CRP Certification: Promoting Accountability and Learning After Adverse Events

 描述(由申请人提供)：沟通和解决方案(CRPS)是一项迅速崛起的创新，旨在促进以患者为中心的责任追究和不良事件后的学习。然而，提供者担心，通过使用CRP来应对患者伤害可能会引发州医学委员会等监管机构的参与，造成不可预测的惩罚性后果。我们已经与华盛顿州的医学委员会，医疗质量保证委员会(MQAC)合作，开发了一种新颖的、可能具有开创性的修复方法，这一过程被称为CRP认证。CRP认证涉及由CRP专家和患者权益倡导者组成的小组审查自愿提交的CRP案例，以确定响应是否包含所有CRP关键要素(早期事件报告、向患者披露、事件分析和预防计划、与患者一起解决方案、传播学习)。符合这一标准的病例将获得“C反应蛋白认证”。预计MQAC将在不施加纪律的情况下，圆满解决CRP认证的案件。涉及严重不称职、供应商损害或边界违规的案件不符合条件。我们提出了一个为期3年的CRP认证计划示范项目，具体目标如下：1)在华盛顿州对CRP认证计划进行试点测试和评估；2)在另外两个州扩展和评估CRP认证计划；3)分析与在全国范围内推广CRP认证计划相关的政策和伦理问题。我们预计，在整个项目过程中，将有大约200个案例提交给CRP认证小组审查。我们将对CRP认证计划的有效性进行多模式评估。这将包括：1)对提交审查的病例及其处理进行描述性分析，包括评估州医学委员会对认证和无纪律病例结案的预测；2)审查州医学委员会的记录，描述委员会对CRP认证病例的反应；3)对机构风险经理、责任保险公司、医学委员会成员、患者权益倡导者和参与医生进行关键线人访谈，以了解他们对CRP认证计划的优缺点的看法；4)与患者权益倡导者举行焦点小组；以及5)对提交CRP认证申请的医生进行调查。此外，我们将分析围绕CRP认证的核心政策和伦理问题，包括它与国家从业者数据银行报告要求的潜在关系，扩展到高绩效机构CRP的认证和与可能的按绩效付费激励的链接，扩展到包括其他医疗专业委员会和监管机构，以及是否适合作为州委员会纪律处分的替代品。CRPS和州医学委员会在应对不良事件方面的密切合作对于激励医生参与CRPS，促进所有关键CRP元素的更有力地使用，以及加强以患者为中心的责任和学习将是重要的。

 DESCRIPTION (provided by applicant): Communication and Resolution Programs (CRPs) are a rapidly emerging innovation for promoting patient- centered accountability and learning following adverse events. However, providers worry that responding to patient injury by using a CRP could trigger involvement of regulators such as state medical boards with unpredictable and punitive consequences. We have collaborated with Washington State's board of medicine, the Medical Quality Assurance Commission (MQAC), to develop a novel and potentially groundbreaking fix, a process known as CRP Certification. CRP Certification involves a panel of CRP experts and patient advocates reviewing voluntarily submitted CRP cases to determine whether the response contained all the CRP key elements (early event reporting, disclosure to patient, event analysis and prevention planning, resolution with patient, disseminated learning). Cases meeting this standard will be "CRP Certified". It is anticipated that MQAC will close CRP Certified cases as satisfactorily resolved without imposing discipline. Cases involving gross incompetence, provider impairment, or boundary violations are not eligible. We propose a 3-year demonstration project of the CRP Certification Program with the following specific aims: 1) pilot test and evaluate the CRP Certification Program in Washington State; 2) expand and evaluate the CRP Certification Program in two additional states; 3) analyze policy and ethical questions associated with taking the CRP Certification Program to scale nationally. We anticipate that over the course of the project approximately 200 cases will be presented for review by the CRP Certification panel. We will conduct a multi-modal evaluation of the effectiveness of the CRP Certification Program. This will include: 1) descriptive analysis of cases presented for review and their disposition, including assessing case-level predictors of certification and case closure without discipline by the state board of medicine; 2) reviewing state board of medicine records to describe how the boards responded to CRP Certified cases; 3) conducting key informant interviews with institutional risk managers, liability insurers, board f medicine members, patient advocates, and participating physicians to explore their perceptions of the strengths and weaknesses of the CRP Certification Program; 4) holding focus groups with patient advocates; and 5) surveying physicians who submitted CRP Certification Applications. In addition, we will analyze core policy and ethical questions surrounding CRP Certification, including its potential relationship to National Practitioner Data Bank reporting requirements, extension to certification of high-performing institutional CRPs and link to possible pay-for-performance incentives, expansion to include other health professional boards and regulators, and suitability as a substitute for disciplinary action by state boards. Close collaboration between CRPs and state medical boards around the response to adverse events will be important to incentivize physician participation in CRPs, promote more robust use of all key CRP elements, and enhance patient-centered accountability and learning.