Patient safety in chiropractic teaching programs: a mixed methods study
Tóm tắt
Patient safety research has lagged within academic settings, including chiropractic teaching institutions. To develop a robust patient safety culture, the Institute of Medicine emphasized the need for employee’s attitudes to be understanding and positive. To initiate the assessment of the current culture and future needs, this study evaluated patient safety attitudes among chiropractic teaching clinic stakeholders (supervising clinicians, student interns, and administrative staff) and compared their standardized survey scores to established medical survey databases. We conducted a cross-sectional, mixed methods survey design with quantitative analytic priority. Chiropractic interns, clinical faculty, and clinic staff of 5 international chiropractic educational programs completed a modified version of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture for Medical Offices Survey with open-ended comment fields between 2014 and 2016. Composite means of positive responses were calculated and compared to patient safety, quality of care, and overall self-ratings benchmarks from Canadian providers and academic settings in the AHRQ database. Qualitative responses were thematically categorized for a convergent analysis of quantitative results for the chiropractic sample. Chiropractic survey response rate was 45.3% (n = 645). Quantitative survey results indicated moderate scores and ranges (57–85%) on all patient safety dimensions for the chiropractic samples. Academic medicine and chiropractic providers’ benchmarks scored higher positive responses than chiropractic teaching clinics on most quantitative dimensions, except for work pressure/pace. Teamwork, organizational learning, and patient tracking/follow-up were the most positively endorsed quantitative dimensions, with communication, staff training, office standardization, and leadership support considered areas for improvement in both settings. Qualitative responses for the chiropractic clinics identified a need for open communication; additional staff training and student involvement in creating safety cultures; standardization of office processes including information exchange, scheduling, and equipment maintenance; and leadership support that focused on decreasing work pressure/pace and setting safety priorities. As the first report of patient safety attitudes from stakeholders in chiropractic teaching clinics, specific areas of improvement were identified. Chiropractic teaching programs might consider incorporating these and related patient safety concepts into their formal curricula. Mixed methods approach offers teaching clinics opportunities to assess stakeholders’ insights and enhance safe delivery of chiropractic care.
Tài liệu tham khảo
Institute of Medicine. To err is human: building a safer health system. Washington DC: National Academies Press (US); 2000.
Wachter R, Gupta K. Understanding patient safety. Third. McGraw-Hill Medical; 2017.
Panesar SS. deSilva D, Carson-Stevens a, Cresswell KM, Salvilla SA, slight SP, et al. how safe is primary care? A systematic review. BMJ Qual Saf. 2016;25(7):544–53.
Chang JE, Brundage SC, Chokshi DA. Convenient ambulatory care--promise, pitfalls, and policy. N Engl J Med. 2015 Jul;373(4):382–8.
Verstappen W, Gaal S, Bowie P, Parker D, Lainer M, Valderas JM, et al. A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care. Eur J Gen Pract. 2015;21 Suppl(sup1):72–7.
Patankar M, Brown J, Sabin E, Bigdo-Peyton T. Safety culture: building and sustaining a cultural change in aviation and health care. VT: Ashgate Publishing Limited; 2012.
Desmedt M, Bergs J, Vertriest S, Vlayen A, Schrooten W, Hellings J, et al. Systematic psychometric review of self-reported instruments to assess patient safety culture in primary care. J Adv Nurs. 2018 Mar;74(3):539–49.
Nie Y, Li L, Duan Y, Chen P, Barraclough BH, Zhang M, et al. Patient safety education for undergraduate medical students: a systematic review. BMC Med Educ. 2011 Jun;11:33.
Vohra S, Kawchuk GN, Boon H, Caulfield T, Pohlman KA, O’Beirne M. SafetyNET: An interdisciplinary research program to support a safety culture for spinal manipulation therapy. Eur J Integr Med. 2014;6(4):473–77.
Vohra S, Cvijovic K, Boon H, Foster BC, Jaeger W, LeGatt D, et al. Study of natural health product adverse reactions (SONAR): active surveillance of adverse events following concurrent natural health product and prescription drug use in community pharmacies. PLoS One. 2012;7(9):e45196.
Rozmovits L, Mior S, Boon H. Exploring approaches to patient safety: the case of spinal manipulation therapy. BMC Complement Altern Med. 2016 Jun;16:164.
Gallup-Palmer College of Chiropractic Annual Report: Managing neck and back pain in America. 2018. Available from: https://www.palmer.edu/getmedia/50bd459e-aaf2-4969-844d-555e421835a3/palmer-gallup-annual-report-2018.pdf.
Christensen M, Hyland J, Goertz C, Kollasch M. Practice Analysis of Chiropractic 2015. A project report, survey analysis, and summary of chiropractic practice in the United States. Greeley: National Board of Chiropractic Examiners; 2015. Available from: https://chiro.org/LINKS/FULL/Practice_Analysis_of_Chiropractic_2015/Practice_Analysis_of_Chiropractic_Home_Page.html.
Zaugg B, Wangler M. A model framework for patient safety training in chiropractic: a literature synthesis. J Manip Physiol Ther. 2009;32(6):493–9.
Miller JE, Benfield K. Adverse effects of spinal manipulative therapy in children younger than 3 years: a retrospective study in a chiropractic teaching clinic. J Manip Physiol Ther. 2008;31(6):419–23.
Improving Safety Through Education and Training [Internet]. Available from: https://www.hee.nhs.uk/the-commission-on-education-and-training-for-patient-safety. Accessed Nov 2019.
Tregunno D, Ginsburg L, Clarke B, Norton P. Integrating patient safety into health professionals’ curricula: a qualitative study of medical, nursing and pharmacy faculty perspectives. BMJ Qual Saf. 2014 Mar;23(3):257–64.
The International Framework for Chiropractic Education and Accreditation [Internet]. Toronto, ON; Available from: https://4df9e6da-23f1-4fd7-9638-d733e3c10afd.filesusr.com/ugd/787ac5_6526e48cbea84feaa3fc961513579189.pdf. Accessed Nov 2019.
CCE Accreditation Standards: Principles, Processes & Requirements for Accreditation [Internet]. Scottsdale, Arizona; Available from: http://www.cce-usa.org/uploads/1/0/6/5/106500339/2018_cce_accreditation_standards.pdf. Accessed Nov 2019.
Funabashi M, Pohlman KA, Mior S, O’Beirne M, Westaway M, De Carvalho D, et al. SafetyNET Community-based patient safety initiatives: Development and application of a Patient Safety and Quality Improvement Survey. J Can Chiropr Assoc. 2018;62(3).
Curry LA, Krumholz HM, O’Cathain A, Plano Clark VL, Cherlin E, Bradley EH. Mixed methods in biomedical and health services research. Circ Cardiovasc Qual Outcomes. 2013;6(1):119–23.
Sorra J, Gray L, Famolaro T, Yount N, Behm J. AHRQ medical office survey on patient safety culture: User’s guide. (prepared by Westat, under contract no. HHSA290201300003C). AHRQ publication no. 15(16)-0051-EF (replaces 08(09)-0059) [internet]. Rockville, MD; Available from: http://www.ahrq.gov/professionals/quality-patientsafety/patientsafetyculture/medical-office/index.html. Accessed Nov 2019.
Pohlman KA, Carroll L, Hartling L, Tsuyuki R, Vohra S. Attitudes and opinions of doctors of chiropractic specializing in pediatric care toward patient safety: a cross-sectional survey. J Manipulative Physiol Ther. 2016;39(7):487–93.
Famolaro T, Yount N, Hare R, Thornton S, Sorra J. Medical office survey on patient safety culture: 2016 user comparative database report. 2016. Available from: https://psnet.ahrq.gov/issue/medical-office-survey-patient-safety-culture-2016-user-comparative-database-report.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–81.
Anderson E, Thorpe L, Heney D, Petersen S. Medical students benefit from learning about patient safety in an interprofessional team. Med Educ. 2009 Jun;43(6):542–52.
Flin R, Patey R, Jackson J, Mearns K, Dissanayaka U. Year 1 medical undergraduates’ knowledge of and attitudes to medical error. Med Educ. 2009 Dec;43(12):1147–55.
Horsburgh M, Merry AF, Seddon M. Patient safety in an interprofessional learning environment. Med Educ. 2005 May;39(5):512–3.
Romijn A, Teunissen PW, de Bruijne MC, Wagner C, de Groot CJM. Interprofessional collaboration among care professionals in obstetrical care: are perceptions aligned? BMJ Qual Saf. 2018 Apr;27(4):279–86.
Paprella G. Person-centred care in Europe: a cross-country comparison of health system performance, strategies and structures. Oxford: Picker Institute Europe; 2016. Available from: https://www.picker.org/wp-content/uploads/2016/02/12-02-16-Policy-briefing-on-patient-centred-care-in-Europe.pdf.
Lyons KJ, Salsbury SA, Hondras MA, Jones ME, Andresen AA, Goertz CM. Perspectives of older adults on co-management of low back pain by doctors of chiropractic and family medicine physicians: a focus group study. BMC Complement Altern Med. 2013 Sep;13:225.
Salsbury SA, Vining RD, Gosselin D, Goertz CM. Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team. Chiropr Man Therap. 2018;26:29.
de Wet C, Spence W, Mash R, Johnson P, Bowie P. The development and psychometric evaluation of a safety climate measure for primary care. Qual Saf Health Care. 2010 Dec;19(6):578–84.
Hoffmann B, Domanska OM, Albay Z, Mueller V, Guethlin C, Thomas EJ, et al. The Frankfurt patient safety climate questionnaire for general practices (FraSiK): analysis of psychometric properties. BMJ Qual Saf. 2011 Sep;20(9):797–805.
Modak I, Sexton JB, Lux TR, Helmreich RL, Thomas EJ. Measuring safety culture in the ambulatory setting: the safety attitudes questionnaire--ambulatory version. J Gen Intern Med. 2007 Jan;22(1):1–5.
Krupat E, Putnam S, Yeager C. The fit between doctors and patients: can it be measured? J Gen Intern Med. 1996;11(suppl):134.
Hammerich K, Stuber K, Hogg-Johnson S, Abbas A, Harris M, Lauridsen HH, et al. Assessing attitudes of patient-centred care among students in international chiropractic educational programs: A cross-sectional survey. Chiropr Man Ther. 2019;27(1). https://doi.org/10.1186/s12998-019-0263-x.
Bowman S. Impact of electronic health record systems on information integrity: quality and safety implications. Perspect Heal Inf Manag. 2013;10(Fall):1c.
Bell SK, Mejilla R, Anselmo M, Darer JD, Elmore JG, Leveille S, et al. When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship. BMJ Qual Saf. 2017 Apr;26(4):262–70.
Welcher CM, Hersh W, Takesue B, Stagg Elliott V, Hawkins RE. Barriers to medical students’ electronic health record access can impede their preparedness for practice. Acad Med. 2018 Jan;93(1):48–53.
Hossain MA, Ahmad M, Islam MR, David Y. Evaluation of performance outcomes of medical equipment technology management and patient safety: skilled clinical engineer’s approach. Glob Clin Eng J. 2019;1(2):4–16.
Saadati M, Nouri M, Rezapour R. Patient safety walkrounds; 5 years of experience in a developing country. Int J Health Plann Manag. 2019 Apr;34(2):773–9.
Santos ALR, Wauben LSGL, Guilavogui S, Brezet JC, Goossens R, Rosseel PMJ. Safety challenges of medical equipment in nurse anaesthetist training in Haiti. Appl Ergon. 2016;53(Pt A):110–21.
Guo M, Tardif G, Bayley M. Medical safety huddles in tehabilitation: a novel patient safety strategy. Arch Phys Med Rehabil. 2018;99(6):1217–9.
Hassen P, Hoffman C, Gebran J, Leonard P, Dyck J. The Canadian patient safety institute: building a safer system and stronger culture of safety. BCMJ. 2006;48(7):334–8 Available from: https://www.bcmj.org/articles/canadian-patient-safety-institute-building-safer-system-and-stronger-culture-safety.
Lypson ML, Gosbee JW, Andreatta P. Assessing the patient safety knowledge and experience of trainees. Med Educ. 2008 Nov;42(11):1133–4.
The National Patient Safety Foundation. Free from harm: accelerating patient safety improvement fifteen years aftet To Err Is Human. [Internet]. Available from: http://www.ihi.org/resources/Pages/Publications/Free-from-Harm-Accelerating-Patient-Safety-Improvement.aspx. Accessed Nov 2019.
Sadr S, Pourkiani-Allah-Abad N, Stuber KJ. The treatment experience of patients with low back pain during pregnancy and their chiropractors: a qualitative study. Chiropr Man Therap. 2012 Oct;20(1):32.
Rajendran D, Bright P, Bettles S, Carnes D, Mullinger B. What puts the adverse in “adverse events”? Patients’ perceptions of post-treatment experiences in osteopathy--a qualitative study using focus groups. Man Ther. 2012 Aug;17(4):305–11.
Carlesso LC, Cairney J, Dolovich L, Hoogenes J. Defining adverse events in manual therapy: an exploratory qualitative analysis of the patient perspective. Man Ther. 2011 Oct;16(5):440–6.
Maiers M, Hondras MA, Salsbury SA, Bronfort G, Evans R. What do patients value about spinal manipulation and home exercise for back-related leg pain? A qualitative study within a controlled clinical trial. Man Ther. 2016 Dec;26:183–91.
Giles SJ, Parveen S, Hernan AL. Validation of the primary care patient measure of safety (PC PMOS) questionnaire. BMJ Qual Saf. 2019 May;28(5):389–96.