Tools for measuring patient safety in primary care settings using the RAND/UCLA appropriateness method

TLDR

Patient safety in general practice is under‑researched compared to hospitals, despite most patient contacts occurring there. The study aims to create a general‑practice patient‑safety toolkit that can be applied broadly to improve safety, cost‑effectiveness, and patient experience. Using a systematic literature review and RAND/UCLA Appropriateness Method, the authors identified 101 necessary safety items from 205 statements, framed by the Structure‑Process‑Outcome taxonomy. The toolkit comprises 101 items—73 structure, 22 process, 6 outcome—providing tools that can drive interventions to improve general‑practice safety outcomes.

Abstract

The majority of patient contacts occur in general practice but general practice patient safety has been poorly described and under-researched to date compared to hospital settings. Our objective was to produce a set of patient safety tools and indicators that can be used in general practices in any healthcare setting and develop a 'toolkit' of feasible patient safety measures for general practices in England.A RAND/UCLA Appropriateness Method exercise was conducted with a panel of international experts in general practice patient safety. Statements were developed from an extensive systematic literature review of patient safety in general practice. We used standard RAND/UCLA Appropriateness Method rating methods to identify necessary items for assessing patient safety in general practice, framed in terms of the Structure-Process-Outcome taxonomy. Items were included in the toolkit if they received an overall panel median score of ≥ 7 with agreement (no more than two panel members rating the statement outside a 3-point distribution around the median).Of 205 identified statements, the panel rated 101 as necessary for assessing the safety of general practices. Of these 101 statements, 73 covered structures or organisational issues, 22 addressed processes and 6 focused on outcomes.We developed and tested tools that can lead to interventions to improve safety outcomes in general practice. This paper reports the first attempt to systematically develop a patient safety toolkit for general practice, which has the potential to improve safety, cost effectiveness and patient experience, in any healthcare system.