Results from the AHRQ Medical Office Survey on Patient Safety Culture 2012 User Comparative Database 2012 AHRQ Annual C

1. Results from the AHRQ Medical Office Survey on Patient Safety Culture 2012 User Comparative Database 2012 AHRQ Annual Conference September 10, 2012 Theresa Famolaro, MPS, Westat

2. Acknowledgements • Westat staff • Joann Sorra • Naomi Dyer • Scott Smith • Helen Liu • Matt Ragan • AHRQ staff • Christine Crofton • James Battles • Technical Expert Panel Members

3. Objectives • Provide background on the development of the AHRQ Medical Office Survey on Patient Safety Culture • Describe the AHRQ Medical Office Survey on Patient Safety Culture Comparative Database • Present the overall results from the AHRQ Medical Office Survey on Patient Safety Culture 2012 User Comparative Database Report • Review results by medical office and respondent characteristics

4. Background • Part of a larger suite of surveys sponsored by the Agency for Healthcare Research and Quality’s (AHRQ) • Hospital, • Medical Office • Nursing Home • Pharmacy (to be released in October) • Specifically designed to measure the culture of patient safety in outpatient medical offices • Assesses staff and provider attitudes and beliefs about patient safety • Assesses many areas that are different than the other surveys • Pilot tested in two survey administrations: • 2007; 182 medical offices, 4,174 office staff • 2009; 292 PBRN medical offices, 6,463 office staff • Pilot test report at http://www.ahrq.gov/qual/mosurvey10/moresults10.pdf

5. MOSOPS Patient Safety Culture Composites 10 composites of organizational culture: • Teamwork • Patient Care Tracking/Follow-up • Organizational Learning • Overall Perceptions of Patient Safety and Quality • Staff Training • Owner/Managing Partner/Leadership Support for Patient Safety • Communication About Error • Communication Openness • Office Processes and Standardization • Work Pressure and Pace Other questions: • Nine questions on Patient Safety and Quality Issues • Five questions on Information Exchange With Other Settings • Ratings on Areas of Quality • Overall Rating on Patient Safety

6. Definition of a Medical Office • A medical office is an outpatient facility in a specific location • A medical office located in a building containing multiple medical offices is considered a separate medical office • A provider in a single medical office with other providers should share administrative and clinical support staff

7. Medical Office Comparative Database • 23,679 medical office respondents from 934 medical offices • Submission to the database is voluntary • Individual Medical Office Feedback Report is a benefit for participation • 290 Medical Offices from the pilot study are retained in the 2012 Database • Pilot PBRN data collected November 2009

8. Call for Data Submission • Data submission occurred September 15 – Oct 31 2011 • Participation requirements • Medical offices located in the United States or U.S. territory • Each medical office had at least five completed surveys • Survey administered in its entirety without significant modifications or deletions • Medical offices signed an AHRQ Data Use Agreement • Submission was online and included a Web-based tutorial

9. Survey Administration Statistics • Surveys were collected by • Paper Only (35%) • Web Only (63%) • Both paper and Web (2%) • The average medical office response rate was 71% • Paper Only (80% response rate) • Web only (66% response rate) • Both Web and Paper (87% response rate) • Average of 25 completed surveys per medical office

10. Medical Offices by Number of Providers Note: Percentages may not add to exactly 100 percent due to rounding; n = 926,

11. Medical Offices by Single vs. Multi-Specialty Note: Percentages may not add to exactly 100 percent due to rounding; n = 932,.

12. Implementation Status of Electronic Tools Note: Percentages may not add to exactly 100 percent due to rounding.

13. Medical Offices by Majority Ownership Note: Percentages may not add to exactly 100 percent due to rounding; n = 929,.

14. Respondents by Staff Position Note: Percentages may not add to exactly 100 percent due to rounding; n = 22,963.

15. Medical Office SOPS Composites

16. Medical Office SOPS Composites

17. Most Positive Items • Teamwork • In this office, there is a good working relationship between staff and providers (88%) • When someone in this office gets really busy, others help out (84%) • Patient Care Tracking/Follow-up • This office follows up with patients who need monitoring (89%) • Our office follows up when we do not receive a report we are expecting from an outside provider (84%)

18. Least Positive Items • Work Pressure and Pace • In this office, we often feel rushed when taking care of patients (31%) • We have enough staff to handle our patient load (47%) • We have too many patients for the number of providers in this office (48%) • Office Processes and Standardization • We have problems with workflow in this office (49%) • Owner/Managing Partner/Leadership Support for Patient Safety • They aren’t investing enough resources to improve the quality of care in this office (49%)

19. Patient Safety and Quality Issues • Nine ratings of things happening in your medical office over the past 12 months • Example items include: • Use of a wrong chart/medical record on a patient • One day follow-up of an abnormal result from a lab or imaging test • Ability of patient to get an appointment within 48 hours for an acute/serious problem • Availability of lab or imaging test results • Contact by pharmacy to clarify or correct a prescription

20. Patient Safety and Quality Issues The wrong chart/medical record was used for a patient. 96% Positive Percent of Respondents

21. Patient Safety and Quality Issues A critical abnormal test from a lab or imaging test was not followed up within 1 business day. 92% Positive Percent of Respondents

22. Patient Safety and Quality Issues A patient was unable to get an appointment within 48 hours for an acute/serious problem. Percent of Respondents 77% Positive

23. Patient Safety and Quality Issues The results from a lab or imaging test were not available when needed. Percent of Respondents 73% Positive

24. Patient Safety and Quality Issues A pharmacy contacted our office to clarify or correct a prescription. Percent of Respondents 51% Positive

25. Information Exchange With Other Settings • Over the past 12 months, how often has your medical office had problems exchanging accurate, complete, and timely information with: • Outside labs/imaging centers? • Other medical offices/ outside physicians? • Pharmacies? • Hospitals? • Other?

26. Most Positive - Hospitals Percent of Respondents 81% Positive

27. Least Positive - Pharmacies Percent of Respondents 75% Positive

28. Overall Ratings on Quality • Overall, how would you rate your medical office on each of the following areas of health care quality? • Percent positive is the combined response of Excellent and Very good • Equitable 81% (51% Excellent, 30% Very good) • Effective 69% (27% Excellent, 42% Very good) • Patient Centered 68% (29% Excellent, 39% Very good) • Efficient 57% (20% Excellent, 37% Very good) • Timely 50% (17% Excellent, 33% Very good)

29. Overall Rating on Patient Safety Overall, how would you rate the systems and clinical processes your medical office has in place to prevent, catch, and correct problems that have the potential to affect patients? Percent of Respondents 65% Positive

30. Average Overall Rating on Quality and Patient Safety • The average of the five overall ratings on quality and the overall rating on patient safety across all 2012 database medical offices Percent of Respondents 65% Positive

31. Results by Medical Office Characteristics • Smaller medical offices had better results • Average % positive across all 10 survey composites • Smaller medical offices (2 providers) (75%)vs. larger (14-19 providers) (66%) • Average Overall Rating on Quality and Patient Safety • Smaller medical offices (2 providers) (74%)vs. larger (14-19 providers) (57%) • Small correlation between size and composite results • Average % positive across 10 survey composites related to size (r = -0.08,to - 0.10, p < 0.05).

32. Results by Medical Office Characteristics • Single specialty scored higher than multi-specialty • Slightly higher on all 10 survey composites • Owner/Managing Partner/Leadership Support for Patient Safety • Single specialty (69%) vs. Multi-specialty (61%) • Ownership impacts patient safety culture results • Average % positive across all 10 survey composites • Community health centers and Provider and/or Physician owned (72%) vs. Federal, State, or local govt. (61%) • Overall Rating on Patient Safety (Excellent, Very Good) • Provider and/or Physician owned (67%)vs. Federal, State, or local govt.(48%)

33. Results by Staff Characteristics • Management scored higher than other staff positions • Management scored highest in 8 out of 10 survey composites • Average % positive across all 10 survey composites • Management (80%) vs. Admin/Clerical staff (68%) • Communication About Error • Management (80%) vs. Admin/Clerical staff (62%) • Communication Openness • Physicians (80%)vs. Admin/Clerical Staff (58%) • Management scored similar to physicians (79%)

34. AHRQ Supporting Materials • Medical Office Survey Toolkit • Survey in English and Spanish • Survey User’s Guide • Medical Office Data Entry and Analysis Tool • Medical Office Survey Feedback Report Template • Medical Office Patient Safety Resource List • Arranged by patient safety culture composite • Tools and resources for improvement • Medical Office Data Submission Timeline • Dates forthcoming in 2013 • Download all materials at: http://www.ahrq.gov/qual/patientsafetyculture/mosurvindex.htm

35. Thank you Questions? TheresaFamolaro@westat.com