We have received a three year $1.2 million AHRQ R18 grant for "A Systems Engineering Approach: Improving Medication Safety with Clinician Use of Health IT". Gurdev Singh is the Principal Investigator. A brief description follows:

Medication errors are among the most serious medication use concerns in older persons cared for in ambulatory care settings. The introduction of health IT into such complex settings can improve patient safety, but its adoption in outpatient offices is only just beginning, and increased use of IT alone will not be enough to deal with the many complex cognitive processes that are intricately interlinked with human factors. This project will implement an IT-based Crew Resource Management (CRM) tool. The selected IT system that will be adapted (with CRM elements embedded) is the ACORN system, developed by the Dendress Corporation.
 This study was formulated in consultation with Upstate New York Practice Based Research Network (UNYNET) clinicians who are already using EMRs and interested in identifying affordable approaches that are useful and generalizable to their offices. Outcome assessment will be focused on medication safety among geriatric patients and office staff use/application of the IT-based CRM tool.

The specific aims of the study are to:

1. Examine the impact of an IT-based CRM intervention on reducing selected adverse drug events (ADEs) among geriatric patients in primary care settings by evaluating changes in:
   (a) number of preventable ADEs;
   (b) severity of those ADEs; and
   (c) stage of the medication use process in which they occur (i.e. diagnosis, prescribing, transcribing, dispensing, administration, and monitoring).
   
   
2. Examine the impact of an IT-based CRM intervention on improving monitoring for geriatric patients on Persistent Medications in primary care settings by evaluating changes in monitoring rates for subjects (age 65+) on:
   (a) ACE Inhibitors or ARBs;
   (b) Digoxin;
   (c) Diuretics; and
   (d) Statins.
   
   
3. Evaluate office staff use and application of the IT-based CRM Tool for improving geriatric medication safety in primary care settings by examining utilization of the IT tool and changes in safety attitude constructs (safety climate, teamwork climate, stress recognition, working conditions, and perceptions of management and job satisfaction).
   

Participatory research methods will be used to assess provider- and staff-identified barriers to implementation.

The overall purpose of this proposed study is to conduct and publish the results of an IT demonstration project using a human factors approach to geriatric medication safety so as to provide pilot data for larger confirmatory studies and perhaps to develop and market test the IT-CRM software via Small Business Innovation Research (SBIR) mechanisms for eventual national release.

In collaboration with the Niagara Falls Memorial Medical Center we have received a grant of $0.4 million from HRSA. A brief description follows:

Patient safety is a major concern to professional and accreditation bodies, because it transcends all the six ACGME core competencies. Sustainable enhancements in safety can only be achieved through establishment of a culture of safety. This culture of safety can be taught to residents through special emphasis on the adoption of a systems approach to "Practice Based Learning & Improvement" and "System-Based Practice."

The role of the micro-system of practice within the overall context of the macro-system of the health care, with attention to transitions/handoffs, is the overview this curriculum is grounded in.
Our goal is to place patient safety at the heart of Residency training at the Niagara Falls Memorial Medical Center by developing and implementing Trans-disciplinary curriculum that can be transferred to residency programs of other specialties.

1. Ranjit and Gurdev presented the experiences of the Safety Team with a Trigger Tool for detecting adverse drug events among older adults in ambulatory primary care at the 3rd Annual PBRN Research Conference in May 2007 in Bethesda, Maryland . This conference was organized by the Agency for Healthcare Research and Quality.
   
   
2. We were invited to the Annual Conference of the Association for the Study of Medical Education (ASME) held in Aberdeen (GB) to share our approach and experience with placing patient safety at the heart of medical education. The theme of this conference was patient safety. ASME is the world's prime learned group concerned with medical education.

Ranjit Singh's invited FAMILY MEDICINE GRAND ROUNDS article was featured on the Cover!!

The team made a presentation at the AHRQ National PBRN Research Conference in Washington, DC

We ran two 90 minute each invited workshops at the 11th European Quality Forum in Prague. The first was on improvement of patient safety in individual primary care clinics and the second was on placing patient safety at the heart of medical training

The team has been invited by the association for the Study of Medical Education to run a workshop at the forthcoming annual conference in Scotland in September of 2006.

Two of our team were invited to be members of the National Panel of Experts on error reporting systems

We received a two year AHRQ R21 grant for "Improving Geriatric Drug Safety in Underserved Practices" The abstract follows:

The team was invited to run a workshop at the 20th Annual Primary Care Research Methods & Statistics Conference in San Antonio, TX. The subject was "The use of Operations Research/Systems Science for meeting the challenges of Enhancing and Measuring Safety in Individual Primary Care Settings."

We presented two papers at the NAPCRG conference in Quebec City.

The first was on use of visual computer interface to facilitate understanding of errors and the second on an error reporting tool designed to stimulate systemic changes.

Gurdev Singh, Director on the Center with Donald Berwick KBE MD, the internationally respected Quality Guru and the CEO of IHI who led the Forum. Dr. Berwick was recently Knighted by the Queen.

Diana Anderson, Program Manager of the Center with William (Skip) Major MD, Executive Director of IPA WNY and Wilson Pace MD, Director of American Academy of Family Physicians’ National Research Network who was one of the Plenary Speakers.

Dr. Ranjit Singh is shown here accepting the award on behalf of the Center. The project funded by this grant, which runs from Dec 2004 to Dec 2005 will identify barriers to mammography faced by African American women at two inner-city clinics. By evaluating the whole mammography process from ordering, through implementations, to reporting of results and follow-up, this study aims to identify and prioritize areas for interventions to improve mammography for this high-risk group of women