Building an Ambulatory Patient Safety Learning Laboratory for Diverse Populations

描述（由申请人提供）：尽管在患者安全性方面取得了重大进展，但仍存在重大差距。从总体上看，循证做法没有得到一贯的执行。对流动环境的研究仍然不足，缺乏安全基础设施和系统。这些问题在不成比例地照顾低收入、多样化和弱势群体的安全网卫生保健环境中尤为严重。因此，我们建议创建一个跨学科的患者安全学习实验室，旧金山弗朗西斯科门诊安全中心创新（ASCENT）。我们的目标是将设计思维，可靠性科学，卫生系统创新和安全研究结合起来，为高优先级的流动安全问题设计和验证技术和工作流程解决方案。有前途的创新将在旧金山弗朗西斯科卫生网络中实施和评估，使用实施科学方法来评估覆盖范围、有效性、采用、实施和维护。我们计划与关系密切的安全网创新网络结成伙伴关系，在安全网保健系统之间传播和分享成功的创新。ASCENT将重点关注以下三个高优先级的门诊安全性问题：（1）检测结果管理：当患者的诊断检测结果没有及时采取行动时，诊断延迟和失败往往随之而来;（2）对高风险亚群的监测：对接受高风险治疗（如抗凝或免疫抑制）的患者的监测失败可能导致不良事件。使用基于团队的工作流程和电子登记工具，与访视脱钩，有可能加强对高风险患者的监测实践;（3）药物理解：患者自我给药与门诊ADE有关，尚未系统实施经验证的增强理解的方法。ASCENT将有一个科学的研究核心，为所有项目提供智力投入。专家咨询委员会将为所有项目提供见解，一线工作人员、临床医生和患者将通过创新过程提供实质性投入。该提案的长期目标是创建一个从问题分析到临床实践的可持续安全创新管道。

DESCRIPTION (provided by applicant): Despite significant strides in patient safety, significant gaps remain. Across the board, evidence-based practices have not been consistently implemented. Ambulatory settings remain understudied and lack safety infrastructure and systems. These issues are particularly acute in safety-net health care settings which disproportionately care for low-income, diverse, and vulnerable populations. Therefore, we propose to create a transdisciplinary patient safety learning laboratory, the San Francisco Ambulatory Safety CEnter for INnovaTion (ASCENT). We aim to bring together design thinking, reliability science, health system innovation and safety research to design and iterate technical and workflow solutions for high-priority ambulatory safety issues. Promising innovations will be implemented and evaluated in the San Francisco Health Network using implementation sciences methodology to assess reach, effectiveness, adoption, implementation, and maintenance. We plan to partner with closely affiliated safety-net innovation networks to disseminate and share successful innovations among safety-net health systems. ASCENT will focus on the following three high-priority ambulatory safety issues: (1) test result management: when patients' diagnostic test results are not acted upon in a timely fashion, diagnostic delays and failures often ensue; (2) monitoring for high-risk sub-populations: failures of monitoring for patients receiving high-risk treatments (such as anticoagulation or immunosuppression) can lead to adverse events. Use of team-based work-flow and electronic registry tools, de-coupled from visits has potential to enhance monitoring practices for high-risk patients; (3) medication comprehension: patient medication self-administration has been implicated in outpatient ADEs, and validated methods to enhance comprehension have not been implemented systematically. ASCENT will have a scientific core of investigators that provide intellectual input on all projects An expert Advisory Board will provide insight into all projects, and front-line staff, clinicians, nd patients will provide substantive input through the innovation process. The long-term goal of the proposal is to create a sustainable pipeline of safety innovations from problem analysis through to clinical practice.