- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01758315
Proactive Reduction of Outpatient Malpractice: Increasing Safety, Efficiency, and Satisfaction (PROMISES)
Medical Malpractice and Patient Safety Proposal
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Reducing medical malpractice in ambulatory care represents a priority area that has been relatively neglected in the face of more dramatic and costly inpatient errors. Given shifts in care, increasing stresses on office practices, growing evidence of unreliable office processes, and recent experience of our malpractice insurance carriers, neither complacency nor resignation to the problems of ensuring safe patient-centered office care can be justified. Working with the two leading malpractice insurers in Massachusetts, we have assembled a consortium to improve patient safety and decrease malpractice risk in ambulatory practice-the Proactive Reduction in Outpatient Malpractice: Improving Safety, Efficiency and Satisfaction (PROMISES) project. We work with leading quality improvement and safety experts to employ state-of-the art approaches and tools to achieve breakthrough changes in demonstration practices. The project has the following three specific aims:
AIM 1. Apply evidence from malpractice claims to identify key failure modes contributing to ambulatory medical errors and malpractice suits in order to redesign systems and care processes to prevent, minimize, and mitigate such errors in a group of Massachusetts primary care practices. We will target problem-prone processes in 3 areas of identified risk: 1) medication management, 2) test ordering and results management 3) follow-up and referral management.
AIM 2. Transform communication culture, processes and outcomes in demonstration practices to become more patient and family-centered, particularly around proactively seeking out, hearing, handling, and learning from patients' safety experiences, concerns and complaints.
AIM 3. In conjunction with key Massachusetts policy leaders, liability insurers, clinical, academic, quality improvement and consumer organizations, we will evaluate and disseminate the lessons learned and share successful intervention tools and strategies statewide with a broader audience of practices, practitioners, payers, and policy makers. The intervention would be designed as a randomized control trial comparing 16 demonstration practices with 9 control practices, each with 2-5 primary care providers recruited by the malpractice insurers. We will measure the effects of the improvement efforts using rigorous quantitative and qualitative data from staff interviews, patient surveys and chart review. We will then spread the successful tools, improvements, and lessons statewide.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02120
- Brigham and Women's Hospital
-
Boston, Massachusetts, United States, 02111
- Massachusetts Department of Public Health
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Primary Subjects: staff members of small to medium-sized primary care (internal medicine or family medicine) practices in Massachusetts with adult, English-speaking patients.
- Secondary Subjects: English-speaking adults who receive care at an enrolled intervention or control office practice.
Exclusion Criteria:
- Non-English-speaking
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Improvement Sessions
We will implement a context-sensitive collaborative improvement model that will emphasize training and in-office coaching by quality improvement, efficiency and safety experts, as well as shared learning methods to develop, test and implement changes in the following four key risk areas: medication management; test and lab results management; follow-up and referral management; and communication - within and between practices as well as with patients.
|
Participating practices will be coached to perform rapid, small-scale tests of change and to iteratively improve performance of problem-prone care systems, as well as to imbed simple measurement in routine daily work streams to guide improvement efforts.
The sixteen intervention practices will serve as realistic research laboratories to help advance malpractice risk prevention and patient safety in specific areas by refining tools and strategies for smaller practices.
|
No Intervention: Control
Control practices will not receive training or in-office coaching.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Staff and patient survey response distribution related to lab test result tracking, referral follow-up, medication management, and communication with patients and among practice staff
Time Frame: Baseline and 15 months
|
Evidence of change in the distribution of staff and patient survey responses related to lab test result tracking, referral follow-up, medication management, and communication with patients and among practice staff
|
Baseline and 15 months
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Number of abnormal lab or test results with improper clinical follow-up
Time Frame: Baseline and 15 Months
|
Baseline and 15 Months
|
Number of specialist referral recommendations with improper clinical follow-up
Time Frame: Baseline and 15 Months
|
Baseline and 15 Months
|
Number of contraindicated medication prescriptions
Time Frame: Baseline and 15 Months
|
Baseline and 15 Months
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Madeleine Biondolillo, MD, Massachusetts Department of Health
- Study Chair: Gordon Schiff, MD, Brigham and Women's Hospital
- Study Director: Nicholas Leydon, MPH, Massachusetts Department of Health
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- AHRQ HS10-021
- 1R18HS019508-01 (U.S. AHRQ Grant/Contract)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Patient Safety
-
Radboud University Medical CenterZonMw: The Netherlands Organisation for Health Research and DevelopmentTerminatedPatient Empowerment | Patient Safety | Medication SafetyNetherlands
-
Anne Estrup OlesenAalborg University; University College of Northern Denmark; Aalborg KommuneRecruitingPatient Safety | Medication SafetyDenmark
-
Fundació d'investigació Sanitària de les Illes...Andalusian School of Public Health; Fundación Avedis Donabedian; IDIAP JORDI GOL and other collaboratorsNot yet recruiting
-
NHS Education for ScotlandRecruitingPatient SafetyUnited Kingdom
-
University of California, San FranciscoCompleted
-
VA Office of Research and DevelopmentUniversity of California, San FranciscoNot yet recruiting
-
University Health Network, TorontoSunnybrook Health Sciences Centre; Sinai Health SystemCompleted
-
Johannes Gutenberg University MainzCompleted
-
Fundació d'investigació Sanitària de les Illes...Ministerio de Economía y Competitividad, SpainUnknown
-
Ottawa Hospital Research InstituteCompleted
Clinical Trials on Training and in-office coaching
-
Georgetown UniversityNational Cancer Institute (NCI); Temple UniversityCompletedColorectal CancerUnited States
-
Hospices Civils de LyonTerminatedAlzheimer DiseaseFrance
-
University of Campania "Luigi Vanvitelli"RecruitingPain, PostoperativeItaly
-
Eastern Mediterranean UniversityCompletedWork-Related ConditionCyprus
-
Johns Hopkins UniversityCompleted
-
University of Campania "Luigi Vanvitelli"CompletedEndometrial Hyperplasia | PCOS | Infertility, FemaleItaly
-
Albany Medical CollegeEnrolling by invitation
-
Lina ZhangZhejiang Chinese Medical UniversityNot yet recruitingCardiopulmonary
-
Texas Christian UniversityRecruitingSubstance Use | Opioid UseUnited States
-
Jens RosenauAbbVieRecruiting