Multi-Method Proactive Risk Assessment

描述（由申请人提供）：尽管在过去的5到10年里，对医疗系统安全性的关注有所增加，但安全性改善的明确证据是零星的。某些机构似乎在特定领域取得了巨大进展。虽然技术为提高安全性提供了很多帮助，但在设计良好的系统中，人为因素的故障却一再被注意到。朝向更安全的医疗保健系统的全国运动继续得到联邦政府和医疗保健研究与质量机构（AHRQ）的大力支持，但很明显，地方一级还有很多工作要做。组织不能指望其他人的工作将自动转化为整个医疗保健系统中更安全的护理。卫生保健系统的住院部分在了解错误的来源和改善护理的干预措施方面受到了最多的关注。尽管如此，在任何一个月里，大约有四分之一的美国公众在门诊护理机构就诊，而大约有1%的人在住院治疗。此外，门诊护理中的错误已被充分记录。因此，需要一个更安全的门诊系统是明确的。制定干预措施以减少错误和伤害需要当地信息，不仅涉及系统故障，还涉及当地护理流程、实践层面的变革准备情况，以及在机构各级提供安全护理的承诺。该项目的具体目标是：1)使用以下工具从科罗拉多大学医院（UCH）的12个门诊诊所收集实践水平的数据，以帮助提供前瞻性风险分析：a) AHRQ医疗办公室关于医疗质量和患者安全的调查；b) ahrq支持的Office生命体征仪；c)医疗集团管理协会办公室风险评估工具；d)通过可视化流程图和群体反思进行前瞻性风险评估；2)分析来自uch特异性两个门诊错误数据库的数据，以确证Aim 1中确定的特定门诊高风险区域；3)利用优势、劣势、机会、威胁（SWOT）分析，在联合医院门诊系统内采用参与式方法，为三个领域之一（实验室管理、成像管理、药物管理）制定数据驱动的风险降低计划。

DESCRIPTION (provided by the applicant): Despite increased attention to the safety of the medical system over the past 5 to 10 years, clear evidence of improvements in safety has been sporadic. Selected institutions appear to have made great gains in specific areas. While technology offers much to improve safety, human factors failures in well intended systems have been repeatedly noted. The national movement towards a safer health care system continues to have strong support from the Federal government and the Agency for Healthcare Research and Quality (AHRQ), but it has become apparent that much still needs to be done at the local level. Organizations cannot expect that the work of others will automatically translate to safer care across the entire healthcare system. The inpatient component of the health care system has received the most attention in understanding the source of errors and interventions to improve care. Nonetheless, in any given month approximately one quarter of the American public are seen in an ambulatory care facility while approximately 1% will be cared for in the inpatient setting. Furthermore, errors in ambulatory care have been well documented. Thus, the need for a safer ambulatory system is clear. Developing interventions to reduce errors and harm requires local information concerning not only system failures but also local care processes, practice level readiness to change, and a commitment to the provision of safe care at all levels of an institution. The specific aims of the project are to: 1) Collect practice level data using the instruments listed below from 12 University of Colorado Hospital (UCH) ambulatory clinics to help inform a proactive risk analysis: a) AHRQ Medical Office Survey on Healthcare Quality and Patient Safety; b) AHRQ-supported Office Vital Signs instrument; c) Medical Group Management Association's office risk assessment instrument; and d) Proactive risk assessment through a visual process map and group reflection; 2) Analyze data from UCH-specific two ambulatory error database to corroborate specific ambulatory high risk areas identified in Aim 1; and 3) Develop a data driven risk reduction plan for one of three areas (laboratory management, imaging management, medication management) using participatory methods within the UCH ambulatory system using a Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis.