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

CHAPTER 2.
UPTAKE OF PATIENT SAFETY PRACTICES IN FOUR
U. S. COMMUNITIES

SPECIFIC AIMS
1. To trace the evolution of patient safety efforts in four U.S. communities that are typical of local health care markets in various regions of the United States. The unit of analysis is the community. The focus was to document patient safety initiatives and trends over time across three specific sectors within each community: hospitals, ambulatory settings, and long-term care facilities.
2. To understand, in particular, how hospitals in those communities made decisions about adoption of safe practices and how they implemented them within their institutions. The unit of analysis was the individual hospital. The focus was to understand how hospitals are implementing the Safe Practices established by the National Quality Forum (2003).

This community study directly examines the extent to which U.S. health care providers are adopting safe practices as of the year 2008. The qualitative, case-study methods used in this study were the best available, given that no instrument yet existed for collection of quantitative data to estimate rates of practice adoption by a nationally representative sample of providers. Indeed, the absence of such an instrument led to our work on developing a questionnaire to measure hospital use of the safe practices established by the NQF, as described in Chapter 4.

The practice-adoption actions are, in themselves, a desired effect of the AHRQ national patient safety initiative, and the adoption process also has effects on the various stakeholders involved. Referring to the framework model presented in Chapter 1, we can see that the information collected in this study contributes to the product evaluation by assessing both aspects of practice adoption: status in adopting practices, and hospital experiences in implementing the practices they identified as priorities for action. It also has the added benefit of capturing the dynamics of the implementation process leading to practice adoption, including which safe practices are being adopted, how organizations are making those choices, and implementation strategies used.


SELECTION OF SITES FOR THE COMMUNITY STUDY

Since 1996, the Community Tracking Study (CTS), led by the Center for Studying Health System Change (HSC), has conducted biannual site visits to 12 nationally representative metropolitan areas, to study how the interactions of providers, insurers, and other stakeholders help to shape the accessibility, cost, and quality of health care in local communities (HSC, 2009). In 2002–2003, they conducted a special data collection on patient safety, in which HSC investigators contrasted the patient safety experience of five CTS communities that were also Leapfrog regional rollout communities with the remainder of the CTS communities. The Leapfrog rollout communities were Boston, Massachusetts; Lansing, Michigan; Northern New Jersey, Orange County, California; and Seattle, Washington. The remaining cities were Cleveland, Ohio; Greenville, South Carolina; Indianapolis, Indiana; Little Rock, Arkansas; Miami, Florida; Phoenix, Arizona; and Syracuse, New York. Since 2003, Cleveland, Indianapolis, and Greenville also have become Leapfrog regional rollout communities.

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