What is Patient Safety in the Medical Home?

什么是医疗之家的患者安全？

• 批准号: 9355591
• 负责人: SYDNEY MORSS DY
• 金额: $ 49.88万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9355591
• 关键词: What; Patient; Safety; Medical; Home

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.

尽管大多数医疗保健发生在门诊环境中，但如何最好地在初级保健中实现患者安全 不太理解。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、信息流和治疗方面的缺陷 护理协调。以患者为中心的医疗之家（PCMH）是改善初级保健的关键模式， 旨在解决全面、以患者为中心、协调和可及的护理的核心属性 以及质量和安全。之前没有研究明确评估过 PCMH 的安全性。此次合作 约翰·霍普金斯大学与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。两个组织在构建 并评估PCMH； NCQA 作为美国 PCMH 认证机构，拥有丰富的数据和与 PCMH 的链接 社会各界对此项目表示了浓厚的兴趣。霍普金斯阿姆斯特朗病人研究所 安全和质量在患者安全的各个方面带来了广泛的专业知识，特别是关键领域，例如 安全文化和人为因素。我们的总体目标是通过评估意义来提高流动安全性 PCMH 中的安全实施。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）正在解决跨区域的流动安全问题 通过来自多个角度的数据（包括患者输入）来了解四个关键领域。我们的具体 目标是： (1) 使用已获得 NCQA 认可的实践和已获得 NCQA 认可的提供商的数据 参与电子健康记录有意义的使用报告，探索采用的趋势和变化 基于实践和区域特点的患者安全活动； (2) 使用三角测量数据 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）跨越四个关键的门诊安全 域； (3) 在以不同方式实施 PCMH 的实践样本中，评估以下方面的关联： 背景问题（例如实践类型）和具体的 PCMH 实施实践以及患者安全措施 使用定性比较分析跨越流动安全的四个关键领域。预期的 结果将是关于 PCMH 和具体实施要素如何与 跨不同门诊安全领域和 PCMH 的患者安全和潜在影响安全结果 程序。结果将为公共和私营部门促进流动安全的努力提供信息， 提供有关评估动态安全结果的各种方法的可行性的关键信息 并提出如何更好地将安全性集成到 PCMH 等模型中的方法。调查结果将予以传播 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以改善患者的治疗结果。