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.

Public Health Relevance

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.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Center Core Grants (P30)
Project #
Application #
Study Section
Special Emphasis Panel (ZHS1-HSR-C (01))
Program Officer
Bartman, Barbara
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
Zip Code
Giardina, Traber Davis; Sarkar, Urmimala; Gourley, Gato et al. (2016) Online public reactions to frequency of diagnostic errors in US outpatient care. Diagnosis (Berl) 3:17-22
Mirsky, Jacob B; Tieu, Lina; Lyles, Courtney et al. (2016) A Mixed-Methods Study of Patient-Provider E-Mail Content in a Safety-Net Setting. J Health Commun 21:85-91
Mirsky, Jacob B; Tieu, Lina; Lyles, Courtney et al. (2016) Readability assessment of patient-provider electronic messages in a primary care setting. J Am Med Inform Assoc 23:202-6
Lyles, Courtney; Schillinger, Dean; Sarkar, Urmimala (2015) Connecting the Dots: Health Information Technology Expansion and Health Disparities. PLoS Med 12:e1001852
Lyles, Courtney R; Sarkar, Urmimala (2015) Health literacy, vulnerable patients, and health information technology use: where do we go from here? J Gen Intern Med 30:271-2