Project PIVOT

about this project

Background

According to a World Health Organization (WHO) report, the evidence suggests that, despite decades of “patient safety improvement” initiatives, approximately 134 million adverse safety events (including inaccurate and delayed diagnosis) are still occurring globally each year. In the United States, an Office of Inspector General (OIG) report revealed that 1 in 4 Medicare patients experience avoidable adverse events in hospitals. Moreover, the adverse effects of unsafe care disproportionately impact socially marginalized populations.

In response to this sobering data, there have been recent global and US national calls to collect new data directly from patients – via patient-reported experience (PRE) and patient-reported outcome (PRO) measures – to help drive new care improvement efforts. This strategy is illustrated by the OECD’s 2018 report entitled, “Measuring Patient Safety: Opening the Black Box,” that identified patient-reported measures as a required component of every safety measurement system. WHO’s Global Patient Safety Action Plan calls on Member States to “Create mechanisms that collect patient reported experiences and outcomes that highlight patient safety to foster the development of more effective solutions." Additionally, in the report to the President by the President’s Council of Advisor’s on Science and Technology (PCAST), there is a recommendation to “Develop and validate new questions focused on racial/ethnic bias and patient safety in the patient-reported measures collected in the HCAHPS.”

Project PIVOT (Please see the Project PIVOT slide deck for a list of partners, funders, and additional information)

Project PIVOT is a novel initiative led by Patients for Patient Safety (PFPS US) to advance the implementation of patient-centered PREs and PROs to improve patient safety, diagnostic accuracy, and equity in health care. Project PIVOT will provide an opportunity for diverse patients, communities of patients, and patient and consumer organizations to collaborate with national and international experts through in-person and virtual convenings and to provide input via novel engagement methods to identify and prioritize PREs and PROs which are related to patient safety, diagnostic accuracy, and equity – and that matter most to patients.  Patients will also have opportunities to identify how and when they prefer to report their experiences and outcomes. Additionally, Project PIVOT will engage healthcare system leaders to identify and prioritize their PREs and PROs to explore possible synergies and integration with the PROs and PREs identified by patients.

Project PIVOT outputs (related to patient safety, diagnostic accuracy, and equity) will include: 

• Patient-identified and prioritized, validated PREs and PROs for which measures already exist
• Patient-identified and prioritized PREs and PROs for which no measures currently exist (for future scientific development and validation)
• PREs and PROs that address the specific challenges faced by older adults, people with disabilities and mothers who experience disparities during their maternal health experiences and
• PREs and PROs that have been identified and prioritized by leaders of healthcare systems. 

Dissemination and Implementation

PIVOT will engage strategic partners (including patient advocacy organizations, government agencies, measure developers, purchaser organizations, healthcare systems, publishers, and others) throughout the project to expedite the dissemination and implementation of the identified PREs and PROs into standard measures of the quality of healthcare (e.g. HCAHPS), patient-centered outcomes research (PCOR) and other relevant processes.

The Goal of Project PIVOT

The ultimate goal of Project PIVOT is to enhance patient safety, diagnostic accuracy, and equity by facilitating:

• More patient-centered quality-improvement initiatives and research
• The integration of new timeframes and modalities of reporting PREs and PROs by patients
• The availability of transparent PREs and PROs on which patients, consumers and purchasers can compare hospitals
• Financial incentives for healthcare systems to improve safety, diagnostic accuracy, and equity and
• The development of governmental policies to make healthcare systems safer and more equitable for populations that have experienced disparities in their healthcare.