This proposal uses an innovative method, Unannounced Standardized Patient (USPs) visits, to describe the transfer of and response to social and behavioral determinants of health in outpatient care among primary care teams. The overall goal is to contribute to our understanding of the factors underlying disparities in outpatient quality of care and safety. Behavioral and social determinants of health, while major influences on the effectiveness of treatment and ultimately on health, are often neglected by health care providers and represent common errors of omission. Outpatient safety depends on accurate collection and documentation of patient-provided information and yet there are few viable methods for systematically tracing patient-provided information through a visit and subsequent health team interactions. USPs provide an innovative method for exposing the health care team to a standardized ?dose? of information that then can be tracked. The study proceeds in two phases: The first phase (Aim 1) introduces highly standardized/controlled information into the primary care process through the use of USP scenarios developed specifically to ?test? the team response to social and behavioral information and assesses transfer of that information from patient to team, from team member to team member, into the EHR, and into treatment plans and follow-up (n=4 teams). In the second phase, a longitudinal cohort design (Aims 2 and 3), we will provide 4 teams with monthly audit feedback data on their performance (for 20 months) and monitor rates of information transfer and response and also explore the degree to which characteristics of team members, teams, and the clinic sites are associated with team performance (Aim 3). We will compare the performance of teams in this feedback group with a comparison group of 2 teams that do not receive feedback. Thus, this proposal uses Unannounced Standardized Patients as a ?test-bed? for understanding and improving clinical processes, and therefore safety, in outpatient care for vulnerable patients.
Social and behavioral factors can have substantial influence on health and yet primary care providers and teams may not routinely elicit, record, and act upon this information. This project uses Unannounced Standardized Patient visits (actors trained to portray a standardized clinical scenario) to 1) describe the degree to which social and behavioral information ? essential to providing safe, effective primary care - is transferred from the patient to the primary care team and then within the team through the Electronic Health Record, to assess how teams respond to these critical information elements; 2) to assess whether repeated ?information transfer? audit and feedback reports are associated with improved transfer of both behavioral and social information and subsequent quality and safety of primary care; and 3) to explore team and clinic factors that may influence effective transfer of and response to social and behavioral information essential to safe, effective primary care. Findings will be used to ensure that social and behavioral information is collected and incorporated into primary care treatment.
