的实践环境、电子健康记录系统和访问类型的可靠性和有效性 (远程医疗与面对面)。在目标3中，我们将使用基于实施科学的混合方法 确定门诊患者安全措施绩效的关键驱动因素的理论。来自于此的数据 研究将用于开发和传播第一个旨在改善患者状况的实施工具包 高风险免疫抑制药物的安全性。拟议的研究将对 国家基础设施为数百万患有免疫疾病的美国人改善门诊患者的安全 媒介疾病。

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.