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Medical Error Prevention/Patient Safety

MD-Individual Practice Association (M.D. IPA) has a formal quality improvement (QI) program and has worked with contracted physicians, health care practitioners and hospitals to improve the systems that impact patient safety.

As a proactive measure M.D. IPA has made information about your role in safety and prevention of medical errors available on www.mamsi.com. Articles regarding how to choose a physician and hospital that include questions you should ask prospective practitioners are posted. Links to sites, such as the Maryland Health Care Commission, Virginia Health Information, and other sites that provide quality information about physicians and hospitals are also provided.

More information about the activities M.D. IPA has initiated to promote patient safety is included below.

HOSPITAL ACTIVITIES

1. Hospital Quality Improvement Programs

   All participating hospitals are contractually required to be Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredited, or to pass a health plan site review that is based on JCAHO standards. These standards require the hospital to have a QI Program that includes patient safety initiatives.

2. Hospital Medical and Surgical Errors, Infection and Adverse Events

   M.D. IPA monitors these events closely and works with any individual hospitals or practitioners with identified problems or trends to address the issues and implement improvements. Specific examples include:

• Identifying adverse events (unanticipated death, return to operating room), trending of events and implementation of corrective action plans when appropriate.
• Identifying sentinel diagnoses that have the potential to be caused by poor quality of care (ketoacidosis, ruptured appendix, etc.).
• Monitoring patient safety practices listed on the Agency for Health Care Research and Policy's Patient Safety publication.

A Medical Director visits any hospital or practitioner with a trend of problems to discuss the patient safety issues and plans for improvement.

3. Centers for Total Joint Replacement, Cardiac Surgery, and Transplant

   In parts of the service area, M.D. IPA uses specific institutions for treating certain conditions or performing specific procedures that offer “best practices.” M.D. IPA has identified Centers for Total Joint Replacement, Cardiac Surgery, and Transplants. Hospitals wishing to be designated as such are evaluated based on the American Hospital Association's criteria. For joint replacement, additional criteria from the Knee and Hip Society are also used.

4. Continuity and Coordination of Care

   M.D. IPA facilitates continuity and coordination of care by:

   • Requiring all care to be coordinated through one Primary Care Physician (PCP) for continuity and to minimize errors.
   • Strengthening the linkages between behavioral health services and medical services. All behavioral services are provided through M.D. IPA and are not “carved out” to a third party.
   • Expanding the number of urgent care access arrangements for behavioral health services to assure timely access to care for those occasions when a member or his/her PCP requests assistance in finding an appointment.
   • Educating hospitalized members about the importance of following discharge instructions, and scheduling and keeping their follow-up appointments to prevent complications and re-admissions to the hospital.

MEMBER AND PHYSICIAN EDUCATION AND CARE MANAGEMENT

1. Member Education

   The following materials are available to you:

   • Recommended treatment guidelines for certain conditions, such as asthma, diabetes and routine pregnancy via the member newsletter, HealthSense.
   • Self-management information on certain chronic diseases such as diabetes and asthma.
   • Discharge plans outlining follow-up treatment after members leave the hospital.
   • The Healthwise Knowledgebase website which includes more than 1,000 topics ranging from allergies and asthma to influenza, pregnancy and other health topics. To access the Healthwise Knowledgebase, you can go to www.mamsi.com, and select Healthwise® Knowledgebase from the Member menu.

2. Disease Profiles

   M.D. IPA identifies members with certain chronic diseases, such as diabetes, who have an omission in testing or treatment according to our claims records. We then notify those members and their physicians of the omission and/or treatment recommendation.

3. Health Management

   M.D. IPA provides personalized direct contact with members who have serious health problems like diabetes, heart conditions, and asthma to help them monitor their care and identify treatment areas that may require further focus.

4. Medications/Pharmacy

   M.D. IPA's Pharmacy Services Department has instituted the following safe-guards to prevent medication errors:

   • Maintenance of centralized medication profiles at a patient level through the Pharmacy Benefit Manager to prevent harmful drug interactions from being dispensed. Depending on the severity of drug-to-drug interactions, the pharmacist may not be able to process the prescription until he/she calls M.D. IPA's Pharmacy Services Department.
   • Use of quantity level limits to ensure that a patient is not consuming medications beyond the normal FDA-approved duration of therapies.