History
Concerns about the safety of the American health care system were sparked by the publishing of several groundbreaking reports from the Institute of Medicine (IOM). To Err is Human: Building a Safer Health Care System (2000) estimated that preventable medical errors kill 44,000 to 98,000 Americans annually. Crossing the Quality Chasm: A New Health System for the 21st Century (2001) advocated system-wide reform of the U.S. health care system.
Following the release of the first report, the University of Iowa College of Public Health and the Iowa Department of Public Health (IDPH) undertook an initiative to better understand the challenges surrounding health care quality in Iowa. In October 2000, IDPH began a research endeavor in collaboration with the Centers for Disease Control and Prevention (CDC) that crossed the traditional boundaries in health care and focused on developing evidence-based action to improve patient safety in the state of Iowa.
IDPH Research
IDPH research was directed toward understanding the challenges of quality health care from the system perspective, as opposed to the perspective of the patient-provider interface. In this context, it was crucial to understand what each stakeholder population saw as problems. Researchers convened focus groups of healthcare professionals (doctors, nurses, and pharmacists), consumers, payors (insurance companies, HMO's), and policymakers to discuss both the barriers to patient safety and the strategies that can be employed to enhance the safety of patients.
Using the data from the focus groups, surveys were developed to identify those areas most critical to the improvement of patient safety. The survey results were then presented to a multidisciplinary advisory committee to develop action steps based on the research findings that can be taken to show demonstrated improvement. Future work will implement these steps statewide and evaluate their impact on patient safety.
The Iowa Department of Public Health embarked on a multi-year project in October 2000 in collaboration with the Centers for Disease Control and Prevention (CDC) to better understand the problem of patient safety in Iowa and the United States.
First, focus groups were convened to better understand the issues facing various populations of provider populations. For the first year, four provider groups were identified: doctors, licensed practical nurses (LPNs), registered nurses (RNs), and pharmacists. Following the focus groups, a survey tool was developed that allowed participants to prioritize the factors they felt acted as barriers to patient safety and those that may be strategies to improve patient safety in Iowa.
Preliminary results were released at the 2002 Iowans Mobilizing Action for Patient Safety Conference.
Other CDC-Funded Research in Iowa
Other research has also been funded throughout the state to better understand challenges facing Iowa health care. These projects are described below:
- Identifying and Understanding Patient Safety, Adverse Event and Error Data Currently Collected and Used by Healthcare Providers
Center for Health Policy and Research, College of Public Health, University of Iowa
Contact: Douglas S. Wakefield, Director, Center for Health Policy and Research
Project Purpose: The purpose of this project is to enhance our understanding, at a statewide level, of acute care hospital and nursing facility safety, adverse event and error data collection and analysis practices. Our focus will be on routinely collected and analyzed data, how the information gleaned from these data is being used to enhance quality, and the extent of the sharing of comparative data and best practices among similar provider organizations. The findings from this study will establish an essential baseline from which improvement initiatives will be developed and evaluated.
- An Interdisciplinary Approach to Improving Patient Safety
Institute for Quality Healthcare, College of Public Health, University of Iowa
Contact: Tanya Uden-Holman, PhD, Director, Institute for Quality Healthcare
Project Description: The project goal is to define factors in the organizational environment that impede or facilitate voluntary reporting processes and bring together an interdisciplinary team of healthcare providers to discuss increasing voluntary reporting and improve patient safety in rural hospitals that are Institute for Quality Healthcare Members.
There are three main purposes of the study: 1) to examine the relationship between organizational variables (i.e., organizational culture and extent of CQI implementation) and one measure of quality, perceived rated of medication administration error (MAE) reporting by nurses; 2) to explore the role of the pharmacy in detecting, reporting, and preventing MAEs; and 3) to use an interdisciplinary discussion format to share survey results and identify next steps in creating a culture of safety, improving the medication administration process, and enhancing patient safety in rural hospitals.
- Reducing Adverse Drug Events and Improving Medication Outcomes in North Central Iowa
Mercy Medical Center - North Iowa
Contact: Jane Brokel, Project Director
Project Description: This research project will design, implement, and test the effectiveness of medication safety improvement strategies aimed at reducing adverse drug events and improving medication outcomes for patients using anticoagulants, diuretics, and digoxin and improving the documentation of adverse drug events and medication errors in rural health care facilities.
- Impact of the Iowa Priority Brown Bag Medication Review on the Safety, Effectiveness and Efficiency of Seniors' Medication Use
University of Iowa College of Pharmacy
Contact: Karen Farris, PhD, Associate Professor
Project Description: The Iowa Priority Prescription Savings Program pays physicians and pharmacists a fee for completing a Brown Bag Medication Review for its members. We will determine the impact of the new payment methodology for Brown Bag Medication Reviews on the safety and quality of medications among Iowa's seniors.
In the proposed project, we will (1) evaluate factors related to the use of the Brown Bag Review by Iowa Priority members to assess its distributional impacts; (2) characterize the individuals with prescription, nonprescription, and herbal-related patient safety issues among seniors receiving a Brown Bag Review; (3) characterize the types of prescription, nonprescription, and herbal-related patiet safety issues that are identified; and (4) measure improvements in the quality of care resulting from communications between patients, physicians and pharmacists following the Brown Bag Review.
- Evaluation of the Implications of Implementing the Leapfrog Group's Patient Safety Standards in Iowa Hospitals
Center for Health Policy and Research, College of Public Health, University of Iowa
Contact: Douglas S. Wakefield, Director, Center for Health Policy and Research
Project Description: The purpose of this study is to evaluate the potential effect of third-party payers using their economic purchasing power to stimulate redesign of acute care hospitals' safety and quality. We will specifically evaluate the potential effects in Iowa of implementing the three patient safety standards developed by the Leapfrog Group: Computer-Based Physician Order Entry Systems (CPOE), Evidence-Based Hospital Referrals (EHR), and specific ICU staffing (IPS).
