Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project.
Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project.
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减少门诊医疗事故和安全风险的随机试验：马萨诸塞州承诺项目的结果。
作者：
Schiff,GordonD;ReyesNieva,Harry;Griswold,Paula;Leydon,Nicholas;Ling,Judy;Federico,Frank;Keohane,Carol;Ellis,BonnieR;Foskett,Cathy;Orav,EJohn;Yoon,Catherine;Goldmann,Don;Weissman,JoelS;Bates,DavidW;Biondolillo,Madeleine;
目的：评价质量改进方法在关键门诊医疗事故风险和安全领域的应用。（16项干预; 9项对照）在马萨诸塞州进行。研究设计：15个月干预的对照试验，包括接触学习网络、网络研讨会、面对面会议和改进顾问针对“3+ 1”高风险领域的辅导：测试结果、转诊和药物管理，以及通过调查和图表审查工具评估的文化/沟通问题。数据收集方法：在基线和干预后对干预部位进行图表审查。工作人员和病人的调查数据收集在基线和干预后的干预和对照sites.Principal调查结果：图表审查证明显着改善文件的异常结果，病人的通知，文件的行动或治疗计划，并完成计划的证据（所有P< 0.001）。实验室检查日期和完成行动/治疗计划的证据之间的平均天数减少了19.4天（P< 0.001）。工作人员的调查显示，适度的，但不显着的改善干预措施相对于控制整体和3个高风险域的重点PROMISES.Conclusions：一个财团的利益相关者，质量改进工具，教练，学习网络减少选定的门诊安全风险经常看到的医疗事故索赔。
Objective:Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas.Study Setting:In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts.Study Design:Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting “3+ 1” high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools.Data Collection Methods:Chart reviews conducted at baseline and postintervention for intervention sites. Staff and patient survey data collected at baseline and postintervention for intervention and control sites.Principal Findings:Chart reviews demonstrated significant improvements in documentation of abnormal results, patient notification, documentation of an action or treatment plan, and evidence of a completed plan (all P< 0.001). Mean days between laboratory test date and evidence of completed action/treatment plan decreased by 19.4 days (P< 0.001). Staff surveys showed modest but nonsignificant improvement for intervention practices relative to controls overall and for the 3 high-risk domains that were the focus of PROMISES.Conclusions:A consortium of stakeholders, quality improvement tools, coaches, and learning network decreased selected ambulatory safety risks often seen in malpractice claims.