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- Facility and Group Administrators
Journal Article > Study
What happens between visits? Adverse and potential adverse events among a low-income, urban, ambulatory population with diabetes.
Sarkar U, Handley MA, Gupta R, et al. Qual Saf Health Care. 2010;19:223-228.
Adverse events after hospital discharge are a known patient safety hazard, but similar events between ambulatory clinic visits are poorly described. This study longitudinally followed a vulnerable patient population with diabetes between clinic visits and discovered 86% experienced at least one adverse or potential adverse event during the 9-month observation period. Medication management was the most common domain identified, while 80% of all events had a combination of system, clinician, and patient factors contributing. The authors discuss the complex safety environment observed and highlight that patients themselves may be key vehicles for reducing events. A past AHRQ WebM&M interview discusses the challenges in safely caring for vulnerable patient populations in the ambulatory setting.
Journal Article > Review
Meta-analysis: effect of interactive communication between collaborating primary care physicians and specialists.
Foy R, Hempel S, Rubenstein L, et al. Ann Intern Med. 2010;152:247-258.
This meta-analysis found that interactive communication between collaborating primary care providers and specialists (psychiatrists and endocrinologists in this study) is associated with improved patient outcomes. The interactive communication methods included joint consultations, scheduled phone discussions, and shared documentation, with the authors suggesting a need for changes in reimbursement models to support such interventions.
Journal Article > Study
Bosch M, Dijkstra R, Wensing M, van der Weijden T, Grol R. BMC Health Serv Res. 2008;8:180.
Improving teamwork among providers of different disciplines is a vitally important step in developing a culture of safety. Despite the development of measurement tools and intervention strategies for addressing inpatient teamwork, comparatively little research has addressed issues of team and organizational culture in the outpatient setting. This study sought to evaluate the relationship between teamwork (measured by the Team Climate Inventory) and organizational culture and chronic disease outcomes in ambulatory clinics. Neither teamwork nor organizational culture at the clinic level was significantly correlated with process or outcome measures, but the authors caution that current measurement methods are not optimal for assessing safety culture in small office practices. A prior trial of crew resource management in an outpatient clinic did result in improved diabetes care.
Nicholas L. Modern Healthc. November 14, 2005;35:24.
In this article, the CEO of the American Diabetes Association comments on the risks diabetes patients face in hospital settings.