A program run by Vanderbilt University Medical Center that provides peer feedback to high-risk clinicians was associated with a significant decrease in malpractice claims costs at a large orthopaedic surgery practice, according to a recent study in the Journal of Bone and Joint Surgery.
The Patient Advocacy Reporting System (PARS), operated by the Vanderbilt Center for Patient and Professional Advocacy (CPPA), is designed to identify clinicians who generate a disproportionate share of patient complaints. Trained physician peers share the comparative data with high-risk clinicians and provide feedback aimed at promoting professional accountability and behavior change.
Researchers analyzed data from a multisite orthopedic practice in the southeastern U.S. that implemented PARS in 2009. Over the 12 years following PARS adoption, malpractice claims costs for the 42 high-risk clinicians fell by 83% compared to their preintervention levels. For the overall practice, which grew from 57 to 260 clinicians during the study period, per-provider claims costs dropped by 87%.
The study demonstrates PARS, a program developed at VUMC, can be successfully implemented in a geographically distributed single-specialty practice network, not just major academic centers where it was previously studied.
The claims reductions associated with PARS adoption were maintained over time, noted one of the paper’s authors, William Cooper, MD, MPH, Cornelius Vanderbilt Professor of Pediatrics and Health Policy and president of CPPA.
“Successful adoption of the PARS program in a large, single practice setting requires essential infrastructure elements to elevate professional accountability,” Cooper said. “This includes establishing PARS champions and peer messengers, an office of patient affairs, and integration into the physician onboarding process.”
Another author, Thomas Doub, PhD, assistant professor of Pediatrics and a faculty member at CPPA, added, “While we can’t claim to identify cause and effect in an observational cohort study such as this, it appears quite plausible that this organization-wide commitment to professional accountability and high reliability had an impact on the overall claims experience of this practice group.”
The CPPA website includes a summary of the center’s impact to date:
• CPPA serves more than 200 sites in 29 states, encompassing some 225,000 clinicians.
• Under PARS and a newer program called CORS (Co-worker Observational Reporting System), CPPA has coded and analyzed more than 3.5 million patient complaints and 280,000 co-worker complaints.
• PARS and CORS are associated with 82% and 87% reductions in complaints, respectively.
Others on the study from VUMC include Gerald Hickson, MD, Thomas Catron, PhD, Henry Domenico, MS, and James Pichert PhD.
