Communication and Resolution Programs (CRPs) are a rapidly emerging innovation for promoting patient- centered accountability and learning following adverse events. However, providers worry that responding to patient injury by using a CRP could trigger involvement of regulators such as state medical boards with unpredictable and punitive consequences. We have collaborated with Washington State's board of medicine, the Medical Quality Assurance Commission (MQAC), to develop a novel and potentially groundbreaking fix, a process known as CRP Certification. CRP Certification involves a panel of CRP experts and patient advocates reviewing voluntarily submitted CRP cases to determine whether the response contained all the CRP key elements (early event reporting, disclosure to patient, event analysis and prevention planning, resolution with patient, disseminated learning). Cases meeting this standard will be CRP Certified. It is anticipated that MQAC will close CRP Certified cases as satisfactorily resolved without imposing discipline. Cases involving gross incompetence, provider impairment, or boundary violations are not eligible. We propose a 3-year demonstration project of the CRP Certification Program with the following specific aims: 1) pilot test and evaluate the CRP Certification Program in Washington State; 2) expand and evaluate the CRP Certification Program in two additional states; 3) analyze policy and ethical questions associated with taking the CRP Certification Program to scale nationally. We anticipate that over the course of the project approximately 200 cases will be presented for review by the CRP Certification panel. We will conduct a multi-modal evaluation of the effectiveness of the CRP Certification Program. This will include: 1) descriptive analysis of cases presented for review and their disposition, including assessing case-level predictors of certification and case closure without discipline by the state board of medicine; 2) reviewing state board of medicine records to describe how the boards responded to CRP Certified cases; 3) conducting key informant interviews with institutional risk managers, liability insurers, board f medicine members, patient advocates, and participating physicians to explore their perceptions of the strengths and weaknesses of the CRP Certification Program; 4) holding focus groups with patient advocates; and 5) surveying physicians who submitted CRP Certification Applications. In addition, we will analyze core policy and ethical questions surrounding CRP Certification, including its potential relationship to National Practitioner Data Bank reporting requirements, extension to certification of high-performing institutional CRPs and link to possible pay-for-performance incentives, expansion to include other health professional boards and regulators, and suitability as a substitute for disciplinary action by state boards. Close collaboration between CRPs and state medical boards around the response to adverse events will be important to incentivize physician participation in CRPs, promote more robust use of all key CRP elements, and enhance patient-centered accountability and learning.

Public Health Relevance

Communication and Resolution Programs (CRPs) represent a breakthrough in promoting patient-centered accountability and disseminated learning following adverse events, but physicians and healthcare institutions worry that using a CRP could trigger a punitive response by regulators such as state boards of medicine. We have developed the CRP Certification Program, in which a neutral review panel will determine if an adverse event was handled appropriately using the key principles of a CRP, in which case the state board of medicine will not pursue disciplinary action. We will implement and evaluate the CRP Certification Program in 3 states and assess its suitability for national rollout.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Healthcare Patient Safety and Quality Improvement Research (HSQR)
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Azam, Irim
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University of Washington
Internal Medicine/Medicine
Schools of Medicine
United States
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