title: Do Written Disclosures of Serious Events Increase Risk of Malpractice Claims? One Health Care System's Experience.
abstract: This study aimed to determine whether Pennsylvania ACT 13 of 2002 (Mcare) requiring the written and verbal disclosure of "serious events" was accompanied by increased malpractice claims or compensation costs in a large U.S. health system.
  
  
  
  The primary outcome was the rate of malpractice claims. The secondary outcome was the amount paid for compensation of malpractice claims. The analyses tested the relationship between the rate of serious event disclosures and the outcome variables, adjusted for the year of the event, category of claim, and the degree of "harm" related to the event.
  
  
  
  There were 15,028 serious event disclosures and 1302 total malpractice claims among 1,587,842 patients admitted to UPMC hospitals from May 17, 2002, to June 30, 2011. As the number of serious event disclosures increased, the number of malpractice claims per 1000 admissions remained between 0.62 and 1.03. Based on a matched analysis of claims that were disclosed and those that were not (195 pairs), disclosure status was significantly associated with increased claim payout (disclosures had 2.71 times the payout; 95% confidence interval, 1.56-4.72). Claims with higher harm levels H and I were independently associated with higher payouts than claims with lower harm levels A to D (11.15 times the payout; 95% confidence interval, 2.30-54.07).
  
  
  
  Implementation of a mandated serious event disclosure law in Pennsylvania was not associated with an overall increase in malpractice claims filed. Among events of similar degree of harm, disclosed events had higher compensation paid compared with those that had not been disclosed.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Painter
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Kelley M
authors.initials: KM
authors.lastname: Kidwell
authors.affiliation: UPMC.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Kidwell
authors.affiliation: UPMC.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Janov
authors.affiliation: Captive Insurance Program, UPMC.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Voinchet
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Simmons
authors.affiliation: Center for Health Services and Outcomes Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Albert W
authors.initials: AW
authors.lastname: Wu
mesh_terms: D030881:Disclosure / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008318:Malpractice / Q000706:statistics & numerical data*; D010414:Pennsylvania; D012189:Retrospective Studies
references.citation: J Am Coll Surg. 2012 Oct;215(4):480-8
references.pmid: 22676963
references.citation: Ann Intern Med. 1992 Dec 1;117(11):947-60
references.pmid: 1443957
references.citation: Ann Intern Med. 1999 Dec 21;131(12):963-7
references.pmid: 10610649
references.citation: N Engl J Med. 2006 May 11;354(19):2024-33
references.pmid: 16687715
references.citation: UCLA Law Rev. 1980 Oct;28(1):52-94
references.pmid: 11665262
references.citation: Ann Intern Med. 2010 Aug 17;153(4):213-21
references.pmid: 20713789
references.citation: Patient Educ Couns. 2013 Sep;92(3):319-27
references.pmid: 23797044
references.citation: Health Aff (Millwood). 2007 Jan-Feb;26(1):215-26
references.pmid: 17211031
references.citation: J Gen Intern Med. 2006 Sep;21(9):942-8
references.pmid: 16918739
references.citation: Patient Educ Couns. 2011 Sep;84(3):344-51
references.pmid: 21636236
references.citation: J Gen Intern Med. 2009 Sep;24(9):1012-7
references.pmid: 19578819
references.citation: Healthc Q. 2008;11(3 Spec No.):85-90
references.pmid: 18382167
references.citation: Chest. 2008 Nov;134(5):1044-1050
references.pmid: 18988779
references.citation: N Engl J Med. 1996 Dec 26;335(26):1963-7
references.pmid: 8960477
references.citation: Health Aff (Millwood). 2010 Sep;29(9):1611-9
references.pmid: 20820016
references.citation: Jt Comm J Qual Patient Saf. 2010 Sep;36(9):402-10
references.pmid: 20873673
references.citation: BMJ Qual Saf. 2013 Aug;22(8):672-80
references.pmid: 23610443
references.citation: Arch Intern Med. 1996 Dec 9-23;156(22):2565-9
references.pmid: 8951299
references.citation: Clin Obstet Gynecol. 2008 Dec;51(4):700-8
references.pmid: 18981794
references.citation: J Gen Intern Med. 1997 Dec;12(12):770-5
references.pmid: 9436897
references.citation: JAMA. 2003 Feb 26;289(8):1001-7
references.pmid: 12597752
references.citation: JAMA. 2010 Oct 20;304(15):1656-7
references.pmid: 20959569
references.citation: Health Aff (Millwood). 2012 Dec;31(12):2681-9
references.pmid: 23213152
references.citation: J Health Life Sci Law. 2009 Jan;2(2):125-59
references.pmid: 19288891
references.citation: J Public Health Res. 2013 Dec 01;2(3):e32
references.pmid: 25170503
references.citation: Surgery. 2013 Apr;153(4):465-72
references.pmid: 23257079
references.citation: Milbank Q. 2012 Dec;90(4):682-705
references.pmid: 23216427
references.citation: Jt Comm J Qual Saf. 2003 Oct;29(10):503-11
references.pmid: 14567259
references.citation: CMAJ. 2001 Feb 20;164(4):509-13
references.pmid: 11233873
references.citation: JAMA. 2006 Sep 20;296(11):1401-4
references.pmid: 16985235
references.citation: Br Med J (Clin Res Ed). 1983 Dec 24-31;287(6409):1919-23
references.pmid: 6418271
references.citation: N Engl J Med. 2013 Oct 31;369(18):1677-9
references.pmid: 24171515
references.citation: N Engl J Med. 2007 Jun 28;356(26):2713-9
references.pmid: 17596606
references.citation: J Am Osteopath Assoc. 2012 May;112(5):302-6
references.pmid: 22582200
references.citation: Int J Qual Health Care. 2010 Oct;22(5):371-9
references.pmid: 20709703