Effective risk management strategies that assure accurate transfer of medication information, improve patient safety and minimize medical liability during care transitions when patients discharge from the hospital to home care, are virtually nonexistent. Medication errors are the most prevalent adverse event following hospital discharge (Greenwald, Denham, &Jack, 2007);subsequently, these errors trigger malpractice claims when patients are harmed (Rothschild et al., 2002).There is a critical need to proactively link medication risk management to emerging transitional care models. The overall objective of this application is to improve medication safety and quality of care during the hospital to community transition, thereby improving patient outcomes and reducing adverse events and costs, including medical liability. When funded, the interdisciplinary team of nurses, pharmacists, nurse attorneys, a physician and a health policy economist will investigate two specific aims. First, the team will evaluate antecedent, structure, process, and outcome factors associated with medication discrepancies, adverse events, and medical liability during hospital to community transitions within a complex health care system. Statistical analyses combined with systematic review to evaluate the medical liability risk associated with ADRs when applied to statutory, regulatory and appellate case law will be completed. Second, the team will design best practice risk management strategies that can be integrated into transitional care. Using a sensemaking conceptual framework, focus groups comprised of stakeholders, including patients, health care providers, health plan administrators and attorneys, will be asked to reflect on, or make sense of, the medication discrepancy and medical liability data. Evidence based risk management strategies to maximize medication safety during hospital to community care transitions can then be designed, and successfully implemented. The proposed planning grant is significant because it will elucidate the actual legal risk associated with medication discrepancies during the transition from hospital to the community, and, it will identify risk management strategies to improve patient safety while minimizing medical liability. Combined, these outcomes are expected to serve as a blueprint for health care systems to proactively integrate medication risk management strategies into emerging transitional care models. Health policy changes that will require continuity of care for most, if not all patients, are imminent. As such, developed risk management strategies can subsequently be tested, replicated and disseminated to improve patient medication safety thereby reducing adverse events and medical liability. Patient outcomes will be improved and lower overall health care costs will be realized. Upon successful completion, the feasibility of integrating medication risk management efforts into transitional comprehensive, rather than episodic care, models to assure patient safety, quality, and cost-effectiveness while reducing medical liability will be demonstrated.
This planning grant is intended to engage all stakeholders in a thoughtful, thorough and productive effort to fundamentally advance medication safety science, reduce adverse events and minimize medical liability, by providing health systems with a quality improvement blueprint to use when implementing hospital to community care transition models. In so doing, this grant addresses AHRQ's national effort to combat medical errors and improve patient safety. Subsequently, developed risk management strategies can be tested, replicated and disseminated to improve medication safety for patients;patient outcomes will be improved and lower overall health care costs will be realized.
