Assessing Patient Safety Practices and Outcomes in the U.S. Health Care System

By Donna O. Farley; M. Susan Ridgely et al. | Go to book overview

EXECUTIVE SUMMARY
In early 2000, the Institute of Medicine (IOM) published the report entitled To Err Is Human: Building a Safer Health System, calling for leadership from the U.S. Department of Health and Human Services (DHHS) in reducing medical errors and identifying AHRQ as the lead agency for patient safety research and practice improvement (IOM, 2000). Soon thereafter, the U.S. Congress funded the Agency for Healthcare Research and Quality (AHRQ), in the Department of Health and Human Services, to establish a national patient safety initiative. In its patient safety initiative, AHRQ has funded a portfolio of patient safety research and implementation projects to expand knowledge in this area, provided motivation and guidance for the activities of others, and integrated its work with that of other public and private organizations to achieve synergy through collaboration.AHRQ contracted with RAND in September 2002 to serve as its Patient Safety Evaluation Center (evaluation center) and evaluate AHRQ’s patient safety initiative. This evaluation was completed in September 2006, culminating in a final report that presents evaluation findings over the full four-year evaluation period (Farley et al., 2008b). The final report was preceded by three annual reports, each of which documents the status of the patient safety initiative as of September 2003, 2004, and 2005 (Farley et al., 2005; Farley et al., 2007a; Farley et al., 2007b).The evaluation center then undertook another two years of work designed to document and analyze the extent to which patient safety infrastructure and practices are being put into place across the nation’s health care system. This report presents the results of that work.
FRAMEWORK AND APPROACH FOR PRACTICE-ADOPTION ASSESSMENT
The study results presented in this report are products of the final phase of work for the Patient Safety Evaluation Center. These analyses focus on one component of the overall framework within which the overall evaluation was performed. Called the product evaluation, this component is the assessment of the effects of the AHRQ patient safety initiative on safety activities and outcomes in the U.S. health care system. See Chapter 1 for a full description of how the analyses presented in this report fit into our overall evaluation framework and approach.
Overall Framework
The overall evaluation design was based on the Context-Input-Process-Product (CIPP) evaluation model, a well-accepted strategy for improving systems that encompasses the full spectrum of factors involved in the operation of a program (Stufflebeam et al., 1971; Stufflebeam, Madaus, and Kellaghan, 2000). The core model components are represented in the CIPP acronym:
Context evaluation assesses the circumstances stimulating the creation or operation of a program as a basis for defining goals and priorities and for judging the significance of outcomes.
Input evaluation examines alternatives for goals and approaches for either guiding choice of a strategy or assessing an existing strategy against the alternatives, including congressional priorities and mandates as well as agency goals and strategies; stakeholders’ perspectives are also assessed.

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