The Practitioner Conection
Volume XXXI, 3rd Quarter

INPATIENT CARE AND SAFETY

CIGNA works to ensure that care delivered through our professional and facility network meets industry standards for safety. We encourage and promote safe clinical services through adherence to nationally accepted clinical practices, continuity and coordination of care, collaboration between network professionals and facilities, regular review of facility and professional treatment records using established guidelines for treatment records, and through an analysis of individual quality of care complaints.

In order to understand the quality of our network facility experience, CIGNA gathers input from individuals who receive inpatient services, investigating individual complaints and the actions taken by facilities to implement necessary improvement.

2008 findings show that the majority of complaints were filed after discharge from the facility. The most frequent reasons for complaint were coordination of care issues and the individual’s disagreement in expectations about treatment provided by a facility. Analysis was completed on all complaints with the exception of cases where customer permission was withheld to investigate and for complaints about Out-of-Network facilities. Of those complaints investigated, an adequate assessment of the issue could not be determined for 31.8%, because insufficient information was available. All cases where investigation was possible found no ongoing concern, and no evidence that the facility had deviated from the industry standard of care. For the complaints where adequate information was provided, results indicate that facilities followed their internal policies and procedures and completed a thorough investigation of the customer complaint. In 2008, important limitations to analysis included: customer non-consent for investigation of the complaint, and limits in our ability to investigate complaints at Out-of-Network facilities.

In 2009, CIGNA's behavioral staff is being trained to better follow-up with, and to document actions taken by, a facility to address complaint issues. Quarterly evaluation of facility Quality of Care complaints will continue, and data will be analyzed and reported into our national Quality Committee annually.

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AUTISM SEMINAR OPPORTUNITY

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