Despite significant strides in patient safety, significant gaps remain. Across the board, evidence-based practices have not been consistently implemented. Ambulatory settings remain understudied and lack safety infrastructure and systems. These issues are particularly acute in safety-net health care settings which disproportionately care for low-income, diverse, and vulnerable populations. Therefore, we propose to create a transdisciplinary patient safety learning laboratory, the San Francisco Ambulatory Safety CEnter for INnovaTion (ASCENT).
We aim to bring together design thinking, reliability science, health system innovation and safety research to design and iterate technical and workflow solutions for high-priority ambulatory safety issues. Promising innovations will be implemented and evaluated in the San Francisco Health Network using implementation sciences methodology to assess reach, effectiveness, adoption, implementation, and maintenance. We plan to partner with closely affiliated safety-net innovation networks to disseminate and share successful innovations among safety-net health systems. ASCENT will focus on the following three high-priority ambulatory safety issues: (1) test result management: when patients'diagnostic test results are not acted upon in a timely fashion, diagnostic delays and failures often ensue;(2) monitoring for high-risk sub-populations: failures of monitoring for patients receiving high-risk treatments (such as anticoagulation or immunosuppression) can lead to adverse events. Use of team-based work-flow and electronic registry tools, de-coupled from visits has potential to enhance monitoring practices for high-risk patients;(3) medication comprehension: patient medication self-administration has been implicated in outpatient ADEs, and validated methods to enhance comprehension have not been implemented systematically. ASCENT will have a scientific core of investigators that provide intellectual input on all projects An expert Advisory Board will provide insight into all projects, and front-line staff, clinicians, nd patients will provide substantive input through the innovation process. The long-term goal of the proposal is to create a sustainable pipeline of safety innovations from problem analysis through to clinical practice.
In outpatient health care settings like physicians'offices, there are significant risks to patients'safety, including delays in diagnosis and treatment which result in disease progression, preventable complications of treatment, and adverse drug events. Few systems exist to recognize and ameliorate such patient safety problems, and we aim to design, develop, test, and evaluate innovative solutions to improve patient safety.
|Matta, George Yaccoub; Khoong, Elaine C; Lyles, Courtney R et al. (2018) Finding Meaning in Medication Reconciliation Using Electronic Health Records: Qualitative Analysis in Safety Net Primary and Specialty Care. JMIR Med Inform 6:e10167|
|Ratanawongsa, Neda; Quan, Judy; Handley, Margaret A et al. (2018) Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims. BMC Health Serv Res 18:254|
|Ratanawongsa, Neda; Matta, George Y; Bohsali, Fuad B et al. (2018) Reducing Misses and Near Misses Related to Multitasking on the Electronic Health Record: Observational Study and Qualitative Analysis. JMIR Hum Factors 5:e4|
|Ratanawongsa, Neda; Matta, George Y; Lyles, Courtney R et al. (2017) Multitasking and Silent Electronic Health Record Use in Ambulatory Visits. JAMA Intern Med 177:1382-1385|
|Issaka, Rachel B; Singh, Maneesh H; Oshima, Sachiko M et al. (2017) Inadequate Utilization of Diagnostic Colonoscopy Following Abnormal FIT Results in an Integrated Safety-Net System. Am J Gastroenterol 112:375-382|
|Lowry, Christina; Orr, Katherine; Embry, Brett et al. (2017) Primary care scribes: writing a new story for safety net clinics. BMJ Open Qual 6:e000124|
|McDonald, Kathryn M; Su, George; Lisker, Sarah et al. (2017) Implementation science for ambulatory care safety: a novel method to develop context-sensitive interventions to reduce quality gaps in monitoring high-risk patients. Implement Sci 12:79|
|Ratanawongsa, Neda; Chan, Lenny L S; Fouts, Michelle M et al. (2017) The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations. J Diabetes Res 2017:8983237|
|Schmajuk, Gabriela; Tonner, Chris; Trupin, Laura et al. (2017) Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab. Medicine (Baltimore) 96:e6528|
|Lee, Shin-Yu; Cherian, Roy; Ly, Irene et al. (2017) Designing and Implementing an Electronic Patient Registry to Improve Warfarin Monitoring in the Ambulatory Setting. Jt Comm J Qual Patient Saf 43:353-360|
Showing the most recent 10 out of 18 publications