Agency for Healthcare Research and Quality Patient Safety and Medical Liability Initiative

Summary of Findings

This progress report provides an update on the seven demonstration projects funded under the Medical Liability Reform and Patient Safety Initiative. The seven projects were funded in 2010 for a total amount of $19.7 million.

On September 9, 2009, President Obama directed the Secretary of Health and Human Services to establish an initiative to help States and health care systems test new models of care delivery, adverse event disclosure, and dispute resolution, with the joint aims of (1) putting patient safety first by reducing preventable injuries; (2) fostering better communication between doctors and patients; (3) ensuring fair and timely compensation for medical injuries, while reducing malpractice litigation; and (4) reducing liability premiums.

In response, the Secretary launched the HHS Patient Safety and Medical Liability (PSML) Initiative in October 2009. Under this initiative, the Agency for Healthcare Research and Quality (AHRQ) funded seven demonstration projects (totaling $19.7 million). Each grant addressed two or more of the Initiative's aims. Of the seven projects, two focused primarily on the use of best practices to reduce harm and liability, one on the use of alternative methods of dispute resolution, and four on improving communication. Below is a table highlighting the projects, their main focus, and selected preliminary results. All but one of the projects were completed in June 2014; the New York court system grant has received an extension through June 2015. AHRQ expects that the projects' final results will be available in 2015.

Project	Main Focus	Selected Preliminary Results
Ascension Health	Prevent Harm Through Best Practices	The project reported a 48% drop in birth injuries caused by difficulties in delivery due to the baby's shoulder becoming lodged behind the mother's pubic bone, a 49% increase in the reporting of serious safety events, and a 57% reduction in the rate of actual and potential obstetric malpractice claims.
Fairview Health Services	Prevent Harm Through Best Practices	The average number of adverse events per 10,000 infant deliveries in participating hospitals was 556 in the first quarter of 2008, and fell to 471 in the fourth quarter of 2012. By contrast, in the comparison hospitals, the figures were 500 and 487, respectively.
New York State Unified Court System	Alternative Methods of Dispute Resolution	The project resulted in a 50% or greater reduction in average time to resolve malpractice claims when compared to a historical baseline for New York City. Claims were resolved in a median of 370 days across courts in Manhattan, Brooklyn, and the Bronx, compared to a historical median of 718 days, 952 days, and 1,266 days, respectively.
University of Illinois at Chicago	Improve Communication	In earlier work, the UIC medical center showed notable improvements in malpractice outcomes and adverse event reporting (including reductions of approximately 50% in both the number of claims and the costs per claim, and an 82% increase in incident reporting). Similar trends were observed at select replication sites, although the impact was not as large.
University of Texas	Improve Communication	Based on 62 interviews conducted using a debriefing method developed through the grant, the results suggest that patients and their families can be key observers to an adverse event that happens to them and could provide critical insights about what took place that are not otherwise known to those analyzing the event.
Massachusetts State Department of Health	Improve Communication	Primary care practices provided positive feedback to exit interviews, focusing largely on the value of interventions such as receiving coaching advice and participating in a learning network of other primary care practices. Potential adverse events in practices that implemented the intervention declined by almost 70% after participation in the project.
University of Washington	Improve Communication	Successful implementation and sustainment of a communication and resolution program is dependent on many factors, and will not be possible without an executive leadership commitment in an organization. This project encountered challenges operating this program outside of a self-insured hospital system, i.e., where two or more insurers were involved. Several preconditions were suggested to overcome this challenge that were not present at the test sites.

Lessons Learned

Four of the seven projects (Ascension Health, Fairview Health Services, the Massachusetts State Department of Health, and the New York State Unified Court System) are reporting encouraging results. Projects at the University of Texas, the University of Illinois, and the University of Washington have uncovered significant barriers for adverse event reporting, patient and family disclosure, and implementation challenges for communication and resolution programs. Nonetheless, the Universities of Illinois and Washington have made a promising start to establishing communication and resolution programs. Researchers are finishing data collection and will soon begin their analysis, and AHRQ expects results in early 2015. Some lessons learned across all the projects include: measuring the intervention's impact on claims is difficult because of a relatively long lag time between an adverse event and the filing of a legal action; changing the culture and processes by which providers and settings handle medical liability and malpractice is a difficult and often lengthy process. In addition, it can be difficult to build the business case for why some interventions, such as communication and resolution programs, should be adopted. This requires leadership and collaboration among all involved in the process.

Next Steps

To extend the reach and impact of the PSML Initiative, AHRQ has launched two additional projects under the PSML umbrella.

The first project, the Safety Program for Perinatal Care, will work with labor and delivery units at 50 participating hospitals to implement perinatal safety interventions that were fielded and tested in two of the PSML demonstration projects. The interventions include safely managing labor-inducing medications and shoulder dystocia (which occurs when the baby's shoulder is lodged behind the mother's pubic bone). These and other interventions are bundled in evidence-based clinical tools and resources. Together with interdisciplinary team training and in-situ simulation, the Safety Program for Perinatal Care creates a comprehensive unit-based approach for labor and delivery. Physicians, nurses and other clinicians at the 50 participating hospitals will receive training and technical assistance from experts, and participate in data collection activities that will measure changes in organizational safety culture and clinical safety outcomes.

In the second project, a comprehensive patient safety and medical liability resource toolkit for communication and resolution programs is being developed, and will be implemented in 14 participating hospitals. Informed by several of the PSML demonstration projects, each hospital can customize the toolkit based on its needs in five core areas: adverse event reporting, process improvement, communication and disclosure, care for the caregiver, and resolution. The evaluation will assess the usability of the tools, as well as each hospital's ability to implement the communication and optimal resolution program, and measure its initial effect on patient safety and medical liability outcomes.

Page last reviewed October 2014

Internet Citation: Agency for Healthcare Research and Quality Patient Safety and Medical Liability Initiative : Summary of Findings. October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/liability/liability_initiative.html