title: Liability claims and costs before and after implementation of a medical error disclosure program.
abstract: 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.
  
  
  METHODS
  Retrospective before-after analysis from 1995 to 2007.
  
  
  METHODS
  Public academic medical center and health system.
  
  
  METHODS
  Inpatients and outpatients involved in claims made to UMHS.
  
  
  METHODS
  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]).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  The UMHS implemented a program of full disclosure of medical errors with offers of compensation without increasing its total claims and liability costs.
  
  
  BACKGROUND
  Blue Cross Blue Shield of Michigan Foundation.
authors: Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. akachalia@partners.org
authors: Allen
authors: A
authors: Kachalia
authors: Samuel R
authors: SR
authors: Kaufman
authors: Richard
authors: R
authors: Boothman
authors: Susan
authors: S
authors: Anderson
authors: Kathleen
authors: K
authors: Welch
authors: Sanjay
authors: S
authors: Saint
authors: Mary A M
authors: MA
authors: Rogers
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000458:organization & administration; D035881:Compensation and Redress; D003365:Costs and Cost Analysis; D030881:Disclosure; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D016365:Liability, Legal / Q000191:economics*; D019300:Medical Errors / Q000191:economics* / Q000331:legislation & jurisprudence; D008824:Michigan; D016134:Organizational Policy; D015397:Program Evaluation; D012189:Retrospective Studies