Predictors of Disclosure of Hospital Adverse Events and Its Impact on Patients' Quality Ratings

1Institute for Health Policy and Department of Medicine, Massachusetts General Hospital, Boston, MA
2Harvard School of Public Health, Boston, MA
3Department of Health Policy and Management, Harvard School of Public Health, Harvard School of Public Health, Boston, MA
4Center for Patient Safety, Dana‐Farber Cancer Institute, Boston, MA
5Department of Health Policy and Management, Harvard School of Public Health, Harvard School of Public Health, Boston, MA
6Institute for Health Policy and Department of Medicine, Massachusetts General Hospital and Department of Healthcare Policy, Harvard Medical School, Boston, MA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 47

Background:

Some clinicians may fear that disclosing adverse events (AEs) to patients will result in malpractice claims and undermine patients' perceptions of health care quality. However, little is known about hospital and patient characteristics associated with disclosure of hospital adverse events and the effect of disclosure on patients' ratings of their quality of care during hospitalization. We hypothesized that greater disclosure would be associated with higher ratings of quality of care.

Methods:

In a 2‐stage probability sample, adult medical and surgical acute care patients in Massachusetts hospitals between April 1 and October 1, 2003, were interviewed by telephone to identify the occurrence of adverse events. Respondents who indicated they had suffered an AE were asked first whether the event was disclosed or more specifically (1) whether the patient was told of the AE by hospital personnel or (2) whether the hospital made a special effort to help the patient handle the effects of the event. Respondents who indicated that disclosure occurred were then asked if anyone from the hospital explained why the event occurred and if the patient felt that things could be done differently in the future. All patients were also asked to rate their perception of the attention and quality of the care they received. The unit of analysis was the AE, and analyses accounted for clustering at the patient level. Binary logistic regression models were used to identify predictors of disclosure and ordinal logistic regression was used to identify factors associated with patient ratings of quality.

Results:

Overall, 603 patients reported 845 AEs, indicating that 39.9% of adverse events were disclosed and 28% of preventable events were disclosed. AEs that increased length of stay (OR 1.82 [CI: 1.13‐2.93]) or that affected male patients (OR 1.53 [CI: 1.032.26]) were more likely to be disclosed, whereas preventable events were less likely to be disclosed (OR 0.65 [CI: 0.46‐0.93]). In adjusted analyses, patients were more likely to rate quality of care higher when the patient received an explanation of the cause of the AE (OR 1.96 [CI: 1.27‐3.01]) and if the patient felt able to protect himself from AEs (OR 2.01 [CI: 1.21‐3.35]). Quality ratings were lower among Latinos (OR 0.37 [CI: 0.14‐0.95]) than among whites, when the patient endorsed the feeling that things could be done differently in the future (OR 0.61 [CI: 0.41‐0.91]), among patients with significant discomfort (OR 0.62 [CI: 0.45‐0.87]), and among those who continued to experience the effect of the AE (OR 0.61 [0.41‐0.92]).

Conclusions:

Disclosure of adverse events by medical personnel remains uncommon relative to the frequency of adverse events, especially for preventable events. Disclosure of adverse events and an explanation of the cause of the events are both associated with patients rating their care more highly. Hospital personnel should encourage disclosure of adverse events to patients.

Author Disclosure:

L. Lopez, none; A. Cohen, none; E. Schneider, none; S. Weingart, none; A. Epstein, none; J. Weissman, none.

To cite this abstract:

Lopez L, Cohen A, Schneider E, Weingart S, Epstein A, Weissman J. Predictors of Disclosure of Hospital Adverse Events and Its Impact on Patients' Quality Ratings. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 47. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/predictors-of-disclosure-of-hospital-adverse-events-and-its-impact-on-patients-quality-ratings/. Accessed September 16, 2019.

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