Summaries of Independent Scientist (K) Awards

Gallagher, Thomas

Institution: University of Washington, Seattle

Grant Title: Enhancing the Disclosure of Medical Errors to Patients

Grant Number: K08 HS014012

Duration: 3 years (2003-2006)

Total Award: $629,500

Project Description:  This research seeks to improve medical error disclosure with the following four goals:

1. To describe the attitudes of physicians towards error disclosure and determine whether these attitudes are related to personal characteristics (e.g., demographics, specialty, time in practice).
2. To describe the attitudes of patients towards error disclosure and determine whether these attitudes are related to personal characteristics (e.g., socio-demographics, past experiences, perceptions of medical care) and how they relate to important outcomes such as trust, satisfaction, and intent to change providers or sue.
3. To assess whether current institutional policies support full disclosure of medical errors.
4. To develop and disseminate a model institutional error disclosure policy and assess the policy's impact on health care providers' attitudes towards and experience with error disclosure.

Career Goals: Dr. Gallagher is an Assistant Professor of Medicine and Medical History & Ethics at the University of Washington School of Medicine. His research prior to his K award examined conflicts of interest in the doctor-patient relationship. More recently, his research focus has shifted to a different conflict of interest in the doctor-patient relationship, namely the disclosure of medical errors. He now seeks to develop a full-time research agenda related to medical error disclosure.

Progress to Date: Dr. Gallagher has led several survey projects related to attitudes of healthcare workers regarding error disclosure, including surveying 4,000 physicians in the US and Canada, 1000 pediatricians, and 900 trainees. Manuscript preparation from these surveys is ongoing. In addition, a comparable sample of 2,000 risk managers was surveyed, and a manuscript comparing risk managers' and physicians' disclosure attitudes is under development. Finally, 11 focus groups with nurses about error disclosure were completed. Qualitative analysis of these focus groups is underway.

Future Plans: Grants have been submitted for a clinical trial of the impact of training practicing physicians in disclosure on patient satisfaction and physicians' claims experience, and for a nationwide survey of nurses' disclosure attitudes. Developmental work is underway to explore how disclosure is actually taking place in clinical settings, and identify the characteristics of high and low quality disclosures.

Highlights and Specific Accomplishments:

• Greenwall Foundation Faculty Scholars in Bioethics Award; 2003.
• Marion E. Smith Junior Faculty Research Award, University of Washington School of Medicine; 2003.
• Best Published Research Paper of the Year, Society of General Internal Medicine; 2004.
• Professional Societies:
  • American College of Physicians.
  • Society of General Internal Medicine.
  • American Society of Bioethics and Humanities.
  • Robert Wood Johnson Clinical Scholars Fellowship, Medical Ethics.

K-Generated Publications:

• Gallagher TH, Levinson W. A Prescription for Protecting the Doctor-Patient Relationship [Response to letter to editor]. American Journal of Managed Care 2004;10(part 1):61-8.
• Gallagher TH, Levinson W. Spotlight Case Commentary, AHRQ Web M&M. June 2004. Available at: http://Webmm.ahrq.gov/.
• Gallagher TH. Policy Forum. Content of Medical Error Disclosures. Virtual Mentor March 2004. Available at: http://www.ama-ssn.org/ama/pub/category/12053.html.
• Gallagher TH, Levinson W. Resolving Disagreements in the Managed Care Doctor-patient Relationships. Curriculum available from The Network: http://www.futurehealth.ucsf.edu.
• Gallagher TH, Waterman AD, Ebers AG, Fraser VF, Levinson W. Patients' and Physicians' Attitudes Regarding the Disclosure of Medical Errors. JAMA 2003;298:1001-7.
• Gallagher TH. Medical Errors in the Outpatient Setting: Ethics in practice. Journal of Clinical Ethics 2002;13:4:291-300.
• Jeffe DB, Dunagan WC, Garbutt J, Burroughs TE, Gallagher TH, Hill PR, Harris CB, Bommarito K, Fraser, VJ. Physicians' and Nurses' Perspectives on Error Reporting in Hospitals. Joint Commission Journal on Quality and Safety 2004;30:471-9.
• Burroughs TE, Waterman AD, Gallagher TH, Waterman BM, Adams D, Jeffe DB, Dunagan WC, Garbutt J, Cohen NM, Cira J. Inguanzo J, Fraser VJ. Patient Concerns about Medical Errors in Emergency Departments. Academic Emergency Medicine 2004;1(12):57-64.
• Gallagher TH, Lucas M. Should we Disclose Harmful Medical Errors to Patients. If so, how? Journal of Clinical Outcomes Management 2005;12:253-9.
• Gallagher TH, Levinson W. Disclosing Harmful Medical Errors to Patients: A Call for Professional Action. Archives of Internal Medicine 2005;165:1819-24.
• Chan D, Gallagher TH, Reznick R, Levinson W. How Surgeons Disclose Medical Errors: A study Using Standardized Patients. Surgery 2005;138:851-8.
• Surbone AS, Gallagher TH, Rich KR, Rowe M. To Err is Human 5 Years Later (letter). JAMA 2005:294:1758.

AHRQ Research Portfolios:  Quality and Patient Safety: Training.
AHRQ Goals:  Safety and Quality.

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