Measuring and Improving Ambulatory Patient Safety with an Electronic Dashboard

使用电子仪表板测量和提高门诊患者安全

• 批准号: 8445135
• 负责人: Urmimala Sarkar
• 金额: $ 15.27万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2014-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8445135
• 关键词: Measuring; Improving; Ambulatory; Patient; Safety

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. PUBLIC HEALTH RELEVANCE: Inadequate patient safety has been recognized as a major public health challenge in the U.S., and because the majority of medical care occurs in the outpatient setting, efforts to improve patient safety must include outpatient care settings. This proposal is to design a health-information technology innovation, a patient safety dashboard, defined as an interactive, visual summary of safety gaps. We have chosen 4 high-priority safety gaps to investigate, including two selected high-risk medication classes for monitoring, incomplete follow-up of abnormal colon cancer screening results, and lack of outpatient care following hospitalization for heart failure. We then plan to pilot-test the tool's ability to efficently identify and address selected high-priority patient safety problems within a safety-net outpatient health system.

描述（由申请人提供）：患者安全问题，例如不良药物事件，监测失败以及缺乏异常测试的随访，通常发生在门诊环境中，并且很少评估健康信息技术（HIT）良好的方法来解决这些门诊安全差距。为了有效，HIT命中工具以检测和减轻患者的安全问题需要检测“医疗之家”人群中的问题，而不是专注于参加门诊就诊的个人。此外，在资源不足的安全网医疗保健环境中，最迫切需要这种以HIT为重点的方法，这些医疗保健环境护理患有健康差异的人群并且缺乏基础设施。这项研究的长期目标是使用Safet-Net医疗保健系统中的命中率识别和减轻患者门诊安全风险。该应用程序的目的是开发一个命中界面，该接口综合了电子健康记录中的数据，以创建一个以门诊为中心的门诊安全仪表板（安全性措施的视觉摘要），并在以安全网络为中心的患者输入的医疗家庭（PCMH）设置中进行试验该工具。中心假设是，使用此仪表板将确定盛行的安全风险，并允许使用跨学科护理团队实时降低风险。该工具将允许检测到整个人口的风险模式，以告知卫生系统过程的变化以减轻风险。一个示例过程更改是进一步的自动化/警报，对于不完整的随访，选定的高风险异常测试。这项研究的理由是，基于杀手的方法可以有效地识别患者的安全风险，并且在基于团队和基于人群的初级保健的背景下，可以实时采取这些风险，而不是通过定期的，基于访问的初级保健。在具有仪表板方法的经验和初步数据的指导下，我们提出了两个具体的目的：（1）开发用于初级保健环境中的卧床安全电子仪表板。仪表板将使用存储在电子健康记录和行政数据库中的数据来告知护理团队在门诊环境中选定的，基于证据的高优先级安全风险； （2）：进行一项试验研究，以评估将仪表板使用在PCMH模型中的可行性。我们将在旧金山综合医院的一家初级保健诊所进行试点研究。除了启用 为了评估可行性，这项试点研究将使我们能够收集有关其“现实世界”实用程序的初步数据，以改善选定的高优先级安全问题。这种方法是创新的，我以前尚未使用医疗保健仪表板来解决患者安全风险或为卫生系统过程的变化提供信息，并且在PCMH交付的背景下尚未对其进行测试。拟议的研究之所以重要，是因为有望告知将以人群为中心的命中工具整合到基于团队的护理中的程度，可以识别和减轻门诊初级保健中不安全的情况。最终，安全网的进步有可能更有效地提供护理并减少医疗保健差异。 公共卫生相关性：在美国，患者安全不足已被认为是主要的公共卫生挑战，并且由于大多数医疗服务发生在门诊环境中，因此改善患者安全的努力必须包括门诊护理环境。该建议是设计健康信息技术创新，这是一种患者安全仪表板，定义为安全间隙的交互式视觉摘要。我们选择了4个高优先性安全差距进行研究，包括两种选择的高风险药物类别，用于监测，对异常结肠癌筛查结果的不完整随访以及住院治疗后缺乏门诊护理。然后，我们计划试点测试该工具在安全网门诊健康系统中有效识别和解决高端患者安全问题的能力。