Potential Unintended Consequences Due to Medicare’s -No Pay for Errors Rule- A Randomized Controlled Trial of an Educational Intervention with Internal Medicine ResidentsReportar como inadecuado




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Journal of General Internal Medicine

, Volume 25, Issue 10, pp 1097–1101

First Online: 08 June 2010Received: 15 November 2009Revised: 09 April 2010Accepted: 20 April 2010

Abstract

BACKGROUNDMedicare has selected 10 hospital-acquired conditions for which it will not reimburse hospitals unless the condition was documented as -present on admission.- This -no pay for errors- rule may have a profound effect on the clinical practice of physicians.

OBJECTIVETo determine how physicians might change their behavior after learning about the Medicare rule.

DESIGNWe conducted a randomized trial of a brief educational intervention embedded in an online survey, using clinical vignettes to estimate behavioral changes.

PARTICIPANTSAt a university-based internal medicine residency program, 168 internal medicine residents were eligible to participate.

INTERVENTIONResidents were randomized to receive a one-page description of Medicare’s -no pay for errors- rule with pre-vignette reminders intervention group or no information control group. Residents responded to five clinical vignettes in which -no pay for errors- conditions might be present on admission.

MAIN MEASURESPrimary outcome was selection of the single most clinically appropriate option from three clinical practice choices presented for each clinical vignette.

KEY RESULTSSurvey administered from December 2008 to March 2009. There were 119 responses 71%. In four of five vignettes, the intervention group was less likely to select the most clinically appropriate response. This was statistically significant in two of the cases. Most residents were aware of the rule but not its impact and specifics. Residents acknowledged responsibility to know Medicare documentation rules but felt poorly trained to do so. Residents educated about the Medicare’s -no pay for errors- were less likely to select the most clinically appropriate responses to clinical vignettes. Such choices, if implemented in practice, have the potential for causing patient harm through unnecessary tests, procedures, and other interventions.

KEY WORDSerrors Medicare unintended consequences residents Electronic supplementary materialThe online version of this article doi:10.1007-s11606-010-1395-9 contains supplementary material, which is available to authorized users.

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Autor: Somnath Mookherjee - Arpana R. Vidyarthi - Sumant R. Ranji - Judy Maselli - Robert M. Wachter - Robert B. Baron

Fuente: https://link.springer.com/







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