Wynia says an abnormal report should sound an alarm if it's the first one, but when patients routinely get abnormal results because of other factors, providers tend "to become inured to all the alerts and warnings and sirens that are going off all the time."
8. The AHRQ's Recommendations
The AMA report lists 11 recommendations stemming from the Agency for Healthcare Research and Quality's consensus conference several years ago on ways to spend money to measure and improve ambulatory care. Jeff Brady, AHRQ's patient safety portfolio lead, says the agency has embarked on a number of projects with research grants.
For example, he says, $74 million has been dedicated to research ambulatory safety and quality through health information technology. Still other strategies include communication improvement courses to build teamwork, and the creation of blameless ambulatory care cultures that encourage providers to speak out about problems.
Wynia says there's still a paucity of research. "If one does a PubMed search for the words, patient, safety, and hospital, "you get 25,000 articles. But if you search for patient, safety, and ambulatory, you get only 1,800."
Ambulatory quality is going to be a tough process to measure, to be sure, because it means monitoring outcomes from much less invasive procedures over the long haul. But the drive to keep outpatients out of the hospital, in much lower acuity settings, must also police itself better, to make sure errors in care don't become mishaps that force these patients back in.