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Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project
Gordon D Schiff1, Harry Reyes Nieva, Paula Griswold
1*Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital †Harvard Medical School, Boston, MA ‡Johns Hopkins Bloomberg School of Public Health, Baltimore, MD §Massachusetts Coalition for the Prevention of Medical Errors, Burlington ∥Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, MA ¶North Shore Medical Center, Salem #Institute for Healthcare Improvement, Cambridge **Risk Management Foundation of the Harvard Medical Institutions (CRICO) ††Coverys Corporation; One Financial Center ‡‡Harvard T.H. Chan School of Public Health §§Center for Surgery and Public Health, Brigham and Women's Hospital ∥∥Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.
Objective:
Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas.
Study Setting:
In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts.
Study Design:
Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools.
Data Collection Methods:
Chart reviews conducted at baseline and postintervention for intervention sites. Staff and patient survey data collected at baseline and postintervention for intervention and control sites.
Principal Findings:
Chart reviews demonstrated significant improvements in documentation of abnormal results, patient notification, documentation of an action or treatment plan, and evidence of a completed plan (all P<0.001). Mean days between laboratory test date and evidence of completed action/treatment plan decreased by 19.4 days (P<0.001). Staff surveys showed modest but nonsignificant improvement for intervention practices relative to controls overall and for the 3 high-risk domains that were the focus of PROMISES.
Conclusions:
A consortium of stakeholders, quality improvement tools, coaches, and learning network decreased selected ambulatory safety risks often seen in malpractice claims.
