Detecting, Addressing and Learning From Patient-Perceived Breakdowns in Care

描述(由申请人提供)：越来越多的人认识到，患者和家属对护理经验有重要的洞察力，包括关于不良事件的信息和如何预防，但许多人不愿直言不讳地表达他们的担忧。造成这种情况的原因有很多，包括感觉不舒服，认为报告不会带来变化，或者担心报告他们的担忧可能会破坏他们的治疗关系。其结果是，许多认为可能出了问题的患者“默默地忍受”，损害了他们的护理体验，并限制了提供者和医疗计划解决他们的担忧和防止类似故障再次发生的能力。提供真正以患者为中心的护理将要求医疗保健组织和提供者创造有效的手段，鼓励患者报告他们对护理故障的担忧，实时回应这些担忧，并使用患者报告防止复发。AHRQ正在进行的工作是为患者创建报告患者安全事件的门户网站。然而，为了达到最有效的效果，患者报告系统需要高度主动，并辅之以实时回应患者关切的机制。因此，在我们先前工作的基础上，并与MedStar Health(MSH)合作，我们建议开发、实施、传播和评估一项检测、解决和预防患者感知的护理故障的计划。该计划将包括一项名为“我们想知道”的积极、多模式、密集的活动，以建立信任，并鼓励患者和家属报告他们的护理经历。这项活动将包括积极的电话联系病人，加强我们想知道的信息。实时响应导航器将协调对患者识别的护理故障的响应，并将促进基于系统的学习。该项目将分两个阶段进行。在第一阶段，该方案将在两家医院的内科/外科病房实施。在RE-AIM框架内工作，我们使用各种评估方法，主要集中在计划的覆盖范围、采用和实施。在第二阶段，我们将利用吸取的经验教训来完善和加强该计划，然后在所有十家MSH医院实施该计划。第二阶段将需要对计划的可达性、采用和实施进行持续评估。我们还将检查维护，重点是维持该计划的领导计划。第二阶段将利用中断的时间序列设计对方案的有效性进行强有力的评估。关键结果将包括患者报告的频率和性质以及卫生系统对这些报告作出反应的能力。MedStar医院服务于社会经济、种族、民族和语言多样化的患者群体，为检查该计划的影响是否受到这些患者特征的影响提供了理想的环境。我们的定性和定量方法的组合将为如何推广该计划并优化所有患者的覆盖范围和有效性提供见解。

DESCRIPTION (provided by applicant): There is a growing recognition that patients and family members have critical insights into care experiences, including information about adverse events and how they might be prevented, but many are hesitant to speak up about their concerns. There are multiple reasons for this, including feeling poorly, the belief that reporting would not lead to change, or fear that reporting their concern might disrupt their therapeutic relationship. As a result, many patients who believe something may have gone wrong "suffer in silence", impairing their experience of care, and limiting the ability of providers and health plan to address their concerns and to prevent similar breakdowns from recurring. Providing truly patient-centered care will require that healthcare organizations and providers create effective means to encourage patients to report their concerns about care breakdowns, respond to these concerns in real time, and use patient reports to prevent recurrences. Ongoing AHRQ-sponsored work is creating portals for patients to report patient safety events. Yet to be most effective, patient reporting systems will need to be highly proactive and coupled with mechanisms to respond to patient concerns in real time. Therefore, building on our prior work, and in partnership with MedStar Health (MSH), we propose to develop, implement, disseminate and evaluate a program for detecting, addressing and preventing patient-perceived breakdowns in care. The program will include a proactive, multi-modal, intensive campaign entitled "We Want to Know" which builds trust and encourages patients and family members to report on their care experiences. The campaign will include active telephone outreach to patients, reinforcing the We Want to Know message. A Real Time Response Navigator will coordinate responses to patient-identified care breakdowns and will facilitate system-based learning. The project will occur in two phases. In Phase I the program will be implemented in medical/surgical units of two hospitals. Working within the RE-AIM framework, we use a variety of evaluation methods, focusing primarily on program Reach, Adoption, and Implementation. In Phase II, we will use the lessons learned to refine and enhance the program before implementing it system- wide throughout all ten MSH hospitals. Phase II will entail a continuing evaluation of program Reach, Adoption, and Implementation. We will also examine Maintenance, focusing on leadership plans for sustaining the program. Phase II will provide a strong evaluation of program Effectiveness utilizing an interrupted time series design. Key outcomes will include the frequency and nature of patient reports and the health system's ability to respond to these reports. MedStar hospitals serve a socio-economically, racially, ethnically and linguistically diverse patient population, providing an ideal environment for examining whether the program's impact is moderated by these patient characteristics. Our mix of qualitative and quantitative methods will provide insights into how to generalize the program and optimize reach and effectiveness for all patients.