I Heart Safety Data
There sure is a lot going on around here lately. Anybody else feel like it’s hard to keep up? Anyway, this could be two separate blog posts but I’m putting them together because they’ve got a common theme: safety data. Which I like to geek out on and I know you do too, comrades.
1) Recent events in Utah have led to a lot of discussion, both on and off-line. If you haven’t read it yet, please check out Elaine’s analysis over at The Acupuncture Observer.
Last week I followed up on the Utah meeting with a phone call with Mina Larson and Kory Ward-Cook of the NCCAOM. We agreed that it’s important to get some clear information out into the community about what the NCCAOM does and doesn’t do. I sent them some questions about the NCCAOM, credentialing, and data, and they’ve promised to respond in writing, which is very convenient for blogging. So stay tuned for a series of blog posts here about understanding the NCCAOM.
In our conversation, though, we were able to clear up what I and others felt like was an area of confusion at the Utah meeting, which is the NCCAOM’s relationship to collecting safety data, particularly about adverse events, and how that relates to credentialing initiatives. This is what I learned:
The NCCAOM primarily collects two kinds of data: demographic information from diplomates when they re-certify, and the KSA (knowledge, skills, abilities) data gathered through their Job Task Analysis.
The NCCAOM does not collect any data about public safety or adverse events. The creation of new credentials, like the herbal credential, are based on requests from within the acupuncture profession, not on data that shows that there is a public safety problem with, say, acupuncturists prescribing Chinese herbs.
The NCCAOM’s mission is to assure the safety and well-being of the public and to advance the professional practice of acupuncture and Oriental medicine by establishing and promoting national evidence-based standards of competence and credentialing. “Evidence-based” refers to the data gathered via their Job Task Analysis, not public safety data. The safety part of their mission is addressed through asking safety-related questions in their JTA.
Everybody clear on that? I was confused, but now I’m not.
It all comes down to the JTA.
2) Something that is common in other health professions but missing from the acupuncture profession is the practice of voluntarily reporting adverse events and errors. There are many excellent reasons for a profession to adopt this practice.
I can’t remember exactly when I started wishing that we had an AERD — an Adverse Events and Errors Database — for acupuncture, especially community acupuncture. It’s been a few years now. After the meeting in Utah, though, I realized how critically important it is — particularly for POCA — to take the responsibility of collecting our own safety data.
Anyway, huge thanks to Gloria Jacobs (POCA volunteer), Wade Phillips (POCA IT wizard), and Suzanne Morrissey (professor of medical anthropology at Whitman College) for making it happen. Whitman College kindly loaned us the use of their Institutional Review Board for this project.
https://acupunctureconsumersafety.net
This AERD will be maintained by students and volunteers of POCA Tech. We feel that this is something POCA Tech can do for the POCA Cooperative as a whole, something that benefits both patients and practitioners. It’s an opportunity for POCA Tech students not just to learn the habit of reporting adverse events and errors at the same time that they’re learning to do acupuncture (Wade already put a link to the AERD into our EHR, so it’s right there when we’re all charting), it’s an opportunity to develop critical thinking and leadership skills as we use the AERD to produce reports on safety practices, particularly trauma-informed safety practices.
Since there is no other AERD for acupuncture, we’re figuring this out as we go along. You can send us feedback through the AERD site, and for POCA members, here’s a thread on the forums where we’ll be discussing its use. We’ll need to tinker with the site and the survey as we go, but we won’t know what to change until folks start using it, so please don’t hesitate, there’s no time like the present!
So glad to see this!
I really don’t remember the safety questions part of the JTA. Were they asking whether people had had adverse events?
I don’t remember that either. It seems like in the JTA format, that the questions would be about what you do in relationship to adverse events and errors. Does anybody else remember? If not, I can submit this question to the NCCAOM in my next batch of questions. That’s how I’m hoping this blog format will work — I ask questions, the NCCAOM answers them, and then people think of more questions, and so on until we can clear everything up. Thanks!
Just double-checked data from the 2013 JTA —
of the 1435 who answered the question about Diplomate status, 1007 were Dipl AC, 245 had Dipl CH, and 478 OM. 70 were not Diplomates.
Not necessarily relevant to this post, but if the JTA is where they get the safety data, doesn’t seem like they’ve got away to compare Active and non-Active (since if you aren’t active you’re not a Diplomate).
Actually I do think it’s relevant. There’s a lot to think about in terms of the relationship of credentialing and safety, and context and comparisons are vital.
One of the reasons I’m invested in our AERD is that I think it’s a mistake to reduce safety to an issue of credentialing, or always frame credentialing as being about safety. You can’t establish a culture of safety with a credentialing process alone. And it’s really important to be clear when credentialing is justified by invoking public safety, but public safety issues are not what initiated the credentialing itself.
One of my questions to the NCCAOM which I hope we’ll address in future posts is, what data do we have that compares adverse events in states that require certain credentials (or active certification) vs. states that don’t? So thanks for giving that particular question an introduction.
In general, I think issues of safety and credentialing have gotten really muddled in a lot of our minds (mine included) and it’s worth putting some real effort into un-muddling them.
I hope that after so much data is collected, we have a good argument for cheaper malpractice insurance.
I don’t think the malpractice companies need or care about our data. I don’t know if they have to set their rates based on safety, but if they do, they know what the payouts are like.
(It’s worth remembering that there is a difference between adverse events and malpractice.)
Which raises a very interesting question — I don’t recall the insurance companies asking if I had active status. Is malpractice insurance less in states with tiered licensure? In states that don’t require active status?
Just wanting to double-check — are you hoping that all Acupuncturists use this reporting site, or is primarily for CA providers?
We hope that anyone who provides acupuncture services will use this database! Thanks for asking!