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

描述（由申请方提供）：来自Baylor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，在门诊初级护理中存在大量不良事件（AE）负担（13. 5 AE/100患者年）。这一测量策略的部署本身就是一种与提高门诊初级保健质量相关的干预措施。基于BI-OTT工具和流程的完善以及第二次大规模部署，有机会准备更广泛地使用这种干预措施，并测试其作为改善干预措施本身的效用，评价特定患者安全性干预措施对AE发生率的影响，并启动对门诊初级护理中发生的AE影响的经济分析。建议工作的具体目标是：1）开发一套培训材料和实施工具的传播包，供其他组织采用，使他们能够有效地使用BI-OTT来测量AE的发生率; 2）测试传播包在其开发环境之外提供可靠和有效的AE测量系统的有效性; 3）从患者、初级保健提供者、付款人、雇主和社会的角度评价已识别的非卧床AE的经济影响; 4）测试BI-OTT检测已知导致住院和/或艾德使用的非卧床初级保健衍生AE的能力; 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。BHCS将与三角研究所合作开发和部署传播包，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。将在帕克兰卫生和医院系统（德克萨斯州达拉斯的安全网提供者）、中大西洋凯撒医疗集团和普罗维登斯卫生服务机构内进行传播测试。假设可证明有效性，这项工作将促进标准化可靠工具的广泛传播，以检测和表征初级保健AE，证明该工具用于更广泛地评价其他安全性干预措施的效用，并提供有关初级保健相关AE成本的有价值信息。这些数据可能有助于在供应商层面（与改善患者安全的潜在投资相关）和政策层面（与安全举措的优先级和报销策略的潜在重新调整相关）为决策提供信息，以更好地分配成本和由此节省的投资，以改善患者安全。 公共卫生相关性：虽然门诊护理占美国医疗保健的大部分，但在这种情况下，对患者安全性和不良事件（AE）的关注相对较少。拟议项目将提供一种广泛传播测量工具的方法，以跟踪和描述初级保健引起的AE，证明该工具在评价初级保健环境中患者安全措施的有效性方面的效用，并提供有关初级保健费用的宝贵信息-衍生的不良事件，为提供者和政策决策提供关于安全措施优先级的信息，并可能重新调整报销策略，以更好地分摊成本以及由此产生的与安全措施投资有关的节省。这项工作对公共卫生具有重大意义，因为所有项目的目标都是在最常用的医疗保健环境中采取重要步骤，减少患者伤害的风险。

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.