Original ArticlesLearning From Lawsuits: Using Malpractice Claims Data to Develop Care Transitions Planning ToolsArbaje, Alicia I. MD, MPH∗,†,‡; Werner, Nicole E. PhD‡,§,∥; Kasda, Eileen M. MHS¶; Wu, Albert W. MD, MPH#,∗∗,††; Locke, Charles F.S. MD∗∗,‡‡; Aboumatar, Hanan MD, MPH§§,∥∥,¶¶,##; Paine, Lori A. RN, MS¶¶; Leff, Bruce MD∗,∗∗∗,†††; Davis, Richard O. PhD‡‡‡; Boonyasai, Romsai MD, MPH§§,¶¶,##,§§§ Author Information From the ∗Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine †Department of Clinical Investigation, Johns Hopkins University Bloomberg School of Public Health ‡Center for Innovative Care in Aging, Johns Hopkins University School of Nursing §Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine ∥Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin ¶Patient Safety, The Johns Hopkins Hospital, Johns Hopkins Health System #Epidemiology, International Health, Johns Hopkins Bloomberg School of Public Health ∗∗Departments of Medicine and Surgery, Johns Hopkins University School of Medicine ††Carey Business School ‡‡Utilization/Clinical Resource Management, Johns Hopkins Medicine §§Division of General Internal Medicine, Johns Hopkins University School of Medicine ∥∥Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health ¶¶Johns Hopkins Armstrong Institute for Safety and Quality ##Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University ∗∗∗Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health †††Department of Community and Public Health, Johns Hopkins University School of Nursing ‡‡‡Sibley Memorial Hospital, Johns Hopkins Medicine §§§John Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, Maryland. Correspondence: Alicia I. Arbaje MD, MPH, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Mason F. Lord Bldg, Center Tower, 5200 Eastern Ave, 7th Floor, Baltimore, MD 21224 (e-mail: [email protected]). This study was supported by funding from the Agency for Healthcare Research and Quality (R21 HS019519-01). A.I.A. and N.E.W. currently receive grant support from the following sources: the National Patient Safety Foundation, the Agency for Healthcare Research and Quality, and the Center for Innovative Care in Aging at the Johns Hopkins School of Nursing. A.W.W. is a consultant to BMS, Genentech, Otsuka, and Pfizer and has an educational grant from the PhRMA Foundation. He is a member of the National Quality Forum Patient Safety Standing Committee. He is supported by grants and contracts from the Agency for Healthcare Research and Quality, the Patient Centered Outcomes Research Institute, the National Institutes of Health, and AIG Corporation. He receives royalties from the Joint Commission for his book The Value of Close Calls in Improving Patient Safety. The financial interests of A.W.W. have been reviewed by the Johns Hopkins University in accordance with its institutional policies. H.A. currently receives grant support from the following sources: the National Institutes of Health, the Patient Centered Outcomes Research Institute, and the Gordon and Betty Moore Foundation. R.B. currently receives grant or contract support from the following sources: the Agency for Healthcare Research and Quality, the National Institutes of Health, the Patient Centered Outcomes Research Institute, and the American Medical Association for research related to improving quality of care and reducing health care–related disparities; and the Center for Medicare and Medicaid Services for implementation of a health systems innovation program. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.journalpatientsafety.com). Journal of Patient Safety: March 2020 - Volume 16 - Issue 1 - p 52-57 doi: 10.1097/PTS.0000000000000238 Buy SDC Metrics Abstract Objectives Our understanding of care transitions from hospital to home is incomplete. Malpractice claims are an important and underused data source to understand such transitions. We used malpractice claims data to (1) evaluate safety risks during care transitions and (2) help develop care transitions planning tools and pilot test their ability to evaluate care transitions from the hospital to home. Methods Closed malpractice claims were analyzed for 230 adult patients discharged from 4 hospital sites. Stakeholders participated in 2 structured focus groups to review concerns. This led to the development of 2 care transitions planning tools—one for patients/caregivers and one for frontline care providers. Both were tested for feasibility on 53 patient discharges. Results Qualitative analysis yielded 33 risk factors corresponding to hospital work system elements, care transitions processes, and care outcomes. Providers reported that the tool was easy to use and did not adversely affect workflow. Patients reported that the tool was acceptable in terms of length and response burden. Patients were often still waiting for information at the time they applied the tool. Conclusions Malpractice claims provided insights that enriched our understanding of suboptimal care transitions and guided the development of care transitions planning tools. Pilot testing suggested that the tools would be feasible for use with minor adjustment. The malpractice data can complement other approaches to characterize systems failures threatening patient safety. 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