Longitudinal Evaluation of the Patient Safety and Medical Liability Reform Demonstration Program
On September 9, 2009, President Obama directed the Secretary of the U.S. Department of Health and Human Services (HHS), who assigned AHRQ to establish an initiative that would help States and health systems test models that meet the following goals:
- Put patient safety first by reducing preventable injuries.
- Foster better communication between doctors and patients.
- Ensure fair and timely compensation for medical injuries while reducing malpractice litigation.
- Reduce liability premiums.
Responding to the President’s directive, in October 2009, the Agency for Healthcare Research and Quality (AHRQ) announced two funding opportunities for the clinical and research communities to participate in AHRQ’s Patient Safety and Medical Liability Reform Initiative. The goal of this initiative was to improve the overall quality of health care by making patient safety the primary goal. In doing so, the effort aimed to connect medical liability to patient safety and quality. In addition, the initiative attempted to move toward a systems-oriented approach to learning and improvement that has been embraced by the patient safety movement. Under the initiative, the Agency sought to fund:
- Demonstration grants. Grants for up to 3 years for up to $3 million each were to be awarded on a competitive basis to States and health systems to develop, implement, and evaluate medical liability models that met the above goals.
- Planning grants. Grants for up to 1 year for up to $300,000 each were to be awarded on a competitive basis to States and health systems to test patient safety and medical liability innovations that met the above goals.
All applications underwent rigorous peer review by independent, scientific experts. Award decisions were based on peer review, program balance, technical merit, and feasibility.
In June 2010, AHRQ announced $23.2 million in funding for seven 3-year demonstration grants ($19.7 million total), thirteen 1-year planning grants ($3.5 million total), and a contract to evaluate the overall initiative and its projects. The total amount awarded and the number of awards depended upon the number, quality, duration, and costs of the applications received.
In general, the seven demonstration projects funded focused on three main approaches to improving patient safety and reducing medical liability:
- Preventing Harm through Best Practices. These projects sought to improve care in clinical areas that frequently are the subject of a large number of medical malpractice claims.
- Improving Communication with Patients. These projects sought to understand how health care providers can best communicate medical errors and incidents of medical negligence to patients and their families so that all involved understand the situation and their options for prompt and fair resolution.
- Alternative Methods of Settling Claims. These projects sought to improve dispute resolution after a malpractice claim has been filed to help prevent protracted legal battles that delay resolutions for patients and families.
And, generally, the thirteen planning projects funded covered three main areas, although there was some overlap in activities:
- Improving patient safety. These projects sought to improve patient safety by measuring safety problems, characterizing adverse events, and conducting clinical safety interventions.
- Improving communication. These projects addressed improved communication by assessing attitudes toward error and harm disclosure and implementing communication interventions in clinical environments.
- Exploring resolution methods. These projects focused on medical liability interventions – variations of a disclosure, apology, and offer (DA&O) model as well as a safe harbor model.
The final demonstration and planning grant evaluation reports reflect a comprehensive evaluation of the initiative and assessment of findings from the multiple grants and across the entire initiative.