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

检测、解决患者感知到的护理故障并从中学习

• 批准号: 8642914
• 负责人: KATHLEEN Michele MAZOR
• 金额: $ 49.54万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8642914
• 关键词: Detecting; Addressing; Learning; Patient; Perceived

Project Summary/Abstract 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 plans 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.

项目概要/摘要 人们越来越认识到患者和家属对护理体验有着重要的见解， 包括有关不良事件及其预防方法的信息，但许多人不愿透露 表达他们的担忧。造成这种情况的原因有多种，包括感觉不舒服、相信报告 不会导致改变，也不会担心报告他们的担忧可能会破坏他们的治疗关系。作为一个 结果，许多认为可能出了问题的患者“默默忍受”，从而损害了他们的健康 护理经验，并限制提供者和健康计划解决他们的担忧和 防止类似故障再次发生。提供真正以患者为中心的护理需要医疗保健 组织和提供者创造有效的手段来鼓励患者报告他们对护理的担忧 故障，实时响应这些问题，并使用患者报告来防止复发。进行中 AHRQ 赞助的工作是为患者创建报告患者安全事件的门户。但要达到最有效的效果， 患者报告系统需要高度主动，并配备响应患者的机制 实时关注。因此，在我们之前的工作基础上，并与 MedStar Health (MSH) 合作，我们 建议制定、实施、传播和评估一项旨在发现、解决和预防的计划 患者感知到的护理失败。该计划将包括一项积极主动、多模式、密集的活动 题为“我们想知道”，建立信任并鼓励患者和家属报告他们的情况 护理经验。该活动将包括积极电话联系患者，强化我们想要 知道留言。实时响应导航器将协调对患者识别护理的响应 故障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 该计划将在两家医院的内科/外科单位实施。在 RE-AIM 框架内工作， 我们使用多种评估方法，主要关注计划的覆盖范围、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增强该计划，然后再实施该计划系统- 广泛覆盖所有十家 MSH 医院。第二阶段将需要对“Reach”计划进行持续评估， 采用和实施。我们还将检查维护，重点关注维持的领导计划 程序。第二阶段将利用中断时间对计划的有效性进行强有力的评估 系列设计。主要成果将包括患者报告的频率和性质以及卫生系统的 回应这些报告的能力。 MedStar 医院服务于社会经济、种族、族裔和 语言多样化的患者群体，为检查该计划是否有效提供了理想的环境 这些患者特征会缓和影响。我们定性和定量方法的结合将 提供有关如何推广该计划并优化所有患者的覆盖范围和有效性的见解。