Study: Online team management could be effective in ambulatory settings

Web-based team resource management (TRM) demonstrates potential for effectiveness in various ambulatory settings, according to research published in the March edition of The American Journal of Managed Care.

Ranjit Singh, MD, from the department of family medicine, State University of New York at Buffalo, and colleagues developed and pilot-tested a web-based implementation of a TRM intervention to improve medication safety in primary care.

Eight practices were randomized to either the web-based TRM or usual practice (four practices in each group). Primary outcome was adverse drug events (ADEs) in older adults, ascertained using a trigger tool chart review at two 12-month periods (before and after the intervention). The prospective TRM approach facilitates systematic appraisal of risk and error reduction.

The authors found that the rate of ADEs decreased from 25.8 to 18.3 per 100 patients per year in the intervention group. “The rate was virtually unchanged in the control group (24.3 vs 24.8),” the authors wrote. “In an analysis of covariance at the practice level, being in the intervention group was associated with a lower rate of ADEs. The interaction between time (preintervention v. postintervention) and group (intervention v. control) was not significant but showed a trend toward a decrease in the intervention group compared with the control group over time.”

The study was limited by small size and short follow-up period, the authors acknowledged.

An additional point raised by the authors is the risk evaluation that drove the safety improvement process was based on self-reflection by the practice staff. “[R]isks were prioritized based on staff perceptions as elicited through their responses to the…instrument. This was a deliberate strategy to tap the organizational memory and inculcate ownership of the problems, in keeping with the principles of TRM. An alternative strategy that is more typically used is to employ external experts to perform an independent risk assessment.”

Future studies should test the intervention on a larger scale and over a longer period of time, with and without practice enhancement associates, and should further explore barriers to change and strategies for overcoming them, the authors concluded.

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