Changes in Physician Practice Patterns after Implementation of a Communication‐and‐Resolution Program

Abstract

Objective. To test if a 2006 communication-and-resolution program to address unexpected adverse outcomes was associated with changes in cost and use trajectories. Data Source. Records of patients discharged with a principal diagnosis of chest pain from 44 nonfederal general hospitals in Cook County, Illinois, between January 2002 and December 2009. Study Design. Propensity-score matched discharges from the intervention and comparison hospitals before computing difference-in-differences estimates of quarterly growth rates. Data Collection Methods. We used discharge records submitted to a central statewide repository. Principal Findings. Relative to the comparison hospitals and to pre-implementation trends, and consistent with reduced testing at presentation, the intervention hospital recorded an increase in the number of patients with a principal diagnosis of chest pain. Among admitted patients, quarterly growth rates of clinical laboratory and radiology charges at the intervention hospital declined by 3.8 and 6.9 percentage points. Conclusions. Among patients with chest pain, the implementation of a comprehensive communication-and-resolution program was associated with substantially reduced growth rates in the use of diagnostic testing and imaging services. Further research is needed to establish to what extent these changes were attributable to the program and clinically appropriate. Key Words. Communication-and-resolution program, medical liability, chest pain, diagnostic radiology Emerging communication-and-resolution programs (CRPs) aim to address adverse patient safety events proactively by recognizing the injury, fully disclosing to patients all information surrounding their care, and offering an apology and remediation if warranted (Boothman et al. 2009;McDonald et al. 2010).

Changes in liability claims, costs, and resolution times following the introduction of a communication-and-resolution program in Tennessee

“…16,17 This can improve quality of care. Helmchen et al 24 demonstrated a decrease ordering of lab tests and imaging, suggesting that CRP may decrease the practice of defensive medicine. The finding in the current study demonstrating a decrease time to resolve a case and the significant percent of cases that were resolved by apology alone supports the conclusions of Kass et al 25 that CRP mitigates the stress of litigation on patients and physicians compared to deny and defend.…”

PARENTS 2 study: consensus report for parental engagement in the perinatal mortality review process

“…Data on written complaints in the National Health Service in the UK (2016–2017) showed that the largest proportion of complaints was attributed to communication issues. The communication‐and‐resolutions program in the USA aims to promptly offer financial and non‐financial resolution when adverse events are caused by substandard care. Patient and family involvement is extensive and integral to this program.…”

“…Patient and family involvement is extensive and integral to this program. A study by the University of Illinois found that by encouraging transparency and taking a proactive approach with patient engagement, the communication‐and‐resolutions program may help to resolve malpractice disputes faster and at a lower cost. By enhancing the quality of communication with parents through engaging them in the process of the review, there is potential to reduce the number of complaints or amount of litigation.…”

Paving the Way for Progress: The Agency for Healthcare Research and Quality Patient Safety and Medical Liability Demonstration Initiative

“…Helmchen et al. further report about changes in physician practice patterns after UIC's implementation of the Seven Pillars program (Helmchen, Lambert, and McDonald ). Gallagher et al.…”