Toho University School of Medicine, Tokyo, Japan.
All Japan Hospital Association, Tokyo, Japan.
PLoS One. 2020 Sep 17;15(9):e0239179. doi: 10.1371/journal.pone.0239179. eCollection 2020.
Various patient safety interventions have been implemented since the late 1990s, but their evaluation has been lacking. To obtain basic information for prioritizing patient safety interventions, this study aimed to extract high-priority interventions in Japan and to identify the factors that influence the setting of priority. Six perspectives (contribution, dissemination, impact, cost, urgency, and priority) on 42 patient safety interventions classified into 3 levels (system, organizational, and clinical) were evaluated by Japanese experts using the Delphi technique. We examined the relationships of the levels and the perspectives on interventions with the transition of the consensus state in rounds 1 and 3. After extracting the high-priority interventions, a chi-squared test was used to examine the relationship of the levels and the impact/cost ratio with high priority. Regression models were used to examine the influence of each perspective on priority. There was a significant relationship between the level of interventions and the transition of the consensus state (p = 0.033). System-level interventions had a low probability of achieving consensus. "Human resources interventions," "professional education and training," "medication management/reconciliation protocols," "pay-for performance (P4P) schemes and financing for safety," "digital technology solutions to improve safety," and "hand hygiene initiatives" were extracted as high-priority interventions. The level and the impact/cost ratio of interventions had no significant relationships with high priority. In the regression model, dissemination and impact had an influence on priority (β = -0.628 and 0.941, respectively; adjusted R-squared = 0.646). The influence of impact and dissemination on the priority of interventions suggests that it is important to examine the dissemination degree and impact of interventions in each country for prioritizing interventions.
自 20 世纪 90 年代末以来，已经实施了各种患者安全干预措施，但对其评估却一直不足。为了获得优先考虑患者安全干预措施的基本信息，本研究旨在从日本提取高优先级干预措施，并确定影响优先级设置的因素。使用德尔菲技术，日本专家对 42 项患者安全干预措施（分为 3 个级别：系统、组织和临床）的 6 个视角（贡献、传播、影响、成本、紧迫性和优先级）进行了评估。我们检查了干预措施的水平和视角与第 1 轮和第 3 轮共识状态转变之间的关系。在提取高优先级干预措施后，使用卡方检验检查干预措施的水平和影响/成本比与高优先级之间的关系。使用回归模型检查每个视角对优先级的影响。干预措施的水平与共识状态的转变之间存在显著关系（p = 0.033）。系统层面的干预措施达成共识的可能性较低。“人力资源干预措施”、“专业教育和培训”、“药物管理/协调协议”、“基于绩效的支付（P4P）计划和安全融资”、“提高安全性的数字技术解决方案”和“手部卫生倡议”被提取为高优先级干预措施。干预措施的水平和影响/成本比与高优先级之间没有显著关系。在回归模型中，传播和影响对优先级有影响（β=-0.628 和 0.941，分别；调整后的 R-squared=0.646）。影响和传播对干预措施优先级的影响表明，对于优先考虑干预措施，在每个国家检查干预措施的传播程度和影响非常重要。
