An Agenda for Research in Ambulatory Patient Safety

Conference Synthesis

Conference Synthesis

This synthesis is of a multidisciplinary conference held November 30 and December 1, 2000, to develop an agenda for research in ambulatory patient safety. It reviews what is known about patient safety in ambulatory care, and contains information from presentations and discussions of conference participants. Eleven consensus recommendations for research and demonstrations are provided.

Recommendations focus on:

• Epidemiological studies of ambulatory patient safety using existing data and experience of physician liability insurers and administrative data.
• The potential of improvements in clinical support infrastructure in ambulatory care including information systems to improve patient safety.
• The effects of the cultural and economic environment of ambulatory care on safety and the potential to improve safety.

There is inadequate knowledge of the ambulatory care sector of the health care system, and of patient safety in ambulatory care in particular. This limits our ability to understand the risks to patients, and to design and predict the effects of changes in ambulatory care to improve care and outcomes, including patient safety. The recommendations and ideas presented are intended to generate badly needed knowledge about ambulatory patient safety and how to improve it.

This conference synthesis provides additional focus on ambulatory patient concerns, but it does not replace the Research Agenda developed as a result of the National Summit on Medical Errors and Patient Safety.

Prepared by:
Terry Hammons, M.D., Medical Group Management Association Center for Research
Neill F. Piland, Dr.P.H., Medical Group Management Association Center for Research
Stephen D. Small, M.D., University of Chicago
Martin J. Hatlie, J.D., Partnership for Patient Safety
Helen R. Burstin, M.D., M.P.H., Agency for Healthcare Policy and Research

This project was supported by grant number R13 HS10106 from the Agency for Healthcare Research and Quality (AHRQ), and by additional support from the Centers for Medicare and Medicaid Services (CMS). The Partnership for Patient Safety provided assistance in managing the conference.

Contents

Executive Summary
Introduction
Methods
Definitions and Assumptions
Dimensions of Ambulatory Patient Safety
Ambulatory Patient Safety: What Do We Know?
Sources of Data for Research on Ambulatory Safety
Other Sources of Data on Ambulatory Safety
Reporting Systems: Learning about Safety and Improving Accountability
Infrastructure for Ambulatory Care
Improving Ambulatory Care as a System
Priorities for Research
Notes
References
Appendixes