In other words, I don't know the exposure distribution for the entire source population. However, the small control sample of non-diseased subjects gives me a way to estimate the exposure distribution in the source population. So, I can't compute the probability of disease in each exposure group, but I can compute the odds of disease in each group. We will consider odds ratios and case-control studies in much greater depth in a later module.
Print Perspective Ina Harvard-based research team reported the incidence of medical errors in the state of New York, based on the hospital discharge Case risk of 30, cases. Many organizations, including the National Patient Safety Foundation, the Leapfrog Group, and the Institute for Healthcare Improvement, were formed with the goal of reducing medical error and improving patient safety.
In addition, the Federal government and a number of private foundations joined in this effort by increasing funding for research aimed at reducing medical errors and improving safety. Less often discussed, some of the most successful patient safety initiatives have come from the risk management activities of professional liability insurance companies.
Since its creation inRisk Management Foundation RMF has created a robust program of risk management activities, including dissemination of focused educational programs, case studies, simulation-based training programs, best practices, and published studies.
The importance of claims analysis in driving these activities cannot be overemphasized: RMF analyzes and codes claims that come through its own insurance program which insures 23 hospitals and 12, physicians as well as claims contributed by many other health care organizations.
This coding and analysis allows RMF to identify patterns of errors and of systems failures e. It is worth considering why medical malpractice claims can be such Case risk rich and unique source of insights about patient safety.
A malpractice claim file contains medical documentation, depositions from patients and providers, and expert reviews from across the whole system. The reviews from experts speak to whether or not the provider met the standard of care and, more important, why the care did or did not met that standard.
In this way, such claims differ from other sources of patient safety data in that the information that they provide is both broader and deeper. Malpractice claims move beyond the boundaries that limit the scope of most patient safety data to allow an understanding of the care given to patients across a system.
While many hospitals understand what happens within their own walls, it is often impossible to grasp the course of patients as their care touches physicians' offices, free-standing laboratories, and other medical institutions.
No such restrictions limit the view of what malpractice claims analysis offers.
Further, the information available is deep—providing a close look at the experience of both the patients and providers of care through testimony and depositions. RMF uses this data to initiate efforts to improve patient safety and decrease malpractice risk both within a particular specialty and across organizations.
For example, in the mids, RMF asked the anesthesia chairs of the major teaching hospitals affiliated with Harvard Medical School to review their claims and consider what might be done to improve anesthesia safety. As a direct result of this claim study, the committee developed standards for pulse oximetry monitoring, protocols for intraoperative staffing, and other safety reforms.
Other examples of the benefits of systems-driven analysis informed by claims analysis are seen in three different initiatives. First, in the mids, RMF's loss prevention staff saw an alarming trend in malpractice cases related to breast cancer. The immediate response was to convene clinical leaders and to review the claims and data with them.
The group created a breast care algorithm and educational programs to support it. More recent evidence comes from the Malpractice Insurers Medical Error Prevention Study, a large study of closed malpractice claims in —, which identified and analyzed patterns of risk factors in several key areas including diagnostic failures 9surgery 10and emergency medicine.
Finally, surgical error also lends itself to a multi-pronged approach. The chiefs began this work by developing a set of potentially risky clinical events, or "triggers" Table. The optimal management of these events was felt to require communication between resident physicians and their attendings.
A study of the triggers was then undertaken at the four largest academic teaching hospitals. A postintervention study has shown promising results.
To address that issue, claims analysis can be performed on many levels. For both open [active] and closed claims, the data are carefully deidentified and primarily examined in the aggregate. This ensures that provider, and often even institutional, identities are shielded.
In our experience, such identifying information contributes little to our efforts to improve systems of care. In summary, medical malpractice insurance companies are uniquely positioned to analyze and trend large data sets to drive improvements in patient safety and decrease system risk.
We recommend that organizations use the lessons from malpractice claims to improve systems of care.
The relationship between risk management and patient safety continues to evolve. Better collaboration and efforts to improve safety, quality, and risk will lead to safer patient care.
In the end, safer systems make patient care safer, which benefits patients, providers, and insurers.PHS’ Case Management Risk Stratification algorithm is a mechanism used to identify patients who might most benefit from case management support services. The Essentials • The case managementrisk stratification algorithm is a composite score on PHP member data based from Facets, patient data from Epic, and proprietary risk calculations.
Case Studies on Key Risk Indicators September 22, NC State’s ERM Initiative is pleased to release a new thought paper, Key Risk Reporting and Key Risk Indicators, that highlights three case study illustrations of how organizations have developed effective processes for reporting risk information.
Since its creation in , Risk Management Foundation (RMF) has created a robust program of risk management activities, including dissemination of focused educational programs, case studies, simulation-based training programs, best practices, and published studies.
Risk Case Studies HIROC's Case Studies are de-identified medical malpractice cases that link learnings to key risk and safety concepts. They include reflective questions designed to prompt discussion – bringing it back to the subscriber and the learnings they can apply to their organization. Adopting multiple risk management solutions is a commonality among successful credit and procurement managers, and CreditRiskMonitor is the top option for assessing financial risk in public companies.
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