MALPRACtice Insurers' Medical Error Prevention Study

MALPRACtice 保险公司的医疗错误预防研究

• 批准号: 6449743
• 负责人: DAVID M STUDDERT
• 金额: $ 138.07万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-30 至 2004-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6449743
• 关键词: clinical research; cooperative study; disease /disorder prevention /control; health care personnel performance; health care quality; health service demonstration project; human subject; iatrogenic disease; malpractice /misconduct; organized financing; patient care

Goals. The 5 study goals are: 1) to harness the potential of malpractice insurance programs to operate as a nationwide error reporting system; 2) to identify the most frequent factors contributing to errors found in a focused review of malpractice claims files; 3) to test case-control analysis as a method of quantifying the role of various contributing factors to the occurrence of specific errors; 4) to assess how the patterns of errors and contributing factors detected through claims file analysis compare to those identified in other reporting systems; 5) to use claims data to facilitate design and implementation of a series of targeted patient safety interventions. Methods. Approximately 3,000 claims files from 6 large malpractice insurers will be analyzed. (Together, these insurers cover approximately 35,000 physicians, 60 acute care hospitals, and more than 100 outpatient facilities in 15 states). Using structured review methods, physician reviewers will identify errors, describe their consequences, and judge the contributing role of a wide range of human factors, including environmental conditions (e.g. workload, technology, interruptions), team/group behavior (e.g. inadequate hand-off, communication failures, lack of supervision, failure to follow/break established protocols), and individual factors (e.g. inexperience, technical incompetence). Descriptive analytical techniques will be used to isolate the combinations of factors that are most frequently implicated in specific errors within each of the clinical categories. Two supplementary data sources will support more in-depth analyses: 1) human factors information on 400 "potential claims" reported to risk managers at 5 hospitals; 2) reviews of 720-1280 medical records ("controls"). These data will allow: a) comparison of factors that contributing to errors in potential claims with those detected in actual claims; (b) 3-4. case-control analyses to designed to help target interventions by isolating those factors that are the key causes of specific errors. Interventions. Study findings will guide identification and design of a series of interventions at institutions covered by the participating insurers. Investigators will facilitate institutions' choice, design, and implementation of interventions through: recruitment and orientation of Coordinating Teams; recruitment of Intervention Teams; support of Intervention Teams through a Safety Collaborative, which will include site

的目标。这5个研究目标是：1)利用医疗事故保险计划的潜力，将其作为一个全国性的错误报告系统来运行；2)在对医疗事故索赔文件的集中审查中，确定导致错误的最常见因素；3)检验病例-对照分析作为一种量化各种因素对特定错误发生的作用的方法；4)评估通过索赔文件分析发现的错误模式和促成因素与其他报告系统中发现的错误模式和促成因素的比较；5)利用索赔数据促进设计和实施一系列有针对性的患者安全干预措施。方法。将分析6家大型医疗事故保险公司的约3000份索赔文件。（这些保险公司总共覆盖了15个州的大约3.5万名医生、60家急症护理医院和100多家门诊机构）。使用结构化审查方法，医师审稿人将识别错误，描述其后果，并判断各种人为因素的影响作用，包括环境条件（例如工作量，技术，中断），团队/群体行为（例如交接不足，沟通失败，缺乏监督，未能遵循/打破既定协议）和个人因素（例如缺乏经验，技术无能）。描述性分析技术将用于分离在每个临床类别中最常涉及特定错误的因素组合。两个补充数据来源将支持更深入的分析：1)向5家医院的风险管理人员报告的400个“潜在索赔”的人为因素信息；2) 720-1280份医疗记录的审查（“对照”）。这些数据将允许：a)将导致潜在索赔错误的因素与实际索赔中发现的因素进行比较；(b) 3 - 4。病例对照分析旨在通过隔离导致特定错误的关键因素来帮助有针对性的干预措施。干预措施。研究结果将指导确定和设计参与保险公司所涵盖的机构的一系列干预措施。调查人员将通过以下方式促进机构对干预措施的选择、设计和实施：协调小组的招聘和指导；招募干预小组；通过安全协作，包括现场，支持干预小组