title: Intended and unintended effects of large-scale adverse event disclosure: a controlled before-after analysis of five large-scale notifications.
abstract: OBJECTIVE
  How patients respond to being notified of a large-scale adverse event (LSAE), such as improper sterilisation of medical equipment that exposes them to bloodborne pathogens, is not well known. The objective of this study was to determine, using administrative data, the intended and unintended consequences of patient notification following a LSAE.
  
  
  METHODS
  We examined five LSAEs where patients may have been inadvertently exposed to hepatitis C virus (HCV), HIV, and hepatitis B virus (HBV). A total of 9638 cases were identified at five Department of Veteran Affairs (VA) medical facilities between 2009 and 2012. We identified controls at the same facility prior to the exposure period and at neighbouring facilities (n=45,274). Difference-in-differences models were used with Veterans Health Administration (VHA) and Medicare data to examine infectious disease testing rates and subsequent utilisation patterns.
  
  
  RESULTS
  Receipt of a LSAE notification was associated with a 73.2, 76.8 and 77.1 adjusted percentage point increase for HCV, HIV and HBV testing, respectively (all p<0.001). Compared with white patients, African-American patients were significantly less likely to return to VHA for follow-up testing. Patients exposed to a dental LSAE reduced their use of preventive and restorative dental care over the subsequent year, but they eventually came back to VHA for dental services 18-months post exposure.
  
  
  CONCLUSIONS
  The majority of patients notified of a LSAE responded by getting tested for HCV, HIV and HBV, although there remains room for improvement. Potential exposure to a LSAE was associated with increased odds of subsequently using non-VA facilities, but the size and timing of the shift depended on the type of care.
authors.affiliation: Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA Department of Health Research and Policy, Stanford University, Stanford, California, USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
authors.affiliation: Department of Health Research and Policy, Stanford University, Stanford, California, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Taylor
authors.affiliation: Department of Health Research and Policy, Stanford University, Stanford, California, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cowgill
authors.affiliation: Department of Health Research and Policy, Stanford University, Stanford, California, USA Division of General Internal Medicine, Stanford University, Stanford California, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.affiliation: Department of Health Research and Policy, Stanford University, Stanford, California, USA.
authors.forename: Pon
authors.initials: P
authors.lastname: Su
authors.affiliation: Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bokhour
authors.affiliation: Veterans Health Administration, Office of Public Health, Washington DC, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Durfee
authors.affiliation: Veterans Health Administration, Office of Public Health, Washington DC, USA Yale School of Medicine, Departments of Internal Medicine and Pediatrics, New Haven, Conneticut, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Martinello
authors.affiliation: Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maguire
authors.affiliation: Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: A Rani
authors.initials: AR
authors.lastname: Elwy
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D016358:Contact Tracing / Q000706:statistics & numerical data*; D030881:Disclosure / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000635:transmission; D006509:Hepatitis B / Q000175:diagnosis / Q000635:transmission; D006526:Hepatitis C / Q000175:diagnosis / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014777:Virus Diseases / Q000175:diagnosis* / Q000635:transmission*; D044465:White People / Q000523:psychology*
keywords: Communication; Decision making; Health services research; Healthcare quality improvement; Patient safety