Harnessing data to enhance Oregon’s Early Discussion & Resolution process
- The Oregon Patient Safety Commission recently partnered with CORE to enhance the Oregon Early Discussion & Resolution (EDR) process's data strategy.
- EDR creates confidential and safe spaces for patients to have transparent conversations with healthcare providers following incidents of patient harm.
- CORE's data experts evaluated existing strategies and developed a roadmap toward better using data to identify potential disparities and ensure more equitable and positive outcomes for participants.
Despite the best intentions of healthcare providers and organizations, medical errors and adverse events sometimes occur. Oregon’s Early Discussion and Resolution (EDR) process, enacted by the state legislature in 2013, creates confidential and safe spaces for patients and families to have transparent conversations with providers following incidents of patient harm in healthcare settings.
While the Oregon Patient Safety Commission (OPSC) has gathered and analyzed EDR process data since its 2014 launch, leadership recognized an opportunity to more effectively and systematically use data to paint a nuanced picture of EDR-protected conversations, identify disparities, and determine which practices and elements are associated with successful resolutions. OPSC engaged our team at the Providence Center for Outcomes Research and Education (CORE) to help meet those data-related goals.
Identifying data system gaps and logic: a roadmap for change
CORE’s first step was to develop a logic model, which serves as a roadmap for determining data system gaps and recommendations. We analyzed documents and past data and analytics recommendations, interviewed staff, conducted stakeholder focus groups, and reviewed existing literature on medical harm event conflict resolution programs. Those analyses were synthesized into a roadmap based on EDR’s intended outcomes, which seek to ensure that:
- Patients and families feel safe and comfortable requesting conversations, as well as respected, empowered, and appropriately compensated at the conclusion of the process.
- Providers and facilities feel safe and comfortable requesting conversations and sharing what they learn.
- Providers and facilities have systems and policies that support a culture of safety and transparency.
According to OPSC executive director Valerie Harmon, "CORE's work gave us a clear roadmap for how we can connect our data with our learning goals, integrate equity into our data strategy, and strengthen this important work we have been entrusted to do.”
Improving data collection to identify & address disparities
To ensure the best possible outcomes for participants, OPSC sought to better understand what good EDR outcomes look like from multiple perspectives, while also considering critical questions around equity. Following an extensive review of existing data collection processes, CORE developed a set of recommendations aimed at ensuring OPSC was collecting the right data, with the right granularity, at the right time.
- Identifying disparities is critical to addressing them, which is why CORE’s recommendations included incorporating new questions to help identify disparities within the EDR process. This is important because even though past research has shown that medical harm events disproportionately impact communities of color, EDR’s race and ethnicity data was incomplete. With more complete data, EDR can evaluate if specific communities are less likely to request a conversation, have a conversation requested, or have a successful outcome.
- Another key recommendation was to gather additional information at the time of the conversation request, including participants’ goals for the process. Resolution goals can vary widely. One family’s primary goal might be an apology, while another may be focused on a specific process improvement. Knowing a patient or family’s goals will allow OPSC to understand the most common goals and how often they are met and tailor questions back to participants at the end of a process.
OPSC is now working to implement these and other recommendations.
CORE's partnership with OPSC highlights data systems' impact on program effectiveness and equity. CORE’s EDR logic model and data system recommendations aim to empower OPSC to identify areas for improvement, measure the program's success, and better identify and address inequities in conversation requests, acceptance rates, and outcomes. This work has the potential to inform other healthcare organizations about effective resolution practices following patient harm events.