title: Disclosure of hospital adverse events and its association with patients' ratings of the quality of care.
abstract: BACKGROUND
  Little is known about how the characteristics of adverse events (AEs) affect the likelihood of disclosure or how the disclosure of an AE relates to patients' perception of quality of care.
  
  
  METHODS
  The study included a random sample of medical and surgical acute care adult patients in Massachusetts hospitals between April 1 and October 1, 2003. The unit of analysis was the AE, and multivariable regression analyses accounted for clustering at the patient level.
  
  
  RESULTS
  Overall, 603 patients reported 845 AEs, and 40% of AEs were disclosed. The AEs that required additional treatment (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.16-2.32) or affected patients who reported good health (OR, 2.04; 95% CI, 1.29-3.24) were more likely to be disclosed. Disclosure was less likely if the events were preventable (OR, 0.58; 95% CI, 0.41-0.83) or if the patients were still affected by the AE at the time of survey (OR, 0.49; 95% CI, 0.31-0.78). Higher-quality ratings were associated with disclosure (OR, 2.04; 95% CI, 1.39-2.99) of preventable and nonpreventable events and with patients who felt that they were able to protect themselves from AEs (OR, 1.98; 95% CI, 1.21-3.24). Lower-quality ratings were associated with events that were preventable (OR, 0.55; 95% CI, 0.40-0.76), with events that caused increased discomfort (OR, 0.62; 95% CI, 0.46-0.86), or with events that still adversely affected the patient at the time of the survey (OR, 0.68; 95% CI, 0.46-0.98).
  
  
  CONCLUSIONS
  Rates of disclosure of AEs by medical personnel remain low in hospitalized patients. Disclosure of some of these events is associated with higher ratings of quality by patients.
authors.affiliation: MDiv, Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St, Ninth Floor, Boston, MA 02114, USA. llopez1@partners.org
authors.forename: Lenny
authors.initials: L
authors.lastname: López
authors.forename: Joel S
authors.initials: JS
authors.lastname: Weissman
authors.forename: Eric C
authors.initials: EC
authors.lastname: Schneider
authors.forename: Saul N
authors.initials: SN
authors.lastname: Weingart
authors.forename: Amy P
authors.initials: AP
authors.lastname: Cohen
authors.forename: Arnold M
authors.initials: AM
authors.lastname: Epstein
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends*; D006769:Hospitals, General; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D019300:Medical Errors / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010358:Patient Participation; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D011336:Probability; D011787:Quality of Health Care; D018570:Risk Assessment; D012494:Sampling Studies