Study: Communication-and-resolution programs can cut liability claims, but their link to safety is less than clear 

Experts say further research should seek a direct link between these communication-and-resolution program and patient safety. (Getty/wutwhanfoto)(Getty/AlexRaths)

New research shows that communication-and-resolution programs for responding to patient harm can reduce liability claims. But experts warn more work is needed to prove the link between these programs and actual improvements in safety.

Researchers in Massachusetts followed the implementation of a CRP called Communication, Apology and Resolution (CARe) at Beth Israel Deaconess Medical Center, Baystate Medical Center and three Baystate community hospitals, according to a new study published in Health Affairs. 

CRP programs like CARe push clinicians to communicate more openly with patients following harm, and, if appropriate, offer an apology and compensation for their experience. 

The team began to measure liability claims in 2006, about six years before the CARe program rolled out at the participating hospitals, and then again between 2013 and 2017. They found that after the program was implemented, the community hospitals and one of the two academic medical centers saw declines new claim rates, while comparison hospitals—three AMCs and two community hospitals—remained flat. 

Defense costs at both Baystate Medical Center and Beth Israel also declined following CARe’s rollout, according to the study. 

The results, though not necessarily explosive, do indicate that hospitals stand to benefit from such programs, said Allen Kachalia, M.D., the study’s lead author and chief quality officer at Brigham Health, at a briefing Tuesday on the HA issue. 

“This shows that hospitals really can do the right thing without increasing their liability exposure,” Kachalia said. 

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But there is still more work to be done to prove that CRP programs can reach their “full potential” and improve safety, not just reduce lawsuits. 

A second Health Affairs study posited five questions that, if answered, could nudge these programs in the right direction: 

  1. How can the industry drive greater use of CRP?
  2. What is the evidence behind these programs, and how are they linked to safety?
  3. Is the promised compensation fair to patients?
  4. How can these programs best meet the needs of patients and their families?
  5. What can policymakers do to support adoption and evolution of CRP? 

Thomas Gallagher, M.D., director of the University of Washington Medicine Center for Scholarship in Patient Safety and Quality and the study’s lead author, said at the briefing that the link between CRP and patient safety is, at present, “largely theoretical.” 

The researchers said that it is positive that providers find the current case in favor of CRP compelling enough to spur adoption, but more research into the role they can play in improving safety is crucial. 

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Gallagher estimated that more than 200 healthcare organizations are trying such a program. But, Kachalia noted, the lack of clear evidence behind them can complicate the process. 

“It’s actually very hard to implement these programs effectively,” he said. 

Policymakers can help by making it clear that CRPs are “essential components of high-quality, ethical medical care” instead of simply a way to mitigate liability claims. Adjusting payment models and getting payers on board can drive the needed changes, according to the study.