Regional Ambulatory Near Miss Reporting and Tracking to Improve Patient Safety (H

描述(由申请人提供)：险些发生的事件，即没有对患者造成实际伤害的事件，代表着改善患者安全和满足患者对医疗护理风险的期望的低风险机会，这两个因素都与医疗事故诉讼和裁决相关。医学研究所(IOM)呼吁建立自愿报告系统，以检测个别医疗保健组织中发生的险些事件，并允许分析可能影响许多或所有保健提供者的差错模式。到目前为止，在美国记录和处理险些发生的事件的大多数尝试都是在医院进行的。需要更广泛的系统开发和评估，以有效地将险情报告扩展到非医院环境。这笔规划赠款将启动一项研究，这将是第一批在广泛的初级保健环境中提出和评估险些报告系统的研究之一。主要目标是更好地了解在初级保健中实施险些失败的报告和改进跟踪系统的障碍、促进者和结果。第二个目标是探索利用险些发生的事件来增加提供者向患者披露错误的信心和经验的可能性，以及这种披露是否降低了患者在发生有害医疗事件时寻求法律建议和提起医疗事故索赔的可能性。北卡罗来纳州农村卫生和社区护理办公室(ORHCC)建议对一个险些报告和改进跟踪系统进行初步研究。该报告和跟踪系统将被引入参加一个区域非卧床实践网络的六个不同的实践中。干预措施包括三个部分：1)每个做法的标准化指导；2)报告和收集6个月内每个做法的险情报告；3)持续的教育和质量改进努力，目的是了解和学习险些发生的事件，包括不断提示和提醒工作人员使用该系统。这项研究的研究内容包括：a)评估该系统在六个研究实践中的实施情况；b)分析报告的险些事件的类型，包括它们的相关性和严重性评级的有效性；c)评估患者和提供者报告的行为对险些披露的影响。作为这项初步研究的结果，研究团队希望更好地了解如何在初级保健环境中实施险情报告系统，实践如何响应险情事件报告(例如，哪些类型的事件可能最值得改进)，对险情事件的更多认可如何与提供者对患者安全和做法变化的认识和态度相关，以及提供者披露可能如何在寻求法律建议方面影响患者行为。 公共卫生相关性：不断上升的医疗事故和医疗保健成本使得在初级保健环境中努力改善患者的安全既及时又重要。险些发生的事件有可能导致患者受伤，但伤害是可以避免的，这是纠正对患者安全造成风险的缺陷的重要机会，但医院以外的险情报告系统很少。通过在六个初级保健实践中实施和评估险情报告和补救跟踪系统，这项初步研究将有助于更好地了解实践如何应对险情报告(例如，哪些类型的事件可能最需要改进)，对险情事件的更多认识如何与提供者对患者安全和做法变化的态度相关，以及提供者披露险情可能如何影响患者寻求法律建议的行为。

DESCRIPTION (provided by applicant): Near-miss events, where no actual harm comes to the patient, represent a low-risk opportunity to improve patient safety and address patient expectations about medical care risks, both factors associated with medical malpractice suits and awards. The Institute of Medicine (IOM) has called for the creation of voluntary reporting systems to detect near-miss events that occur in individual health care organizations, and to allow for analysis of patterns of errors that may affect many or all providers of care. To date, most attempts to record and address near-miss events in the United States have been conducted in hospitals. More extensive system development and evaluation are needed to effectively extend near-miss reporting to non-hospital settings. This planning grant will initiate a study that will be among the first to present and evaluate a near-miss reporting system in a broad range of primary care settings. The primary goal is to better understand the barriers, facilitators, and results of implementing a near-miss reporting and improvement tracking system in primary care. The secondary goal is to explore the potential of using near-miss events to increase provider confidence and experience with error disclosure to patients, and whether such disclosure decreases the likelihood that patients will seek legal advice and file malpractice claims in the event of a harmful medical event. The North Carolina Office of Rural Health and Community Care (ORHCC) proposes to conduct a preliminary study of a near-miss reporting and improvement tracking system. The near-miss reporting and tracking system will be introduced into six diverse practices participating in a regional ambulatory practice network. The intervention has three components: 1) a standardized orientation for each practice; 2) reporting and collection of near-miss reports from each practice for six months, and 3) ongoing educational and quality improvement efforts aimed at understanding and learning from the near-miss events including ongoing staff prompts and reminders to use the system. Research aspects of the study include: a) evaluation of the implementation of the system in the six study practices; b) analysis of the types of near-miss events reported including their correlates and the validity of seriousness ratings; and c) evaluation of patient and provider reported behaviors regarding the influence of near-miss disclosure. As a result of this preliminary study, the research team expects to gain a better understanding about how to implement a near-miss reporting system in primary care settings, how practices respond to near-miss event reporting (e.g., which types of events may be most amenable to improvement), how increased recognition of near-miss events relates to provider awareness and attitudes toward patient safety and practice change, and how provider disclosure might influence patient behavior in terms of seeking legal advice. PUBLIC HEALTH RELEVANCE: Rising malpractice and health care costs make efforts to improve patient safety in the primary care setting both timely and important. Near-miss events, which have the potential to lead to patient harm but harm is averted, represent a significant opportunity to correct flaws that create risks to patient safety, yet few near-miss reporting systems exist outside of hospital settings. Through implementation and evaluation of a near-miss reporting and remediation tracking system in six primary care practices, this preliminary study will lead to better understanding of how practices respond to near-miss reporting (e.g., which types of events may be most amenable to improvement), how increased recognition of near-miss events relates to provider attitudes toward patient safety and practice change, and how provider disclosure of near-misses might influence patient behavior in terms of seeking legal advice.