Transitional Care Medication Safety and Medical Liability: Closing the Chasm

过渡护理药物安全和医疗责任：弥合鸿沟

• 批准号: 8015943
• 负责人: Cindy Lou Corbett
• 金额: $ 29.88万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2011-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8015943
• 关键词: Transitional; Care; Medication; Safety; Medical

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.

描述（由申请人提供）：实际上不存在有效的风险管理策略，以确保准确传输药物信息、提高患者安全并在患者出院到家庭护理的护理过渡期间最大程度地减少医疗责任。用药错误是出院后最常见的不良事件（Greenwald、Denham 和 Jack，2007 年）；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，2002）。迫切需要主动将药物风险管理与新兴的过渡护理模式联系起来。该应用程序的总体目标是提高医院向社区过渡期间的用药安全和护理质量，从而改善患者的治疗效果并减少不良事件和成本，包括医疗责任。一旦获得资助，由护士、药剂师、护士律师、医生和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，该团队将评估复杂的医疗保健系统内医​​院向社区过渡期间与药物差异、不良事件和医疗责任相关的前因、结构、过程和结果因素。将完成统计分析与系统审查相结合，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，团队将设计可纳入过渡护理的最佳实践风险管理策略。使用意义建构概念框架，由患者、医疗保健提供者、健康计划管理者和律师等利益相关者组成的焦点小组将被要求反思或理解药物差异和医疗责任数据。然后可以设计并成功实施基于证据的风险管理策略，以最大限度地提高医院到社区护理过渡期间的用药安全。拟议的规划拨款意义重大，因为它将阐明从医院到社区过渡期间与药物差异相关的实际法律风险，并且将确定风险管理策略，以提高患者安全，同时最大限度地减少医疗责任。总而言之，这些结果预计将成为医疗保健系统的蓝图，以主动将药物风险管理策略整合到新兴的过渡性护理模式中。卫生政策的变化迫在眉睫，需要为大多数（如果不是全部）患者提供持续的护理。因此，制定的风险管理策略随后可以进行测试、复制和传播，以提高患者用药安全，从而减少不良事件和医疗责任。患者的治疗效果将得到改善，总体医疗保健成本也将降低。成功完成后，将证明将药物风险管理工作整合到过渡性综合而非间歇性护理模型中的可行性，以确保患者安全、质量和成本效益，同时减少医疗责任。 公共卫生相关性：这项规划拨款旨在让所有利益相关者参与深思熟虑、彻底和富有成效的努力，通过为卫生系统提供质量改进蓝图以供实施医院时使用，从根本上推进药物安全科学，减少不良事件并最大限度地减少医疗责任到社区护理过渡模式。这笔赠款旨在支持 AHRQ 在全国范围内打击医疗差错和改善患者安全的努力。随后，可以测试、复制和传播已制定的风险管理策略，以提高患者的用药安全；患者的治疗效果将得到改善，总体医疗保健成本也将降低。