PMID- 20378619
OWN - NLM
STAT- MEDLINE
DCOM- 20120608
LR  - 20211020
IS  - 1475-3901 (Electronic)
IS  - 1475-3898 (Linking)
VI  - 19
IP  - 3
DP  - 2010 Jun
TI  - What happens between visits? Adverse and potential adverse events among a 
      low-income, urban, ambulatory population with diabetes.
PG  - 223-8
LID - 10.1136/qshc.2008.029116 [doi]
AB  - BACKGROUND: Little is known about adverse events (AEs) that occur between 
      physician visits for ambulatory chronic disease patients. An automated telephone 
      self-management support programme for a diverse population of diabetes patients 
      was implemented to capture AEs, describe the self-management domains from which 
      they emanate and explore contributing causes. METHODS: AEs and potential AEs 
      (PotAEs) were identified among 111 ethnically diverse diabetes patients. An AE is 
      an injury that results from either medical management or patient self-management; 
      a PotAE is an unsafe state likely to lead to an event if it persists without 
      intervention. Medical record reviews were conducted to ascertain which 
      self-management domain was involved with the event and to explore contributing 
      causes. RESULTS: Among the 111 patients, 86% had at least one event detected over 
      the 9-month observation period. 111 AEs and 153 PotAEs were identified. For all 
      events, medication management was the most common domain (166 events, 63%). Only 
      20% of events reflected a single contributing cause; in the remaining 80%, a 
      combination of system, clinician and patient factors contributed to their 
      occurrence. Patient actions were implicated in 205 (77%) events, systems issues 
      in 183 (69%) events and inadequate physician-patient communication in 155 (59%) 
      events. Aside from communication, primary care clinician actions contributed to 
      the occurrence of the event in only 16 cases (6%). CONCLUSIONS: Our findings 
      reveal a complex safety ecology, with multiple contributing causes for AEs and 
      PotAEs among ambulatory diabetes patients. Moreover, patients themselves seem to 
      be key drivers of safety and of AEs, suggesting that patient-level 
      self-management support and patient-centred communication are critical to AE 
      prevention.
FAU - Sarkar, Urmimala
AU  - Sarkar U
AD  - Division of General Internal Medicine, Department of Medicine, University of 
      California, San Francisco, Center for Vulnerable Populations, San Francisco 
      General Hospital, San Francisco, California 94143-1364, USA. 
      usarkar@medicine.ucsf.edu
FAU - Handley, M A
AU  - Handley MA
FAU - Gupta, R
AU  - Gupta R
FAU - Tang, A
AU  - Tang A
FAU - Murphy, E
AU  - Murphy E
FAU - Seligman, H K
AU  - Seligman HK
FAU - Shojania, K G
AU  - Shojania KG
FAU - Schillinger, D
AU  - Schillinger D
LA  - eng
GR  - K24 CA212294/CA/NCI NIH HHS/United States
GR  - R21 HS014864/HS/AHRQ HHS/United States
GR  - UL1 RR024131/RR/NCRR NIH HHS/United States
GR  - K08 HS017594/HS/AHRQ HHS/United States
GR  - R18 HS01726101/HS/AHRQ HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20100408
PL  - England
TA  - Qual Saf Health Care
JT  - Quality & safety in health care
JID - 101136980
MH  - Ambulatory Care/*methods/*standards
MH  - Communication
MH  - Diabetes Mellitus, Type 2/*complications/*therapy
MH  - Humans
MH  - Medication Adherence
MH  - Office Visits
MH  - Patient Education as Topic/*methods
MH  - Physician-Patient Relations
MH  - Poverty
MH  - Self Care/*methods
MH  - Telephone
MH  - Urban Population
EDAT- 2010/04/10 06:00
MHDA- 2012/06/09 06:00
CRDT- 2010/04/10 06:00
PHST- 2010/04/10 06:00 [entrez]
PHST- 2010/04/10 06:00 [pubmed]
PHST- 2012/06/09 06:00 [medline]
AID - qshc.2008.029116 [pii]
AID - 10.1136/qshc.2008.029116 [doi]
PST - ppublish
SO  - Qual Saf Health Care. 2010 Jun;19(3):223-8. doi: 10.1136/qshc.2008.029116. Epub 
      2010 Apr 8.