Medical Malpractice and Patient Safety Proposal

医疗事故和患者安全提案

• 批准号: 8015453
• 负责人: Madeleine Biondolillo
• 金额: $ 291.26万
• 依托单位: MASSACHUSETTS STATE DEPT OF PUB HEALTH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8015453
• 关键词: Medical; Malpractice; Patient; Safety; Proposal

DESCRIPTION (provided by applicant): Reducing medical malpractice in ambulatory care represents a priority area that has been relatively neglected in the face of more dramatic and costly inpatient errors. Given shifts in care, increasing stresses on office practices, growing evidence of unreliable office processes, and recent experience of our malpractice insurance carriers, neither complacency nor resignation to the problems of ensuring safe patient-centered office care can be justified. Working with the two leading malpractice insurers in Massachusetts, we have assembled a consortium to improve patient safety and decrease malpractice risk in ambulatory practice-the Proactive Reduction in Outpatient Malpractice: Improving Safety, Efficiency and Satisfaction (PROMISES) project. We would work with leading quality improvement and safety experts to employ state-of-the art approaches and tools to achieve breakthrough changes in sixteen demonstration practices. The project has the following three specific aims: AIM 1. Apply evidence from malpractice claims to identify key failure modes contributing to ambulatory medical errors and malpractice suits in order to redesign systems and care processes to prevent, minimize, and mitigate such errors in a group of Massachusetts primary care practices. We will target problem-prone processes in 3 areas of identified risk: 1) medication management, 2) test ordering and results management 3) follow-up and referral management AIM 2. Transform communication culture, processes and outcomes in demonstration practices to become more patient and family-centered, particularly around proactively seeking out, hearing, handling, and learning from patients' safety experiences, concerns and complaints. AIM 3. In conjunction with key Massachusetts policy leaders, liability insurers, clinical, academic, quality improvement and consumer organizations, we will evaluate and disseminate the lessons learned and share successful intervention tools and strategies statewide with a broader audience of practices, practitioners, payers, and policy makers. The intervention would be designed as a randomized control trial comparing 16 demonstration practices with 16 control practices, each with 2-5 primary care providers recruited by the malpractice insurers. We will measure the effects of the improvement efforts using rigorous quantitative and qualitative data from staff interviews, patient surveys and chart review. We will then spread the successful tools, improvements, and lessons statewide. PUBLIC HEALTH RELEVANCE: Previous studies found that malpractice was common, but malpractice suits failed to illuminate the seven of every eight cases where preventable harm occurred. We propose to focus on outpatient practice where most health care is delivered and where the majority of malpractice claims now originate. Legal advocates and medical professionals agree that a more productive focus would be to reduce errors from occurring in the first place. Employing a public health approach, we propose to more effectively engage clinicians, patients, malpractice insurers, and the state public health agency to ensure more timely mitigation of medical errors that occur in outpatient practices, and enhance communication around all aspects of care, particularly in problematic cases.

描述（由申请人提供）：减少门诊护理中的医疗事故是一个优先领域，在面对更戏剧性和昂贵的住院错误时相对被忽视。考虑到护理的转变，对办公室实践的压力越来越大，越来越多的证据表明办公室流程不可靠，以及我们的医疗事故保险公司最近的经验，确保以病人为中心的安全办公室护理的问题，既不能自满，也不能辞职。 我们与马萨诸塞州两家领先的医疗事故保险公司合作，组建了一个联盟，以提高患者安全和减少门诊医疗事故的风险--主动减少门诊医疗事故：提高安全性、效率和满意度（PROMISES）项目。我们将与领先的质量改进和安全专家合作，采用最先进的方法和工具，在16个示范实践中实现突破性的变化。该项目有以下三个具体目标： AIM 1.应用医疗事故索赔的证据，以确定关键的故障模式，有助于流动医疗错误和医疗事故诉讼，以重新设计系统和护理流程，以防止，最大限度地减少和减轻这种错误在一组马萨诸塞州初级保健的做法。我们将针对3个已确定风险领域中容易出现问题的流程：1）药物管理，2）测试订购和结果管理，3）随访和转诊管理 AIM 2.在示范实践中转变沟通文化、流程和结果，使其更加以患者和家庭为中心，特别是主动寻找、倾听、处理和学习患者的安全体验、担忧和投诉。 AIM 3.在与关键马萨诸塞州的政策领导人，责任保险公司，临床，学术，质量改进和消费者组织一起，我们将评估和传播经验教训，并分享成功的干预工具和策略全州范围内的做法，从业人员，付款人和政策制定者的更广泛的受众。 干预将被设计为一个随机对照试验，比较16个示范实践与16个对照实践，每个实践有2-5个由医疗事故保险公司招募的初级保健提供者。我们将使用来自员工访谈、患者调查和图表审查的严格定量和定性数据来衡量改进工作的效果。然后，我们将在全州范围内传播成功的工具，改进和经验教训。 公共卫生关系：以前的研究发现，医疗事故很常见，但医疗事故诉讼未能说明每八个案例中有七个发生了可预防的伤害。我们建议把重点放在门诊实践中，大多数医疗保健是提供和大多数医疗事故索赔现在起源。法律的倡导者和医学专业人士一致认为，一个更有成效的重点将是减少错误的发生摆在首位。采用公共卫生方法，我们建议更有效地让临床医生，患者，医疗事故保险公司和州公共卫生机构参与，以确保更及时地缓解门诊实践中发生的医疗错误，并加强围绕护理各个方面的沟通，特别是在有问题的情况下。

项目成果

Integrating: A managerial practice that enables implementation in fragmented health care environments.

整合：一种能够在分散的医疗保健环境中实施的管理实践。

• DOI: 10.1097/hmr.0000000000000114
• 发表时间: 2017
• 期刊: Health care management review
• 影响因子: 2.5
• 作者: Kerrissey,Michaela;Satterstrom,Patricia;Leydon,Nicholas;Schiff,Gordon;Singer,Sara
• 通讯作者: Singer,Sara

Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project.

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。

• DOI: 10.1097/mlr.0000000000000759
• 发表时间: 2017
• 期刊: Medical care
• 影响因子: 3
• 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

We have strict statutes and most biting laws--reply.

我们有严格的法规和最严厉的法律——答复。

• DOI: 10.1001/jamainternmed.2014.764
• 发表时间: 2014
• 期刊: JAMA internal medicine
• 影响因子: 39
• 作者: Schiff,GordonD;Biondolillo,Madeleine
• 通讯作者: Biondolillo,Madeleine