Quality and Patient Safety in Primay Care

OKADA, Tadao

Tessyoukai Kameda Family Clinic Tateyam

Quality and Patient Safety in Primary Care Committee, Japanese Primary Care Association

2014 5
2016

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Quality in Family Practice

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30 Vol.12 No.1 (2017)



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STEPPS Team STEPPS Team Strategies and improvement (FOCUS-PDSA)24)

Tools to Enhance Performance and Patient Safety7) QI (quality indicator)25)

32 Vol.12 No.1 (2017)



8),9).

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(multimorbidities
8),9),11)

ACE/ARB
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commission
omission 8)

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MaPSaF (Manchester patient safety frameworkPrimary Care 15)

AHRQ hospital survey on patient safety culture16)

RCGP GP patient safety toolkit for general practice (Trigger toolsignificant event audit
17)

never event 18)

LINNEAUS Euro-PC collaboration(Learning from International Networks about Errors and Understanding
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JPCAT (Japanese version of Primary Care Assessment Tool) 3)

Quality in Family Practice Book of Tools 4)

Assessment Tool
https://www.primary-care-quality.com/jpcat
4) Quality in Family Practice Book of Tools

https://qualitybookoftools.ca/
5) Cheryl Levitt :


Quality in family practice Book of
Tools . 2015
6) 50.
(2005/06)
7) ,
[ ]
.
2012 12 3
8) Sarkar U: Tip of the iceberg: patient safety
incidents in primary care. BMJ Qual Saf
25(7):477-179, 2016.
9) Cooper A, Chuter A: Patient safety research
in primary care: where are we now? Br J Gen
Pract 65(641):622-623,2015.
10) Panesar et al: How safe is primary care?

A systematic review. BMJ Qual Saf, 2015

2017 1 15 doi:10.1136/bmjqs-2015-004178
11) The Safer Primary Care Expert Working
1) Group: Safer primary care: a global challenge.
http://www.primary-care.or.jp/about/committee. Geneva, World Health Organization 2012.
html#i05 http://www.who.int/patientsafety/summary_
2) report_of_primary_care_consultation.pdf
http://kyodokodo.jp/ 12) National Academies of Sciences, Engineering,
3) JPCAT Japanese version of Primary Care and Medicine: Improving diagnosis in health

34 Vol.12 No.1 (2017)


care. Washington DC, The National Academies
Press, 2015.
13) Kostopoulou O, Delaney BC, Munro CW;
Diagnostic difficulty and error in primary
care-a systematic review. Fam Pract 25(6):400-
413,2008;.
14) Singh H, Schiff GD, Graber ML, Onakpoya I,
Thompson MJ, The global burden of diagnostic
errors in primary care. BMJ Qual Saf, 2016.
doi:10.1136
15) Kirk S et al: Patient safety culture in primary
care: Developing a theoretical framework
for practical use. Qual Saf Health Care 16:
313- 320, 2007. Manchester Patient Safety
Framework (MaPSaF)
h t t p : / / w w w. n r l s . n p s a . n h s . u k / r e s o u r c e s /
?entryid45=59796
16) Sorra J, Franklin M, Streagle S: Medical
Office Survey on Patient Safety Culture.
(Prepared by Westat, under Contract No. 233-
02-0087). Rockville, MD, Agency for Healthcare
Research and Quality, December 2008. AHRQ
Publication No. 08(09)-0059.
17) RCGP: Patient Safety Toolkit for General
Practice
http://www.rcgp.org.uk/clinical-and-research/
toolkits/patient-safety.aspx
18) Wet C, O Donnell C, Bowie P: Developing a
preliminary ever event list for general practice
using consensus-building methods. Br J Gen
Pract 64(620):e159-e167, 2014.
19) Learning from International Networks about
Errors and Understanding Safety in Primary
Care (LINNEAUS Euro-PC)
http://www.linneaus-pc.eu/index.html
20) Parker D, Wensing M, Esmail A, Valderas JM:
Measurement tools and process indicators of
patient safety culture in primary care. A mixed
methods study by the LINNEAUS collaboration
on patient safety in primary care. Eur J Gen
Pract 21 Suppl:26-30, 2015.
21) Institute of Medicine (US) Committee on
Quality of Health Care in America: Crossing
the Quality Chasm: A New Health System for
the 21st Century. National Academies Press
(US), Washington (DC), 2001.
22) The Institute for Healthcare Improvement.
The IHI Triple Aim. http://www.ihi.org/Engage/
Initiatives/TripleAim/Pages/default.aspx
23) Bodenheimer T, Sinsky C: From triple to
quadruple aim: care of the patient requires care
of the provider. Ann Fam Med 12(6):573-576, .
2014.
24) B a t a l d e n P : B u i l d i n g k n o w l e d g e f o r
improvement-an introductory guide to the use
of FOCUS-PDCA. Quality Resource Group,
Hospital Corporation of America, Nashville,
TN, 1992.
25) (
24-25 H24
009
http://quality-indicator.net/%E5%8C%BB%E7%
99%82%E3%81%AE%E8%B3%AA%E6%8C%8
7%E6%A8%99%E3%81%A8%E3%81%AF/
26) Leiyu Shi et al Primary care, race, and
mortality in US states. Social Science &
Medicine 61(1): 65-75, 2005.
27) Macinko J, Starfield B, Shi L: Quantifying
the health benefits of primary care physician
supply in the United States. Int J Health Serv
37(1):111-126, 2007.
28) OECD: Reviews of National Health Care
Quality: Japan (Released 21 August 2015).
http://www.oecd.org/health/health-systems/
health-care-quality-reviews.htm
29) NHS. QOF (Quality and Outcomes Framework).
http://content.digital.nhs.uk/qof
30) National Committee for Quality Assurance
(NCQA). Patient-Centered Medical Home
(PCMH) Recognition.
http://www.ncqa.org/programs/recognition/
practices/patient-centered-medical-home-pcmh
31) Choosing Wisely.
http://www.choosingwisely.org/
35