ExPERTS-PC: Engaging Patients in Event ReporTing for Safety in Primary Care

项目摘要/摘要 动态药品不良事件(ADE)发生在25%的新处方中，估计造成450万 每年的办公室就诊和100,000次住院治疗，来自弱势群体的患者 更高的ADE比率。患者和照顾者负责用药自我管理和观察 家庭和社区中的ADE，但不参与检测或向门诊护理报告ADE 团队。该提案的目标是通过开发利益相关者为患者设计的工具来填补这一空白- 启动ADE报告。目标1利用自然语言处理(NLP)来识别患者、护理者和 多州患者安全组织的ADE报告中确定的医疗团队贡献性原因。 AIM 2采用以用户为中心的设计来开发和进行文本消息原型的可行性测试- 基于患者发起的ADE报告系统，与患者、护理人员和初级保健人员合作 来自公共卫生安全网，目标1中确定的目标因素。此工具将根据一名住院患者进行改编 短信工具，特别适用于健康素养较低的初级保健患者。候选人安贾纳 夏尔马，医学博士，医学硕士，加州大学旧金山分校家庭与社区医学助理教授 旧金山(加州大学旧金山分校)她在研究病人的混合方法和观察性研究方面有专长 参与弱势群体的质量和安全工作。在这项提案中，夏尔马博士试图培养技能 在自然语言处理方面，为低健康素养人群进行以用户为中心的设计，并进行干预 开发使她能够设计患者发起的ADE报告工具。夏尔马博士已经组装了一支技术娴熟的 由门诊患者质量和安全专家Urmiala Sarkar博士领导的导师团队，包括NLP 专家Atul Butte博士、以用户为中心的设计专家Courtney Lyles博士和初级保健负责人Kevin博士 格伦巴赫。职业发展计划得益于加州大学旧金山分校和 来自家庭和社区医学部的大量材料和方法支持。这 该提案意义重大，因为它扩展了有关高风险药物危害的有限知识库 发生在门诊护理中，并开发了一种新的方法来测量患者的动态ADE- 已启动报告。这项工作与医疗保健研究和质量机构的优先领域保持一致 用药安全、门诊安全和患者参与度。目标2侧重于AHRQ优先考虑的 城市、低收入和少数民族人口。这项提案的技能和发现将转化为 在安全网初级保健中对患者发起的ADE报告工具进行随机试验的R级建议 网络。拟议的职业发展将推动夏尔马博士朝着她的研究目标前进 独立性，开发让患者和家庭照顾者参与的干预措施的专业知识，以及国家 在弱势群体的门诊护理安全和质量方面发挥领导作用。

PROJECT SUMMARY/ABSTRACT Ambulatory adverse drug events (ADEs) occur in 25% of new prescriptions and cause an estimated 4.5 million office visits and 100,000 hospitalizations per year, with patients from vulnerable populations experiencing higher rates of ADEs. Patients and caregivers are responsible for medication self-management and observe ADEs in the home and community, but are not engaged in detecting or reporting ADEs to ambulatory care teams. The objective of this proposal is to fill this gap by developing a stakeholder-designed tool for patient- initiated ADE reporting. Aim 1 utilizes natural language processing (NLP) to identify patient, caregiver and healthcare team contributory causes identified in ADE reports from a multistate Patient Safety Organization. Aim 2 employs user-centered design to develop and conduct feasibility testing of a prototype text messaging- based patient-initiated ADE reporting system, working with patients, caregivers and primary care personnel from the public health safety net, targeting factors identified in Aim 1. This tool will be adapted from an inpatient text-messaging tool and adapted specifically for low-health literacy primary care patients. Candidate Anjana Sharma, MD, MAS, is Assistant Professor of Family & Community Medicine at the University of California, San Francisco (UCSF). She has expertise in mixed methods and observational research studying patient engagement in quality and safety for vulnerable populations. In this proposal, Dr. Sharma seeks to build skills in natural language processing, user-centered design for low-health-literacy populations, and intervention development to enable her to design a patient-initiated ADE reporting tool. Dr. Sharma has assembled a skilled mentorship team, led by ambulatory patient quality and safety expert Dr. Urmimala Sarkar, including NLP expert Dr. Atul Butte, user-centered design expert Dr. Courtney Lyles, and primary care leader Dr. Kevin Grumbach. The career development plan benefits from the extensive resources available at UCSF and substantial material and methodologic support from the Department of Family & Community Medicine. This proposal is significant because it expands the limited knowledge base about harms from high-risk medications occurring in ambulatory care, and develops a novel means to measure ambulatory ADEs through patient- initiated reports. The work is aligned with Agency for Healthcare Research and Quality's priority areas of medication safety, ambulatory safety, and patient engagement. Aim 2 focuses on AHRQ priority populations of urban, low-income and ethnic minority populations. The skills and findings from this proposal will translate into an R-level proposal for a randomized trial of the patient-initiated ADE reporting tool in a safety-net primary care network. The proposed career development will advance Dr. Sharma toward her goals of research independence, expertise in developing interventions that engage patients and family caregivers, and national leadership in ambulatory care safety and quality for vulnerable populations.