title: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  Propensity-score matched discharges from the intervention and comparison hospitals before computing difference-in-differences estimates of quarterly growth rates.
  
  
  METHODS
  We used discharge records submitted to a central statewide repository.
  
  
  RESULTS
  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.
authors.affiliation: Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC.
authors.forename: Lorens A
authors.initials: LA
authors.lastname: Helmchen
authors.affiliation: Department of Communication Studies, Center for Communication and Health, Northwestern University, Chicago, IL.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Lambert
authors.affiliation: MedStar Institute for Quality & Safety, MedStar Health Research Institute, Columbia, MD.|Beazley Institute for Health Law and Policy, Loyola University Chicago, Chicago, IL.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: McDonald
mesh_terms: D002637:Chest Pain / Q000175:diagnosis / Q000628:therapy; D003142:Communication; D005260:Female; D006801:Humans; D016365:Liability, Legal; D008297:Male; D008318:Malpractice / Q000706:statistics & numerical data; D019300:Medical Errors / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D016730:Program Development; D057216:Propensity Score
keywords: Communication-and-resolution program; chest pain; diagnostic radiology; medical liability