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Original Investigation
Health Care Reform
November 9, 2009

Disclosure of Hospital Adverse Events and Its Association With Patients' Ratings of the Quality of Care

Author Affiliations

Author Affiliations: Institute for Health Policy and Department of Medicine, Massachusetts General Hospital (Drs López and Weissman), and Section on Health Services and Policy Research, Division of General Medicine, Brigham and Women's Hospital (Drs Schneider and Epstein), Harvard Medical School, Boston, Massachusetts; Departments of Health Policy and Management (Drs Weissman and Epstein) and Information Technology (Ms Cohen), Harvard School of Public Health, Boston; Center for Patient Safety, Dana-Farber Cancer Institute, Boston (Dr Weingart); and Massachusetts Executive Office of Health and Human Services, Boston (Dr Weissman).

Arch Intern Med. 2009;169(20):1888-1894. doi:10.1001/archinternmed.2009.387

Background  Little is known about how the characteristics of adverse events (AEs) affect the likelihood of disclosure or how the disclosure of an AE relates to patients' perception of quality of care.

Methods  The study included a random sample of medical and surgical acute care adult patients in Massachusetts hospitals between April 1 and October 1, 2003. The unit of analysis was the AE, and multivariable regression analyses accounted for clustering at the patient level.

Results  Overall, 603 patients reported 845 AEs, and 40% of AEs were disclosed. The AEs that required additional treatment (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.16-2.32) or affected patients who reported good health (OR, 2.04; 95% CI, 1.29-3.24) were more likely to be disclosed. Disclosure was less likely if the events were preventable (OR, 0.58; 95% CI, 0.41-0.83) or if the patients were still affected by the AE at the time of survey (OR, 0.49; 95% CI, 0.31-0.78). Higher-quality ratings were associated with disclosure (OR, 2.04; 95% CI, 1.39-2.99) of preventable and nonpreventable events and with patients who felt that they were able to protect themselves from AEs (OR, 1.98; 95% CI, 1.21-3.24). Lower-quality ratings were associated with events that were preventable (OR, 0.55; 95% CI, 0.40-0.76), with events that caused increased discomfort (OR, 0.62; 95% CI, 0.46-0.86), or with events that still adversely affected the patient at the time of the survey (OR, 0.68; 95% CI, 0.46-0.98).

Conclusions  Rates of disclosure of AEs by medical personnel remain low in hospitalized patients. Disclosure of some of these events is associated with higher ratings of quality by patients.