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Liability Claims and Costs Before and After Implementation of a Medical Error Disclosure Program

Allen Kachalia, MD, JD; Samuel R. Kaufman, MA; Richard Boothman, JD; Susan Anderson, MBA, MSN; Kathleen Welch, MS, MPH; Sanjay Saint, MD, MPH; and Mary A.M. Rogers, PhD
[+] Article and Author Information

From Brigham and Women's Hospital, Boston, Massachusetts, and Ann Arbor Veterans Affairs Medical Center, University of Michigan Health System, University of Michigan, and Center for Statistical Consultation and Research, Ann Arbor, Michigan.


Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs or the National Institutes of Health.

Acknowledgment: The authors thank Vinita Bahl, DMD, MPP; Ellen Bunting, MA; and Elaine Commiskey, MS, for their invaluable efforts in supplying data essential to this study.

Grant Support: By Blue Cross Blue Shield of Michigan Foundation (1217.II). In addition, Dr. Saint was supported by an Advanced Career Development Award from the Health Services Research & Development Service of the Department of Veterans Affairs during a portion of the time this study was conducted. Dr. Saint is currently supported by awards R21-DK078717 and R01-NR010700 from the National Institutes of Health.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-1494.

Reproducible Research Statement:Study protocol, statistical code, and data set: Not available.

Requests for Single Reprints: Allen Kachalia, MD, JD, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, akachalia@partners.org.

Current Author Addresses: Dr. Kachalia: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Mr. Kaufman: Department of Internal Medicine, Division of Cardiovascular Medicine, The Blue Cross Blue Shield of Michigan Cardiovascular Consortium, 2929 Plymouth Road, Suite 225, Ann Arbor, MI 48105-3206.

Mr. Boothman: University of Michigan Health System, Med Inn Building, C 201, SPC 5825, 1500 East Medical Center Drive, Ann Arbor, MI 48109.

Ms. Anderson: University of Michigan Health System, Risk Management Department, 300 North Ingalls Building, Room 8A06/SPC 5478, Ann Arbor, MI 48109-5478.

Ms. Welch: Center for Statistical Consultation and Research, 3554 Rackham Building, 915 East Washington Street, Ann Arbor, MI 48109-1070.

Dr. Saint: Ann Arbor Veterans Affairs Medical Center, Division of General Medicine, Department of Internal Medicine, University of Michigan, 300 North Ingalls Building, Room 7E08, Ann Arbor, MI 48109.

Dr. Rogers: Division of General Medicine, Department of Internal Medicine, University of Michigan, 300 North Ingalls Building, Room 7E07, Ann Arbor, MI 48109.

Author Contributions: Conception and design: A. Kachalia, S. Saint, S.R. Kaufman, M.A.M. Rogers, R. Boothman, S. Anderson.

Analysis and interpretation of the data: A. Kachalia, S. Saint, S.R. Kaufman, M.A.M. Rogers, R. Boothman, S. Anderson, K. Welch.

Drafting of the article: A. Kachalia, S.R. Kaufman, M.A.M. Rogers.

Critical revision of the article for important intellectual content: A. Kachalia, S. Saint, S.R. Kaufman, M.A.M. Rogers, R. Boothman.

Final approval of the article: A. Kachalia, S. Saint, S.R. Kaufman, M.A.M. Rogers, R. Boothman, S. Anderson.

Statistical expertise: S.R. Kaufman, M.A.M. Rogers, K. Welch.

Obtaining of funding: A. Kachalia, S.R. Kaufman, S. Saint, M.A.M. Rogers.

Administrative, technical, or logistic support: A. Kachalia, R. Boothman, S. Anderson.

Collection and assembly of data: A. Kachalia, S.R. Kaufman, R. Boothman, S. Anderson.


Ann Intern Med. 2010;153(4):213-221. doi:10.7326/0003-4819-153-4-201008170-00002
Text Size: A A A

Background: Since 2001, the University of Michigan Health System (UMHS) has fully disclosed and offered compensation to patients for medical errors.

Objective: To compare liability claims and costs before and after implementation of the UMHS disclosure-with-offer program.

Design: Retrospective before–after analysis from 1995 to 2007.

Setting: Public academic medical center and health system.

Patients: Inpatients and outpatients involved in claims made to UMHS.

Measurements: Number of new claims for compensation, number of claims compensated, time to claim resolution, and claims-related costs.

Results: After full implementation of a disclosure-with-offer program, the average monthly rate of new claims decreased from 7.03 to 4.52 per 100 000 patient encounters (rate ratio [RR], 0.64 [95% CI, 0.44 to 0.95]). The average monthly rate of lawsuits decreased from 2.13 to 0.75 per 100 000 patient encounters (RR, 0.35 [CI, 0.22 to 0.58]). Median time from claim reporting to resolution decreased from 1.36 to 0.95 years. Average monthly cost rates decreased for total liability (RR, 0.41 [CI, 0.26 to 0.66]), patient compensation (RR, 0.41 [CI, 0.26 to 0.67]), and non–compensation-related legal costs (RR, 0.39 [CI, 0.22 to 0.67]).

Limitations: The study design cannot establish causality. Malpractice claims generally declined in Michigan during the latter part of the study period. The findings might not apply to other health systems, given that UMHS has a closed staff model covered by a captive insurance company and often assumes legal responsibility.

Conclusion: The UMHS implemented a program of full disclosure of medical errors with offers of compensation without increasing its total claims and liability costs.

Primary Funding Source: Blue Cross Blue Shield of Michigan Foundation.

Figures

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Figure 1.
Monthly rates of new claims before and after implementation of the University of Michigan Health System disclosure-with-offer program.
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Figure 2.
Time to claim resolution before and after implementation of the University of Michigan Health System disclosure-with-offer program.
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Figure 3.
Monthly rates of legal and patient compensation costs before and after implementation of the University of Michigan Health System disclosure-with-offer program.
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Figure 4.
Mean costs per claim before and after implementation of the University of Michigan Health System disclosure-with-offer program.
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Appendix Figure.
Number of incidents reported to University of Michigan Health System risk management, by fiscal year.

An incident is any event (whether involving injury, potential injury, or any concern) that was reported to risk management. FY = fiscal year.

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Summary for Patients

Does Admitting Mistakes to Patients Lead to More Lawsuits?

The summary below is from the full report titled “Liability Claims and Costs Before and After Implementation of a Medical Error Disclosure Program.” It is in the 17 August 2010 issue of Annals of Internal Medicine (volume 153, pages 213-221). The authors are A. Kachalia, S.R. Kaufman, R. Boothman, S. Anderson, K. Welch, S. Saint, and M.A.M. Rogers.

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