Measuring and Improving Ambulatory Patient Safety with an Electronic Dashboard

描述（由申请人提供）：患者安全性问题，如药物不良事件、监测失败和缺乏对异常检查的随访，通常发生在门诊环境中，并且很少有健康信息技术（HIT）支持的方法来解决这些门诊安全性差距。为了有效，检测和缓解患者安全问题的HIT工具需要检测“医疗之家”人群中的问题，而不是专注于参加门诊的个人。此外，这种以HIT为重点的方法在资源不足的安全网卫生保健环境中最迫切需要，这些环境照顾健康差异和缺乏HIT基础设施的人群。这项研究的长期目标是识别和减轻病人门诊安全风险，使用HIT跨安全网医疗保健系统。本应用程序的目的是开发一个HIT界面，该界面综合电子健康记录中的数据，以创建一个以门诊患者为中心的动态安全仪表板（安全措施的视觉摘要），并在安全网以患者为中心的医疗之家（PCMH）环境中对该工具进行试点测试。核心假设是，使用该仪表板将识别当前的安全风险，并允许使用跨学科护理团队实时缓解风险。该工具将允许检测整个人群的风险模式，以告知卫生系统流程变化，以减轻风险。流程变更的一个示例是对选定的高风险异常测试进行进一步自动化/警报，但后续工作不完整。这项研究的基本原理是，HIT启用的方法可以有效地识别患者的安全风险，并在基于团队和基于人群的初级保健的背景下，这些风险可以实时采取行动，而不是通过定期的，基于访问的初级保健。根据仪表板方法的经验和表明存在重大安全问题的初步数据，我们提出了两个具体目标：（1）开发一种用于初级保健环境的流动安全电子仪表板。仪表板将使用存储在电子健康记录和管理数据库中的数据，以告知护理团队关于门诊设置中选定的、基于证据的、高优先级的安全风险;以及（2）：进行试点研究，以评估在PCMH模型中使用仪表板的可行性。我们将在San弗朗西斯科总医院的初级保健诊所进行试点研究。除了使 这项试验性研究将使我们能够收集关于其在改善选定的高度优先的安全问题方面的“真实的世界”效用的初步数据。该方法具有创新性，因为医疗保健仪表板以前未用于解决患者安全风险或告知卫生系统流程变更，并且尚未在PCMH交付的背景下进行测试。拟议的研究是重要的，因为它预计将告知在何种程度上，以人口为中心的HIT工具集成到团队为基础的护理可以识别和减轻不安全的情况下，在门诊初级保健。最终，HIT在安全网方面的进步有可能更有效地提供护理并减少医疗保健差距。

DESCRIPTION (provided by applicant): Patient safety problems such as adverse drug events, monitoring failures, and lack of follow-up of abnormal tests, occur commonly in outpatient settings, and few health-information-technology (HIT)-enabled approaches to addressing these outpatient safety gaps have been evaluated. To be effective, HIT tools to detect and mitigate patient safety problems need to detect problems across the population of a "medical home", rather than focusing on individuals attending outpatient visits. Moreover, such HIT-focused approaches are most urgently needed in under-resourced safety-net health care settings that care for populations with health disparities and that lack HIT infrastructure. The long-term goal of this research is to identify and mitigate patient outpatient safety risks using HIT across safet-net health care systems. The objective of this application is to develop an HIT interface that synthesizes data from the electronic health record to create an outpatient- focused ambulatory safety dashboard (visual summary of safety measures) and to pilot-test this tool in a safety-net patient-centered medical home (PCMH) setting. The central hypothesis is that using this dashboard will identify prevailing safety risks and permit mitigation of risks in real-time using a interdisciplinary care team. This tool will allow detection of patterns of risk across the populatin to inform health system process changes to alleviate risk. An example process change is further automation/alerting for selected high-risk abnormal tests with incomplete follow-up. The rationale for this research is that HIT-enabled approaches can efficiently identify patient safety risks and in the context of team-based and population-based primary care, these risks can be acted upon in real-time rather than through periodic, visit-based primary care. Guided by experience with the dashboard approach and preliminary data indicating significant existing safety problems, we propose two specific aims: (1) To develop an ambulatory safety electronic dashboard for use in primary care settings. The dashboard will use data stored in the electronic health record and administrative databases to inform the care team about selected, evidence-based, high-priority safety risks in the outpatient setting; and (2): To conduct a pilot study to assess the feasibility of incorporating use of the dashboard in a PCMH model. We will conduct the pilot study in a primary care clinic at San Francisco General Hospital. In addition to enabling us to assess feasibility, this pilot study will enable us to collect preliminary data on its "real world" utility in ameliorating selected high-priority safety problems. The approach is innovative i that health care dashboards have not been previously used to address patient safety risks or to inform health systems process changes, and they have not been tested in the context of PCMH delivery. The proposed research is significant because it is expected to inform the extent to which a population-focused HIT tool integrated into team-based care can identify and mitigate unsafe situations in outpatient primary care. Ultimately, HIT advances in the safety net have the potential to deliver care more efficiently and reduce healthcare disparities.