What is Patient Safety in the Medical Home?

虽然大多数医疗保健发生在门诊设置，如何最好地实施病人的安全，在初级保健 并没有得到很好的理解。关键的门诊安全领域包括漏诊、延误适当治疗， 用药错误和可预防的药物不良事件以及沟通、信息流和 护理协调。以病人为中心的医疗之家（PCMH）是改善初级保健的一个关键模式， 旨在解决全面、以患者为中心、协调和可获得的护理的核心属性 质量和安全。之前没有研究明确评估PCMH的安全性。这种伙伴关系 约翰霍普金斯和国家质量保证委员会（NCQA）之间的合作是一个独特的机会， 评估PCMH如何最好地解决安全问题。这两个组织都有丰富的经验， 和评估PCMH; NCQA，作为美国PCMH认证机构，拥有广泛的数据和与PCMH的链接 该公司表示对该项目有浓厚的兴趣。霍普金斯阿姆斯特朗患者研究所 安全和质量部在患者安全的各个方面都有丰富的专业知识，特别是在以下关键领域， 安全文化和人为因素。我们的总体目标是通过评估 以及PCMH的安全实施。在这项混合方法研究中，我们将评估初级保健如何 实践（使用3级PCMH的最佳情况）正在解决 这四个关键领域通过数据从多个角度，包括病人的投入。我们的具体 目的是：（1）使用已获得NCQA认可的实践和提供者的数据， 参与电子健康记录有意义的使用报告，探索采用 基于实践和区域特征的患者安全活动;（2）使用来自 访谈，观察和患者焦点小组，分析PCMH模型如何与患者安全相互作用 从不同的角度-患者、提供者和管理者-在四个关键的门诊安全 （3）在以不同方式实施PCMH的实践样本中，评估 背景问题（例如，实践类型）和具有患者安全措施的特定PCMH实施实践 在四个关键领域的流动安全使用定性比较分析。预期 结果将是关于PCMH和具体实施要素如何与 患者安全性和潜在影响安全性结局，跨不同的门诊安全领域和PCMH 程序.研究结果将为公共和私营部门推进流动安全的努力提供信息， 提供各种方法评价门诊安全结局可行性的关键信息 并建议如何更好地将安全性融入PCMH等模型中。将传播调查结果 通过NCQA标准和PCMH社区合作伙伴，并将提高有关流动安全的知识 以及如何最好地设计未来的干预措施来改善患者的治疗效果。

Although most health care occurs in ambulatory settings, how best to implement patient safety in primary care is not well understood. Key ambulatory safety domains include missed diagnoses, delays in proper treatment, medication errors and preventable adverse drug events and defects in communication, information flow, and care coordination. The Patient-Centered Medical Home (PCMH), a key model for improving primary care, is designed to address core attributes of comprehensive, patient-centered, coordinated, and accessible care and quality and safety. No previous research has explicitly evaluated safety in the PCMH. This partnership between Johns Hopkins and the National Committee on Quality Assurance (NCQA) is a unique opportunity to evaluate how the PCMH can best address safety. Both organizations have significant experience with building and evaluating the PCMH; NCQA, as the US PCMH accreditor, has extensive data and links to the PCMH community, which has expressed strong interest in this project. The Hopkins Armstrong Institute for Patient Safety and Quality brings extensive expertise in all aspects of patient safety, particularly critical areas such as safety culture and human factors. Our overall goal is to improve ambulatory safety by evaluating the meaning and implementation of safety in PCMHs. In this mixed-methods study, we will evaluate how primary care practices (using the best-case scenario of Level 3 PCMHs) are addressing ambulatory safety across the four key domains through data from multiple perspectives, including patient input. Our specific aims are: (1) Using data on practices that have achieved NCQA recognition and providers that have participated in electronic health record meaningful use reporting, explore trends and variation in adoption of patient safety activities based on practice and regional characteristics; (2) using triangulated data from interviews, observation, and patient focus groups, analyze how the PCMH model interacts with patient safety from different perspectives-patient, provider, and administrator - across the four key ambulatory safety domains; and (3) in a sample of practices implementing the PCMH in diverse ways, evaluate the association of contextual issues (eg, practice type) and specific PCMH implementation practices with patient safety measures across the four key domains of ambulatory safety using qualitative comparative analysis. The expected outcomes will be important findings about how the PCMH and specific implementation elements interact with patient safety and potentially impact safety outcomes, across diverse ambulatory safety domains and PCMH programs. The results will inform public and private sector efforts to advance ambulatory safety, provide critical information on viability of various methods for evaluating ambulatory safety outcomes and suggest ways to better integrate safety into models such as the PCMH. Findings will be disseminated through NCQA standards and PCMH community partners and will improve knowledge about ambulatory safety and how best to design future interventions to improve patient outcomes.