Liability Claims and Costs Before and After Implementation of a Medical Error Disclosure Program
Liability Claims and Costs Before and After Implementation of a Medical Error Disclosure Program
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DOI：
10.7326/0003-4819-153-4-201008170-00002
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发表时间：
2010-08-17
影响因子：
39.2
通讯作者：
Rogers, Mary A. M.
中科院分区：
文献类型：
--
作者：
Kachalia, Allen;Kaufman, Samuel R.;Rogers, Mary A. M.
背景资料：自2001年以来，密歇根大学卫生系统（UMHS）已充分披露，并提供赔偿病人的医疗错误。目的：比较责任索赔和成本之前和之后的UMHS的赔偿提供程序的实施。设计：回顾性前后分析，从1995年至2007年。设置：公共学术医疗中心和卫生系统。患者：涉及向UMHS提出索赔的住院和门诊患者。测量：新索赔的数量，已赔偿的索赔数量，索赔解决时间和索赔相关成本。结果：在全面实施“有报价的担保”计划后，平均每月新申索率由每10万次求诊的7.03宗下降至4.52宗（比率[RR]，0.64 [95%CI，0.44至0.95]）。平均每月诉讼率从2.13/10万例患者下降至0.75/10万例患者，RR，0.35 [CI，0.22至0.58]）。从索赔报告到解决的中位时间从1.36年减少到0.95年。总责任（RR，0.41 [CI，0.26 - 0.66]）、患者赔偿（RR，0.41 [CI，0.26 - 0.67]）和非赔偿相关法律的费用（RR，0.39 [CI，0.22 - 0.67]）的平均月费用率降低。在研究期间的后半部分，密歇根州的医疗事故索赔普遍下降。调查结果可能不适用于其他卫生系统，因为UMHS有一个封闭的工作人员模型所涵盖的专属保险公司，往往承担法律的responsibility.Conclusion：UMHS实施了一项计划，充分披露医疗差错提供赔偿，而不增加其总索赔和责任成本。
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.