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Communication and resolution programs at four Massachusetts medical centers helped resolve adverse medical events without increasing lawsuits or leading to excessive payouts to patients, according to Michelle M. Mello, PhD, and her colleagues.
They evaluated a communication and resolution program (CRP) model known as CARe (Communication, Apology, and Resolution) implemented at Beth Israel Deaconess Medical Center in Boston and Baystate Medical Center in Springfield, Mass., and at two of each center’s community hospitals. As part of the CARe model, hospital staff and insurers communicate with patients when adverse events occur, investigate and explain what happened, and, when appropriate, apologize and offer compensation.
Of 989 total events studied, 929 (90%) entered the program because an adverse event that allegedly exceeded the severity threshold was reported and 60 (6%) entered CARe because a prelitigation notice or claim was received, said Dr. Mello, professor of law and health research and policy at Stanford (Calif.) University.
Few events that entered the CARe process met the criteria for compensation. The standard of care was violated in 26% of cases where a determination could be reached. No determination could be reached in 59 cases, 9 cases were pending at the close of data collection, and 5 were referred directly to the insurer. Of the 241 cases involving standard-of-care violations, 55% were potentially eligible for compensation because they involved significant harm. After further review, monetary compensation was offered in 43 cases and paid in 40 cases by August 2016, with $75,000 as the median payment (Health Aff. 2017 Oct 2;36[10]:1795-1803).
As of August 2016, 5% of the 929 adverse events led to claims or lawsuits. Insurers deemed 14 of the 47 events that ultimately resulted in legal action ineligible for compensation because of a lack of negligence or lack of harm. They deemed 22 of the cases compensable, offered compensation in all of them, and had settled 20 by August 2016.
During the CARe process, patient safety improvements were frequently identified and improvements made, the investigators said. Of 132 cases in which review progressed far enough for patient safety questions to have been answered, 41% of the incidents gave rise to a safety improvement action. Actions included sharing investigation findings with clinical staff members, clinical staff educational efforts, policy changes, safety alerts sent to staff members, input into the quality improvement system for further analysis, new process flow diagrams, and human factor engineering analysis, among others.
Investigators also surveyed clinicians on their satisfaction with the CARe program. Of 162 clinicians (124 physicians), nearly 40% were either not very or not at all familiar with the program. More than two-thirds (69%) of those who felt well informed about the program gave strongly positive ratings and 10% gave a negative rating to the program. The most commonly suggested improvement to CARe was to improve communication with clinicians.
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