American Academy of Family Physicians

The American Academy of Family Physicians (AAFP) appreciates the opportunity to provide written comments regarding the information needs of individual family physicians, and the AAFP as an organization, around medical errors and patient safety. The American Academy of Family Physicians represents 89,400 family physician members, including residents and medical students, on the front lines of patient care. The AAFP is committed to offering quality healthcare in family practice, achieving optimal physical and mental health through accessible, cost-effective care that is based on best evidence, responsive to the needs and preferences of patients and populations, and respectful of the patients' families, personal values, and beliefs.

Currently, the Robert Graham Center for Policy Studies in Family Practice and Primary Care is studying wide-spread and common threats to patient safety in primary care settings - errors or potential errors that have not been studied nearly as widely as those in the in-patient setting, yet are of great interest to the practicing family physician. More studies like this would be useful to compare research findings. In addition, after the Policy Center's initial work in identifying threats to patient safety in the primary care setting is complete, it will be vital to further study:

• The frequency of various errors—are some much more prevalent than others in primary care settings and why.
• The root causes for the errors in the primary care setting and their relation to the health system as a whole.
• How the errors may impact the quality and safety of care throughout the entire system of care, e.g. from the primary care physicians' offices to sub-specialists' offices to hospitals to nursing homes, etc.
• How to avoid errors/threats throughout the system—at the primary care level through the tertiary care level.
• What interventions are effective in preventing errors, e.g., electronic pharmacy systems that alert providers to potentially dangerous drug interactions, etc.
• What interventions are easiest and most cost-effective to implement.
• How to influence a "no-blame" system, so that providers can learn about errors and develop interventions to avoid them in the future, without fear of litigation.
• What training and educational programming will be most effective in teaching/changing behavior of physicians and medical staffs for effective, error prevention system designs?
• What are some of the safest health systems, in the US and worldwide? How are they designed; how do they function safely? How can they be implemented nation and worldwide?
• What will it cost to develop an error-proof or nearly error-proof health system in the US? What will it cost an individual physician? What are the potential savings in lives and dollars?
• Are there some errors limited to the micro-system, or individual physician office level? What are they? How can they be prevented?
• Do all errors, in one way or another, impact patient safety at the macro-health system level?
• Will error prevention ultimately require a complete US health care system redesign? If so, how? What will the redesign entail? Can the redesign occur effectively in incremental steps? What are the incremental steps? What role do physicians play in the redesign?
• What are the best means for disseminating best practices in effective patient safety system designs and interventions?
• How can patients and families best work with physicians and medical staffs to ensure they are receiving the safest, highest quality care possible?

Clearly, the research questions are numerous, and they build on one another. What are the errors; what causes them; are the errors unique at various levels in the health system; are the interventions to prevent them unique; how do errors at various levels of the system inter-relate; how can they be prevented; how do we teach the medical system personnel how to prevent them; how do we change the medical system to prevent errors? In addition to original research on these questions, meta-analyses, and recommendations based on the analyses, would be extremely useful information to the AAFP and family physicians. For example, it may be interesting to fund the Evidence-Based Practice Centers to conduct systematic evidence reviews on effective interventions for preventing medical errors, particularly in the ambulatory care setting.

When research studies and/or meta-analyses are completed, the AAFP will be interested in working with the AHRQ to translate the research findings into practice. We envision the dissemination of research findings to include stories in family practice publications, on-line "how-to" modules on improving patient safety overall, or preventing particular, prevalent errors in the primary care setting, courses and conferences, and enlisting a group of family physicians to participate in collaborative quality improvement projects, based on improving a particular aspect of patient safety.

Many patient safety courses and conferences have centered on identifying the problems or errors. The AAFP would like the research findings and application of the findings to move beyond problem identification to solution identification. What are some practical, easy solutions that physicians can implement in their practices to make the care they provide to patients the safest, highest quality care possible? Capturing the research findings in practical, step-by-step improvement instructions, that can be applied in practice today, will be highly beneficial to busy, practicing family physicians.

Again, the AAFP appreciates the opportunity to comment, and we look forward to contributing to and following the Agency for Healthcare Research and Quality (AHRQ) research agenda for medical errors and patient safety.

Current as of September 2000

Internet Citation:

American Academy of Family Physicians. Additional Statement. National Summit on Medical Errors and Patient Safety Research. September 2000. http://www.quic.gov/summit/aaafp.htm

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