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与监管机构合作以在医疗差错后支持质量和问责制:沟通与解决计划认证试点项目

Collaboration with Regulators to Support Quality and Accountability Following Medical Errors: The Communication and Resolution Program Certification Pilot.

作者信息

Gallagher Thomas H, Farrell Michael L, Karson Hannah, Armstrong Sarah J, Maldon John T, Mello Michelle M, Cullen Bruce F

机构信息

University of Washington School of Medicine, Seattle, WA.

Washington State Medical Quality Assurance Commission, Spokane, WA.

出版信息

Health Serv Res. 2016 Dec;51 Suppl 3(Suppl 3):2569-2582. doi: 10.1111/1475-6773.12557. Epub 2016 Sep 7.

DOI:10.1111/1475-6773.12557
PMID:27601424
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5134339/
Abstract

OBJECTIVE

Communication and resolution programs (CRPs) involve institutions responding to adverse events using transparency with patients, event analysis, recurrence prevention, and compensation. Collaboration with regulators around CRPs could enhance health care quality.

SETTING AND PARTICIPANTS

Health care institutions, liability insurers, and the Medical Quality Assurance Commission (MQAC, board of medicine) in Washington State.

STUDY DESIGN

MQAC has collaborated with the Foundation for Health Care Quality (FHCQ) on the CRP Certification pilot. A panel of physicians, risk managers, and patient advocates at FHCQ will review cases for use of the CRP key elements. Cases meeting this standard will be "CRP Certified." If MQAC determines that the CRP enhanced patient safety comparable or better than board action, the Commission may close the case.

PRINCIPAL FINDINGS

Developing this process identified the following issues: (1) protecting information submitted for CRP Certification; (2) determining what information the Commission needs to assess whether additional investigation is warranted; (3) preserving the Commission's responsibility to protect the public while working with health care organizations; and (4) addressing concerns that CRP Certification not shield incompetent providers.

CONCLUSIONS

The CRP Certification program is a promising example of collaboration among institutions, insurers, and regulators to promote patient-centered accountability and learning following adverse events.

摘要

目的

沟通与解决计划(CRP)要求医疗机构在应对不良事件时,对患者保持透明,进行事件分析、预防复发并提供补偿。围绕CRP与监管机构开展合作有助于提高医疗质量。

背景与参与者

华盛顿州的医疗机构、责任保险公司以及医疗质量保证委员会(MQAC,医学委员会)。

研究设计

MQAC与医疗质量基金会(FHCQ)就CRP认证试点项目展开了合作。FHCQ的一个由医生、风险管理人员和患者权益倡导者组成的小组将审查病例,以确定是否使用了CRP的关键要素。符合该标准的病例将被“认证为CRP”。如果MQAC认定CRP在提高患者安全方面与委员会采取的行动相当或更优,委员会可能会结案。

主要发现

制定这一流程发现了以下问题:(1)保护提交用于CRP认证的信息;(2)确定委员会评估是否需要进一步调查所需的信息;(3)在与医疗机构合作时,保留委员会保护公众的责任;(4)解决对CRP认证不会庇护不称职提供者的担忧。

结论

CRP认证项目是机构、保险公司和监管机构之间合作的一个有前景的范例,旨在促进不良事件发生后以患者为中心的问责制和经验教训总结。

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本文引用的文献

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Should Malpractice Settlements Be Secret?医疗事故和解协议应保密吗?
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Implementing hospital-based communication-and-resolution programs: lessons learned in New York City.实施基于医院的沟通与解决计划:纽约市的经验教训。
Health Aff (Millwood). 2014 Jan;33(1):30-8. doi: 10.1377/hlthaff.2013.0849.
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Communication-and-resolution programs: the challenges and lessons learned from six early adopters.沟通与解决计划:来自六个早期采用者的挑战与经验教训
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