Transitional Care Medication Safety and Medical Liability: Closing the Chasm

描述(由申请人提供)：当患者从医院出院到家庭护理时，有效的风险管理策略几乎不存在，这些策略确保了药物信息的准确传输，提高了患者的安全性，并将护理过渡期间的医疗责任降至最低。用药错误是出院后最常见的不良事件(Greenwald，Denham，&Jack，2007)；随后，当患者受到伤害时，这些错误会引发医疗事故索赔(Rothschild等人，2002)。迫切需要将用药风险管理与新兴的过渡护理模式联系起来。这一应用的总体目标是在医院向社区过渡期间提高用药安全和护理质量，从而改善患者结局，减少不良事件和成本，包括医疗责任。一旦获得资金，由护士、药剂师、护士律师、一名医生和一名卫生政策经济学家组成的跨学科团队将调查两个具体目标。首先，该小组将评估与复杂医疗保健系统内医院向社区过渡期间的药物差异、不良事件和医疗责任相关的前置因素、结构、过程和结果因素。将完成统计分析和系统审查，以评估适用于法定、监管和上诉判例法时与ADR相关的医疗责任风险。其次，该团队将设计可整合到过渡期护理中的最佳实践风险管理战略。使用一个耸人听闻的概念框架，由利益相关者组成的焦点小组，包括患者、医疗保健提供者、健康计划管理人员和律师，将被要求反思或理解药物差异和医疗责任数据。然后，可以设计和成功实施基于证据的风险管理战略，以最大限度地提高医院向社区护理过渡期间的用药安全。拟议的规划拨款意义重大，因为它将阐明在从医院向社区过渡期间与药物差异相关的实际法律风险，并将确定风险管理战略，以改善患者安全，同时将医疗责任降至最低。总而言之，这些结果预计将成为卫生保健系统的蓝图，以便主动将药物风险管理战略纳入新兴的过渡性护理模式。卫生政策的变化即将到来，这将需要为大多数患者(如果不是所有患者)提供持续的护理。因此，随后可以测试、复制和传播制定的风险管理策略，以提高患者的用药安全性，从而减少不良事件和医疗责任。患者的预后将得到改善，总体医疗成本将得到降低。在成功完成后，将证明将药物风险管理努力整合到过渡性全面(而不是间歇性)护理模式中的可行性，以确保患者的安全、质量和成本效益，同时减少医疗责任。 公共卫生相关性：这一规划拨款旨在通过为卫生系统提供质量改进蓝图，使其在实施医院向社区护理过渡模式时使用，从而促使所有利益相关者进行深思熟虑、彻底和富有成效的努力，从根本上推进药物安全科学，减少不良事件，并将医疗责任降至最低。通过这样做，这笔赠款解决了AHRQ在打击医疗差错和改善患者安全方面的全国性努力。随后，可以测试、复制和传播制定的风险管理战略，以提高患者的用药安全性；患者的结果将得到改善，并将实现更低的总体医疗成本。

DESCRIPTION (provided by applicant): Effective risk management strategies that assure accurate transfer of medication information, improve patient safety and minimize medical liability during care transitions when patients discharge from the hospital to home care, are virtually nonexistent. Medication errors are the most prevalent adverse event following hospital discharge (Greenwald, Denham, & Jack, 2007); subsequently, these errors trigger malpractice claims when patients are harmed (Rothschild et al., 2002).There is a critical need to proactively link medication risk management to emerging transitional care models. The overall objective of this application is to improve medication safety and quality of care during the hospital to community transition, thereby improving patient outcomes and reducing adverse events and costs, including medical liability. When funded, the interdisciplinary team of nurses, pharmacists, nurse attorneys, a physician and a health policy economist will investigate two specific aims. First, the team will evaluate antecedent, structure, process, and outcome factors associated with medication discrepancies, adverse events, and medical liability during hospital to community transitions within a complex health care system. Statistical analyses combined with systematic review to evaluate the medical liability risk associated with ADRs when applied to statutory, regulatory and appellate case law will be completed. Second, the team will design best practice risk management strategies that can be integrated into transitional care. Using a sensemaking conceptual framework, focus groups comprised of stakeholders, including patients, health care providers, health plan administrators and attorneys, will be asked to reflect on, or make sense of, the medication discrepancy and medical liability data. Evidence based risk management strategies to maximize medication safety during hospital to community care transitions can then be designed, and successfully implemented. The proposed planning grant is significant because it will elucidate the actual legal risk associated with medication discrepancies during the transition from hospital to the community, and, it will identify risk management strategies to improve patient safety while minimizing medical liability. Combined, these outcomes are expected to serve as a blueprint for health care systems to proactively integrate medication risk management strategies into emerging transitional care models. Health policy changes that will require continuity of care for most, if not all patients, are imminent. As such, developed risk management strategies can subsequently be tested, replicated and disseminated to improve patient medication safety thereby reducing adverse events and medical liability. Patient outcomes will be improved and lower overall health care costs will be realized. Upon successful completion, the feasibility of integrating medication risk management efforts into transitional comprehensive, rather than episodic care, models to assure patient safety, quality, and cost-effectiveness while reducing medical liability will be demonstrated. PUBLIC HEALTH RELEVANCE: This planning grant is intended to engage all stakeholders in a thoughtful, thorough and productive effort to fundamentally advance medication safety science, reduce adverse events and minimize medical liability, by providing health systems with a quality improvement blueprint to use when implementing hospital to community care transition models. In so doing, this grant addresses AHRQ's national effort to combat medical errors and improve patient safety. Subsequently, developed risk management strategies can be tested, replicated and disseminated to improve medication safety for patients; patient outcomes will be improved and lower overall health care costs will be realized.