Improving Patient Safety and Restructuring Medical Liability Using ACEs

描述（由申请人提供）：该项目的最终目标是制定一项综合计划，为华盛顿州西雅图-塔科马大都市区的主要卫生系统实施综合医疗责任和患者安全计划，以取代现行的侵权制度。新的医疗责任计划将基于对可避免事件类别 (ACE) 发生情况的识别、在可能的情况下向患者（和家属，视情况而定）道歉和立即标准化赔偿，以及一些相关的辅助支持流程。该计划将用于快速识别错误并尽早提供补偿，从而增加获得补偿的患者数量。作为规划拨款的一部分，将制定一项以减少这些 ACE 为目标的重点患者安全培训计划并进行试点测试。规划拨款将由领先的地区卫生系统组成的财团进行，该财团以华盛顿州塔科马市的 Multicare 卫生系统为首。其他卫生系统赠款参与者包括西雅图的瑞典卫生服务中心和西雅图的弗吉尼亚梅森医疗中心。除了这三个大型直接医疗保健提供系统外，协作规划拨款项目的其他参与者还包括华盛顿医疗保健论坛、华盛顿州医学协会、华盛顿州医院协会、几家主要健康保险公司以及该州最大的首选医疗服务提供者组织 First Choice Health。为了完成该计划，该联盟将首先召集一个由当地医疗责任从业者、患者安全领导者和国家专家组成的专家小组，以选择一系列可预防的医疗事件，这些事件将构成 ACE 计划的核心。然后将为这些 ACE 制定标准补偿计划，支付金额根据影响的严重程度和预期持续时间进行分层。将制定个案赔偿确定计划，以涵盖所有其他可预防的医疗责任案件。该综合计划的其他组成部分将包括建立替代性争议解决方案的仲裁或调解程序、通过焦点小组测试患者参与流程、采用既定的提供者道歉流程以及在地区医院试点测试相关的、重点突出的患者安全计划。 公共健康相关性：拟议项目的相关性是充分探索和充实当前基于诉讼的侵权制度方法的综合替代方案来解决医疗责任案件 - 通过为可预防的不良医疗事件创建一个基于证据的合理补偿制度，并与专注于这些可预防事件的医院和医生患者安全培训计划相联系。规划拨款将创建这一系统，该系统的实施将开始将当前的医疗责任环境转变为这样一个过程：提供者接受过避免不良事件的专门培训，立即承认确实发生的错误，并迅速向受伤患者道歉并公平赔偿。这一结果不仅会提高患者的安全性和满意度，而且随着时间的推移，还可以降低护理成本。

DESCRIPTION (provided by applicant): The ultimate goal of this project is to prepare a comprehensive plan for implementing an integrated medical liability and patient safety program for major health systems in the Seattle-Tacoma metropolitan area of Washington State, to be used in lieu of the current tort system. The new medical liability program will be based on identification of the occurrence of Avoidable Classes of Events (ACEs), an apology and immediate, standardized compensation to the patient (and family, as appropriate) when possible, and several related ancillary support processes. This program will be used to quickly identify errors and make early offers of compensation, increasing the number of patients who are compensated. A focused patient safety training program targeting reduction of these same ACEs will be developed and pilot tested as part of the planning grant. The planning grant will be conducted by a consortium of the leading regional health systems, headed by Multicare Health System of Tacoma, Washington. Other health system grant participants include Swedish Health Services of Seattle and Virginia Mason Medical Center, also of Seattle. In addition to these three large direct health care delivery systems, other participants in the collaborative planning grant project are the Washington Healthcare Forum, the Washington State Medical Association, the Washington State Hospital Association, several major health insurers, and First Choice Health, the state's largest preferred provider organization. To complete the plan, the consortium will first convene an expert panel of local medical liability practitioners, patient safety leaders, and national experts to select a broad set of preventable of medical events that will form the core of the ACEs program. Standard compensation schedules will then be developed for these ACEs, with payment amounts stratified by severity and expected duration of the impact. A case-by-case compensation determination program will be developed to cover all other preventable medical liability cases. Other components of the comprehensive program will include establishing an arbitration or mediation process for alternative dispute resolution, testing patient participation processes through focus groups, adopting an established provider apology process, and pilot testing the linked, focused patient safety program at area hospitals. PUBLIC HEALTH RELEVANCE: The relevance of the proposed project is to fully explore and flesh-out a comprehensive alternative to the current litigation-based tort system approach to resolving medical liability cases - by creating an evidence-based, reasonable compensation system for preventable adverse medical events, linked to hospital and physician patient safety training programs focused on these preventable events. The planning grant will create this system, the implementation of which will begin the process of transforming the current medical liability environment to one in which providers are specifically trained on avoiding adverse events, immediately acknowledge those errors which do occur, and rapidly apologize and fairly compensate the injured patient. This outcome will not only improve patient safety and satisfaction but also can, over time, reduce the costs of care.