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Addressing Ambulatory Safety and Malpractice: The Massachusetts PROMISES Project

More than half of malpractice claims involve care in the ambulatory setting (Zuccotti and Sato 2011; Saber Tehrani et al. 2013). As the sole project of the seven AHRQ-funded Patient Safety and Medical Liability Demonstration Program grants to focus on outpatient malpractice safety and risk, the Massachusetts PROMISES (Proactive Reduction of Outpatient Malpractice: Improving Safety, Efficiency, and Satisfaction) project sought to identify and improve safety in what we referred to as “3 + 1” areas of known risk in the outpatient setting: test result, referral, and medication management plus overarching communication issues (Agency for Healthcare Research and Quality 2014). We assembled a coalition of key Massachusetts safety, regulatory, malpractice, and academic groups and recruited 25 small- and medium-sized primary care practices of which 16 were randomly selected to receive a multifaceted improvement intervention. While the quantitative outcomes and evaluation fell short of demonstrating some of the significant improvements we had hoped to show, here we describe how we developed and fielded our intervention, describing some of the lessons learned in the course of this project and implications for future efforts in this field.

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