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Physician, Assess Thyself


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Physician, Assess Thyself

By Jock Hoffman, CRICO

Related to: Ambulatory, Primary Care, Surgery


Errors linked to office-based medical care account for nearly 30 percent of all CRICO cases. Over the past five years, 312 claims and suits were filed against CRICO-insured providers alleging medical error in the physician office. Those cases represent more than $162 million in incurred losses; the average indemnity payment was more than $647,000. As the trend toward conducting care in the office setting increases, so too does the risk of a malpractice claim alleging that the care was substandard.

In 2005, The Commonwealth Fund helped three healthcare research organizations (HRET, ISMP, MGMA) create a self-assessment tool physician practices can use to understand their opportunities for improvement. The Physician Practice Patient Safety Assessment (PPPSA) guides participating practices through six domains (medications, handoffs, invasive procedures, personnel, patient education and communication, and practice management and culture). Participants score the practice’s performance on 79 measures within those domains on a scale ranging from “unaware of the issue” to “best practice fully implemented.”

Self-assessment is not new: the American College of Surgeons introduced its surgical education self-assessment program (SESAP) back in 1972 and, more recently, the American Board of Medical Specialties has established self evaluation as a component of maintenance of certification (MOC) programs. And, as pay-for-performance reimbursement structures reward quality improvement in primary care settings, office-based physicians will be looking for more efficient and effective ways to identify and prioritize their quality improvement efforts.

Our Recommendation

Quality improvement begins with identifying and understanding which patient safety risks need attention. A self-administered assessment—done properly and thoughtfully—can help a practice begin to see where it might be vulnerable. Of course, self-assessment has limitations. A practice with complex issues to be understood and resolved may achieve those goals more efficiently—if, perhaps, more uncomfortably—by calling for a third-party evaluation process.

Since 1998, CRICO/RMF has surveyed nearly 600 practices across the Harvard medical community through its Office Practice Evaluation (OPE) program. This process has already introduced, or reinforced, the fundamentals of office-based patient safety to hundreds of CRICO-insured clinicians. Now, as CRICO/RMF faces the challenge of increasing requests for patient safety assessments, it too has begun exploring the idea of integrating a self-evaluation tool into its OPE program. A self assessment process could provide a baseline from which practices can determine where they fall on the patient safety continuum. In addition, the self assessment results could help a practice determine if it would further benefit from a more in-depth, and external, assessment.

May 1, 2007
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