ASCENT is an on-going implementation science project, funded by the Agency for Healthcare Research and Quality, geared towards reducing morbidity and mortality in the outpatient setting by improving patient safety through integrated information technology solutions and workflows. We are made up of an interdisciplinary team of clinicians, researchers and information technology personnel committed to reducing health disparities in the San Francisco Health Network. We hope that our work will not only reduce this disparate burden of disease among San Francisco's most marginalized residents, but we also hope to create workflow and technology solutions that are generalizeable and replicable across the country -- and even the world.

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Despite strides in patient safety, significant gaps remain. Across the board, evidence-based practices have not been consistently implemented. Ambulatory settings remain understudied and lack safety infrastructure and systems. These issues are particularly acute in safety-net health care settings which disproportionately care for low-income, diverse, and vulnerable populations. Therefore, we created a transdisciplinary patient safety learning laboratory, the San Francisco Ambulatory Safety CEnter for iNnovaTion (ASCENT), to develop creative solutions to these safety problems. We aim to bring together design thinking, reliability science, health system innovation and safety research to design and iterate technical and workflow solutions for high-priority ambulatory safety issues. Promising innovations are implemented and evaluated in the San Francisco Health Network using implementation sciences methodology to assess reach, effectiveness, adoption, implementation, and maintenance. We plan to partner with closely affiliated safety-net innovation networks to disseminate and share successes.

ASCENT addresses three specific ambulatory safety problems. First, missed and delayed diagnoses lead to significant morbidity and mortality and represent the leading cause of successful ambulatory malpractice claims. While diagnostic problems are multifactorial, it is clear that lack of timely identification of test results contributes to diagnostic failures and delays. Second, gaps exist in ongoing monitoring of high-risk conditions, such that delays occur in recognizing and ameliorating known adverse effects of treatment. Finally, there is a significant burden of adverse drug events in outpatient care, and patient error in medication self-administration plays a significant role in such errors. These three projects and their progress are discussed in more detail in the "Current Projects" section of this website.

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ASCENT is dedicated to improving the safety of ambulatory populations through health systems innovations. ASCENT will conduct the full spectrum of innovation work in the San Francisco Health Network, starting from interdisciplinary conceptualization, through rigorous evaluation research, to implementation and sustainment of novel approaches to safety. ASCENT will partner with safety-net healthcare delivery systems to disseminate ambulatory safety solutions to safety-net health care systems throughout California. ASCENT seeks to build capacity for trans-disciplinary ambulatory safety innovation at UCSF and across the SF Health Network.