Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project

Med Care. 2017 Aug;55(8):797-805. doi: 10.1097/MLR.0000000000000759.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care*
  • Health Care Surveys
  • Humans
  • Malpractice / trends*
  • Massachusetts
  • Middle Aged
  • Patient Safety
  • Primary Health Care*
  • Retrospective Studies
  • Risk Management / organization & administration*
  • Young Adult