title: Progress at the Intersection of Patient Safety and Medical Liability: Insights from the AHRQ Patient Safety and Medical Liability Demonstration Program.
abstract: OBJECTIVE
  To identify lessons learned from the experience of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety and Medical Liability (PSML) Demonstration Program.
  
  
  METHODS
  On September 9, 2009, President Obama directed the Secretary of Health and Human Services to authorize demonstration projects that put "patient safety first" with the intent of reducing preventable adverse outcomes and stemming liability costs. Seven demonstration projects received 3 years of funding from AHRQ in the summer of 2010, and the program formally came to a close in June 2015.
  
  
  METHODS
  The seven grantees implemented complex, broad-ranging innovations addressing both patient safety and medical liability in "real-world" contexts. Some projects featured novel approaches, while others implemented adaptations of existing models. Each project was funded by AHRQ to collect data on the impact of its interventions. In addition, AHRQ funded a cross-cutting qualitative evaluation focused on lessons learned in implementing PSML interventions.
  
  
  METHODS
  Site visits and follow-up interviews supplemented with material abstracted from formal project reports to AHRQ.
  
  
  RESULTS
  The PSML demonstration projects focused on three broad approaches: (1) improving communication around adverse events through disclosure and resolution programs; (2) preventing harm through implementation of clinical "best practices"; and (3) exploring alternative methods of settling claims. Although the demonstration contributed to accumulating evidence that these kinds of interventions can positively affect outcomes, there is also evidence to suggest that these interventions can be difficult to scale.
  
  
  CONCLUSIONS
  In addition to producing at least preliminary positive outcomes, the demonstration also lends credence to the idea that targeted interventions that improve some aspect of patient safety or malpractice performance may also contribute more broadly to institutional culture and the alignment of all parties around reducing risk and preventing harm. However, more empirical work needs to be carried out to quantify the effect of such interventions.
authors.affiliation: RAND Corporation, Santa Monica, CA.
authors.forename: M Susan
authors.initials: MS
authors.lastname: Ridgely
authors.affiliation: RAND Corporation, Pittsburgh, PA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Greenberg
authors.affiliation: James Bell Associates, Inc., Arlington, VA.
authors.forename: Michelle B
authors.initials: MB
authors.lastname: Pillen
authors.affiliation: James Bell Associates, Inc., Arlington, VA.
authors.forename: James
authors.initials: J
authors.lastname: Bell
mesh_terms: D006302:Health Services Research; D006801:Humans; D016365:Liability, Legal; D019300:Medical Errors / Q000517:prevention & control; D017146:Models, Organizational; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D014481:United States; D016270:United States Agency for Healthcare Research and Quality
keywords: Patient safety; adverse events; claims; disclosure; medical error; medical malpractice; offer