Patient Safety
Dean Health Plan (DHP) is committed to providing its members with safe, quality health care. As a health insurance company we include patient safety in our quality programs because we want the hospitals and physicians in our network to make safety an important part of how they care for our members.
Patient safety has been defined as those care and intervention practices that reduce actual and potential risks contributing to accidental patient injury or unintended adverse patient outcomes across a range of diagnoses or causes. Threats to patient safety can occur in all health care settings and stem from a wide variety of systemic and human causes. These risks can lead to health-care acquired infections, wrong-site surgeries, falls, diagnostic and medication errors and hospital readmissions that may result in significant increase of unintentional mortality or morbidity and an increase in financial costs to both patients and health care organizations.
The Institute of Medicine (IOM) report estimates that one million injuries and 44,000 - 98,000 deaths occur each year as a result of medical errors. Research has shown that inefficiencies and deficiencies in the health care system itself, rather than carelessness or poor caregiver performance, are often most responsible for risks to patient safety. For this reason, DHP's approach to improving patient safety centers on assisting practitioners and members in recognizing potential risks, identifying contributing systemic and human factors, and determining the systemic changes necessary to mitigate risk.
Dean Health Plan has a number of systems in place to help minimize the chance of errors and ensure our members receive safe, quality care. They include monitoring of medication reconciliation, infection prevention, inappropriate drug use, quality of care and quality of service. In addition DHP has development initiatives to continue improving patient safety through member and provider education.
Member and provider education is an important method used to help minimize the chance of patient safety errors. Throughout the last year, DHP has worked with providers and members to improve all parties' understanding around appropriate care. DHP encourages its members to take an active role in their healthcare. Here are a few initiatives to help improve awareness around patient safety:
- Shared decision making: member and providers both need to play a role in treatment plans and understand any impacts and risks associated with each option. Dean Health Plan has expanded tools to help members understand more about how to address preference-sensitive conditions, review procedures that may be performed and the risks and alternatives to those procedures. The information provided is designed to empower members to have discussions with their provider regarding the best treatment option for the member.
- Appropriate use of the ER: it is very important for members to use their primary care practitioner when possible. This allows PCPs to proactively monitor care and not only treat current symptoms, but identify underlying health issues that may be controlled.
- Communications: DHP provides patient safety information and program updates through provider and member newsletters. DHP also continually adds provider and member resources to help manage appropriate care.
In addition, DHP includes quality improvement initiatives into our care management process through preventative health and disease management activities. DHP offers members additional nursing care to help with disease management. Each disease management program includes condition monitoring and is ongoing and proactive. This allows the member, practitioner, and disease/case manager to assess how well the condition is being managed. Currently, DHP has disease management programs for diabetes, heart failure, asthma, chronic obstructive pulmonary disease (COPD), prenatal care, and autism. DHP bases care on evidence-based guidelines. These guidelines are measured and reviewed each year to ensure guidelines are being followed and remain current. Current guidelines are used for ADHD treatment in children, alcohol misuse, asthma, depression, heart failure, childhood immunizations, and prenatal care. These guidelines are distributed to practitioners on an annual basis.