Investigating Failures of Notification and Monitoring in Outpatient Care: the Safety Promotion Action Research and Knowledge (SPARK) Network

 描述（由申请人提供）：确保患者安全仍然是医疗保健系统的关键问题。特别是，门诊（门诊）医疗保健机构容易受到患者安全问题的影响。大多数医疗保健都是在门诊环境中提供的，美国每年有12亿人次门诊就诊。监测失败之间，以及 由于漏诊和延误诊断，门诊病人的安全问题造成了严重的发病率和死亡率。虽然在识别和预防不良事件方面取得了长足的进步，但对门诊护理环境中患者安全的流行病学以及导致这些差异的因素知之甚少。本提案的总体目标是检查门诊护理环境中患者安全性的流行病学，这些环境为不同的低收入人群提供护理，具体如下：（1）通过种族/民族和语言能力来描述特定安全差距的发生率和流行率;（2）收集关于可以提高安全性和描述患者安全差异的策略的深入定性证据;（3）在五个安全网医疗系统的不同样本中对病人安全监测方法进行试点测试;以及（4）开发一个测量和错误调查工具包，供安全网医疗系统使用。具体而言，我们将确定可采取行动的检测结果的遗漏通知程度和高风险人群的遗漏监测程度。这两个流程差距，即对高风险状况的定期监测和可操作的异常检测结果的通知，都导致了可预防的患者伤害。虽然这些护理差距被记录在案，但伤害和最高风险人群的差异程度仍然不清楚。为了进一步加深这方面的知识，我们将阐明这些安全差距的根本原因，重点是我们在数据中发现的差异。最后，我们的目标是让参与这项研究的安全网卫生系统的方法工具，进行测量这些安全差距，并进行事件调查，以便为未来的改进和创新工作，以缩小差距的差距。我们建议建立一个合作的安全促进行动研究和知识网络（SPARK网络），以实现以下具体目标：1）制定可行的，及时的，准确的电子措施的病人安全通知和监测的差距，在门诊护理设置为高风险的亚群和特点的程度差异，病人的安全; 2）对五个公共门诊护理机构的患者安全通知/监测差距进行根本原因分析，以确定导致这些差距的因素;以及3）评估在五个不同的门诊医疗保健机构中根据目标1和2开发的患者安全监测方法的试点实施情况。我们设想，该项目的试点结果将导致患者安全监测方法的测量和根本原因分析工具包，可以在照顾不同人群的医疗保健系统中广泛传播。

 DESCRIPTION (provided by applicant): Ensuring patient safety remains a critical issue for health care systems. In particular, ambulatory (outpatient) health care settings are vulnerable to patient safety concerns. The majority of health care is delivered in ambulatory settings, with 1.2 billion outpatient visits annually in the United States (U.S.). Between failures of monitoring, and missed and delayed diagnosis, there is significant morbidity and mortality from patient safety problems in outpatient care. Although strides have been made in recognizing and preventing adverse events, little is known about the epidemiology of patient safety in ambulatory care settings and factors that contribute to these disparities. The overall goals of this proposal are t examine the epidemiology of patient safety in ambulatory care settings that care for diverse, low-income populations as follows; (1) to characterize the incidence and prevalence of specific safety gaps, by race/ ethnicity and language proficiency; (2) to gather in- depth, qualitative evidence about strategies that can improve safety and characterize disparities in patient safety; (3) to pilot-test patient safety monitoring methodologies in a diverse sample of five safety net health care systems; and (4) to develop a measurement and error investigation toolkit for dissemination amongst safety-net health care systems. Specifically, we will identify the extent of missed notification for actionable test results and extent of missed monitoring for high-risk populations. These two process gaps, periodic monitoring of high-risk conditions and notification of actionable abnormal test results, both lead to preventable patient harm. While these care gaps are documented, the extent of disparities in harm and the populations at highest risk remain unclear. To further deepen this knowledge, we will elucidate underlying causes for these safety gaps, focusing on disparities we identify in the data. Finally, we aim to give safety-net health systems participating in this study the methodological tools to conduct measurement of these safety gaps and perform event investigation, in order to set the stage for future improvement and innovation work to close gaps in disparities. We propose a collaborative Safety Promotion Action Research and Knowledge Network (SPARK Network) to achieve the following specific aims: 1) to develop feasible, timely, and accurate electronic measures of patient safety notification and monitoring gaps in an ambulatory care setting for high-risk sub- populations and characterize the extent of disparities in patient safety; 2) to conduct a root cause analysis of patient safety notification/ monitoring gaps in five public ambulatory care settings to identify factors contributing to these disparities; and 3) to evaluate the pilot implementation of patient safety monitoring methodologies developed from Aims 1 and 2 across five diverse ambulatory health care settings. We envision that pilot findings from this project wil result in a measurement and root cause analysis toolkit of patient safety monitoring methodologies that can be widely disseminated across health care systems that care for diverse populations.