A simple intervention promoting patient safety improvements in small internal medicine practices.
BACKGROUND
small primary care practices may face difficulties in staying abreast of patient safety recommendations and implementing them. Some safety issues, however, may be easily and inexpensively addressed, given the necessary information on what is required.


OBJECTIVE
to assess changes in patient safety measures in small practices and describe simple mechanisms that appear to have facilitated change.


METHODS
The design uses pre-post bivariate tests to determine the effect of a quality improvement intervention provided by the Center for Practice Innovation (CPI) of the American College of Physicians (ACP) to 34 small internal medicine practices. Compliance with safety measures was reassessed in 30 practices after the intervention. The CPI intervention involved two site visits, a practice assessment, self-selection of clinical, operational and financial focus areas for improvement and ongoing 'directed guidance' of the practices in their efforts, including weekly 'Practice tips' email alerts. Data used in this study came from the practice assessment form completed by the CPI team, which included 21 safety measures. The Wilcoxon signed-rank test and McNemar's test were used to compare the practices' safety compliance before and after the intervention.


RESULTS
many safety measures had high compliance rates at the first site visit; for other safety measures, fewer than half the practices followed the recommended procedures. The intervention was associated with statistically significant positive change on over 70% of the 21 safety issues. The positive effects were most profound in safety measures regarding how a practice managed sharps, hazardous materials, medications and vaccines.


CONCLUSIONS
this study provides insights into mechanisms that assist practices to make initial steps to improve patient safety and care quality. The study also suggests that with concrete recommendations, small practices can make significant changes in a short period of time and at relatively low cost.
Health Policy and Management, Postdoctoral Researcher, Bloomberg School of Public Health, Johns Hopkins University, 433 Hampton House, 624 N. Broadway Street, Baltimore, MD 21205, USA. jmarstel@jhsph.edu
Jill A
JA
Marsteller
Chun-Ju
CJ
Hsiao
William S
WS
Underwood
Paula
P
Woodward
Michael S
MS
Barr
D019983:Guideline Adherence; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D019300:Medical Errors / Q000517:prevention & control*; D011216:Practice Management, Medical / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D017751:Safety Management / Q000592:standards*; D018709:Statistics, Nonparametric; D014481:United States