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Patient and family empowerment as agents of ambulatory care safety and quality
  1. Debra L Roter1,
  2. Jennifer Wolff2,
  3. Albert Wu2,
  4. Annegret F Hannawa3
  1. 1Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Faculty of Communication Sciences, Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Università della Svizzera italiana, Switzerland
  1. Correspondence to Professor Debra L Roter, Johns Hopkins Bloomberg School of Public Health, Department of Health Behavior and Society, 624 N. Broadway, Baltimore, MD 21209, USA; Droter1{at}jhu.edu

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Introduction

Since publication of To Err is Human: Building a Safer Health System,1 consideration of medical errors and injuries has broadened beyond hospital-based harms to patient experiences of harm in primary care.2 ,3 The National Patient Safety Foundation (NPSF)4 has concluded that progress towards a healthcare culture of safety depends on the establishment of a systems approach that extends beyond hospitals to care settings in the community and patients' homes, herein referred to as ambulatory care settings. Included in NPSF's recommendations for such an approach is partnering with patients and families at all levels of care. Less well articulated is how this partnering may be achieved in the settings highlighted by NPSF.

The objectives of this viewpoint are twofold. The first is to hypothesise pathways through which an empowered patient–family partnership may effectively advance healthcare safety and quality in ambulatory care settings and the home. The second is to describe key elements and lessons learned from a successful communication intervention designed to empower patients and families to effectively work together with clinicians during ambulatory medical visits.

Throughout the remainder of this commentary, family will be broadly defined to include spouses, partners, adult children and other relatives, and friends.

Family accompaniment of patients in ambulatory care visits

Adult patients over the age of 65 are routinely accompanied to medical visits by family members.5 ,6 Moreover, patients who are older, less educated and in poorer physical and mental health, which are characteristics associated with safety risks, are more likely to attend medical visits with family visit companions than others.5 ,6 For the most part, the same family member accompanies older adult patients over time and across clinical settings.7

When family members accompany patients to medical visits, they influence communication processes of care and treatment decision making in mostly helpful ways. …

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