Don Goldmann’s research while affiliated with Institute for Healthcare Improvement and other places

Both the Affordable Care Act (ACA) and attempts to repeal and replace it have been criticized for their highly partisan passage. Many argue that only bipartisan reform can be sustained over time regardless of which party is in power. Bipartisan reforms require that at least some specific, articulated, health policy goals from each party are met.(1,2) A new survey of state legislators' goals for US health policy provides crucial insights into the challenges and opportunities for future bipartisan reform. (Am J Public Health. Published online ahead of print August 17, 2017: e1-e3. doi:10.2105/AJPH.2017.304023).

Objective: Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas. Study setting: In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts. Study design: Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools. Data collection methods: Chart reviews conducted at baseline and postintervention for intervention sites. Staff and patient survey data collected at baseline and postintervention for intervention and control sites. Principal findings: Chart reviews demonstrated significant improvements in documentation of abnormal results, patient notification, documentation of an action or treatment plan, and evidence of a completed plan (all P<0.001). Mean days between laboratory test date and evidence of completed action/treatment plan decreased by 19.4 days (P<0.001). Staff surveys showed modest but nonsignificant improvement for intervention practices relative to controls overall and for the 3 high-risk domains that were the focus of PROMISES. Conclusions: A consortium of stakeholders, quality improvement tools, coaches, and learning network decreased selected ambulatory safety risks often seen in malpractice claims.