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

摘要

Background: Since 2001, the University of Michigan Health Systemn(UMHS) has fully disclosed and offered compensation to patientsnfor medical errors.nObjective: To compare liability claims and costs before and afternimplementation of the UMHS disclosure-with-offer program.nDesign: Retrospective before–after analysis from 1995 to 2007.nSetting: Public academic medical center and health system.nPatients: Inpatients and outpatients involved in claims made tonUMHS.nMeasurements: Number of new claims for compensation, numbernof claims compensated, time to claim resolution, and claims-relatedncosts.nResults: After full implementation of a disclosure-with-offer pro-ngram, the average monthly rate of new claims decreased from 7.03nto 4.52 per 100 000 patient encounters (rate ratio [RR], 0.64 [95%nCI, 0.44 to 0.95]). The average monthly rate of lawsuits de-ncreased from 2.13 to 0.75 per 100 000 patient encounters(RR, 0.35 [CI, 0.22 to 0.58]). Median time from claim report-ning to resolution decreased from 1.36 to 0.95 years. Averagenmonthly cost rates decreased for total liability (RR, 0.41 [CI,n0.26 to 0.66]), patient compensation (RR, 0.41 [CI, 0.26 ton0.67]), and non–compensation-related legal costs (RR, 0.39n[CI, 0.22 to 0.67]).nLimitations: The study design cannot establish causality. Malprac-ntice claims generally declined in Michigan during the latter part ofnthe study period. The findings might not apply to other healthnsystems, given that UMHS has a closed staff model covered by ancaptive insurance company and often assumes legal responsibility.nConclusion: The UMHS implemented a program of full disclosurenof medical errors with offers of compensation without increasing itsntotal claims and liability costs.nPrimary Funding Source: Blue Cross Blue Shield of MichigannFoundation.