Improving the Safety of Primary Care by Measuring Adverse Events and Improvement

描述(由申请人提供)：来自贝勒医疗保健系统(BHCS)/医疗保健改善研究所门诊触发工具(BI-OTT)的大规模本地部署的数据表明，在非卧床初级保健中存在大量不良事件(13.5不良事件/100pt年)。这一衡量战略的部署本身就是一种与提高门诊初级保健质量有关的干预措施。在改进BI-OTT工具和流程以及第二次大规模部署的基础上，有机会为更广泛地使用这种干预措施做好准备，并测试其作为改进干预措施本身的有效性，评估特定患者安全干预对AEs发生率的影响，并启动对门诊初级保健中发生的AEs的影响的经济分析。拟议工作的具体目标是：1)开发供其他组织采用的培训材料和实施工具的传播包，使它们能够有效地使用BI-OTT来衡量AEs的比率；2)测试传播包在为其开发环境之外的AEs提供可靠和有效的测量系统方面的有效性；3)从患者、初级保健提供者、付款人、雇主和社会的角度评估已确定的AEs的经济影响；4)测试BI-OTT检测已知导致住院和/或急诊使用的由初级保健派生的AEs的能力；以及5)使用BI-OTT来量化部署动态电子健康记录对药物不良事件发生率的影响。BHC将与三角研究所合作开发和部署传播包，其中包括培训视频、网站和BI-OTT电子数据收集工具的可下载版本。传播将在帕克兰卫生和医院系统(德克萨斯州达拉斯的一家安全网提供商)、中大西洋凯撒永久医疗集团和普罗维登斯卫生服务公司内进行测试。这项工作假定具有明显的有效性，将促进广泛传播一种标准化的可靠工具来检测和表征初级保健急救，展示该工具在更广泛地评估其他安全干预措施方面的效用，并提供有关初级保健衍生急救相关费用的有价值的信息。这些数据可能有助于在提供者层面(与改善患者安全的潜在投资有关)和与安全倡议的优先顺序和潜在的重新调整报销策略相关的政策层面的决策，以更好地分配成本和由此产生的投资节省，以改善患者的安全。 公共卫生相关性：尽管门诊护理在美国的医疗保健中占大多数，但在这种情况下，对患者安全和不良事件(AEs)的关注相对较少。拟议的项目将提供一种广泛传播测量工具的手段，以跟踪和描述初级保健派生的AEs，展示该工具在评估初级保健环境中患者安全倡议的有效性方面的效用，并提供关于与初级保健派生的AEs相关的成本的有价值的信息，以向提供者和政策决策提供有关安全倡议的优先顺序和潜在的重新调整报销战略的信息，以更好地分摊与安全倡议投资相关的成本和由此产生的节省。这项工作对公共卫生具有重大影响，因为所有项目都旨在解决在最频繁使用的卫生保健环境中减少患者伤害风险的关键步骤。

DESCRIPTION (provided by applicant): Data from a large-scale local deployment of the Baylor Health Care System (BHCS)/Institute for Healthcare Improvement Outpatient Trigger Tool (BI-OTT) indicate the presence of a substantial burden of adverse events (AEs) in ambulatory primary care (13.5 AEs/100 pt years). Deployment of this measurement strategy represents, itself, an intervention related to improving the quality of ambulatory primary care. Based upon refinement of the BI-OTT tool and process and a second large scale deployment, an opportunity exists to ready this intervention for broader use and to test its utility as an improvement intervention itself, to evaluate the impact of a specific patient safety intervention upon the rate of AEs, and to initiate an economic analysis of the impact of AEs taking place in ambulatory primary care. Specific aims of the proposed work are: 1) To develop a dissemination package of training materials and implementation tools for adoption by other organizations to enable them to effectively use the BI-OTT to measure the rate of AEs; 2) To test the effectiveness of the dissemination package in providing a reliable and valid measurement system for AEs outside of its development environment; 3) To evaluate the economic impact of identified ambulatory AEs from the perspectives of the patient, primary care provider, payer, employer, and society; 4) To test the ability of the BI-OTT to detect ambulatory primary care-derived AEs known to result in hospitalization and/or ED use; and 5) To use the BI-OTT to quantify the effects of deploying an ambulatory electronic health record on the rate of adverse drug events. BHCS will collaborate with Research Triangle Institute to develop and deploy the dissemination package, to include a training video, Web site, and downloadable version of the BI- OTT electronic data collection tool. Dissemination will be tested within the Parkland Health and Hospital System (a safety-net provider in Dallas, Texas), the Mid-Atlantic Kaiser Permanente Medical Group, and Providence Health Services. Presuming demonstrable effectiveness, this work will facilitate widespread dissemination of a standardized reliable tool to detect and characterize primary care AEs, demonstrate the utility of this tool for evaluating other safety interventions more broadly, and provide valuable information regarding the costs associated with primary care-derived AEs. These data may help to inform decision-making at the provider level (related to potential investments to improve patient safety) and at the policy level related both to prioritization of safety initiatives and potential realignment of reimbursement strategies to better apportion both cost and resultant savings of investments to improve patient safety. PUBLIC HEALTH RELEVANCE: Although ambulatory care accounts for the majority of health care encounters in the United States, relatively little attention has been paid to patient safety and adverse events (AEs) in this setting. The proposed project will provide a means of broadly disseminating a measurement tool to track and characterize primary care-derived AEs, demonstrate the utility of this tool in evaluating effectiveness of patient safety initiatives in the primary care setting, and contribute valuable information regarding costs associated with primary care-derived AEs to inform provider and policy decisions regarding prioritization of safety initiatives and potential realignment of reimbursement strategies to better apportion costs and resultant savings related to investments in safety initiatives. This work has significant implications for public health, as all of the project aims address vital steps in reducing the risk of patient harm in the most frequently utilized health care setting.