Adverse Event Directed Analysis in Ambulatory Primary Care

描述(由申请人提供)：与作为住院护理一部分观察到的不良事件相比，门诊护理中发生的不良事件(AEs)的危害的性质和程度受到的监管和改善关注要少得多。因此，贝勒医疗保健系统对IHI门诊触发工具(I-OTT)的内容和流程进行了修改，以评估由HealthTexas Provider Network(HTPN)雇用的初级保健医生看过的患者所接受的护理。修订后的工具--贝勒/IHI门诊触发工具(Bl-OTT)于2006年用于评估2005年期间接受179名初级保健医生护理的5,246名病人的护理情况。这项审查使2005年能够初步估计与护理有关的急诊护理的范围、模式和性质。主要调查结果包括，每100个病人年中存在25.6例不良事件，对符合需要额外护理/监测标准的成年病人进行护理。大约54%的急诊室有一定程度的可预防意识，80%与所提供的护理有关(20%与未提供的指示护理有关)，63%与儿科医生的护理有关(46%与患者责任有关，25%与儿科医生诊所以外提供的护理有关)。这些数据表明，在门诊初级保健中存在相当大的患者风险，并强烈鼓励提出与以下广泛目标相关的具体目标：a)改进和表征BI-OTT工具/审计过程，以便更广泛地使用，以更准确地估计初级保健患者的伤害负担；以及b)使用这种相对无偏见的方法来选择事件进行深入研究，以评估造成所观察到的威胁/风险的性质 AES.拟议研究的结果将：1)产生一个成熟的审计工具/程序(包括电子数据收集工具和培训手册)，可用于对门诊环境中的急性脑病进行广泛的量化；2)提供对急性脑炎的范围、性质和来源的大规模估计，并具有足够的普遍性，以便开始评估美国成年患者的这一负担；3)建立有助于发展急性脑炎的潜在高风险护理程序，而不依赖于更有偏见的方式来识别它们；4)估计由于风险缓解而能够预防或改善的急性脑炎的负担。更成熟的BI-OTT2审计工具/程序将提供机会：a)衡量旨在改善门诊初级保健中患者安全性的干预措施的有效性；b)允许对确诊的AE患者的经历进行纵向评估(与他们的临床和经济结果相关)；c)允许对类似的患者结果进行评估，这些结果是通过使用B1-OTT2确定的具有较高与较低的不良事件发生率的实践中得出的。

DESCRIPTION (provided by the applicant): The nature and extent of harm from adverse events (AEs) taking place in ambulatory care has received considerably less regulatory and improvement attention than AEs observed as part of inpatient care. Accordingly, the Baylor Health Care System has modified in content and process the IHI Outpatient Trigger Tool (I-OTT) to evaluate care received by patients seen by primary care physicians employed by HealthTexas Provider Network (HTPN). A revised instrument - the Baylor/IHI Outpatient Trigger Tool (Bl-OTT) was used in 2006 to evaluate the care of 5,246 patients who received care from 179 primary care physicians during 2005. This review has allowed initial estimates of the extent, pattern and nature of AEs related to care during 2005. Major findings include the existence of 25.6 adverse events per 100 patient years of care for audited adult patients that met the criterion of requiring some additional level of care/monitoring. Approximately 54% of AEs had some level of perceived preventability, 80% were associated with the care that was provided (vs. 20% related to indicated care that was not provided) and 63% were associated with the PCP's care (46% were associated with patient responsibility and 25% with care provided outside the PCP's practice). These data indicate that there is considerable patient risk in ambulatory primary care and strongly encourages the proposed specific aims related to the broad goals of: a) refining and characterizing the BI-OTT instrument/audit process for broader use to more accurately estimate the burden of harm to primary care patients; and b) using this relatively nonbiased approach to select events for in depth study to evaluate the nature of the threats/risks that contribute to the observed AEs. The results of the proposed research will: 1) generate a mature audit instrument/process (including electronic data collection tools and training manuals) that can be used to quantify AEs in ambulatory environments broadly; 2) provide a large scale estimate of the extent, nature and source of AEs with sufficient generalizability to begin to estimate this burden upon adult patients in the US; 3) establish the underlying high risk care processes that contribute to the development of AEs that do NOT depend upon more biased ways to identify them; 4) estimate the burden of AEs that are amenable to prevention or amelioration as a result of risk mitigation. The more mature BI-OTT2 audit instrument / process will provide the opportunity to: a) measure the effectiveness of interventions designed to improve patient safety in ambulatory primary care; b) permit longitudinal evaluation of the experience of patients with an identified AE (related to their clinical and economic outcomes); c) permit evaluation of similar patient outcomes that derive from care in practices that demonstrate higher vs. lower rates of AEs as identified through use of the Bl-OTT2.