Disclosure of medical injury to patients: An improbable risk management strategy

Health Affairs

Volumn 26, Issue 1, 2007, Pages 215-226

  Studdert, David M ^a   Mello, Michelle M ^b   Gawande, Atul A ^c   Brennan, Troyen A ^d   Wang, Y Claire ^b  

^a UNIVERSITY OF MELBOURNE   (Australia)

^b HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^c BRIGHAM AND WOMEN S HOSPITAL   (United States)

^d AETNA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CLASSIFICATION; COMPENSATION; ECONOMICS; EPIDEMIOLOGY; HEALTH ECONOMICS; HUMAN; IATROGENIC DISEASE; INCIDENCE; INJURY; INJURY SCALE; INTERPERSONAL COMMUNICATION; LEGAL ASPECT; LEGAL LIABILITY; MALPRACTICE; MEDICAL ERROR; METHODOLOGY; MONTE CARLO METHOD; RISK MANAGEMENT; STATISTICS; UNITED STATES;

COMPENSATION AND REDRESS; DISCLOSURE; ECONOMICS, HOSPITAL; ECONOMICS, MEDICAL; HEALTH CARE SURVEYS; HUMANS; IATROGENIC DISEASE; INCIDENCE; INJURY SEVERITY SCORE; LIABILITY, LEGAL; MALPRACTICE; MEDICAL ERRORS; MONTE CARLO METHOD; RISK MANAGEMENT; UNITED STATES; WOUNDS AND INJURIES;

EID: 33846878528     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.1.215     Document Type: Article

References (51)

1. T.H. Gallagher et al., "Patients' and Physicians' Attitudes regarding the Disclosure of Medical Errors," Journal of the American Medical Association 289, no. 8 (2003): 1001-1007;
2. J. Banja, Medical Errors and Medical Narcissism (Sudbury: Jones and Bartlett, 2005);
3. and R. Bovbjerg, "Patient Safety and Physician Silence," Journal of Legal Medicine 25, no. 4 (2004): 505-516.
4. Joint Commission on Accreditation of Healthcare Organizations, "Comprehensive Accreditation Manual for Hospitals: Standard RI 1.2.2" (Chicago: JCAHO, 2001);
5. and National Academy for State Health Policy, "State Adverse Event Reporting Rules and Statutes," 5 December 2005, http://www.nashp.org/
6. N. Berlinger, After Harm: Medical Error and the Ethics of Forgiveness (Baltimore: Johns Hopkins University Press, 2005).
7. See, for example, D.N. Frenkel and C.B. Liebman, "Words That Heal," Annals of Internal Medicine 140, no. 6 (2004): 482-483;
8. A.W. Wu, "Handling Hospital Errors: Is Disclosure the Best Defense?" Annals of Internal Medicine 131, no. 12 (1999): 970-972;
9. and R. Zimmerman, "Doctors' New Tool to Fight Lawsuits: Saying 'I'm Sorry'," Wall Street Journal, 18 May 2004.
10. P.C. Weiler et al., A Measure of Malpractice (Cambridge, Mass.: Harvard University Press, 1993).
11. W.L.F. Felstiner, R.L. Abel, and A. Sarat, "The Emergence and Transformation of Disputes: Naming, Blaming, Claiming," Law and Society Review 15, no. 3-4 (1980): 631-654;
12. D. Hensler et al., Compensation for Accidental Injuries in the United States (Santa Monica, Calif.: RAND, 1991);
13. and M.J. Saks, "Do We Really Know Anything about the Behavior of the Tort Litigation System - and Why Not?" University of Pennsylvania Law Review 140, no. 4 (1992): 1147-1292.
14. T.A. Brennan et al., "Incidence of Adverse Events and Negligence in Hospitalized Patients: Results of the Harvard Medical Practice Study I," New England Journal of Medicine 324, no. 6 (1991): 370-376;
15. and E.J. Thomas et al., "Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado," Medical Care 38, no. 3 (2000): 261-271.
16. Part A of our Technical Appendix provides details of how the estimates shown in Exhibit 1 were derived. See http://content.healthaffairs.org/cgi/ content/full/26/1/215/DC1.
17. M. Sowka, ed., Malpractice Claims: Final Compilation (Brookfield, Wis.: National Association of Insurance Commissioners, 1980).
18. The NYMPS and UTCOMPS involved reviews of inpatient medical records only. They nonetheless provide reasonable systemwide estimates of the prevalence of serious injuries because, in addition to injuries that arose from hospital care, they captured injuries that necessitated hospital care, wherever they occurred.
19. D.M. Studdert et al., "Claims, Errors, and Compensation Payments in Medical Malpractice Litigation," New England Journal of Medicine 354, no. 19 (2006): 2024-2033;
20. and B. Black et al., "Stability, Not Crisis: Medical Malpractice Claim Outcomes in Texas, 1988-2002," Journal of Empirical Legal Studies 2, no. 2 (2005): 207-259.
21. Part B of the online Technical Appendix details the cost calculation methodology; see Note 8.
22. S.S. Kraman and G. Hamm, "Risk Management: Extreme Honesty May Be the Best Policy," Annals of Internal Medicine 131, no. 12 (1999): 963-967.
23. A compilation of the data sources used for this calculation appears in the online Technical Appendix; see Note 8.
24. Patients' willingness to accept this trade-off is the premise of so-called Early Offer programs.
25. Part C of the online Technical Appendix provides further details of the survey scenarios and instructions to respondents; see Note 8.
26. K.M. Thompson and J.D. Graham, "Going Beyond the Single Number: Using Probabilistic Risk Assessment to Improve Risk Management," Human and Ecological Risk Assessment 2, no. 4 (1996): 1008-1034.
27. J.J. Kim, T.C. Wright, and S.J. Goldie, "Cost-Effectiveness of Alternative Triage Strategies for Atypical Squamous Cells of Undetermined Significance," Journal of the American Medical Association 287, no. 18 (2002): 2382-2390;
28. and P. Lurie et al., "Financial Conflict of Interest Disclosure and Voting Patterns at Food and Drug Administration Drug Advisory Committee Meetings," Journal of the American Medical Association 295, no. 16 (2006): 1921-1928.
29. C.E. Clark, "The PERT Model for the Distribution of an Activity Time," Operations Research 10, no. 3 (1962): 405-406;
30. and D.G. Malcolm et al., "Application of a Technique for Research and Development Program Evaluation," Operations Research 7, no. 5 (1959): 646-669.
31. Bounding the distribution in this way differs from the conventional approach to fitting a beta distribution, which uses bounds of 0 and 1.
32. P. Doubilet et al., "Probabilistic Sensitivity Analysis using Monte Carlo Simulation: A Practical Approach," Medical Decision Making 5, no. 2 (1985): 157-177. Part D of the online Technical Appendix describes in greater detail how the model worked; see Note 8.
33. R.M. Lamb et al., "Hospital Disclosure Practices: Results of a National Survey," Health Affairs 22, no. 2 (2003): 73-83.
34. To arrive at the break-even point, the percentages of prompted claims (transitions B and D) were reduced proportionally, beginning at the best guess.
35. P.M. Danzon, Medical Malpractice: Theory, Evidence, and Public Policy (Cambridge, Mass.: Harvard University Press, 1985);
36. A.R. Localio et al., "Relation between Malpractice Claims and Adverse Events Due to Negligence: Results of the Harvard Medical Practice Study III," New England Journal of Medicine 325, no. 4 (1991): 245-251;
37. and D.M. Studdert et al., "Negligent Care and Malpractice Claiming Behavior in Utah and Colorado," Medical Care 38, no. 3 (2000): 250-260;
38. Hensler, "Compensation."
39. Saks, "Do We Really Know Anything?"
40. Kraman and Hamm, "Risk Management."
41. A. Kachalia et al., "Does Full Disclosure of Medical Errors Affect Malpractice Liability? The Jury Is Still Out," Joint Commission Journal on Quality and Safety 29, no. 10 (2003): 503-511.
42. Lamb et al., "Hospital Disclosure Practices."
43. K.M. Mazor et al., "Health Plan Members' Views about Disclosure of Medical Errors," Annals of Internal Medicine 140, no. 6 (2004): 409-418.
44. See, for example, G.B. Hickson et al., "Factors That Prompted Families to File Medical Malpractice Claims following Perinatal Injuries," Journal of the American Medical Association 267, no. 10 (1992): 1359-1363;
45. C. Vincent, M. Young, and A. Phillips, "Why Do People Sue Doctors? A Study of Patients and Relatives Taking Legal Action," Lancet 343, no. 8913 (1994): 1609-1613;
46. W. Levinson et al., "Physician-Patient Communication: The Relationship with Malpractice Claims among Primary Care Physicians and Surgeons," Journal of the American Medical Association 277, no. 7 (1997): 553-559;
47. and H.B. Beckman et al., "The Doctor-Patient Relationship and Malpractice: Lessons from Plaintiff Depositions," Archives of Internal Medicine 154, no. 12 (1994): 1365-1370.
48. A.B. Witman, D.M. Park, and S.B. Hardin, "How Do Patients Want Physicians to Handle Mistakes? A Survey of Internal Medicine Patients in an Academic Setting," Archives of Internal Medicine 156, no. 22 (1996): 2565-2569;
49. and P.J. Moore, N.E. Adler, and P.A. Robertson, "Medical Malpractice: The Effect of Doctor-Patient Relations on Medical Patient Perceptions and Malpractice Intentions," Western Journal of Medicine 173, no. 4 (2000): 244-250.
50. Witman et al., "How Do Patients Want Physicians to Handle Mistakes?"; and Vincent et al., "Why Do People Sue Doctors?"
51. Part E of the online Technical Appendix explains why this is the case; see Note 8.