Results from the AHRQ Medical Office Survey on Patient Safety Culture 2012 User Comparative Database

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Slide 1

Results from the AHRQ Medical Office Survey on Patient Safety Culture 2012 User Comparative Database

2012 AHRQ Annual Conference

September 10, 2012

Theresa Famolaro, MPS, Westat

Image: A photograph shows two medical office staff members with a laptop computer.

Slide 2

Acknowledgements

Westat staff

• Joann Sorra.
• Naomi Dyer.
• Scott Smith.
• Helen Liu.
• Matt Ragan.

AHRQ staff

• Christine Crofton.
• James Battles.

Technical Expert Panel Members

Slide 3

Objectives

• Provide background on the development of the AHRQ Medical Office Survey on Patient Safety Culture.
• Describe the AHRQ Medical Office Survey on Patient Safety Culture Comparative Database.
• Present the overall results from the AHRQ Medical Office Survey on Patient Safety Culture 2012 User Comparative Database Report.
• Review results by medical office and respondent characteristics.

Slide 4

Background

• Part of a larger suite of surveys sponsored by the Agency for Healthcare Research and Quality's (AHRQ):
  • Hospital.
  • Medical Office.
  • Nursing Home.
  • Pharmacy (to be released in October).
• Specifically designed to measure the culture of patient safety in outpatient medical offices:
  • Assesses staff and provider attitudes and beliefs about patient safety.
  • Assesses many areas that are different than the other surveys.
• Pilot tested in two survey administrations:
  • 2007; 182 medical offices, 4,174 office staff.
  • 2009; 292 PBRN medical offices, 6,463 office staff.
  • Pilot test report at https://www.ahrq.gov/qual/mosurvey10/moresults10.htm.

Slide 5

MOSOPS Patient Safety Culture Composites

10 composites of organizational culture:

1. Teamwork:
2. Patient Care Tracking/Follow-up.
3. Organizational Learning.
4. Overall Perceptions of Patient Safety and Quality.
5. Staff Training.
6. Owner/Managing Partner/Leadership Support for Patient Safety.
7. Communication About Error.
8. Communication Openness.
9. Office Processes and Standardization.
10. Work Pressure and Pace.

Other questions:

• Nine questions on Patient Safety and Quality Issues.
• Five questions on Information Exchange With Other Settings.
• Ratings on Areas of Quality Overall.
• Rating on Patient Safety.

Slide 6

Definition of a Medical Office

• A medical office is an outpatient facility in a specific location.
• A medical office located in a building containing multiple medical offices is considered a separate medical office.
• A provider in a single medical office with other providers should share administrative and clinical support staff.

Images: Photographs show a medical office building and a group of medical office staff.

Slide 7

Medical Office Comparative Database

• 23,679 medical office respondents from 934 medical offices.
• Submission to the database is voluntary.
• Individual Medical Office Feedback Report is a benefit for participation.
• 290 Medical Offices from the pilot study are retained in the 2012 Database.
  • Pilot PBRN data collected November 2009.

Slide 8

Call for Data Submission

• Data submission occurred September 15 – Oct 31 2011.
• Participation requirements:
  • Medical offices located in the United States or U.S. territory.
  • Each medical office had at least five completed surveys.
  • Survey administered in its entirety without significant modifications or deletions.
  • Medical offices signed an AHRQ Data Use Agreement.
• Submission was online and included a Web-based tutorial.

Slide 9

Survey Administration Statistics

• Surveys were collected by:
  • Paper Only (35%).
  • Web Only (63%).
  • Both paper and Web (2%).
• The average medical office response rate was 71%:
  • Paper Only (80% response rate).
  • Web only (66% response rate).
  • Both Web and Paper (87% response rate).
• Average of 25 completed surveys per medical office.

Slide 10

Medical Offices by Number of Providers

Number of Providers	N	%
1	34	4%
2	111	12%
3	110	12%
4-9	382	41%
10-13	87	9%
14-19	63	7%
More than 19	139	15%

Note: Percentages may not add to exactly 100 percent due to rounding; n = 926.

Slide 11

Medical Offices by Single vs. Multi-Specialty

Single vs. Multi-Specialty	N	%
Single specialty	641	69%
Multi-specialty with primary care only	85	9%
Multi-specialty with primary care and specialty care	188	20%
Multi-specialty with specialty care only	18	2%

Note: Percentages may not add to exactly 100 percent due to rounding; n = 932.

Slide 12

Implementation Status of Electronic Tools

Electronic Tools	% Not Implemented	% Implementation in Process	% Fully Implemented
Appointment scheduling	4%	8%	88%
Ordering of medications	30%	18%	52%
Ordering of tests, imaging, or procedures	34%	18%	48%
Access to patients' test or imaging results	16%	15%	69%
Medical/health records	25%	13%	62%

Note: Percentages may not add to exactly 100 percent due to rounding.

Slide 13

Medical Offices by Majority Ownership

Majority Ownership	N	%
Provider(s) and/or physician(s)	92	10%
University or academic medical institution	53	6%
Hospital or health system	678	73%
Community health system	58	6%
Government (Federal, State, local)	34	4%
Other	14	2%

Slide 14

Respondents by Staff Position

Staff position	N	%
Administrative or clerical staff	6,378	28%
Other clinical staff or clinical support staff	5,557	24%
Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN)	4,203	18%
Physician (M.D. or D.O.)	2,943	13%
Management	1,621	7%
Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Nurse Midwife, Advanced Practice Nurse, etc.	1,061	5%
Other	1,200	5%

Slide 15

Medical Office SOPS Composites

Image: A bar graph shows positive response percentages for the following composites:

• Teamwork: 84%.
• Patient Care Tracking/Follow-up: 82%.
• Organizational Learning: 77%.
• Overall Perceptions of Patient Safety and Quality: 76%.
• Staff Training: 73%.

Slide 16

Medical Office SOPS Composites (continued)

Image: A bar graph shows positive response percentages for the following composites:

• Owner Managing Partner/Leadership Support for Patient Safety: 67%.
• Communication About Error: 66%.
• Communication Openness: 64%.
• Office Processes and Standardization: 64%.
• Work Pressure and Pace: 48%.

Slide 17

Most Positive Items

• Teamwork:
  • In this office, there is a good working relationship between staff and providers (88%).
  • When someone in this office gets really busy, others help out (84%).
• Patient Care Tracking/Follow-up:
  • This office follows up with patients who need monitoring (89%).
  • Our office follows up when we do not receive a report we are expecting from an outside provider (84%).

Slide 18

Least Positive Items

• Work Pressure and Pace:
  • In this office, we often feel rushed when taking care of patients (31%).
  • We have enough staff to handle our patient load (47%).
  • We have too many patients for the number of providers in this office (48%).
• Office Processes and Standardization:
  • We have problems with workflow in this office (49%).
• Owner/Managing Partner/Leadership Support for Patient Safety:
  • They aren't investing enough resources to improve the quality of care in this office (49%).

Slide 19

Patient Safety and Quality Issues

• Nine ratings of things happening in your medical office over the past 12 months.
• Example items include:
  • Use of a wrong chart/medical record on a patient.
  • One day follow-up of an abnormal result from a lab or imaging test.
  • Ability of patient to get an appointment within 48 hours for an acute/serious problem.
  • Availability of lab or imaging test results.
  • Contact by pharmacy to clarify or correct a prescription.

Slide 20

Patient Safety and Quality Issues

Image: A bar graph shows percentage of respondents who reported how often the wrong chart/medical record was used for a patient:

• Not in the past 12 months: 52%.
• Once or twice in the past 12 months: 37%.
• Several times in the past 12 months: 7%.
• Monthly: 2%.
• Weekly: 1%.
• Daily: 0%.

A bracket over the first 3 bars is captioned "96% positive."

Slide 21

Patient Safety and Quality Issues

Image: A bar graph shows percentage of respondents who reported a critical abnormal test from a lab or imaging test that was not followed up within 1 business day:

• Not in the past 12 months: 60%.
• Once or twice in the past 12 months: 24%.
• Several times in the past 12 months: 8%.
• Monthly: 4%.
• Weekly: 3%.
• Daily: 1%.

A bracket over the first 3 bars is captioned "92% positive."

Slide 22

Patient Safety and Quality Issues

Image: A bar graph shows percentage of respondents who reported how often a patient was unable to get an appointment within 48 hours for an acute/serious problem:

• Not in the past 12 months: 47%.
• Once or twice in the past 12 months: 21%.
• Several times in the past 12 months: 9%.
• Monthly: 6%.
• Weekly: 8%.
• Daily: 7%.

A bracket over the first 3 bars is captioned "77% positive."

Slide 23

Patient Safety and Quality Issues

Image: A bar graph shows percentage of respondents who reported how often the results from a lab or imaging test were not available when needed:

• Not in the past 12 months: 20%.
• Once or twice in the past 12 months: 29%.
• Several times in the past 12 months: 24%.
• Monthly: 13%.
• Weekly: 11%.
• Daily: 3%.

A bracket over the first 3 bars is captioned "73% positive."

Slide 24

Patient Safety and Quality Issues

Image: A bar graph shows percentage of respondents who reported how often a pharmacy contacted the office to clarify or correct a prescription:

• Not in the past 12 months: 7%.
• Once or twice in the past 12 months: 20%.
• Several times in the past 12 months: 24%.
• Monthly: 14%.
• Weekly: 22%.
• Daily: 12%.

A bracket over the first 3 bars is captioned "51% positive."

Slide 25

Information Exchange With Other Settings

• Over the past 12 months, how often has your medical office had problems exchanging accurate, complete, and timely information with:
  • Outside labs/imaging centers?
  • Other medical offices/ outside physicians?
  • Pharmacies?
  • Hospitals?
  • Other?

Slide 26

Most Positive — Hospitals

Image: A bar graph shows percentage of respondents who reported:

• No problems in the past 12 months: 34%.
• Problems once or twice in the past 12 months: 30%.
• Problems several times in the past 12 months: 17%.
• Problems monthly: 10%.
• Problems weekly: 6%.
• Problems daily: 2%.

A bracket over the first 3 bars is captioned "81% positive."

Slide 27

Least Positive — Pharmacies

Image: A bar graph shows percentage of respondents who reported:

• No problems in the past 12 months: 32%.
• Problems once or twice in the past 12 months: 26%.
• Problems several times in the past 12 months: 17%.
• Problems monthly: 10%.
• Problems weekly: 10%.
• Problems daily: 5%.

A bracket over the first 3 bars is captioned "75% positive."

Slide 28

Overall Ratings on Quality

• Overall, how would you rate your medical office on each of the following areas of health care quality?
• Percent positive is the combined response of Excellent and Very good:
  • Equitable 81% (51% Excellent, 30% Very good).
  • Effective 69% (27% Excellent, 42% Very good).
  • Patient Centered 68% (29% Excellent, 39% Very good).
  • Efficient 57% (20% Excellent, 37% Very good).
  • Timely 50% (17% Excellent, 33% Very good).

Slide 29

Overall Rating on Patient Safety

Overall, how would you rate the systems and clinical processes your medical office has in place to prevent, catch, and correct problems that have the potential to affect patients?

Image: A bar graph shows percentage of respondents who rated the systems and clinical processes their medical office has in place to prevent, catch, and correct problems that potentially affect patients:

• Excellent: 22%.
• Very good: 43%.
• Good: 27%.
• Fair: 7%.
• Poor: 1%.

A bracket over the first 2 bars is captioned "65% positive."

Slide 30

Average Overall Rating on Quality and Patient Safety

The average of the five overall ratings on quality and the overall rating on patient safety across all 2012 database medical offices.

Image: A bar graph shows percentage of the average of the five overall ratings across all 2012 database medical offices:

• Excellent: 28%.
• Very good: 37%.
• Good: 26%.
• Fair: 7%.
• Poor: 2%.

A bracket over the first 2 bars is captioned "65% positive."

Slide 31

Results by Medical Office Characteristics

Smaller medical offices had better results.

• Average % positive across all 10 survey composites:
  • Smaller medical offices (2 providers) (75%) vs. larger (14-19 providers) (66%).
• Average Overall Rating on Quality and Patient Safety:
  • Smaller medical offices (2 providers) (74%) vs. larger (14-19 providers) (57%).
• Small correlation between size and composite results:
  • Average % positive across 10 survey composites related to size (r = -0.08, to - 0.10, p < 0.05).

Slide 32

Results by Medical Office Characteristics

• Single specialty scored higher than multi-specialty:
  • Slightly higher on all 10 survey composites.
  • Owner/Managing Partner/Leadership Support for Patient Safety:
    • Single specialty (69%) vs. Multi-specialty (61%).
• Ownership impacts patient safety culture results:
  • Average % positive across all 10 survey composites:
    • Community health centers and Provider and/or Physician owned (72%) vs. Federal, State, or local govt. (61%).
  • Overall Rating on Patient Safety (Excellent, Very Good):
    • Provider and/or Physician owned (67%) vs. Federal, State, or local govt.(48%).

Slide 33

Results by Staff Characteristics

• Management scored higher than other staff positions:
  • Management scored highest in 8 out of 10 survey composites.
  • Average % positive across all 10 survey composites:
    • Management (80%) vs. Admin/Clerical staff (68%)
  • Communication About Error:
    • Management (80%) vs. Admin/Clerical staff (62%)
  • Communication Openness:
    • Physicians (80%) vs. Admin/Clerical Staff (58%)
    • Management scored similar to physicians (79%)

Slide 34

AHRQ Supporting Materials

• Medical Office Survey Toolkit:
  • Survey in English and Spanish.
  • Survey User's Guide.
  • Medical Office Data Entry and Analysis Tool.
  • Medical Office Survey Feedback Report Template.
• Medical Office Patient Safety Resource List:
  • Arranged by patient safety culture composite.
  • Tools and resources for improvement.
• Medical Office Data Submission Timeline:
  • Dates forthcoming in 2013.
• Download all materials at:
  https://www.ahrq.gov/qual/patientsafetyculture/mosurvindex.htm.

Slide 35

Thank you

Questions?

TheresaFamolaro@westat.com