Medical Malpractice and Patient Safety Proposal

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，在面对更多戏剧性和代价更高的住院错误时，这个领域相对被忽视。鉴于护理的转变、对办公室做法的日益强调、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，确保以患者为中心的安全办公室护理的问题既不能自满也不能听天由命。 与马萨诸塞州两家领先的医疗事故保险公司合作，我们组建了一个联盟，以提高患者的安全，降低门诊医疗中的医疗事故风险--主动减少门诊医疗事故：提高安全、效率和满意度(承诺)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变化。该项目有以下三个具体目标： 目的1.应用医疗事故索赔的证据来确定导致非卧床医疗差错和医疗事故诉讼的关键故障模式，以便重新设计系统和护理流程，以防止、最大限度地减少和减轻马萨诸塞州初级保健实践中的此类差错。我们将针对3个已确定风险的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)跟踪和转诊管理 目标2.改变示范实践中的沟通文化、过程和结果，使之更加以患者和家庭为中心，特别是围绕主动寻找、听取、处理和学习患者的安全经验、关切和投诉。 目标3.我们将与马萨诸塞州的主要政策领导人、责任保险公司、临床、学术、质量改进和消费者组织一起，评估和传播吸取的经验教训，并在全州范围内与更广泛的从业人员、从业者、付款人和政策制定者分享成功的干预工具和战略。 干预措施将设计为一项随机对照试验，比较16种示范做法和16种对照做法，每种做法都有2-5名初级保健提供者由医疗事故保险公司招聘。我们将使用来自工作人员访谈、患者调查和图表审查的严格的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推广成功的工具、改进和经验教训。 与公共健康相关：之前的研究发现，医疗事故很常见，但医疗事故诉讼未能阐明每八起案件中就有七起发生了可预防的伤害。我们建议将重点放在门诊实践上，在那里提供最多的医疗保健，以及现在大多数医疗事故索赔的来源。法律倡导者和医疗专业人士一致认为，更有成效的重点应该是从一开始就减少错误的发生。采用公共卫生方法，我们建议更有效地吸引临床医生、患者、医疗事故保险公司和州公共卫生机构，以确保更及时地减少门诊实践中发生的医疗差错，并加强围绕护理的各个方面的沟通，特别是在有问题的病例中。

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.