Research Roundup: Lowering malpractice costs; Advance care planning limitations; Consumers review their own health care

Annals of Internal Medicine:  Liability Claims And Costs Before And After Implementation Of A Medical Error Disclosure Program - This study focused on a "disclosure-with-offer program" launched by the University of Michigan Health System (UMHS) in 2001. "After full implementation of a disclosure-with-offer program, the average monthly rate of new claims decreased from 7.03 to 4.52 per 100,000 patient encounters. … The average monthly rate of lawsuits decreased from 2.13 to 0.75 per 100,000 patient encounters. … Median time from claim reporting to resolution decreased from 1.36 to 0.95 years."

The authors conclude, "In an era of calls for greater transparency in health care, disclosure is often cited as a practice necessary to physician ethics and patient safety. The UMHS experience demonstrates that disclosure with offer can be conducted—in a setting similar to many other centers in the United States—without exacerbating liability costs" (Kachalia et al., 8/17).

Urban Institute: Will The Patient Protection And Affordable Care Act Address The Problems Associated With Medical Malpractice? - This brief (.pdf) examines the medical malpractice provisions of the health law, the Patient Protection And Affordable Care Act (PPACA). Additionally, the brief describes alternative liability and safety reforms, noting whether such approaches are eligible for PPACA demonstration grants.

"[D]ebates about liability reform have become nonproductive battles between pro-defendant and pro-plaintiff forces. Health reform did nothing to alter that political dynamic, nor the underlying problems of preventable injury and defensive medicine. Patients as a whole could benefit if conventional tort limits were traded for better-value care as health reform is implemented or if broader reforms of liability could be demonstrated successful," the author writes. "The pre-existing demonstration mechanisms of the Agency for Healthcare Research and Quality better serve this purpose than do PPACA's very limited provisions on demonstrations" (Bovbjerg, 8/1).

The Urban Institute also features briefs on provisions in the new health law relating to the buying insurance across state lines and those aimed at containing costs.

The Robert Wood Johnson Foundation/ State Health Access Data Assistance Center (SHADAC): Health Care Consumer Confidence Index: An Analysis of Findings from July 2009 - June 2010 - This survey tracks American consumers' attitudes about their own health care. "An analysis of the past year's data reveals that while consumer confidence spiked the month after reform, it quickly returned to baseline numbers and proceeded to level out.  Interestingly, two groups who received significant attention during the health reform debate—seniors, and those who already have health insurance—saw relatively minimal fluctuation over the past year, both maintaining high levels of confidence in their health care. ... Uninsured Americans continued to have the lowest levels of confidence" (8/19).

Annals of Internal Medicine: Redefining The "Planning" In Advance Care Planning: Preparing For End-of-Life Decision Making - "Although advance directives have shown benefit in some cases, they frequently do not affect the quality of end-of-life care or improve clinician and surrogate knowledge of patient preferences," according to this study which analyzes existing literature. "Preparation for in-the-moment decision making shifts the focus from having patients make premature decisions based on incomplete information to preparing them and their surrogates for the types of decisions and conflicts they may encounter when they do have to make in-the-moment decisions. Advance directives, although important, are just one piece of information to be used at the time of decision making" (Sudore and Fried, 8/17).

The Cochrane Library: Pharmaceutical Policies: Effects Of Restrictions On Reimbursement - Researchers reviewed "29 studies that evaluated policies that restrict reimbursement of specific prescriptions drugs. Where drugs have cheaper, effective alternatives and they target symptoms, this review found that reimbursement restriction policies can ensure better use of the medications with reduced costs and without an increase in the use of other health services, as would be expected if there were negative health effects of the restriction policies. ... When restrictions to reimbursement policies are designed using the best available evidence on the health impact of the medications, they support equitable access to the drugs that best support health by supporting the sustainability of [publicly] subsidized drug plans."

According to the authors of the study, "[p]articipants were most often senior citizens or low income adult populations, or both, in [publicly] subsidized or administered pharmaceutical benefit plans" (Green et al., August 2010).

Commonwealth Fund: Predictive Modeling In Action: How 'Virtual Wards' Help High-Risk Patients Receive Hospital Care at Home - This issue brief (.pdf) explores a model of home-based coordinated care launched in Britain in 2004 that provides "multidisciplinary case management services to people who have been identified, using a predictive model, as high risks for future emergency hospitalization." As described by the author, "Virtual wards operate using the systems, staffing, and daily routines of a hospital ward but without a physical ward building." Patients identified as being at high-risk for future hospitalization "are provided with intensive preventive care while still living in their own homes." The brief also includes information on virtual ward programs being planned for or piloted in the U.S. (Lewis, 8/12).