Developing and Testing the Health Care Safety Hotline: A Prototype Consumer Reporting System for Patient Safety Events.

This article describes the design, development, and testing of the Health Care Safety Hotline, a prototype consumer reporting system for patient safety events. The prototype was designed and developed with ongoing review by a technical expert panel and feedback obtained during a public comment period. Two health care delivery organizations in one metropolitan area collaborated with the researchers to demonstrate and evaluate the system. The prototype was deployed and elicited information from patients, family members, and caregivers through a website or an 800 phone number. The reports were considered useful and had little overlap with information received by the health care organizations through their usual risk management, customer service, and patient safety monitoring systems. However, the frequency of reporting was lower than anticipated, suggesting that further refinements, including efforts to raise awareness by actively soliciting reports from subjects, might be necessary to substantially increase the volume of useful reports. It is possible that a single technology platform could be built to meet a variety of different patient safety objectives, but it may not be possible to achieve several objectives simultaneously through a single consumer reporting system while also establishing trust with patients, caregivers, and providers.

Implementation and evaluation of a prototype consumer reporting system for patient safety events.

OBJECTIVE: No methodologically robust system exists for capturing consumer-generated patient safety reports. To address this challenge, we developed and pilot-tested a prototype consumer reporting system for patient safety, the Health Care Safety Hotline. DESIGN: Mixed methods evaluation. SETTING: The Hotline was implemented in two US healthcare systems from 1 February 2014 through 30 June 2015. PARTICIPANTS: Patients, family members and caregivers associated with two US healthcare systems. INTERVENTION: A consumer-oriented incident reporting system for telephone or web-based administration was developed to elicit medical mistakes and care-related injuries. MAIN OUTCOMES MEASURES: Key informant interviews, measurement of website traffic and analysis of completed reports. RESULTS: Key informants indicated that Hotline participation was motivated by senior leaders' support and alignment with existing quality and safety initiatives. During the measurement period from 1 October 2014 through 30 June 2015, the home page had 1530 visitors with a unique IP address. During its 17 months of operation, the Hotline received 37 completed reports including 20 mistakes without harm and 15 mistakes with injury. The largest category of mistake concerned problems with diagnosis or advice from a health practitioner. Hotline reports prompted quality reviews, an education intervention, and patient follow-ups. CONCLUSION: While generating fewer reports than its capacity to manage, the Health Care Safety Hotline demonstrated the feasibility of consumer-oriented patient safety reporting. Further research is needed to understand how to increase consumers' use of these systems.

Population Health Management and the Second Golden Age of Arab Medicine: Promoting Health, Localizing Knowledge Industries, and Diversifying Economies in the GCC Countries.

Over the past half-century, the Gulf Cooperation Council (GCC) countries-Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates-have experienced rapid economic growth and, with it, dramatic lifestyle changes. Low levels of physical activity and calorie-dense diets have led to an increase in the prevalence of chronic disease, most prominently diabetes. After having successfully controlled communicable diseases and made advanced acute care accessible locally, the GCC countries now face the challenge of orienting their health care systems toward prevention and treatment of chronic diseases. In this study, Dr. Mattke and his colleagues argue that this challenge presents GCC countries with a historic opportunity to reestablish the thought leadership role that Arab medicine had in the Islamic Golden Age. They propose that GCC countries could apply their considerable wealth to design and implement innovative health care systems based on population health management principles and sophisticated health information technology. Taking this path would not only improve prevention and management of chronic disease in the GCC countries but also contribute to the diversification of their economies and localization of knowledge industries.

The Role of Health Care Transformation for the Chinese Dream: Powering Economic Growth, Promoting a Harmonious Society.

After having successfully expanded health insurance coverage, China now faces the challenge of building an effective and efficient delivery system to serve its large and aging population. The country finds itself at a crossroads-it can emulate the models of Western countries with their well-known limitations, or embark on an ambitious endeavor to create an innovative and sustainable model. We recommend that China choose the second option and design and implement a health care system based on population health management principles and sophisticated health information technology. Taking this path could yield a triple dividend for China: Health care will contribute to the growth of service sector employment, stimulate domestic demand by unlocking savings, and enable China to export its health system development capabilities to other emerging economies, mirroring its success in building other critical infrastructure. These forces can help turn the Chinese Dream into a reality.

Promoting Patient Safety Through Effective Health Information Technology Risk Management.

The potential for health information technology (IT) to improve health care delivery has been appreciated for decades, but "digitizing" health care can also introduce new risks and even harm. As the use of health IT has grown, these risks have become more apparent. The authors of this report evaluated the efforts of 11 hospitals and ambulatory practices to use an improvement strategy and tools developed to promote safe use of health IT and to diagnose, monitor, and mitigate health IT-related safety risks. Through interviews, the authors discovered that some health care organizations (especially hospitals) with expertise in process improvement were able to identify and begin to mitigate health IT-related safety risks, but in most others, awareness of these risks was limited (especially in ambulatory practices). The authors concluded that better tools like the recently released Safety Assurance Factors for EHR Resilience (SAFER) Guides are needed to help organizations optimize the safe use of health IT. However, health care organizations will require a better understanding of the safety risks posed by electronic health record (EHR) use to take full advantage of the SAFER Guides. There may also be a need for additional tools and metrics (and further usability studies of existing tools and metrics) to better support the needs of health care organizations as they increasingly rely on health IT to improve the quality and safety of patient care.

Nurse Practitioners and Sexual and Reproductive Health Services: An Analysis of Supply and Demand.

Use of Sexual and Reproductive Health (SRH) services is projected to grow between 10 and 20 percent from 2006 to 2020. This growth is driven largely by changes in the racial/ethnic make-up of the population of women of reproductive age and an increase in the number of people with insurance coverage because of new health care legislation. Trends in supply and demand for SRH services, particularly for low-income individuals, suggest demand will outstrip supply in the next decade. Nurse Practitioners (NPs) with a women's health focus are key providers of SRH care in Title X-funded clinics, which deliver a significant proportion of U.S. family planning and SRH services to low-income populations. This article looks at why numbers of women's health NPs (WHNPs) have been declining, and are projected to continue to decline, despite significant growth in total numbers of NPs. Barriers to increasing the supply of NPs competent in SRH care-such as reduced funding for WHNP training, increased funding for primary care and geriatric NP training, and a shrinking proportion of WHNPs choosing to work in public health, clinics, and family planning-are identified. From the standpoint that the evolution of the health care delivery system may serve as an opportunity to optimize the delivery of SRH services in the United States, a comprehensive set of options spanning education, federal and state regulations, and emerging models of care delivery are explored to reverse this trend of too few WHNPs, particularly for servicing Title X facilities and their patients.

Improving Access to Medicines for Non-Communicable Diseases in the Developing World.

Non-communicable diseases (NCDs) now account for the majority of global morbidity and mortality and are increasingly affecting developing countries whose under-resourced health care systems also have to handle a high burden of infectious disease. To counter the global devastation caused by NCDs, the United Nations General Assembly decided to "set a new global agenda" and convened a high-level meeting on NCDs in September 2011. In connection with this meeting, the authors of this article took a first step toward developing a policy research agenda for improving access to NCD medicines in developing countries, a step that the research-based pharmaceutical industry, in particular, can carry forward as part of broader global efforts to combat NCD. The authors provide a framework for understanding the obstacles to access for NCD medicines, review specific issues to be confronted within each obstacle in the developing world, identify promising ideas for improving access to NCD medicines, and point to several highly promising areas for the research-based pharmaceutical industry to focus on as it develops its NCD policy research program in close collaboration with other key stakeholders.