Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project

Abstract

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.

Figure 1

Abnormal test result documentation and follow-up among intervention practices. (a) Percentage of abnormal test results without appropriate documentation or follow-up at baseline and post-intervention. (b) Days until evidence of completed action plan or referral for abnormal test results at baseline and post-intervention.