Intended and unintended effects of large-scale adverse event disclosure: a controlled before-after analysis of five large-scale notifications.
Large-scale adverse events are those in which a group of patients are exposed to a risk of infection. Disclosure and notification of patients in such cases is complicated by the lack of relationship between the notifying clinician and patient. The Veterans Affairs (VA) medical centers examined patient utilization from administrative data following notification of a possible exposure to a bloodborne pathogen. Compared to reference patients, those notified of a possible exposure were more likely to be tested for bloodborne pathogens. African American patients were less likely to undergo blood testing for exposures compared to white patients, adding to concerns about disparities in patient safety. Those patients exposed to a large-scale adverse event during dental care were more likely to seek non-VA dental care in the short term, but most returned to the VA within 18 months of the exposure, suggesting some loss of trust that resolves over time.