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Search results for "Family Medicine"
Journal Article > Study
'Tempos' management in primary care: a key factor for classifying adverse events, and improving quality and safety.
Amalberti R, Brami J. BMJ Qual Saf. 2012;21:729-736.
The systems approach to analyzing adverse events emphasizes how active errors (those made by individuals) and latent errors (underlying system flaws) contribute to preventable harm. Adverse events in ambulatory care may arise from an especially complex array of latent errors. This paper explores the role of time management problems, which the authors term "tempos," as a contributor to errors in ambulatory care. Through a review of closed malpractice claims, the authors identify 5 tempos that can affect the risk of an adverse event: disease tempo (the expected disease course), patient tempo (timing of complaints and adherence to recommendations), office tempo (including the availability of clinicians and test results), system tempo (such as access to specialists or emergency services), and access to knowledge. The role of these tempos in precipitating diagnostic errors and communication errors is discussed through analysis of the patterns of errors in malpractice claims. A preventable adverse event caused by misunderstanding of disease tempo is discussed in this AHRQ WebM&M commentary.
Kingston-Riechers J, Ospina M, Jonsson E, Childs P, McLeod L, Maxted JM. Edmondton, AB, Canada: Canadian Patient Safety Institute; 2010. ISBN: 9781926541273.
This report analyzed patient safety in Canadian primary care practice to identify themes, priorities, gaps in research, and opportunities for improvement.
Journal Article > Study
The management of test results in primary care: does an electronic medical record make a difference?
Elder NC, McEwen TR, Flach J, Gallimore J, Pallerla H. Fam Med. 2010;42:327-333.
Electronic health records (EHRs) hold great promise for improving patient safety, but remain underutilized, especially in ambulatory care settings. Failure to appropriately follow up on abnormal test results is a common ambulatory care safety problem, and has been implicated in malpractice lawsuits arising from missed or delayed diagnoses. In this study conducted at eight family medicine clinics, those with an EHR documented clinician and patient notification of abnormal test results and clear follow-up plans more often than those with paper charts. However, even in clinics using EHRs, more than one-third of abnormal results had no follow-up plan documented. This finding corroborates prior research that clinician notification alone does not ensure timely and complete follow-up of test results.
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.
Grant > Government Resource
AHRQ Risk-informed Intervention Development and Implementation of Safe Practices in Ambulatory Care.
Rockville, MD: Agency for Healthcare Research and Quality; October 2008.
This AHRQ grantee announcement lists 13 projects funded to demonstrate effective strategies in identifying and addressing risks and in improving processes in ambulatory care.