Mandatory Error Reporting Discourages Disclosure of Information
Cathy Tokarski
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March 17, 2005 � In response to pressure for greater hospital accountability for medical errors and to spur efforts to prevent them, 21 states have created systems that call for mandatory reporting of major errors to regulatory agencies. Some states, such as
But a new study finds that instead of encouraging more reporting of medical errors, a majority (69%) of hospital leaders believe that mandatory reporting systems that share error-related information with the public actually discourage the reporting of such events within hospitals. And nearly three fourths (73%) thought that a mandatory system would have either no effect or a negative effect on patient safety in their hospital.
An even higher percentage (79%) of hospital leaders said that mandatory, nonconfidential systems encouraged lawsuits against hospitals, the study found. It was published in the March 16 issue of JAMA.
Two key findings emerged from the study, noted lead author Joel S. Weissman, PhD, an associate professor in the Department of Medicine and Institute for Health Policy at
"The other message is that they'd like to see more value from these system," such as more dissemination of aggregate data by states to help hospitals learn how to prevent or minimize the likelihood of serious errors. Such data-sharing has not yet occurred in
To assess hospital leaders' opinion of state medical error reporting systems, study researchers conducted a survey of hospital chief executive and chief operating officers from two states (Massachusetts and Colorado) with mandatory reporting with public disclosure, two states (Pennsylvania and Florida) with mandatory reporting without public disclosure, and two states (Florida and Georgia) without mandatory systems. Since the survey was conducted in 2002-2003, both
In addition to their perceptions of the effects of mandatory reporting systems on error reporting, the likelihood of lawsuits, and overall patient safety, respondents were also queried about their attitudes on releasing reports of error incidents to the public. They were also asked about the likelihood of reporting incidents to the state or to an affected patient based on hypothetical clinical scenarios that varied the type and severity of injury caused to the patient.
Although 79% of hospital leaders worried that mandatory, nonconfidential reporting would lead to a greater likelihood of lawsuits, that concern was not shared as widely by respondents from those states where such systems were already in place, the study found. One third of respondents from states with mandatory, nonconfidential systems said such systems had either no effect or discouraged the filing of lawsuits.
To a certain extent, "familiarity breeds acceptance," Dr. Weissman said of the fractured opinion. Hospitals in
While hospital leaders' perceptions of mandatory reporting on error reporting, the likelihood of lawsuits, and patient safety were fairly uniform, they were more mixed on the questions of releasing reports of error incidents to the public and to patients, the study found.
When a "moderate or minor" injury, described in the study's three clinical vignettes, occurred in mandatory, nonconfidential state, for example, responses ranged from 22% to 69% in saying that they would "always or usually" report the incident to the state or the patient. In contrast, responses from hospital officials in states where that information was confidential ranged from 43% to 89% in saying that they would always or usually report the incident.
The differences in reporting, according to Dr. Weissman, may depend on clinicians' decision to report fewer incidents of minor injury if the information does not remain confidential. Responses also may vary due to the differences in regulatory definitions among states about what constitutes a reportable event, he said. "Some of the language is not really definite, and that certainly could be behind part of it."
Hospitals need more consistency in the type of information to be reported to state authorities so there are no hidden "disincentives" to report, noted Leslie Kirle, MPH, study coauthor and senior director for clinical policy and patient advocacy at the Massachusetts Hospital Association. Mandatory reporting has served its role of fostering accountability, she said, but "the jury is out on its impact on quality of care."
JAMA. 2005;293:1359-1366
Reviewed by Gary D. Vogin, MD
Cathy Tokarski Program director/site editor of Medscape Business of Medicine
Medscape Medical News is edited by Deborah Flapan, assistant managing editor of news at Medscape. Send press releases and comments to [EMAIL PROTECTED].
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