law firm Hogan Lovells, in Washington, D.C., USA.
Health Aff (Millwood). 2012 Dec;31(12):2681-9. doi: 10.1377/hlthaff.2012.0185.
Under "disclosure-and-resolution" programs, health systems disclose adverse events to affected patients and their families; apologize; and, where appropriate, offer compensation. Early adopters of this approach have reported reduced liability costs, but the extent to which these results stem from effective disclosure and apology practices, versus compensation offers, is unknown. Using survey vignettes, we examined the effects of different compensation offers on individuals' responses to disclosures of medical errors compared to explanation and apology alone. Our results show that although two-thirds of these individuals desired compensation offers, increasing the offer amount did not improve key outcomes. Full-compensation offers did not decrease the likelihood of seeking legal advice and increased the likelihood that people perceived the disclosure and apology as motivated by providers' desire to avoid litigation. Hospitals, physicians, and malpractice insurers should consider this complex interplay as they implement similar initiatives. They may benefit from separating disclosure conversations and compensation offers and from excluding physicians from compensation discussions.
在“披露与解决”计划中，医疗系统会向受影响的患者及其家属披露不良事件；道歉；并在适当情况下提供赔偿。这种方法的早期采用者报告称，责任成本有所降低，但这些结果在多大程度上归因于有效的披露和道歉实践，而不是赔偿提议，尚不清楚。我们使用调查案例研究，考察了不同赔偿提议对个人对医疗失误披露的反应的影响，与单独的解释和道歉相比。我们的研究结果表明，尽管这些人中的三分之二希望获得赔偿提议，但增加提议金额并不能改善关键结果。全额赔偿提议并未降低寻求法律建议的可能性，并增加了人们认为披露和道歉是由提供者避免诉讼的愿望所驱动的可能性。医院、医生和医疗事故保险公司在实施类似计划时应考虑到这种复杂的相互作用。他们可以从分离披露对话和赔偿提议以及将医生排除在赔偿讨论之外中受益。
