Every year we support a handful of projects that align CHOT with, and further the mission of, UAB’s Department of Health Services Administration goals of producing applied research in conjunction with providing high-quality education to future health care executives.

This model is mutually beneficial to our department and industry partners, creating opportunities to generate knowledge and innovations for implementation. Our faculty provides a host of research expertise including care coordination, health information technology, quality improvement, and patient/person experience with care. Recent projects are listed below by the academic year.

  • Developing a Risk Prediction Model for Hosptial Acquired Clostridium Difficile Infection

    Principal Investigator: Midge N. Ray, PhD
    Co-Principal Investigator: Ferhat D. Zengul, PhD

    Project Description:

    Hospital Acquired Infections (HAI) are infections that are acquired after admission to the hospital and consume about $25 to 31 billion. In 2002, the Centers for Disease Control and Prevention estimated the rate for HAIs to be about 1.7 million and of those 99,000 are related to deaths during hospitalization. Hence, HAI affect quality and cost of healthcare. Medicare initiated a plan in 2008 to reduce payments to hospitals for complications that occur during the hospital stay, including hospital acquired infections. One such infection is the Clostridium difficile infection (CDI) which is the most common cause of infectious diarrhea occurring in the hospital and treatments costs per patient is approximately $8,911 to $30,049 in the United States.

    We have identified predictors of hospital acquired CDI in the phase one of the study. In the second phase, we will conduct a retrospective study using UAB i2b2 dataset to develop a risk prediction model for CDI. The main goal of this study is to develop a CDI risk prediction model that allows categorizing patients into high, medium, and low risk categories. which would allow the development of more targeted testing strategies for CDI infection.

    How this is different than related research:

    Even though there have been studies exploring the predictors of CDI, there has not been a study that developed a CDI risk prediction model that allows categorizing patients into high, medium, and low risk categories. These risk categories would allow the development of more targeted testing strategies for CDI infection. Given that CDI testings tend to be expensive and they are not reimbursed by the payers, it is crucial for hospitals to be able to develop more targeted CDI testing strategies.

    Project benefits to industry:

    Developing a risk prediction model of CDI will be useful in screening patients at risk for the infection at the time of admission. This would allow developing more targeted strategies in testing CDI, which can be very costly for hospitals. Identifying predictors of CDI would also allow development of potential interventions to reduce the rate of CDI by (1) administering proactive treatment to patients at risk (2) diagnosing patients who have pre-existing or HAI CDI resulting in quicker treatment and (3) potentially reducing the length of stay thereby potentially reducing hospital costs.

    The Socio-demographic Predictors of Pain Management: Comparison of Previous and Revised HCAHPS Survey Questions

    Principal Investigator: Ferhat D. Zengul, PhD
    Co-Principal Investigator: Bunyamin Ozaydin, PhD

    Project Description:

    • As part of the 2017 outpatient Prospective Payment System (OPPS) final rule, CMS removed "pain management dimension" from the scoring formula used in the Hospital Value-Based Purchasing (VBP) program.
    • CMS introduced revised questions on pain management in 2018 HCAHPS survey.
    • Given that the law requires public reporting of new measures for one year prior to including in VBP program, after the end of this one year period, it is expected that pain management dimension will be re-introduced into the VBP scoring formula.
    • To better prepare for the re-introduction of revised pain management questions into VBP program, hospitals needs to improve their insights about the socio demographic predictors of Pain Management scores by analyzing information before and after CMS' revision. Enhancing their insights on pain management dimension would allow hospital decision makers to develop targeted strategies, which may enhance patient experience and hospital's financial bottom line.

    How this is different than related research:

    • Even though there were studies exploring the predictors such as racial/ethnic differences in patient perceptions of inpatient care, there has been limited numbers of studies focusing on the pain management dimension of HCAHPS survey.
    • Moreover, due to recent CMS ruling, there has not been a study exploring the revised pain management questions.
    • Therefore, the aim of this study to address this gap in the literature by developing predictive models to determine socio demographic predictors of Pain Management Questions.

    Project benefits to industry:

    • Development of information and insight on pain management dimension of HCAHPS survey.
    • Being prepared to the re-introduction of paint management questions into VBP program

    Care Coordination Activities for Individuals with Spinal Cord Injury

    Principal Investigator: Robert Weech-Maldonado, MBA, PhD
    Co-Principal Investigator: Justin Lord, PhD

    Project Description:

    Value-based reimbursement in health care has resulted in an increasing focus on patient engagement as a mechanism to improve post-acute care outcomes, particularly in reducing readmissions. However, interventions to address patient engagement should account for health literacy and generational differences. Strategies that may work with a high literacy population may not be as effective among a population with low literacy. This project will develop a targeted intervention that will reduce some of the barriers associated with health literacy and increase patient engagement.

    How this is different than related research:

    This is a two-phase project. During the current first phase, we are conducting a literature review to identify best practices/strategies in addressing health literacy barriers in a home health environment,with the ultimate goals of improving patient engagement and reducing hospital readmissions. We are proposing a second phase, which will consist of a pilot intervention in a home health setting that incorporates some of the best practices/strategies identified in phase one. An example of an intervention is the Ask Me 3® developed by the Agency for Healthcare Research and Quality. Ask Me 3® is an educational program that encourages patients and families to ask three specific questions of their providers to better understand their health conditions and what they need to do to stay healthy: 1. What is my main problem?; 2. What do I need to do?; 3. Why is it important for me to do this?

    Project benefits to industry:

    This project will provide the foundation for future interventions of health system strategies to address barriers related to health literacy, increase patient engagement, and improve patient outcomes.

    Using Socioeconomic and Sociodemographic Variables in the Electronic Health Record to Predict Risk of Repeated ED Visits

    Principal Investigator: Allyson G. Hall, PhD
    Co-Principal Investigator: Sue Feldman, RN, MEd, PhD

    Project Description:

    Preventing hospital readmissions and repeated emergency department (ED) visits, especially for preventable conditions continues to be a vexing problem for health systems. Many health systems adopt transition of care and care coordination strategies to reduce this repeated cycle of care(e.g. coaches, community-based services, medication reconciliation, primary care services). Unfortunately, there is no clear evidence that these programs are effective. Critics argue that for these programs to be more effective there needs to be greater emphasis on developing more precise ways to identify those patients who are most at risk and then developing targeted care coordination programs specifically aimed at patients. Current risk-prediction models have limited prediction accuracy in part because they fail to include patient level social an economic characteristics as well as neighborhood/ community level factors. The purpose of this project is to develop a predictive model to assess the likelihood of inpatient readmissions or emergency department use utilizing UAB health system data that includes patient level clinical, social, and economic data as well as a measure of the level of deprivation of the patient's neighborhood.

    How this is different than related research:

    Current predictive models fail to include measures of social and economic well-being as well as assessments of community deprivation into their risk prediction models. UAB Health System collects patient-reported data on social and economic circumstance. In addition, measures of community deprivation can be assessed using the Area Deprivation Index which is calculated based on zip code. The proposed work seeks to improve the ability of predictive models to identify patients at risk for readmission for preventable conditions by incorporating patient level measures of social and economic well being and measures of community deprivation into the statistical analyses.

    Project benefits to industry:

    The industry will have a better understanding how the use of non-clinical data (i.e. individual patient social and economic data as well as community level data) can predict the risk of re-admission. The resulting risk prediction model can be used to develop communication tools (e.g. dashboards, alert systems) to inform providers who their high risk patients are. Such information can be better used to target patients who might benefit most from care transition and coordination of care strategies.

    An Intervention to Address Health Literacy Barriers, Increase Patient Engagement, and Improve Patient Experience and Outcomes

    Principal Investigator: Robert Weech-Maldonado, MBA, PhD
    Co-Principal Investigators: Nancy Borkowski, DBA, FACHE, FHFMA and Justin Lord, PhD

    Project Description:

    Value-based reimbursement in health care has resulted in an increasing focus on patient engagement as a mechanism to improve post-acute care outcomes, particularly in reducing readmissions. However, interventions to address patient engagement should account for health literacy and generational differences. Strategies that may work with a high literacy population may not be as effective among a population with low literacy. This project will develop a targeted intervention that will reduce some of the barriers associated with health literacy and increase patient engagement.

    How this is different than related research:

    This is a two-phase project. During the current first phase, we are conducting a literature review to identify best practices/strategies in addressing health literacy barriers in a home health environment,with the ultimate goals of improving patient engagement and reducing hospital readmissions. We are proposing a second phase, which will consist of a pilot intervention in a home health setting that incorporates some of the best practices/strategies identified in phase one. An example of an intervention is the Ask Me 3® developed by the Agency for Healthcare Research and Quality. Ask Me 3® is an educational program that encourages patients and families to ask three specific questions of their providers to better understand their health conditions and what they need to do to stay healthy: 1. What is my main problem?; 2. What do I need to do?; 3. Why is it important for me to do this?

    Project benefits to industry:

    This project will provide the foundation for future interventions of health system strategies to address barriers related to health literacy, increase patient engagement, and improve patient outcomes.

    Integrated Chronic Care Management System for Monitoring and Clinical Decision Support

    Principal Investigator: Bunyamin Ozaydin, PhD
    Co-Principal Investigators: Ferhat Zengul, PhD and Eta Berner, EdD

    Project Description:

    We propose to perform the initial phase to design, build, and test an integrated chronic care management system to capture, analyze and present real-time, consumable health information for patients with chronic conditions (e.g., CHF, COPD, diabetes). The technology will use existing home use medical devices that are capable of securely communicating with their server and state-of-the-art analytics to provide useful decision-support information for patients, their caregivers and their healthcare providers. We will incorporate user-centered design to develop and test a system to (1) aggregate data from medical devices used by patients with chronic conditions, (2) provide new algorithms and decision-support tools that filter and present the vast array of data input from both devices and system users, in an accessible form for each audience, and (3) integrate the system in order to provide and display feedback automatically and on-demand for each audience.

    How this is different than related research:

    The ultimate goal of this proposal is to build a fully-integrated user platform for both patients with multiple chronic conditions along with their caregivers and their providers. When operating outside traditional facilities, usability of the technology and information security pose major challenges. We propose to utilize user-centered design approach an keep the server side of the system with institutions' data storage used for the rest of the patient data. In addition, the ongoing capture of data from devices can lead to information overload, making clinical decision-making more difficult. We propose to build analytics and visualization tools to present aggregate information that is meaningful and actionable. This system will also be designed to be interoperable with other information systems such as a provider’s electronic health record, while being in with full compliance with HIPAA privacy and information security requirements.

    Project benefits to industry:

    The elderly constitutes an increasingly larger portion of the US population, with many suffering from multiple chronic conditions. The focus on the triple aim (better healthcare experience, better health outcomes and decreased cost) coupled with new advances in technologies, in particular mobile technologies, have led to greater emphasis on “aging in place” and monitoring health indicators in order to facilitate population health. In this environment, this system proposes to better manage individual patient health outside of costly traditional healthcare institutions.

  • Patient Engagement and Hospital Readmissions: The Role of Health Literacy

    Patient Engagement and Hospital Readmissions: The Role of Health Literacy
    Principal Investigator: Robert Weech-Maldonado, MBA, PhD
    Co-Principal Investigator: Nancy Borkowski, DBA, FACHE, FHFMA

    Project Description:

    Value-based reimbursement in health care has resulted in an increasing focus on patient engagement as a mechanism to improve post-acute care outcomes, particularly in reducing readmissions. However, interventions to address patient engagement should account for health literacy and generational differences. Strategies that may work with a high literacy population may not be as effective among a population with low literacy. Similarly, strategies used with millennials may not be as effective among baby boomers. The purpose of this research project is to: 1) conduct a systematic literature of the relationships among health literacy, generational differences, patient engagement, and hospital readmissions; 2) identify best practices of health system strategies to address barriers related to health literacy and generational differences to increase patient engagement and ultimately reduce hospital readmissions; and 3) propose a pilot project based on literature review findings.

    How this is different than related research:

    Prior research has focused on the relationship between patient engagement and health outcomes. However, there has been relatively little research examining how health literacy and generational differences can influence patient engagement and readmission rates, as well as the health system strategies to address barriers related to health literacy and generational differences.

    Project benefits to industry:

    This project will provide the foundation for future interventions of health system strategies to address barriers related to health literacy and generational differences, increase patient engagement, and improve patient outcomes.

    Telehealth and Remote Patient Monitoring Systems to Improve Access & Promote Active Patient Engagement in Rural Communities

    Principal Investigator: Nancy Borkowksi, DBA, FACHE, FHFMA (UAB)
    Co-Principal Investigators: Neeraj Puro (UAB), Eva Lee (GOT), Cory Wang (GIT)

    Project Description:

    As discussed in the 2015 IOM report, timely access to (quality) healthcare service has been a real challenge. Misalignment of resources and increased demands results in long delays. Furthermore, rural areas lack sufficient healthcare options. Telehealth can offer alternative and timely care to these patients. It can also help improving health conditions and promoting active patient engagement, which is particularly important for chronic disease management. However, there has been limited research regarding patients’ acceptance and continued utilization of telehealth/telemedicine options. There are also reimbursement challenges. Exploring the current literature, this project will: First, identify drivers and barriers of patient engagement by population groups (i.e., aged, generational differences) and chronic conditions (i.e., diabetes, obesity, COPD). Second, explore successful telehealth/telemedicine applications in rural care settings and by various patient groups. Third, make recommendations for implementing appropriate telehealth/telemedicine interventions given governmental policies, reimbursement payments (i.e., FFS, bundle payments), and delivery of care models (i.e., ACOs). This project involves UAB, GIT, PSU, FAU, TAMU, UWT, NEU.

    How is this different than related research:

    Since its introduction almost 20 years ago, the adoption of telemedicine and the level of patient engagement and services provided across healthcare facilities remain uneven and far from optimal. There is enormous opportunity to expand remote health services so as to provide more timely communication and consultation to patients, reduce the face-to-face demand, and the cost of delivery. There has been relatively little research examining various patient populations engagement in the successful use of telehealth/telemedicine options.

    Project benefits to industry:

    This project will provide the foundation for selecting the appropriate telehealth/telemedicine options by providers to increase quality of care with the goals of increasing efficiency, reducing hospital admissions/readmissions, and improving defined patient outcomes.

    Engaging Home Health Patients through Digital Health Technology

    Principal Investigator: Shannon Houser, PhD

    Project Description:

    Digital technologies, such as remote monitoring programs, and wearable devices are intended to remotely monitor, diagnose, treat, and consult with patients from a distance. It has potential to improve the efficiency, cost, and chronic condition management, by reducing emergency room visits, re-hospitalizations, operations, premature deaths, and unnecessary costs to the health care system. Home health care patients present new and unique opportunities and challenges of adopting technologies. Nevertheless, patient acceptance and engagement is an important factor for successfully and effectively adopting technology. In addition, the roles of home health community health workers are changing with the use of technology. It has critical policy implications to understand the new roles, skills and training needs for the community health workers in adoption of digital technologies.

    This study focuses on a special population in home-health care settings, such as older adults, people with chronic obstructive pulmonary disease (COPD), and spinal cord injury. The purpose of this study is threefold: First, assess patient acceptance, attitudes, engagement, and challenges to digital health technology. Second, explore roles, skills, and impacts of technology on community health workers. Third, identify the best mediums to reach special patient populations in home-health care settings.

    How this is different than related research:

    This study will examine how digital health technologies impact a special patient population, such as older adults, patients with COPD, and spinal cord injuries, who need care in home-health care settings. This unique patient population and specific care setting differ from other related research studies.          

    Project benefits to industry:

    This study will have policy implications, will identify best practices in utilization of technology, explore training and skill needs for community health workers. The study will also identify the best technological medium to engage patients with chronic conditions who need home-health care. Patient engagement efforts, and tailored educational programs will also be suggested.

    New Methods for Reducing Adverse Events and Harmful Overuse

    Principal Investigator: Ilies (NEU) and Tapan Mehta, PhD (UAB)

    Project Description:

    This is a collaborative project of NEU, UAB, and multiple industry members. The objective is to research and integrate existing and new methods for analyzing and reducing adverse events (AEs), patient exposure to harm, and associated costs. AEs and harmful overuse are a widespread problem across healthcare, with huge cost and health implications, with a significant opportunity for improvement through the use of recently emerging new approaches to patient safety. Our combined research team will use hybrid methods to assess practice variation analysis, develop prediction models based in regression and machine learning, and apply complexity systems failure analysis methods from the emerging "Safety-2" field, building on a past CHOT project (16-0515151.NEU: "Improvements to Root Cause Analysis of Patient Safety Events"). The application areas will be determined by our IAB members, two being patient falls and overtesting of ED and pre-op patients. The integrated team also will meet monthly via conference calls and web-ex meetings.

    How this is different than related research:

    Our project is unique in four respects: (1) seeking to compare and combine traditional methods commonly used in analysis and prevention of adverse events and harmful overuse with more modern methods, such as Bayesian Belief networks, etc., (2) considering combined prediction of adverse/overuse events at both individual-level and unit-level, (3) investigating the use of retrospective causality and prospective context assessment methods from the emerging "safety-2" field, and (4) integrating these methods into a unified approach that can be used to better understand, predict, and prevent adverse events and harmful overuse.

    Experimental Plan:

    1. Assess practice variation analysis in patient safety and/or overuse areas targeted by industry members
    2. Apply FRAM (function resonance analysis method), HFACS (human factors analysis classification system), and related "safety-2" methods to each member setting and adverse/overuse area
    3. Conduct linear and/or nonlinear predictive modeling as warranted
    4. Integrate results of variation analysis, safety-2 methods, and predictive modeling to reduce number of adverse and/or overuse events
    5. Measure impact on costs, number of harmful or unnecessary events prevented, and exposure to harm

    Project benefits to industry:

    • Reduced costs associated with adverse events and unnecessary testing
    • Reduced number of adverse and/or harmful events
    • Reduced exposure to harm

    Identifying Best Practices in Readmission Reduction Programs

    Principal Investigator: Nathan Carroll, PhD

    Project Description:

    The rate of readmissions from medical facilities is high nationwide, suggesting that providers have an opportunity to improve the quality of care they offer. In addition, hospitals and post-acute care providers have a strong business case for reducing readmissions. Hospitals face costly readmission penalties. CMS estimates that penalties from its Hospital Readmission Reduction Program will total over $500 million in 2017. These penalties also affect post-acute care provides, since acute care hospitals are becoming more active in directing patients towards the post-acute care providers that are most successful in transitioning patients back to a home setting. Research suggests that medication adherence is an important determinant of whether or not a patient is readmitted. In fact, an estimated 66% of readmissions are associated with medication nonadherence. This project will review published evaluations of provider-sponsored readmission reduction programs to identify best practices employed by these programs. Programs aimed at improving medication adherence will be targeted.

    How this is different than related research:

    The literature contains many case studies in which organizations report the results of programs designed to improve medication adherence and reconciliation for discharged patients. However, these studies have yet to be considered as a cohesive body. A systematic review of published evaluations of readmission reduction programs will allow researchers to identify "best practices" common to the most effective programs. The review will also identify contextual elements important to the programs' success and characteristics of interventions that tend to be less effective. In addition, this review will assess the rigor of published case studies since evaluations are heavily influenced by the methods study authors choose to estimate how many readmissions would have taken place if the organization had not pursued any readmission reduction effort.

    Project benefits to industry:

    The proposed research will highlight important aspects of successful readmission reduction programs. This will assist acute care hospitals and post-acute care providers in designing programs that reduce readmissions. This research will also provide important information about how to best implement and evaluate readmission reduction programs.

  • Inexpensive Technologies to Manage Patient Populations

    Principal Investigator: Amy Landry, PhD

    Project Description:

    Caring for patients outside the confines of a hospital and beyond acute episodes of care is proving
to be challenging for organizations built upon incentive systems that traditionally reward more sickness and more interventions. In learning to communicate and better
manage patients beyond the hospital walls, the utilization
 of inexpensive technologies (e.g. apps) to manage patient populations shows some promise.

    The main objectives of the project are to: 1) identify mobile apps that can be utilized in managing diabetic patient populations, 2) educate the patient population on how to download and use the app, 3) evaluate the effects of the technology on patient activation and health management, and 4) investigate demographic trends that correlate with patient activation. Understanding how inexpensive technology can be used to manage chronically ill patients is the goal of this research, so the targeted patient population includes diabetic patients. The incidence of diabetes is higher in the Deep South region of the United States, where UAB’s industry partners are located.

    How this is different than related research:

    A 2012 report by the Pew Research Center suggests that 85% of U.S. adults own a cell phone, and 53% of those own smartphones. Smartphone owners routinely gather health related information on their phones, and this type of health information seeking behavior is increased in individuals with some sort of medical crisis or condition. Almost 20% of smart phone owners have at least one health app on their phone; however, limited research exists to assess the way that using such widespread technology influences health behaviors or outcomes. This study will be the first to evaluate how smartphone apps can affect patient activation. Simple, inexpensive technology has great potential to improve disease management of chronically ill patient populations.

    Project benefits to industry:

    • Provides information on using inexpensive technologies to manage patient population
    • Evaluates a method of patient activation
    • Explores activation trends in patient demographics

    The Clinical Staff Perception and use of and Satisfaction with IT

    Co-Principal Investigator: Midge Ray, PhD

    Project Description:

    We are working with a large home health agency to measure the clinical staff use of and satisfaction with telemedicine and other point-of-care technology including the EHR. We will first conduct two focus groups with high and low users of technology for the purpose of informing the online survey instrument. The online survey will be administered via the internet to the home health clinical staff, including RNs, LPNs, PTs and OTs to determine the staff satisfaction with the technology and barriers to using the technology. We will use the area health resource file (ARF) to look at geographic variation and home health agency data on hospital readmissions to look at any association. In the final phase of project we will explore the patient use of technology.

    The main objectives of this project are to: 1) measure use of and satisfaction with electronic health record (EHR) and point of care technology by clinical staff, 2) identify barriers to successful technology use and, 3) examine geographic variation and 30 – day hospital readmissions.

    How is this different than related research:

    There is a dearth of empirical research that has examined HIT use and factors associated with use in non-healthcare settings of care delivery such as home health. With an increasing focus on population health management, care in non clinical settings needs to follow the six patient care aims. To this aim, our focus is to understand factors associated with HIT use by clinicians in a large agency. We plan to develop a survey that encompases comfort in using technology, barriers to using technology, training approaches used, and other factors associated with technology use.

    Project benefits to industry:

    • Identify barriers and facilitators of HIT use
    • Refine strategies on IT adoption and implementation

    Understanding the "White Space" of Where Patients Go

    Principal Investigator: Amy Landry, PhD
    Co-Principal Investigator: Larry Hearld, PhD

    Project Description:

    The ACA/value based purchasing have placed increased urgency on providing health care services beyond a specific acute care episode. Hospitals are now responsible for preventing avoidable readmissions for particular diagnoses, and will be financially penalized by Medicare for not doing so in an effective manner. Patients, however, are often discharged to a variety of settings and organizations, such as home health, skilled nursing facilities, inpatient rehabilitation, and home with no care, which can influence a hospital’s ability to manage the transition effectively. Understanding the frequency of different transitions of care and how successful these transitions are in reducing avoidable readmissions for a health system can help decision makers choose the appropriate care destination for patients and target interventions to improve transitions.

    The main objectives of the project are to: 1) examine the settings and organizations to which patients are being discharged, and 2) identify whether certain settings and strategies of outplacement are more successful in reducing avoidable readmissions.

    How this is different than related research:

    A variety of research is being conducted on clinical strategies to reduce avoidable readmissions. However, this work will evaluate the influence of a particular clinical setting on hospital readmission rates for particular conditions. Additionally, organization specific factors contributing to success in reducing avoidable readmissions will be assessed.     

    Project benefits to industry:

    • Information can inform hospital partners in managing transitions of care
    • Provides evidence base for post-acute care providers to demonstrate effectiveness in managing care transitions

    New Methods for Reducing Adverse Events and Harmful Overuse

    Principal Investigator: Ilies (NEU) and Tapan Mehta, PhD (UAB)

    Project Description:

    This is a collaborative project of NEU, UAB, and multiple industry members. The objective is to research and integrate existing and new methods for analyzing and reducing adverse events (AEs), patient exposure to harm, and associated costs. AEs and harmful overuse are a widespread problem across healthcare, with huge cost and health implications, with a significant opportunity for improvement through the use of recently emerging new approaches to patient safety. Our combined research team will use hybrid methods to assess practice variation analysis, develop prediction models based in regression and machine learning, and apply complexity systems failure analysis methods from the emerging "Safety-2" field, building on a past CHOT project (16-0515151.NEU: "Improvements to Root Cause Analysis of Patient Safety Events"). The application areas will be determined by our IAB members, two being patient falls and overtesting of ED and pre-op patients. The integrated team also will meet monthly via conference calls and web-ex meetings.

    How this is different than related research:

    Our project is unique in four respects: (1) seeking to compare and combine traditional methods commonly used in analysis and prevention of adverse events and harmful overuse with more modern methods, such as Bayesian Belief networks, etc., (2) considering combined prediction of adverse/overuse events at both individual-level and unit-level, (3) investigating the use of retrospective causality and prospective context assessment methods from the emerging "safety-2" field, and (4) integrating these methods into a unified approach that can be used to better understand, predict, and prevent adverse events and harmful overuse.

    Experimental Plan:

    1. Assess practice variation analysis in patient safety and/or overuse areas targeted by industry members
    2. Apply FRAM (function resonance analysis method), HFACS (human factors analysis classification system), and related "safety-2" methods to each member setting and adverse/overuse area
    3. Conduct linear and/or nonlinear predictive modeling as warranted
    4. Integrate results of variation analysis, safety-2 methods, and predictive modeling to reduce number of adverse and/or overuse events
    5. Measure impact on costs, number of harmful or unnecessary events prevented, and exposure to harm

    Project benefits to industry:

    • Reduced costs associated with adverse events and unnecessary testing
    • Reduced number of adverse and/or harmful events
    • Reduced exposure to harm