Minimizing Error, Maximizing Outcome (MEMO): The Physic*

说明(应用摘要)：备忘录研究的长期目标 (最小化误差，最大化结果)是为了确定 医疗工作环境对护理质量和医生作用的影响 作为这一效果的调解人。具体目标包括：1)确定效果 工作场所特征对患者结果的影响，如满意度、疾病 控制和医疗差错；2)确定最低错误率和最佳 结果发生在医生压力和职业倦怠较低的环境中，并且 确定这种环境的要素；以及3)定义预测者如何 质量和差错在女性和男性医生之间存在差异，少数民族和 非少数民族医生和城乡医生。备忘录研究是一项 对500名医生和3000名医生进行的纵向观察性研究 5个诊所的患者：纽约、芝加哥、密尔沃基、麦迪逊和乡村 威斯康星州。患者会有以下三种情况中的一种或多种：高血压， 糖尿病和慢性肺病。最初的6个月阶段将包括 由医生、其他医护人员和患者组成的焦点小组， 个人可以讲述他们的成功和挑战的故事 他们的日常医疗保健体验。这些信息将被用来 为第二阶段制定调查，即为期两年的前瞻性评估 医生、病人和他们的结果。治疗中的医疗差错和 诊断将在第二阶段结束时通过图表审查进行评估。 第三阶段将包括数据分析和传播活动， 包括编写非技术性专著和使用“知识” 在区域和国家初级保健会议上的CAF方法。一项研究结果 将会是一个“最佳实践指数”，列出工作场所的特点 低错误率和高质量的护理。该索引将提供以下菜单 业务经理和医疗保健组织在确定如何 最好修改他们的实践以提高质量。由于我们的临床多样化 网站上，我们希望能够回答有关医生和 农村和市中心的病人。我们还预计能够 回答有关女性和少数族裔医生的问题，这些群体 在以医生为中心的研究中通常代表不足。

DESCRIPTION (APPLICATION ABSTRACT): The long-term objective of the MEMO Study (Minimizing Error, Maximizing Outcome) is to determine the effect of the healthcare work environment on the quality of care and the role of physicians as mediators of this effect. Specific aims include: 1) to determine the effect of workplace characteristics on patient outcomes such as satisfaction, disease control and medical errors; 2) to determine if the lowest error rates and best outcomes occur in an environment with low physician stress and burnout, and to identify the elements of such an environment; and 3) to define how predictors of quality and errors differ between women and men physicians, minority and non-minority physicians, and urban and rural physicians. The MEMO Study is a longitudinal, observational study of 500 physicians and 3,000 of their patients in 5 clinical sites: New York, Chicago, Milwaukee, Madison and rural Wisconsin. Patients will have one or more of three conditions: hypertension, diabetes and chronic lung disease. The initial 6 month phase will include focus groups with physicians, other healthcare personnel, and patients where individuals can "tell their stories" about the successes and challenges of their day-to-day healthcare experiences. This information will be utilized to develop surveys for the second phase, a two year prospective evaluation of physicians, patients and their outcomes. Medical errors in treatment and diagnosis will be assessed via chart review at the conclusion of phase two. Phase three will consist of data analysis and dissemination activities, including preparation of non-technical monographs, and use of the "Knowledge Caf method at regional and national primary care meetings. One study outcome will be a "best practice index" listing workplace characteristics that result in low error rates and high quality care. This index will provide a menu for practice managers and healthcare organizations to use in determining how to best modify their practices to improve quality. Due to our diverse clinical sites, we anticipate being able to answer questions concerning physicians and patients in rural and inner-city settings. We also anticipate being able to answer questions about women and minority physicians, groups that are typically underrepresented in physician-centered research.