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17 August 2010 Annals of Internal Medicine Tip Sheet

Below is information about two early online releases and two articles being published in the July 6 issue of Annals of Internal Medicine. The information is not intended to substitute for articles as sources of information. Annals of Internal Medicine attribution is required for all coverage. For an embargoed copy of a study, contact Angela Collom at acollom@acponline.org or 215-351-2653.

1. Disclosing Medical Errors Does Not Increase Malpractice Claims

While experts acknowledge that patients should be informed of medical errors, some fear that proactive disclosure will increase litigation and costs to health care systems. In 2001, the University of Michigan Health System (UMHS) launched a comprehensive claims management program that centered on full disclosure for medical errors. Under this model, UMHS proactively looked for medical errors, fully disclosed found errors to patients, and offered compensation when at fault. Researchers conducted a retrospective before-and-after analysis to determine how this model affected claims and costs. According to records from 1995 to 2007, researchers found a decrease in new legal claims, number of lawsuits per month, time to claim resolution, and costs after implementation of the disclosure with offer program.

2. Pre-transplant Corticosteroids Do Not Prevent Renal Failure in Allograft Recipients

Approximately 25 percent of recipients of organs from deceased donors suffer from post-transplant acute renal failure, or ARF. Inflammation in the donor organ is associated with risk for ARF. There is no drug treatment for end-stage renal disease, so patients must receive renal replacement therapy by either dialysis or kidney transplantation. Researchers conducted a randomized, controlled trial to determine whether administering corticosteroids to deceased organ donors could reduce the incidence and duration of ARF. Three hundred and six deceased heart-beating donors and 455 renal transplant recipients were studied. Organ donors were administered an intravenous infusion of either 1000 mg methylprednisone (n=136 donors) or placebo (n=133 donors) at least three hours before organ harvesting. The researchers found that systemic suppression of inflammation in deceased donors with corticosteroids did not reduce the incidence or duration of post-transplant ARF in allograft recipients.

3. Physician Collaboration May Improve Care for Patients with Chronic Hepatitis C

Medicare has proposed quality-of-care indicators for chronic hepatitis C virus (HCV) infection. Researchers analyzed a national database of 10,385 HCV patients to determine if these indicators are followed in clinical practice. They found that only about 20 percent of patients received all recommended care. Care was especially poor for patients who were economically disadvantaged or members of a racial minority group. Overall, adherence to quality-of-care measures was lowest for vaccination and highest for pretreatment HCV genotype testing. However, patients who were cared for by both internists and specialists received the highest-quality care. Researchers conclude that collaboration between internists and specialists may lead to higher-quality care.