Dataset Information

Evaluation of the AHRQ patient safety initiative: framework and approach.

ABSTRACT:

Objective

Describe the evaluation performed of the patient safety initiative operated by the Agency for Healthcare Research and Quality (AHRQ). AHRQ PATIENT SAFETY INITIATIVE When patient safety became a national priority in 2000, Congress charged and funded AHRQ to improve health care safety. Over the next 6 years, AHRQ funded more than 300 research projects and other activities, addressing diverse patient safety issues and practices.

The patient safety evaluation

AHRQ contracted with RAND in 2002 to perform a 4-year evaluation of the initiative, which was completed in 2006. This formative evaluation used the CIPP program evaluation model, which emphasizes multiple stakeholders' interests (e.g., patients, providers, funded researchers). We monitored the progress of the patient safety initiative and provided AHRQ annual feedback that assessed each year's activities, identifying issues and offering suggestions for actions by AHRQ. Given the size and complexity of the initiative, the evaluation needed to examine key individual components and synthesize results across them, and it also had to be responsive to changes in the initiative over time. We used a conceptual framework to bring together the disparate pieces to synthesize overall findings. The remaining articles in this issue describe selected results from this evaluation.

SUBMITTER: Farley DO

PROVIDER: S-EPMC2677032 | biostudies-literature | 2009 Apr

REPOSITORIES: biostudies-literature

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Evaluation of the AHRQ patient safety initiative: framework and approach.

Farley Donna O DO Battles James B JB

Health services research 20090401 2 Pt 2

<h4>Objective</h4>Describe the evaluation performed of the patient safety initiative operated by the Agency for Healthcare Research and Quality (AHRQ). AHRQ PATIENT SAFETY INITIATIVE When patient safety became a national priority in 2000, Congress charged and funded AHRQ to improve health care safety. Over the next 6 years, AHRQ funded more than 300 research projects and other activities, addressing diverse patient safety issues and practices.<h4>The patient safety evaluation</h4>AHRQ contracted ...[more]

PMID: 21456107

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Project description:BackgroundThe Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture was designed to assess staff views on patient safety culture in hospital settings. The purpose of this study was to examine the multilevel psychometric properties of the survey.MethodsSurvey data from 331 U.S. hospitals with 2,267 hospital units and 50,513 respondents were analyzed to examine the psychometric properties of the survey's items and composites. Item factor loadings, intraclass correlations (ICCs), design effects, internal consistency reliabilities, and multilevel confirmatory factor analyses (MCFA) were examined as well as intercorrelations among the survey's composites.ResultsPsychometric analyses confirmed the multilevel nature of the data at the individual, unit and hospital levels of analysis. Results provided overall evidence supporting the 12 dimensions and 42 items included in the AHRQ Hospital Survey on Patient Safety Culture as having acceptable psychometric properties at all levels of analysis, with a few exceptions. The Staffing composite fell slightly below cutoffs in a number of areas, but is conceptually important given its impact on patient safety. In addition, one hospital-level model fit indicator for the Supervisor/Manager Expectations & Actions Promoting Patient Safety composite was low (CFI = .82), but all other psychometrics for this scale were good. Average dimension intercorrelations were moderate at .42 at the individual level, .50 at the unit level, and .56 at the hospital level.ConclusionsPsychometric analyses conducted on a very large database of hospitals provided overall support for the patient safety culture dimensions and items included in the AHRQ Hospital Survey on Patient Safety Culture. The survey's items and dimensions overall are psychometrically sound at the individual, unit, and hospital levels of analysis and can be used by researchers and hospitals interested in assessing patient safety culture. Further research is needed to study the criterion-related validity of the survey by analysing the relationship between patient safety culture and patient outcomes and studying how to improve patient safety culture.

Project description:ObjectiveTo identify lessons learned from the experience of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety and Medical Liability (PSML) Demonstration Program.Data sources/study settingOn September 9, 2009, President Obama directed the Secretary of Health and Human Services to authorize demonstration projects that put "patient safety first" with the intent of reducing preventable adverse outcomes and stemming liability costs. Seven demonstration projects received 3 years of funding from AHRQ in the summer of 2010, and the program formally came to a close in June 2015.Study designThe seven grantees implemented complex, broad-ranging innovations addressing both patient safety and medical liability in "real-world" contexts. Some projects featured novel approaches, while others implemented adaptations of existing models. Each project was funded by AHRQ to collect data on the impact of its interventions. In addition, AHRQ funded a cross-cutting qualitative evaluation focused on lessons learned in implementing PSML interventions.Data collection/extraction methodsSite visits and follow-up interviews supplemented with material abstracted from formal project reports to AHRQ.Principal findingsThe PSML demonstration projects focused on three broad approaches: (1) improving communication around adverse events through disclosure and resolution programs; (2) preventing harm through implementation of clinical "best practices"; and (3) exploring alternative methods of settling claims. Although the demonstration contributed to accumulating evidence that these kinds of interventions can positively affect outcomes, there is also evidence to suggest that these interventions can be difficult to scale.ConclusionsIn addition to producing at least preliminary positive outcomes, the demonstration also lends credence to the idea that targeted interventions that improve some aspect of patient safety or malpractice performance may also contribute more broadly to institutional culture and the alignment of all parties around reducing risk and preventing harm. However, more empirical work needs to be carried out to quantify the effect of such interventions.

Project description:Given that patient safety measures are increasingly used for public reporting and pay-for performance, it is important for stakeholders to understand how to use these measures for improvement. The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) are one particularly visible set of measures that are now used primarily for public reporting and pay-for-performance among both private sector and Veterans Health Administration (VA) hospitals. This trend generates a strong need for stakeholders to understand how to interpret and use the PSIs for quality improvement (QI). The goal of this study was to develop an educational program and tailor it to stakeholders' needs. In this paper, we share what we learned from this program development process.Our study population included key VA stakeholders involved in reviewing performance reports and prioritizing and initiating quality/safety initiatives. A pre-program formative evaluation through telephone interviews and web-based surveys assessed stakeholders' educational needs/interests. Findings from the formative evaluation led to development and implementation of a cyberseminar-based program, which we tailored to stakeholders' needs/interests. A post-program survey evaluated program participants' perceptions about the PSI educational program.Interview data confirmed that the concepts we had developed for the interviews could be used for the survey. Survey results informed us on what program delivery mode and content topics were of high interest. Six cyberseminars were developed-three of which focused on two content areas that were noted of greatest interest: learning how to use PSIs for monitoring trends and understanding how to interpret PSIs. We also used snapshots of VA PSI reports so that participants could directly apply learnings. Although initial interest in the program was high, actual attendance was low. However, post-program survey results indicated that perceptions about the program were positive.Conducting a formative evaluation was a highly important process in program development. The useful information that we collected through the interviews and surveys allowed us to tailor the program to stakeholders' needs and interests. Our experiences, particularly with the formative evaluation process, yielded valuable lessons that can guide others when developing and implementing similar educational programs.

Dataset Information

Evaluation of the AHRQ patient safety initiative: framework and approach.

Objective

The patient safety evaluation

Publications

Evaluation of the AHRQ patient safety initiative: framework and approach.

Similar Datasets

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