CRP Certification: Promoting Accountability and Learning After Adverse Events

CRP 认证：在不良事件发生后促进问责制和学习

• 批准号: 9072668
• 负责人: THOMAS Henry GALLAGHER
• 金额: $ 24.02万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9072668
• 关键词: CRP; Certification; Promoting; Accountability; Learning

 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.

 描述（由申请人提供）：沟通和解决方案（CRP）是一种快速出现的创新，用于促进以患者为中心的问责制和不良事件后的学习。然而，供应商担心，通过使用CRP来应对患者受伤可能会引发州医疗委员会等监管机构的参与，从而产生不可预测的惩罚性后果。我们与华盛顿州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、可能具有开创性的解决方案，这一过程被称为CRP认证。CRP认证涉及一个由CRP专家和患者倡导者组成的小组，审查自愿提交的CRP病例，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，患者解决方案，传播学习）。符合此标准的病例将被“CRP认证”。预计MQAC将在不施加纪律的情况下关闭CRP认证的案件。涉及严重不称职、供应商受损或违反边界的案件不符合资格。我们提出了一个为期3年的CRP认证计划的示范项目，其具体目标如下：1）在华盛顿州试点测试和评估CRP认证计划; 2）在另外两个州扩展和评估CRP认证计划; 3）分析与全国范围内开展CRP认证计划相关的政策和伦理问题。我们预计，在项目实施过程中，将有大约200个案例提交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置进行描述性分析，包括评估州医学委员会无纪律认证和病例关闭的病例水平预测因素; 2）审查州医学委员会记录，以描述委员会如何回应CRP认证病例; 3）与机构风险管理人员，责任保险公司，医学委员会成员，患者倡导者进行关键线人访谈，和参与医生探讨他们对CRP认证计划的优点和缺点的看法; 4）与患者倡导者举行焦点小组会议; 5）调查提交CRP认证申请的医生。此外，我们将分析围绕CRP认证的核心政策和道德问题，包括其与国家执业者数据库报告要求的潜在关系，扩展到高绩效机构CRP的认证，并与可能的按绩效付费激励措施联系起来，扩展到包括其他卫生专业委员会和监管机构，以及作为州委员会纪律处分替代品的适用性。CRP和州医学委员会之间围绕不良事件反应的密切合作对于激励医生参与CRP，促进更有力地使用所有关键CRP元素，并加强以患者为中心的问责制和学习至关重要。