Abstract：
BACKGROUND: Ambulatory adverse events (AEs) affect up to 25% of the global population and cause over 7 million preventable hospital admissions around the world. Though patients and caregivers are key actors in promoting and monitoring their own ambulatory safety, healthcare teams do not traditionally partner with patients in safety efforts. We sought to identify what patients and caregivers contribute when engaged in ambulatory AE review, focusing on under-resourced care settings.
METHODS: We recruited adult patients, caregivers and patient advisors who spoke English, Spanish and/or Cantonese, from primary care clinics affiliated with a public health network in the USA. All had experience taking or managing a high-risk medication (blood thinners, insulin or opioid). We presented two exemplar ambulatory AEs: one involving a warfarin drug-drug interaction, and one involving delayed diagnosis of colon cancer. We conducted semistructured focus groups and interviews to elicit participants\' perceptions of causal factors and potential preventative measures for similar AEs. The study team conducted a mixed inductive-deductive qualitative analysis to derive major themes.
RESULTS: The sample included 6 English-speaking patients (2 in the focus group, 4 individual interviews), 6 Spanish-speaking patients (individual interviews), 4 Cantonese-speaking patients (2 in the focus group, 2 interviews), and 6 English-speaking patient advisors (focus group). Themes included: (1) Patients and teams have specific safety responsibilities; (2) Proactive communication drives safe ambulatory care; (3) Barriers related to limited resources contribute to ambulatory AEs. Patients and caregivers offered ideas for operational changes that could drive new safety projects.
CONCLUSIONS: An ethnically and linguistically diverse group of primary care patients and caregivers defined their agency in ensuring ambulatory safety and offered pragmatic ideas to prevent AEs they did not directly experience. Patients and caregivers in a safety net health system can feasibly participate in AE review to ensure that safety initiatives include their valuable perspectives.
METHODS: We recruited adult patients, caregivers and patient advisors who spoke English, Spanish and/or Cantonese, from primary care clinics affiliated with a public health network in the USA. All had experience taking or managing a high-risk medication (blood thinners, insulin or opioid). We presented two exemplar ambulatory AEs: one involving a warfarin drug-drug interaction, and one involving delayed diagnosis of colon cancer. We conducted semistructured focus groups and interviews to elicit participants\' perceptions of causal factors and potential preventative measures for similar AEs. The study team conducted a mixed inductive-deductive qualitative analysis to derive major themes.
RESULTS: The sample included 6 English-speaking patients (2 in the focus group, 4 individual interviews), 6 Spanish-speaking patients (individual interviews), 4 Cantonese-speaking patients (2 in the focus group, 2 interviews), and 6 English-speaking patient advisors (focus group). Themes included: (1) Patients and teams have specific safety responsibilities; (2) Proactive communication drives safe ambulatory care; (3) Barriers related to limited resources contribute to ambulatory AEs. Patients and caregivers offered ideas for operational changes that could drive new safety projects.
CONCLUSIONS: An ethnically and linguistically diverse group of primary care patients and caregivers defined their agency in ensuring ambulatory safety and offered pragmatic ideas to prevent AEs they did not directly experience. Patients and caregivers in a safety net health system can feasibly participate in AE review to ensure that safety initiatives include their valuable perspectives.
摘要：
背景：动态不良事件（AE）影响全球25％的人口，并导致全球超过700万可预防的住院。尽管患者和护理人员是促进和监测自身动态安全的关键参与者，传统上，医疗团队不与患者合作进行安全工作。我们试图确定患者和护理人员在进行动态不良事件审查时做出了哪些贡献，专注于资源不足的护理环境。
方法：我们招募了成年患者，会说英语的护理人员和耐心顾问，西班牙语和/或粤语，来自美国公共卫生网络下属的初级保健诊所。所有人都有服用或管理高风险药物的经验(血液稀释剂，胰岛素或阿片类药物）。我们提出了两个示例性动态AE：一个涉及华法林药物相互作用，和一个涉及结肠癌的延迟诊断。我们进行了半结构化焦点小组和访谈，以引起参与者对类似AE的因果因素和潜在预防措施的看法。研究小组进行了归纳-演绎混合定性分析，以得出主要主题。
结果：样本包括6名讲英语的患者（焦点组中有2名，4个人访谈)，6名讲西班牙语的患者（个人访谈），4名讲广东话的病人(焦点小组2名,2采访），和6位讲英语的病人顾问（焦点小组）。主题包括：（1）患者和团队具有特定的安全责任；（2）主动沟通推动安全的门诊护理；（3）与有限资源相关的障碍有助于门诊AE。患者和护理人员提供了可能推动新安全项目的运营变革的想法。
结论：一组种族和语言不同的初级保健患者和护理人员在确保门诊安全方面定义了他们的机构，并提供了务实的想法来预防他们没有直接经历的AE。安全网卫生系统中的患者和护理人员可以合理地参与AE审查，以确保安全措施包括他们有价值的观点。
方法：我们招募了成年患者，会说英语的护理人员和耐心顾问，西班牙语和/或粤语，来自美国公共卫生网络下属的初级保健诊所。所有人都有服用或管理高风险药物的经验(血液稀释剂，胰岛素或阿片类药物）。我们提出了两个示例性动态AE：一个涉及华法林药物相互作用，和一个涉及结肠癌的延迟诊断。我们进行了半结构化焦点小组和访谈，以引起参与者对类似AE的因果因素和潜在预防措施的看法。研究小组进行了归纳-演绎混合定性分析，以得出主要主题。
结果：样本包括6名讲英语的患者（焦点组中有2名，4个人访谈)，6名讲西班牙语的患者（个人访谈），4名讲广东话的病人(焦点小组2名,2采访），和6位讲英语的病人顾问（焦点小组）。主题包括：（1）患者和团队具有特定的安全责任；（2）主动沟通推动安全的门诊护理；（3）与有限资源相关的障碍有助于门诊AE。患者和护理人员提供了可能推动新安全项目的运营变革的想法。
结论：一组种族和语言不同的初级保健患者和护理人员在确保门诊安全方面定义了他们的机构，并提供了务实的想法来预防他们没有直接经历的AE。安全网卫生系统中的患者和护理人员可以合理地参与AE审查，以确保安全措施包括他们有价值的观点。
