Caregiver and Patient Input for Quality and Safety (C-PIQS) Pilot Study: Patient-Initiated Safety Observations Using an m-Health Tool

Abstract

Background: Safety reporting systems do not identify all adverse events affecting hospitalized patients. Patients and caregivers may identify inpatient safety events that health care staff miss.

Objective: To assess the feasibility of a text message-enabled safety reporting tool among adult inpatients and caregivers at a public hospital.

Design: Prospective, observational pilot study to gather patient or caregiver safety observations. We assessed feasibility through engagement with the tool, reporting rates, content analysis of observations by category, and comparison to staff-entered incident reports.

Participants: English-speaking and Spanish-speaking adults and caregivers age 18+ admitted to an urban, public hospital.

Intervention: Participants received a daily text message eliciting safety observations, with a link to an online reporting tool.

Main measures: Number of safety observations/100 study-days, adjusted for patient sociodemographics, patient activation, and patient electronic health literacy.

Results: Seventy-five patients and 6 caregivers participated in the study (participation rate: 50%). Of patients, 56% were Latinx and 19% Black/African American; 44% were Spanish-speaking. Of all participants, 50.6% (41/81) engaged with at least 1 text message. There were 64 total safety observations, 27 patient-entered and 37 by caregivers. In multivariable analysis, Spanish-speaking Latinx patients made 1.8 [0.04-3.5] observations/100 study-days; English-speaking Latinx patients 3.4 [0-10.2]; Black/African American patients 5.8 [1.5-10.2] and combined Asian/Multiracial/white/Other English-speaking patients 11.9 [5.9-17.9] (P=0.006). The most common category was "What Went Well" (34%), followed by Other (27%). Only one observation overlapped with a staff-entered incident report.

Conclusions: The tool feasibly gathered relevant patient-reported safety observations from admitted patients from marginalized populations. Our study found lower reporting rates among Spanish-preferring, Latinx, and Black/African American patients, despite known higher rates of adverse events for these groups. Tracking minoritized patient participation and addressing differential engagement in patient engagement safety initiatives can improve racial and ethnic equity in reporting rates and, ultimately, safety, and health outcomes.

Keywords: communication; mobile health; patient safety.