Medication prescribing and monitoring errors in primary care: a report from the Practice Partner Research Network.

INTRODUCTION: Medication errors have been associated with poor patient outcomes and pose significant public health consequences. Establishing medication safety quality indicators is crucial to capturing the pervasiveness of preventable errors and is a fundamental first step in the process of improvement. In this article, a study is presented in which a set of medication prescribing and monitoring quality indicators were developed, and adherence to them was assessed among a group of US primary care practices. METHODS: Twenty Practice Partner Research Network practices in 14 US states with 94 clinicians and 52,246 active adult patients participated in the study. All practices use a common electronic medical record with dosing, interaction and monitoring decision support features. A consensus development process was used to select indicators in the categories of inappropriate treatment, dosing, drug-drug and drug-disease interactions, and monitoring of potential adverse events. Data extracted electronically from practices' electronic medical record were used to assess practice-level adherence with the indicator set as of 1 July 2008. RESULTS: Thirty medication safety indicators were selected. Across all practices, inappropriate treatment, dosing, drug-drug and drug-disease interactions were avoided in 75%, 84%, 98% and 86% of eligible patients, respectively; monitoring of preventable adverse drug events occurred in 75% of patients. There was wide variability in practice adherence with the indicators. DISCUSSION: The consensus development process was successful in selecting a broad set of primary care medication safety quality indicators. Although aggregate adherence was relatively high in this group of practices, opportunities exist to improve potential errors in treatment selection, dosing and monitoring.

Classifying reasons for hospital readmissions.

Readmissions are a key measurement tool in today's outcomes-focused health care environment. Monitoring the volume of readmissions is a straightforward process in light of the database resources available to care providers. Examining and reporting on the actual reasons for readmissions provides opportunities for improvement specific to the needs of a patient population. The readmission coding tool used at the Medical University of South Carolina demonstrates both the ability to assess the causes for patients returning to our institution within thirty days of discharge and the opportunity to correct problems in specific service areas with regard to discharge planning.

Developing a variance reporting system to facilitate quality improvement.

A major challenge of clinical pathway programs is measurement of elements of patient care that affect health outcomes and applying this knowledge to institute systematic improvement. Development of a variance reporting system requires planning, teamwork, and an understanding of the underlying quality process. This article describes a sample approach for using data as part of a comprehensive strategy to reach quality and fiscal goals.