Changes in Physician Practice Patterns
 after Implementation of a Communication-and-Resolution Program
Lorens A. Helmchen, PhD[1], Timothy B. McDonald, MD, JD[2], Bruce L. Lambert, PhD[3]
Emerging communication-and-resolution programs (CRPs) aim to address adverse patient safety events proactively by recognizing the injury, fully disclosing to patients all information surrounding their care, and offering an apology and remediation if warranted.
Although much attention has focused on their potential to curb the incidence of lawsuits, CRPs may arguably have a more immediate and widely felt impact on patients who are not injured insofar as they affect physicians’ practice patterns. Specifically, the perceived reduction in the risk of a lawsuit may convince physicians to discharge patients sooner and order fewer imaging studies or laboratory tests of little medical value and thus rely less on the practice of defensive medicine.
We examined how the implementation of a communication-and-resolution program at the University of Illinois Hospital and Health Sciences System (UIH) affected physicians’ patterns of treating patients admitted with a principal diagnosis of chest pain. The UIH is a large urban tertiary-care academic medical center located in Cook County, Illinois, a jurisdiction considered to be among the most plaintiff-friendly counties in the United States, which exacerbates its exposure to professional liability claims and enhances incentives for defensive medicine. Chest pain is a common and costly reason for hospital admissions.
The study sample comprised all 140,347 records of patients who were discharged with a principal diagnosis of chest pain between January 1, 2002, and December 31, 2009, from the University of Illinois Hospital and Health Sciences System (UIH) or any non-federal general hospital in Cook County, Illinois.
For seven outcomes, we computed difference-in-differences estimates of quarterly growth rates at UIH and the comparison hospitals. We allowed both the levels and the growth rates of the outcomes to vary separately for UIH and the comparison hospitals and for the pre- and post-implementation periods.
Relative to the comparison hospitals and to pre-implementation trends, quarterly growth rates of clinical laboratory and radiology charges at the intervention hospital declined by 3.7 and 6.5 percentage points, while the number of diagnostic radiology procedures per discharge and length of stay stopped increasing entirely. We found no evidence that these growth rate reductions were attributable to physician turnover, patient selection, or changes in billing practices.