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.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Exploratory/Developmental Grants (R21)
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Study Section
Special Emphasis Panel (HSQR)
Program Officer
Nunley, Angela
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Lyles, Courtney R; Sarkar, Urmimala; Osborn, Chandra Y (2014) Getting a technology-based diabetes intervention ready for prime time: a review of usability testing studies. Curr Diab Rep 14:534