An Effective Program to Reduce Malpractice Claims and Payments in a Large Orthopaedic Practice.

BACKGROUND: High reliability in health care requires a balance between intentionally designed systems and individual professional accountability. One element of accountability includes a process for addressing clinicians whose practices are associated with a disproportionate share of patient complaints. This study aimed to evaluate the impact of the Patient Advocacy Reporting System (PARS), a tiered intervention model to reduce patient complaints about clinicians. METHODS: A retrospective cohort study was conducted involving a southeastern U.S. orthopaedic group practice. The study assessed the implementation of the PARS program and subsequent malpractice claims from 2004 to 2020. RESULTS: The implementation of PARS was associated with an 83% reduction in malpractice claims cost per high-risk clinician after intervention (p = 0.05; Wilcoxon rank sum test). The overall practice group experienced an 87% reduction in mean annual claims cost per clinician (p = 0.007; segmented regression). The successful adoption required essential elements such as PARS champions, peer messengers, an Office of Patient Affairs, and a clear statement of practice values and professionalism expectations at the time of onboarding. CONCLUSIONS: The PARS program was successfully adopted within a surgical specialty group as a part of ongoing risk prevention and management efforts. The period following PARS was associated with a retrospectively measured reduction in malpractice claim costs. The PARS program can be effectively implemented in a large, single-specialty orthopaedic practice setting and, although not necessarily causal, was, in our case, associated with a period of reduced malpractice claim costs. CLINICAL RELEVANCE: We have learned in previous research that there are clear links between professionalism and patient outcomes (e.g., surgical complications), but agree that the focus here on medical malpractice is not directly clinical.

Improving the effectiveness of SUD treatment through a national registry.

CONTEXT: Recent research into the effectiveness of abstinence-based substance use disorder (SUD) treatment indicates that there has not been a substantial improvement since the Drug Abuse Treatment Outcome Study research in 1993. Research into medication-supported treatments for SUD are hindered by a dearth of real-world longitudinal outcome studies. Patient registries have dramatically improved survival rates in many diseases by providing researchers with longitudinal data on a broad spectrum of patients undergoing a variety of treatments. Policy prescription: We recommend the creation of a national registry for patients receiving treatment for SUD akin to the Surveillance, Epidemiology, and End Results Program established in 1971 to track cancer patient outcomes. One option would be to expand the data currently being collected in the Treatment Episode Data Set (TEDS) to include all nonpublicly funded treatment and to allow for longitudinal tracking of deidentified individuals. Information on medication use and deaths could be kept up to date through integrations with state-wide death registries and Prescription Drug Monitoring Programs. The TEDS dataset already undergoes extensive data deidentification to make sure individuals cannot be identified prior to releasing the admissions and discharge datasets to researchers. Once longitudinal tracking is available, even more stringent deidentification will be necessary, and access to the dataset would be restricted to public health researchers. CONCLUSION: The development of a registry of individuals undergoing treatment for SUD can be expected to enhance our understanding of the progression of the disease and the relative effectiveness of different treatment modalities for patients with different drug use histories and characteristics.

Implementation of Peer Messengers to Deliver Feedback: An Observational Study to Promote Professionalism in Nursing.

BACKGROUND: The Co-Worker Observation System (CORS) is a tool and a process to address disrespectful behavior through feedback from trained peer messengers. First used by physicians and advanced practice providers (APPs), CORS has been shown to decrease instances of unprofessional behaviors among physicians and APPs. The research team assessed the feasibility and fidelity of implementing CORS for staff nurses. METHODS: CORS was implemented at three academic medical centers using a project bundle with 10 essential implementation elements. Reports of unprofessional behavior among staff nurses that were submitted through the institution's electronic reporting system were screened through natural language processing software, coded by trained CORS coders using the Martinez taxonomy, and referred to a trained peer messenger to share the observations with the nurse. A mixed methods, observational design assessed feasibility and fidelity. RESULTS: A total of 590 reports from three sites were identified by the Center for Patient and Professional Advocacy from September 1, 2019, through August 31, 2021. Most reports included more than one problematic behavior, each of which was coded. Of the peer messages, 76.5% were successfully documented using the debriefing survey as complete, 2.2% as awaiting messenger feedback, and 0.2% as awaiting messenger assignments (total of 78.9 % considered delivered). A total of 21.1% were not shared; 4.7% of reports were intentionally not shared because the issue stemmed from a new system or policy implementation (4.0%) or because of known factors affecting the nurse (0.7%). CONCLUSION: CORS can be implemented with staff nurses efficiently when nursing infrastructure is adequate.