Association of Implementation and Social Network Factors With Patient Safety Culture in Medical Homes: A Coincidence Analysis.
Journal
Journal of patient safety
ISSN: 1549-8425
Titre abrégé: J Patient Saf
Pays: United States
ID NLM: 101233393
Informations de publication
Date de publication:
01 01 2022
01 01 2022
Historique:
pubmed:
3
8
2020
medline:
24
2
2022
entrez:
3
8
2020
Statut:
ppublish
Résumé
The patient-centered medical home (PCMH) may provide a key model for ambulatory patient safety. Our objective was to explore which PCMH and patient safety implementation and social network factors may be necessary or sufficient for higher patient safety culture. This was a cross-case analysis study in 25 diverse U.S. PCMHs. Data sources included interviews of a clinician and an administrator in each PCMH, surveys of clinicians and staff, and existing data on the PCMHs' characteristics. We used coincidence analysis, a novel method based on set theory and Boolean logic, to evaluate relationships between factors and the implementation outcome of patient safety culture. The coincidence analysis identified 5 equally parsimonious solutions (4 factors), accounting for all practices with higher safety culture. Three solutions contained the same core minimally sufficient condition: the implementation factor leadership priority for patient safety and the social network factor reciprocity in advice-seeking network ties (advice-seeking relationships). This minimally sufficient condition had the highest coverage (5/7 practices scoring higher on the outcome) and best performance across solutions; all included leadership priority for patient safety. Other key factors included self-efficacy and job satisfaction and quality improvement climate. The most common factor whose absence was associated with the outcome was a well-functioning process for behavioral health. Our findings suggest that PCMH safety culture is higher when clinicians and staff perceive that leadership prioritizes patient safety and when high reciprocity among staff exists. Interventions to improve patient safety should consider measuring and addressing these key factors.
Identifiants
pubmed: 32740134
pii: 01209203-202201000-00042
doi: 10.1097/PTS.0000000000000752
pmc: PMC7855411
mid: NIHMS1628657
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e249-e256Subventions
Organisme : AHRQ HHS
ID : R01 HS024859
Pays : United States
Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors disclose no conflict of interest. This research was funded by the Agency for Healthcare Research and Quality (grant number R01 HS024859). The views expressed are those of the authors and not necessarily those of the Agency for Healthcare Research and Quality.
Références
Joint Commission. 2019 National Patient Safety Goals. 2019; Available at: https://www.jointcommission.org/standards_information/npsgs.aspx . Accessed August 14, 2019.
American College of Physicians. Patient Safety in the Office-Based Practice Setting . Philadelphia, PA: American College of Physicians; 2017. Available at: https://www.acponline.org/acp_policy/policies/patient_safety_in_the_office_based_practice_setting_2017.pdf . Accessed August 28, 2019.
Shekelle PG, Wachter RM, Pronovost PJ, et al. Making health care safer II: an updated critical analysis of the evidence for patient safety practices. Evid Rep Technol Assess (Full Rep) . 2013;211:1–945.
Shekelle PG, Sarkar U, Shojania K, et al. AHRQ Comparative Effectiveness Technical Briefs. Patient Safety in Ambulatory Settings . Rockville, MD: Agency for Healthcare Research and Quality (US); 2016.
Webster JS, King HB, Toomey LM, et al. Understanding quality and safety problems in the ambulatory environment: seeking improvement with promising teamwork tools and strategies. In: Henriksen K, Battles JB, Keyes MA, et al, eds. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools) . Rockville, MD: Agency for Healthcare Research and Quality (US); 2008.
Carson-Stevens A, Hibbert P, Williams H, et al. Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice. In: Health Services and Delivery Research 27 . Southampton, UK: NIHR Journals Library; 2016.
Lorincz C, Drazen E, Sokol P, et al. Research in ambulatory patient safety 2000–2010: a 10-year review. Am Med Assoc . 2011. Available at: https://c.ymcdn.com/sites/npsf.site-ym.com/resource/resmgr/PDF/Research-in- Amb-Pat-Saf_AMAr.pdf . Accessed August 28, 2019.
Kim JM, Suarez-Cuervo C, Berger Z, et al. Evaluation of patient and family engagement strategies to improve medication safety. Patient . 2018;11:193–206.
Schneider EC, Ridgely MS, Meeker D, et al. Promoting patient safety through effective health information technology risk management. RAND Health Qual . 2014;4:7.
Caimo A, Lomi A. Knowledge sharing in organizations: a Bayesian analysis of the role of reciprocity and formal structure. J Manag . 2015;41:665–691.
Weaver SJ, Lubomksi LH, Wilson RF, et al. Promoting a culture of safety as a patient safety strategy: a systematic review. Ann Intern Med . 2013;158(5 Pt 2):369–374.
Baumgartner M, Ambuhl Mnd. Causal modeling with multi-value and fuzzy-set coincidence analysis. Polit Sci Res Methods . 2018;1–17.
Urban Institute. Using Qualitative Comparative Analysis (QCA) to Study Patient-Centered Medical Homes. 2013. Available at: https://www.urban.org/sites/default/files/publication/24261/412969-Using-Qualitative-Comparative-Analysis-QCA-to-Study-Patient-Centered-Medical-Homes.PDF . Accessed on August 28, 2019.
Rojas Smith L, Ashok M, Dy S, et al. Contextual Frameworks for Research on the Implementation of Complex System Interventions. AHRQ Methods for Effective Health Care . Rockville, MD: Agency for Healthcare Research and Quality; 2014.
Solberg LI, Asche SE, Margolis KL, et al. Measuring an organization’s ability to manage change: the change process capability questionnaire and its use for improving depression care. Am J Med Qual . 2008;23:193–200.
Medical Office Survey on Patient Safety Culture. 2019; Available at: https://www.ahrq.gov/sops/surveys/medical-office/index.html . Accessed August 16th, 2019.
Friedberg MW, Safran DG, Coltin KL, et al. Readiness for the patient-centered medical home: structural capabilities of Massachusetts primary care practices. J Gen Intern Med . 2009;24:162–169.
Alidina S, Rosenthal MB, Schneider EC, et al. Practice environments and job satisfaction in patient-centered medical homes. Ann Fam Med . 2014;12:331–337.
Scholle SH, Pawlson LG, Solberg LI, et al. Measuring practice systems for chronic illness care: accuracy of self-reports from clinical personnel. Jt Comm J Qual Patient Saf . 2008;34:407–416.
Standards and Guidelines for NCQA’s Patient-Centered Medical Home (PCMH). 2014; Available at: http://www.acofp.org/acofpimis/Acofporg/Apps/2014_PCMH_Finals/Tools/1_PCMH_Recognition_2014_Front_Matter.pdf . Accessed August 28, 2019.
Yuan C, Lai A, Marsteller J, et al. What is patient safety in the medical home?. AcademyHealth Annual Research Meeting 2019.
Brennan SE, Bosch M, Buchan H, et al. Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments. Implement Sci . 2012;7:121.
Burns KE, Duffett M, Kho ME, et al. A guide for the design and conduct of self-administered surveys of clinicians. CMAJ . 2008;179:245–252.
SAFER Guides. 2018; Available at: https://www.healthit.gov/topic/safety/safer-guides . Accessed July 1, 2019.
Sittig DF, Salimi M, Aiyagari R, et al. Adherence to recommended electronic health record safety practices across eight health care organizations. J Am Med Indorm Assoc . 2018;25:913–918.
Venkatesh V, Zhang X, Sykes T. “Doctors do too little technology”: a longitudinal field study of an electronic healthcare system implementation. Inform Syst Res . 2011;22:523–546.
Borgatti SPF, Foster PC. The network paradigm in organizational research: a review and typology. J Manag . 2003;29:991–1013.
Sorra J, Gray L, Famolaro T, et al. AHRQ Medical Office Survey on Patient Safety Culture: User’s Guide . Rockville, MD: Agency for Healthcare Research and Quality; 2016.
Troyanskaya O, Cantor M, Sherlock G, et al. Missing value estimation methods for DNA microarrays. Bioinformatics . 2001;17:520–525.
Goldstein R. Phi Coefficient (Fourfold Correlation). The Stata Technical Bulletin Re-Prints . College Station, TX: Stata Corporation; 1991:158–159.
Baumgartner M, Thiem A. Identifying complex causal dependencies in configurational data with coincidence analysis. R J . 2015;7:176–184.
Ambuehl M, Baumgartner M. CNA: Causal Modeling With Coincidence Analysis. 2019; Available at: https://cran.r-project.org/web/packages/cna/index.html . Accessed August 28, 2019.
Mendel P, Chen EK, Green HD, et al. Pathways to medical home recognition: a qualitative comparative analysis of the PCMH transformation process. Health Serv Res . 2018;53:2523–2546.
Agneessens F, Wittek R. Where do intra-organizational advice relations come from? The role of informal status and social capital in social exchange. Soc Netw . 2012;34:333–345.
Nahapiet J, Ghoshal S. Social capital, intellectual capital, and the organizational advantage. Acad Manage Rev . 1998;23:242–266.
Porath CL, Gerbasi A, Schorch SL. The effects of civility on advice, leadership, and performance. J Appl Psychol . 2015;100:1527–1541.
Agency for Healthcare Research and Quality. A framework for measuring integration of behavioral health and primary care. Available at: https://integrationacademy.ahrq.gov/products/ibhc-measures-atlas/framework-measuring-integration-behavioral-health-and-primary-care . Accessed August 28, 2019.
Hatoun J, Chan JA, Yaksic E, et al. A systematic review of patient safety measures in adult primary care. Am J Med Qual . 2016;32:237–245.