The Value of Hospital-Related Patient-Safety Interventions to Key Stakeholders

描述(由申请人提供)：Teryl Nuckols，医学博士，M.S.H.S.，加州大学洛杉矶分校普通内科和卫生服务研究部和兰德公司的联合内科医生。她在医院行医，并成功地领导或为几个患者安全和护理质量项目做出了实质性贡献，其中一些项目与成本问题有关。她的长期目标是更好地阐明质量/安全问题与经济问题之间的关系。这类研究的目的是为决策者和其他人提供信息，以便他们能够优先考虑质量/安全干预措施，了解如何将经济激励措施与实施相结合，并预测有关质量/安全和成本的政策决定的后果。这份申请描述了一项计划，将使她能够实现这一目标。首先，她需要更多的微观经济学理论知识；执行成本、成本效益和成本效益分析的额外技能；以及对质量和安全改进计划的更深层次理解。她将在何塞·埃斯莱特博士(首席导师)、Steven Asch博士(联合导师)、Emmett Keeler博士(贡献者)和Lee Hilborne博士(贡献者)的指导下获得这些专业知识，他们分别在卫生经济学、质量评估方法、经济评估方法和与医院相关的患者安全问题方面拥有丰富的经验。加州大学洛杉矶分校公共卫生学院和兰德·帕迪研究生院的课程将增加她的知识和技能。其次，她的近期目标是在这一领域建立一个实质性的研究计划。她将开发一种方法来评估与医院相关的患者安全干预措施对关键利益攸关方的影响，包括对付款人、雇主、医院和医生的财务影响，以及对患者的健康和财务影响(具体目标一)。在开发了这种方法后，她将把它应用于被广泛接受的与医院相关的患者安全干预、计算机化的医嘱输入，并从利益相关者那里获得反馈(具体目标二)。这将增加对执行障碍的了解，确定促进执行的潜在政策杠杆，并为关于其他干预措施的类似研究奠定基础。每年，医疗差错都会伤害许多住院患者。现在有几种预防这种伤害的策略，但由于成本问题，医院和医生可能不愿使用它们。更好地了解改善患者安全的战略将如何影响医院、医生、保险公司、雇主和患者，将使政策制定者和其他人更好地将财政激励与改善相结合。

DESCRIPTION (provided by applicant): Teryl Nuckols, M.D., M.S.H.S., is an Internist jointly based at the UCLA Division of General Internal Medicine and Health Services Research and the RAND Corporation. She practices hospital medicine and has successfully led or made substantive contributions to several patient-safety and quality-of-care projects, some pertaining to cost issues. Her long-term objective is to better elucidate the relationship between quality/safety problems and economic issues. The purpose of such research is to inform policy makers and others so that they can prioritize quality/safety interventions, understand how to align economic incentives with implementation, and anticipate the consequences of policy decisions on quality/safety and costs. This application describes a plan that will enable her to achieve this objective. First, she requires greater knowledge of microeconomic theory; additional skill in performing cost, cost-effectiveness, and cost-benefit analyses; and a deeper understanding of quality and safety improvement programs. She will acquire this expertise under the guidance of Dr. Jose Escarce (Principal Mentor), Dr. Steven Asch (Co-Mentor), Dr. Emmett Keeler (Contributor), and Dr. Lee Hilborne (Contributor) who have, respectively, extensive experience in health economics, quality assessment methodology, economic evaluation methodology, and hospital-related patient-safety issues. Coursework at the UCLA School of Public Health and RAND Pardee Graduate School will increase her knowledge and skill. Second, her immediate objective is to establish a substantive research program in this area. She will develop an approach to evaluating the effects of hospital-related patient-safety interventions on key stakeholders, including financial effects on payers, employers, hospitals, and physicians, as well as health and financial effects on patients (Specific Aim One). After developing the approach, she will apply it to a widely accepted hospital-related patient-safety intervention, computerized physician order entry, and obtain feedback from stakeholders (Specific Aim Two). This will increase the understanding of barriers to implementation, identify potential policy levers for promoting implementation, and lay the groundwork for similar studies on other interventions. Each year, medical errors harm many hospitalized patients. There are now several strategies for preventing such harm but hospitals and doctors can be reluctant to use them due to the cost. A better understanding of how strategies for improving patient safety would affect hospitals, doctors, insurance companies, employers, and patients would enable policymakers and others to better align financial incentives with improvement.