Hojjat Salmasian MD, PhD, MPH (is Assistant Professor of Medicine, Brigham and Women’s Hospital, Boston, and Harvard Medical School.), Astrid Van Wilder PhD, MPH (is Postdoctoral Research Associate, Center for Health System Sustainability, Brown University School of Public Health, and Postdoctoral Researcher, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.), Michelle Frits (is Senior Project Manager, Information Systems, Brigham and Women’s Hospital.), Christine Iannaccone MPH (is Senior Project Manager. Brigham and Women’s Hospital.), Merranda Logan MD, MPH, FACP (is Attending Nephrologist, Massachusetts General Hospital, Boston, and Assistant Professor, Harvard Medical School.), Jonathan P. Zebrowski MD, MHQS (is Attending Psychiatrist, Massachusetts General Hospital.), David Shahian MD (is Senior Surgeon, Massachusetts General Hospital, and Professor of Surgery, Harvard Medical School.), Mitchell Rein MD (is Reproductive Endocrinologist, Salem Hospital, Salem, Massachusetts, and Associate Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School.), David Levine MD, MPH, MA (is Clinician-Investigator, Brigham and Women’s Hospital, and Associate Professor of Medicine, Harvard Medical School), David W. Bates MD, MSc (is Chief, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Professor of Medicine, Harvard Medical School. Please address correspondence to Astrid Van Wilder)
{"title":"哈佛附属医院患者安全指标监测：一项混合方法研究。","authors":"Hojjat Salmasian MD, PhD, MPH (is Assistant Professor of Medicine, Brigham and Women’s Hospital, Boston, and Harvard Medical School.), Astrid Van Wilder PhD, MPH (is Postdoctoral Research Associate, Center for Health System Sustainability, Brown University School of Public Health, and Postdoctoral Researcher, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.), Michelle Frits (is Senior Project Manager, Information Systems, Brigham and Women’s Hospital.), Christine Iannaccone MPH (is Senior Project Manager. Brigham and Women’s Hospital.), Merranda Logan MD, MPH, FACP (is Attending Nephrologist, Massachusetts General Hospital, Boston, and Assistant Professor, Harvard Medical School.), Jonathan P. Zebrowski MD, MHQS (is Attending Psychiatrist, Massachusetts General Hospital.), David Shahian MD (is Senior Surgeon, Massachusetts General Hospital, and Professor of Surgery, Harvard Medical School.), Mitchell Rein MD (is Reproductive Endocrinologist, Salem Hospital, Salem, Massachusetts, and Associate Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School.), David Levine MD, MPH, MA (is Clinician-Investigator, Brigham and Women’s Hospital, and Associate Professor of Medicine, Harvard Medical School), David W. Bates MD, MSc (is Chief, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Professor of Medicine, Harvard Medical School. Please address correspondence to Astrid Van Wilder)","doi":"10.1016/j.jcjq.2025.05.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div><span>The past two decades have seen a surge in available patient safety metrics. However, the variability in how </span>health care organizations choose and monitor these metrics remains unknown.</div></div><div><h3>Methods</h3><div>The authors cataloged the metrics organizations chose and how actively they monitored them. Factors influencing the monitoring of patient<span> safety metrics were investigated using surveys and in-depth interviews with patient safety experts from 11 Harvard-affiliated organizations.</span></div></div><div><h3>Results</h3><div>Eighty-four individuals across 11 sites helped complete the surveys, with a mean of 2.5 representatives from each site interviewed. Significant variability in active monitoring of safety metrics was observed across different sites. Overall, 108 measures were monitored by at least 1 site. Agreement between sites about the choice of measures was weak (κ = 0.40, 95% confidence interval [CI] 0.37–0.43), ranging from κ = 0.13 (95% CI 0.07–0.20) for maternal safety measures to κ = 0.86 (95% CI 0.69–1.00) for measures of hospital-acquired infections. Although not all 23 mandatory measures were monitored across all sites, these had the highest likelihood of active monitoring. A substantial overlap existed in measures targeting the same safety event but with slight differences in definitions, limiting the comparability of rates across institutions. Key considerations for active monitoring included the perceived measure usefulness and measurement burden, although external mandates or internal institutional commitments were stronger motivators overall. Other contributors included access to analytics teams and platforms, registry participation, vendor investments, and strategic or leadership interests.</div></div><div><h3>Conclusion</h3><div>This study offers critical guidance to health policymakers on designing and mandating safety metrics. Despite high variability in metric selection, health care organizations share common themes when deciding what to actively measure.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Pages 558-565"},"PeriodicalIF":2.4000,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Patient Safety Metrics Monitoring Across Harvard-Affiliated Hospitals: A Mixed Methods Study\",\"authors\":\"Hojjat Salmasian MD, PhD, MPH (is Assistant Professor of Medicine, Brigham and Women’s Hospital, Boston, and Harvard Medical School.), Astrid Van Wilder PhD, MPH (is Postdoctoral Research Associate, Center for Health System Sustainability, Brown University School of Public Health, and Postdoctoral Researcher, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.), Michelle Frits (is Senior Project Manager, Information Systems, Brigham and Women’s Hospital.), Christine Iannaccone MPH (is Senior Project Manager. Brigham and Women’s Hospital.), Merranda Logan MD, MPH, FACP (is Attending Nephrologist, Massachusetts General Hospital, Boston, and Assistant Professor, Harvard Medical School.), Jonathan P. Zebrowski MD, MHQS (is Attending Psychiatrist, Massachusetts General Hospital.), David Shahian MD (is Senior Surgeon, Massachusetts General Hospital, and Professor of Surgery, Harvard Medical School.), Mitchell Rein MD (is Reproductive Endocrinologist, Salem Hospital, Salem, Massachusetts, and Associate Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School.), David Levine MD, MPH, MA (is Clinician-Investigator, Brigham and Women’s Hospital, and Associate Professor of Medicine, Harvard Medical School), David W. Bates MD, MSc (is Chief, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, and Professor of Medicine, Harvard Medical School. Please address correspondence to Astrid Van Wilder)\",\"doi\":\"10.1016/j.jcjq.2025.05.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div><span>The past two decades have seen a surge in available patient safety metrics. However, the variability in how </span>health care organizations choose and monitor these metrics remains unknown.</div></div><div><h3>Methods</h3><div>The authors cataloged the metrics organizations chose and how actively they monitored them. Factors influencing the monitoring of patient<span> safety metrics were investigated using surveys and in-depth interviews with patient safety experts from 11 Harvard-affiliated organizations.</span></div></div><div><h3>Results</h3><div>Eighty-four individuals across 11 sites helped complete the surveys, with a mean of 2.5 representatives from each site interviewed. Significant variability in active monitoring of safety metrics was observed across different sites. Overall, 108 measures were monitored by at least 1 site. Agreement between sites about the choice of measures was weak (κ = 0.40, 95% confidence interval [CI] 0.37–0.43), ranging from κ = 0.13 (95% CI 0.07–0.20) for maternal safety measures to κ = 0.86 (95% CI 0.69–1.00) for measures of hospital-acquired infections. Although not all 23 mandatory measures were monitored across all sites, these had the highest likelihood of active monitoring. A substantial overlap existed in measures targeting the same safety event but with slight differences in definitions, limiting the comparability of rates across institutions. Key considerations for active monitoring included the perceived measure usefulness and measurement burden, although external mandates or internal institutional commitments were stronger motivators overall. Other contributors included access to analytics teams and platforms, registry participation, vendor investments, and strategic or leadership interests.</div></div><div><h3>Conclusion</h3><div>This study offers critical guidance to health policymakers on designing and mandating safety metrics. Despite high variability in metric selection, health care organizations share common themes when deciding what to actively measure.</div></div>\",\"PeriodicalId\":14835,\"journal\":{\"name\":\"Joint Commission journal on quality and patient safety\",\"volume\":\"51 9\",\"pages\":\"Pages 558-565\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-05-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Joint Commission journal on quality and patient safety\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1553725025001424\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725025001424","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
摘要
背景：过去二十年来，可用的患者安全指标激增。然而，医疗机构如何选择和监控这些指标的可变性仍然未知。方法：作者编目了组织选择的度量标准以及他们如何积极地监控这些度量标准。通过对11个哈佛附属机构的患者安全专家的调查和深度访谈，研究了影响患者安全指标监测的因素。结果：来自11个站点的84个人帮助完成了调查，平均每个站点有2.5名代表接受采访。在不同地点观察到主动监测安全指标的显著差异。总体而言，至少有一个站点监测了108项措施。不同地点对措施选择的一致性较弱（κ = 0.40, 95%可信区间[CI] 0.37-0.43），范围从孕产妇安全措施的κ = 0.13 （95% CI 0.07-0.20）到医院获得性感染措施的κ = 0.86 （95% CI 0.69-1.00）。虽然并非所有地点都监测了所有23项强制性措施，但这些措施进行主动监测的可能性最高。针对同一安全事件的措施存在大量重叠，但在定义上略有不同，限制了各机构费率的可比性。积极监测的关键考虑因素包括感知到的测量有用性和测量负担，尽管外部授权或内部机构承诺总体上是更有力的激励因素。其他贡献包括访问分析团队和平台、注册参与、供应商投资以及战略或领导兴趣。结论：本研究为卫生政策制定者设计和实施安全指标提供了重要指导。尽管在度量选择上有很大的可变性，但在决定积极度量什么时，医疗保健组织有共同的主题。
Patient Safety Metrics Monitoring Across Harvard-Affiliated Hospitals: A Mixed Methods Study
Background
The past two decades have seen a surge in available patient safety metrics. However, the variability in how health care organizations choose and monitor these metrics remains unknown.
Methods
The authors cataloged the metrics organizations chose and how actively they monitored them. Factors influencing the monitoring of patient safety metrics were investigated using surveys and in-depth interviews with patient safety experts from 11 Harvard-affiliated organizations.
Results
Eighty-four individuals across 11 sites helped complete the surveys, with a mean of 2.5 representatives from each site interviewed. Significant variability in active monitoring of safety metrics was observed across different sites. Overall, 108 measures were monitored by at least 1 site. Agreement between sites about the choice of measures was weak (κ = 0.40, 95% confidence interval [CI] 0.37–0.43), ranging from κ = 0.13 (95% CI 0.07–0.20) for maternal safety measures to κ = 0.86 (95% CI 0.69–1.00) for measures of hospital-acquired infections. Although not all 23 mandatory measures were monitored across all sites, these had the highest likelihood of active monitoring. A substantial overlap existed in measures targeting the same safety event but with slight differences in definitions, limiting the comparability of rates across institutions. Key considerations for active monitoring included the perceived measure usefulness and measurement burden, although external mandates or internal institutional commitments were stronger motivators overall. Other contributors included access to analytics teams and platforms, registry participation, vendor investments, and strategic or leadership interests.
Conclusion
This study offers critical guidance to health policymakers on designing and mandating safety metrics. Despite high variability in metric selection, health care organizations share common themes when deciding what to actively measure.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
