The Family Input for Quality and Safety (FIQS) Study

摘要 医院中的不良患者安全事件发生率居高不下。对于儿童，不良反应为1.5-2 是成人住院患者的两倍(40.0次/100次伤害比25.1次/100次住院)。父R01建议书 使用未开发的安全事件报告来源-住院儿科患者和家属 患者-评估儿科安全事件的流行病学；目前方法的优点和局限性 差错报告系统；预防儿科用药差错的方法；以及学习的发展 卫生系统，以解决住院儿科安全问题。我们基于移动电话的方法，家庭输入 质量和安全(FIQS)，是与家庭和临床医生合作开发的，并在 儿科内外科单位，参与者和工作人员热情参与。这样做的目的是 提案旨在解决以下目标中先前工作的严谨性，同时在其他医院测试该方法 在病房(如重症监护室、血液肿瘤科)和安全网医院。目标1：描述安全事件的变化 使用家庭和患者生成的安全报告跨越护理环境和人群(N~6,500名参与者； N~3000份FIQS报告)。这将使用实时移动电话工具来确定家庭和 按医院设置、医疗复杂性、语言、卫生技术知识和患者列出的患者安全报告 以及家庭成员的人口统计数据。拟议的行政副刊将支持职业生涯。 开发未来的拉丁裔医生兼研究人员Maite Garcia女士，以改善对拉丁裔患者的护理，并 通过严谨和创新的研究为家庭服务。候选人是一名美国公民，其父母没有收到 高中以上学历。加西亚女士将领导一项定性研究，以更好地在 在试点研究中被发现不经常报告事件的Latinx患者和家庭。目标2：比较 FIQS报告到事件报告和医疗记录中记录的临床医生生成的报告。这将是 使用混合方法，量化来自每个源的重叠和唯一事件的数量，并使用 定性分析，以描述每个来源所涵盖的独特领域。目标3：评估改进 协作性的重点是将家庭和患者报告问题纳入安全工作。建议数 研究在其范式转换概念模型方面具有创新性，1)患者参与的质量改进，2) 它使用移动电话技术来收集实时数据，以及3)它使用改进的协作来 制定强有力的实施战略，将家庭和患者报告纳入安全工作。这个 拟议研究的贡献将是对多个家庭和患者的安全报告的描述 两种不同卫生系统的住院环境类型；家庭和患者安全报告的比较 检测不良事件的其他方法；以及交叉设置实施工具和战略，以 将家庭和患者安全报告纳入护理。这些贡献将是重大的，因为它们是 实施和评估改善儿科住院安全的潜在新方法的关键步骤。

Abstract Adverse patient safety event rates remain stubbornly high in hospitals. For children, adverse events are 1.5-2 times more common than in adult inpatients (40.0 vs. 25.1 harms/100 admissions). The parent R01 proposal uses an untapped source of safety event reporting—patients and family members of hospitalized pediatric patients—to assess the epidemiology of pediatric safety events; strengths and limitations of current methods of error reporting systems; methods to prevent pediatric medication errors; and the development of learning health systems to address inpatient pediatric safety. Our mobile phone-based approach, Family Input for Quality and Safety (FIQS), was developed in partnership with families and clinicians, and was pilot-tested on a pediatric medical-surgical unit, with enthusiastic engagement from participants and staff. The objectives of this proposal are to address the rigor of prior work in the following aims, while testing the approach in other hospital units (e.g., ICU, hematology-oncology) and in a safety net hospital. Aim 1: Describe variations in safety events across care settings and populations using family- and patient-generated safety reports (N~6,500 participants; N~3000 FIQS Reports). This will use the real-time mobile phone tool to determine differences in family and patient safety reports by hospital setting, medical complexity, language, health technology literacy, and patient and family-member demographics. The proposed administrative supplement will support the career development for a future Latinx physician-researcher, Ms. Maite Garcia, to improve care for Latinx patients and families through rigorous and innovative research. The candidate is a US citizen whose parents did not receive post-secondary high school degrees. Ms. Garcia will lead a qualitative study to better elicit safety events in Latinx patients and families, who were found to report events infrequently in the pilot study. Aim 2: Compare FIQS reports to clinician-generated reports documented in incident reports and in the medical record. This will employ mixed-methods, quantifying the number of overlapping and unique events from each source, and using qualitative analysis to describe unique domains covered in each source. Aim 3: Evaluate an improvement collaborative focused on incorporating family and patient reports issues into safety efforts. The proposed research is innovative in its paradigm-shifting conceptual model of 1) patient-engaged quality improvement, 2) its use of mobile phone technologies to gather real time data, and 3) its use of an improvement collaborative to develop robust implementation strategies for incorporating family and patient reports into safety efforts. The contribution of the proposed research will be a description of family and patient safety reports across multiple types of inpatient settings in two diverse health systems; a comparison of family and patient safety reports to other methods of detecting adverse events; and cross-setting implementation tools and strategies to incorporate family and patient safety reports into care. These contributions will be significant because they are key steps in implementing and evaluating a potential new approach to improving pediatric inpatient safety.