Table 2.

Criteria Used by KPSC Leadership to Assess Potential Topics for Outpatient Safety Net Program

Criteria Used by KPSC Leadership to Assess Potential Topics for Outpatient Safety Net Program
Clinical Impact	Will it improve patient safety or quality? If yes, – How many people will be affected? – What is the severity of the potential safety gap?
Identification	Is the potential safety gap readily identifiable using existing electronic health data? That is: – Is the information required discretely coded? (e.g., captured by diagnostic or procedure codes, pharmacy data) – If the information required is not discretely coded, is it noted consistently in a way that makes natural language processing a reasonable option? If the potential safety problem is not readily identifiable, is it important enough that revisions to existing documentation should be considered?
Follow-up	How many patients might be identified & what follow-up would be necessary? – If the Safety Net is likely to identify a large number of patients, the importance of automated systems becomes more important (e.g., automated mailings to patients reminding them of labs) – If the number of patients identified is smaller, it may be feasible to have central review (e.g.. by a pharamcist or expert clinician) – In considering the capacity for follow-up, existing care processes and resources to resolve safety issues in a timely fashion are considered (e.g., care managers, automated direct mailings to patients**)
Other Operational Considerations	Is anyone already working on addressing this safety issue? Does the issue fall solely within one group’s domain? (and thus may be better-suited to intervention by that group rather than by the centralized approach of the Safety Nets)

^*The KPSC Outpatient Safety Net focuses on medication safety and diagnosis detection and follow-up. However, these are not listed among the criteria above because the Safety Net framework can be used to address a wide range of potential care gaps.

^**After quality gaps are identified, an intervention is required to resolve the quality gap in a timely fashion. These interventions have included: automated outreach to patients via mailed letter or Interactive Voice Recognition (IVR); notification of physicians with recommendations; use of case managers; use of pharmacists to review medications manually for flagged patients; batch order of lab tests with automated notification of the patient; and manual tracking and follow-up of other safety issues. “High volume” results require more automated solutions, or more staff, than “low volume” results; while there is no set definition for what constitutes high- versus low-volume issues, institutions will want to consider both the identification and resolution in assessing feasibility and solutions.