ORLANDO – A systemwide medical error disclosure program that successfully reduced the rate of claims and improved claim resolution time for a large university health system had similar effects on gastroenterology-specific claims, a retrospective study has shown.
The findings suggest that error disclosure programs can benefit even procedure-based specialties like gastroenterology, Dr. Megan A. Adams reported at the annual Digestive Disease Week.
Dr. Megan A. Adams
The medical error disclosure program, which included incident reporting and disclosure, internal investigation of all claims, an offer of apology and compensation for all reasonable claims, and vigorous defense of all unreasonable claims, was adopted at the University of Michigan Health System (UMHS) in 2001 following a 1999 Institute of Medicine report calling for efforts to reduce medical errors. The program was developed in light of an increasing realization that traditional "deny-and-defend" approaches to claims were failing to achieve the goal of improving patient care.
A hospitalwide analysis published in 2010 showed a statistically significant 36% decrease in the average monthly rate of new claims per patient encounter, 30% decrease in the median time from claim reporting to resolution, and 44% decrease in the average cost per lawsuit following program implementation (Ann. Intern. Med. 2010;153:213-21).
"But the question remained: ‘Can we apply these systemwide findings to gastroenterology?’ First, we have a procedure-based specialty. We also do many open-access procedures where we have no preexisting or established relationship with our patients. And, finally, we treat gastrointestinal-specific diseases, such as [those in] patients with functional bowel disorders, who represent a complex patient population," said Dr. Adams of the University of Michigan Medical Center, Ann Arbor.
A review of gastroenterology-specific claims in the UMHS Risk Management database from 1990 to 2010 showed that despite a 72% increase in encounters in the 10 years after implementation, compared with the 10 years prior (412,000 vs. 240,000 encounters), only 28 claims were made after, versus 38 before, implementation.
The rate of claims declined significantly from 0.16% to 0.068% per 1,000 patient encounters. Moreover, after adjustment for inflation, total settlement dollars decreased by 54%, overall claims-related costs decreased by 94%, mean total liability per claim decreased by 52%, and time to claim resolution decreased by 50%.
Although the findings are limited by the small number of claims and an inability to determine causality, and did not consider statewide or national trends in the filing of claims, the results do demonstrate that the systemwide findings at UMHS were "reproduced in a dramatic way in the procedure-based specialty of gastroenterology," Dr. Adams said.
"When properly implemented as part of a systemwide quality improvement effort, medical error disclosure programs help to foster a culture of transparency, and in doing so, strengthen patients’ trust in the health care system. They also help to promote ongoing medical error prevention in a way that does not lead to increased medical liability," she said, adding that further research looking at the generalizability of these findings to other health systems is warranted.
Dr. Adams reported having no relevant financial disclosures.