PROMIS Learning Lab: Partnership in Resilience for Medication Safety

Principal Investigator: Yan Xiao, Ph.D., The University of Texas at Arlington, TX 
AHRQ Grant No.: R18 HS027277 
Project Period: 09/30/19–03/31/25 
Description: This learning lab addressed medication safety risks facing older adults in ambulatory and community settings, where polypharmacy, fragmented care, and social determinant barriers elevate the likelihood of adverse drug events. More than one-third of older adults take five or more medications, and preventable harms contribute to over 700,000 emergency department visits annually.¹ PROMIS Lab used systems engineering methods to redesign primary care work systems and strengthen patient–professional partnerships for safer medication use.

The project’s aims were to:

1. Identify and define work system requirements to address common medication-related safety hazards and enable resilience.
2. Improve primary care services through the design of educational tools, workflow strategies, and environmental redesign.
3. Implement and evaluate redesigned care processes in safety-net and private clinics serving vulnerable populations.

To achieve these aims, the team conducted literature reviews, process mapping, time-motion studies, and interviews with more than 70 stakeholders, including physicians, pharmacists, nurses, administrators, and older adults with caregivers. Participatory design workshops and simulations were used to codevelop interventions, while crowdsourcing and behavioral economics approaches accelerated design and evaluation.

Key products included:

• Tools for patients and clinicians. The team created a bilingual visit guide, five short educational videos, and a clinician-facing tip sheet to foster safer care. ^1–3

Key findings included:

• Insights into system gaps. Pharmacist–clinician collaboration remained limited;⁴ patient role expectations were often unknown to professionals; ⁵ and compliance-based safety strategies were insufficient to reduce adverse events.⁶
• Implementation results. Redesigned visit bundles were feasible and well-received, with significant differences in medication review practices between public and private clinics.⁷ Smaller clinics more readily adopted new workflows, while safety-net settings faced staffing disruptions.
• Research contributions. Simulation and participatory design effectively informed office visit redesigns,⁸ crowdsourcing accelerated strategy development,⁹ and Safety-II approaches offered new perspectives for resilient safety improvement.⁶

PROMIS Lab advanced the science of medication safety by demonstrating that empowering patients and redesigning primary care work systems can improve resilience and reduce preventable harms, especially in populations facing socioeconomic barriers.

To date, this PSLL’s work has resulted in at least 17 peer-reviewed publications that have been cited 165 times in other publications. It has also produced at least 27 national and international conference presentations and has provided extensive training for students and fellows.

Publications

2025

• Hendrix ZN, Jallow F, Fulda KG, et al. What should patients learn? Co-designing patient education to improve medication safety, professional-patient communication, and partnership. Front Med (Lausanne) 2025 Sep 10;12:1631606.
• Jodray M, White A, Fulda KG, et al. Impact of COVID-19 on A1c management and telehealth use among a type 2 diabetes mellitus population in the outpatient setting. Healthcare 2025;13(18):2372.
• Neelamegam M, Espinoza AM, Fulda KG, et al. Exploring primary care providers’ perspectives on medication review and management through telehealth during the COVID-19 pandemic. J Patient Saf 2025 Aug 22.
• Opara C, White A, Fulda KG, et al. Type II Diabetes Mellitus and COVID-19: Exploring insulin management in patients from family medicine clinics. Pharmacy 2025;13(4):93.
• White A, Thompson EL, Kim S, et al. Enhancing the role of community pharmacists in medication safety: A qualitative study of voices from the frontline. Pharmacy 2025;13(4):94.
• Young RA, Blair S, Teigen K, et al. Ambulatory medication safety events in high-risk patients with diabetes before and after a COVID-19 clinic slowdown. J Patient Saf 2025;21(4):240-245.
• Young RA, Xiao Y, Fulda KG, et al. Safety-I versus Safety-II: A mixed-methods study revealing the imbalance of approaches in primary care medication safety. J Patient Saf 2025 Oct 1;21(7Supp):S81-S88.

2024

• Jallow F, Stehling E, Sajwani-Merchant Z, et al. Medication management strategies by community-dwelling older adults: A multisite qualitative analysis. J Patient Saf 2024;20(3):192-197.
• Lang Y, Chen KY, Zhou Y, et al. Perception of medication safety-related behaviors among different age groups: Web-based cross-sectional study. Interact J Med Res 2024;13:e58635.
• Xiao Y, Fulda KG, Young RA, et al. Patient partnership tools to support medication safety in community-dwelling older adults: Protocol for a nonrandomized stepped wedge clinical trial. JMIR Res Protoc 2024;13:e57878.

2023

• Chen KY, Lang Y, Zhou Y, et al. Assessing interventions on crowdsourcing platforms to nudge patients for engagement behaviors in primary care settings: Randomized controlled trial. J Med Internet Res 2023;25:e41431.
• Jallow F, Stehling E, Sajwani-Merchant Z, et al. A multisite qualitative analysis of perceived roles in medication safety: Older adults’ perspectives. J Patient Exp 2023;10:23743735231158887.
• Xiao Y, Miller K, Werner N, et al. Co-design with patients for improving patient safety: Strategies, barriers and pitfalls. Proc Hum Factors Ergon Soc Annu Meet 2023;67(1):633-638.
• Young RA, Gurses AP, Fulda KG, et al. Primary care teams’ reported actions to improve medication safety: A qualitative study with insights in high reliability organising. BMJ Open Qual 2023;12(3):e002350.
• Zhou Y, Viswanatha A, Abdul Motaleb A, et al. A predictive decision analytics approach for primary care operations management: A case study of double-booking strategy design and evaluation. Comput Ind Eng 2023;17:109069.

2022

• White A, Fulda KG, Blythe R, et al. Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety. Expert Opin Drug Saf 2022;21(11):1357-1364.
• Xiao Y, Catchpole K, Rodrick D, et al. Patient Safety Learning Labs: Effective collaborations for enhanced patient safety. Proc Hum Factors Ergon Soc Annu Meet 2022;66(1):1581-1585.
• Young RA, Fulda KG, Espinoza A, et al. Ambulatory medication safety in primary care: A systematic review. J Am Board Fam Med 2022;35(3):610-628.

2021

• Batsis JA, Daniel K, Eckstrom E, et al. Promoting healthy aging during COVID-19. J Am Geriatr Soc 2021;69(3):572-580.
• Holden RJ, Hill JR, Campbell NL, et al. Human-centered design and research in deprescribing. Proc Hum Factors Ergon Soc Annu Meet 2021;65(1):398-402.
• Jallow F. Medication safety in community-dwelling older adults [dissertation]. Arlington, TX: The University of Texas at Arlington; 2021.

References

1. Xiao Y. Final Report: PROMIS Learning Lab: Partnership in Resilience for Medication Safety. 2025, The University of Texas: Arlington, Texas.
2. Chen KY, Lang Y, Zhou Y, et al. Assessing interventions on crowdsourcing platforms to nudge patients for engagement behaviors in primary care settings: Randomized controlled trial. J Med Internet Res 2023;25:e41431.
3. Xiao Y, Fulda KG, Young RA, et al. Patient partnership tools to support medication safety in community-dwelling older adults: Protocol for a nonrandomized stepped wedge clinical trial. JMIR Res Protoc 2024;13:e57878.
4. Young RA, Gurses AP, Fulda KG, et al. Primary care teams’ reported actions to improve medication safety: A qualitative study with insights in high reliability organising. BMJ Open Qual 2023;12(3):e002350.
5. Jallow F, Stehling E, Sajwani-Merchant Z, et al. A multisite qualitative analysis of perceived roles in medication safety: Older adults’ perspectives. J Patient Exp 2023;10:23743735231158887.
6. White A, Fulda KG, Blythe R, et al. Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety. Expert Opin Drug Saf 2022;21(11):1357-1364.
7. Young RA, Blair S, Teigen K, et al. Ambulatory medication safety events in high-risk patients with diabetes before and after a COVID-19 clinic slowdown. J Patient Saf 2025;21(4):240-245.
8. Xiao Y, Miller K, Werner N, et al. Co-design with patients for improving patient safety: Strategies, barriers and pitfalls. Proc Hum Factors Ergon Soc Annu Meet 2023;67(1):633-638.
9. Jallow F, Stehling E, Sajwani-Merchant Z, et al. Medication management strategies by community-dwelling older adults: a multisite qualitative analysis. J Patient Saf 2024;20(3):192-197.