Article Figures & Data
Tables
Type of practice n (%) Private 1 (14.3) Part of a hospital system or other health system 3 (42.9) Community health center 1 (14.3) County health department 1 (14.3) Residency program 1 (14.3) Primary medical specialty represented n (%) Family medicine 6 (85.7) Pediatrics 1 (14.3) Number of Providers (full-time equivalents) Mean (SD); Range Physicians 3.9 (2.8); 1–8.75 Nurse practitioner or physician assistants 2.8 (2.3); 0.5–5.6 Physicians-in-training (residents) 5.2 (10.2); 0–27 Services provided n (%) Pediatric care 7 (100) Obstetric care 3 (42.9) Geriatric care 5 (71.4) Number of Patient Encounters Per Year Mean (SD); Range Outpatient medical visits 22,589 (11,258.6); 10,000–36,000 Inpatient visits 3,433 (2,528.6); 0–5,688 Obstetric deliveries 230 (122.4); 0–315 Behavioral health visits 2,584 (1,835.0); 0–4,637 Nursing home visits 1,077 (748.5); 0–2,000 Home visits 41.6 (74.6); 0–185 Predominant medical record system for office visits n (%) Paper 1 (14.3) Electronic 6 (85.7) Percentage of Annual Patient Visits, by Age Category Mean (SD); Range < 18 years 52 (44.0); 10–100 18–64 years 47 (31.2); 0–75 ≥ 65 years 16 (17.8); 0–50 Percentage of Annual Patient Visits, by Payer Status Mean (SD); Range Private insurance 27 (23.4); 0–70 HMO 3 (8.0); 0–22 Medicare 26 (23.2); 0–60 Medicaid 22 (14.5); 0–45 Self-pay 11 (15.1); 0–45 Charity 11 (23.1); 0–63 Percentage of Annual Visits by Patient Race/Ethnicity Mean (SD); Range White 88 (9.1); 75–95 African American 9 (6.2); 4–20 American Indian 0 (0.8); 0–2 Asian 1 (1.8); 0–5 Other 2 (3.3); 0–9 Hispanic or Latino Ethnicity 16 (18.8); 1–40 SD, standard deviation.
Near Miss Event Number of Near Miss Events (% of Reports, by Site) All Practices (n=632) Practice A (n=43) Practice B (n=177) Practice C (n=80) Practice D (n=139) Practice E (n=69) Practice F (n=43) Practice G (n=81) Office Process Problem Filinga 160 (25.3) 7 (16.3) 72 (40.7) 25 (31.3) 18 (13.0) 7 (10.1) 15 (34.9) 16 (19.8) Chart dataa 95 (15.0) 6 (14.0) 20 (11.3) 12 (15.0) 14 (10.1) 10 (14.5) 4 (9.3) 29 (35.8) Patient flow 14 (2.2) 1 (2.3) 2 (1.1) 3 (3.8) 5 (3.6) 1 (1.5) 1 (2.3) 1 (1.2) Appointment or referral 30 (4.8) 1 (2.3) 4 (2.3) 3 (3.8) 14 (10.1) 7 (10.1) 1 (2.3) — Equipment or Building Problem Equipment and physical building/surroundings/practice site 8 (1.3) — 2 (1.1) 1 (1.3) 3 (2.2) 2 (2.9) — — Other specific problems with computer 8 (1.3) — 1 (0.6) — 4 (2.9) 3 (4.4) — — Investigations Ordering investigations 39 (6.2) 8 (18.6) 6 (3.4) 5 (6.3) 4 (2.9) 8 (11.6) 5 (11.6) 3 (3.7) Implementing investigations 45 (7.1) 2 (4.7) 9 (5.1) 14 (17.5) 13 (9.4) 4 (5.8) — 3 (3.7) Reporting investigations 77 (12.2) 1 (2.3) 16 (9.0) 4 (5.0) 12 (8.6) 8 (11.6) 12 (27.9) 24 (29.6) Medications or Other Treatments Ordering medications or treatmentsa 55 (8.7) 8 (18.6) 22 (12.4) — 18 (13.0) 2 (2.9) 3 (7.0) 2 (2.5) Dispensing medications or implementing treatments 36 (5.7) 4 (9.3) 14 (7.9) 1 (1.3) 11 (7.9) 6 (8.7) — — Communication Communication with patients 30 (4.8) 1 (2.3) 6 (3.4) 8 (10.0) 8 (5.8) 5 (7.3) 2 (4.7) — Communication with other healthcare providers sharing patient carea 23 (3.6) 3 (7.0) 2 (1.1) 2 (2.5) 10 (7.2) 3 (4.4) — 3 (3.7) Clinical Knowledge or Performance Failure to follow standard or recommended practice 12 (1.9) 1 (2.3) 1 (0.6) 2 (2.5) 5 (3.6) 3 (4.4) — — ↵a Across all practices, 21.9% (filing), 28.4% (chart data), 40.0% (ordering medications or treatments), and 4.3% (communication with other healthcare providers sharing patient care) of these near misses were secondarily attributable to an EMR-related problem.
- Table 3. Perceived Severity and Estimated Cost of Selected Near Miss Events in Seven Primary Care Practices
Code # of Reports Event Description Severity Ratinga Mean (SD) Likelihood of Adverse Event if Near Miss not Identifiedb n (%) Potential Financial Cost of Event to Patientb n (%) Estimated Financial Cost of Event to Practiceb n (%) Five Most Common Near Miss Events 1.1.1 160 Filing problems 51.8 (30.7) 38 (23.8) 12 (7.5) 5 (3.1) 1.1.2 95 Chart data problems 35.4 (29.9) 11 (11.6) 8 (8.4) 4 (4.2) 1.3.2 45 Implementing investigations 52.2 (28.2) 10 (22.2) 4 (8.9) 3 (6.7) 1.3.3 77 Reporting investigations 72.0 (28.3) 38 (49.4) 17 (22.1) 1 (1.3) 1.4.1 55 Ordering medication or treatments 59.1 (29.3) 17 (30.9) 6 (10.9) 5 (9.1) Five Near Miss Events Rated Most Potentially Severe 1.2.1 8 Other specific problems with computer 59.2 (25.2) 5 (62.5) 1 (12.5) 0 (0) 1.3.3 77 Reporting investigations 72.0 (28.3) 38 (49.4) 17 (22.1) 1 (1.30) 1.4.1 55 Ordering medications or treatments 59.1 (29.3) 17(30.9) 6 (10.9) 5 (9.1) 1.4.2 36 Dispensing medications or implementing treatments 63.0 (31.0) 16 (44.4) 11 (30.6) 3 (8.3) 2.1 12 Failure to follow standard or recommended practice 56.5 (21.7) 2 (16.7) 3 (25.0) 1 (8.3) Fivec Near Miss Events Rated Most Potentially Costly to the Practice 1.1.4 30 Appointment or referral 46.1 (28.6) 6 (20.0) 4 (13.3) 1.2 8 Equipment and physical building/surroundings/practice site 49.7 (31.8) 2 (25.0) 1 (12.5) 1.3.2 45 Implementing investigations 52.2 (28.2) 10 (22.2) 4 (8.9) 1.4.1 55 Ordering medication or treatments 59.1 (29.3) 17 (30.9) 6 (10.9) 1.4.2 36 Dispensing medications or implementing treatments 63.0 (31.0) 2 (44.4) 11 (30.6) 2.1 12 Failure to follow standard or recommended practice 56.5 (21.7) 2 (16.7) 3 (25.0) - Table 4. Summary of Practice Improvement Projects Implemented by Participating Primary Care Practices during the Study Period
Primary Care Practice A B C D E F G Length of study period in months 8 9 8 9 9 6 6 Number of Practice Improvement Projects Initiated 6 6 2 3 15 1 1 Completed in study period 0 0 0 0 7 0 1 Still in process at end of study period 6 0 1 1 4 1 0 On hold at end of study period 0 1 1 1 0 0 0 Inactivated during study period 0 5 0 1 4 0 0
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