Patient safety self-advocacy in patient-centered care

University Of Cincinnati, Cincinnati OH

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Abstract

DESCRIPTION: (Provided by the Applicant) Problem: Medical error and patient safety have been studied primarily from the inpatient health care system's perspective; there are minimal data about medical errors in outpatient primary care or how patients actively affect medical errors. Purpose: This study explores a patient-centered orientation for preventing errors and adverse events by studying primary care patients' experiences and opinions on acting as patient safety self-advocates. Research question: This study will investigate four interlinked questions: 1) What types of errors have patients experienced in primary care settings, 2) From these experiences, what behaviors and actions do primary care patients believe constitute the role of patient safety self-advocate, 3) How comfortable are patients using these behaviors and what utilization barriers do they perceive, and 4) Do these behaviors corroborate the patient's role in a proposed "hourglass" model that represents the interaction between errors and patient safety? Methods: Phase one: In depth interviews will be conducted with 20 primary care patients in Ohio and consumer advocates nationwide who have experienced medical errors in their lives. They will be asked about the errors they experienced and what behaviors they have adopted to prevent future adverse events. Recommendations for becoming one's own patient safety advocate will be developed based on analysis of these interviews, and from the existing illness self-management and consumer advocacy literature. Phase two: Self-advocacy suggestions will be advanced to 8 focus groups of primary care patients to learn what behaviors patients are comfortable using and what barriers patients perceive to incorporate patient safety self-advocacy. These focus groups will consist of a stratified purposeful sample of primary care patients at high and low medical and demographic risk for medical errors. Qualitative analysis of both the individual and focus group interviews will consist of computer-assisted content analysis using a codebook developed from the interview guides with expansion of the codebook from the interviews themselves. During the analysis, the proposed model of interaction between medical errors and patient safety will be examined in light of identified themes, and a model-based set of patient advocacy training guidelines will be devised. Benefits: This study will assess patients' willingness to become their own safety advocates within a model of error and safety. The study will contribute to development of advocacy guidelines that can be investigated in future intervention studies.