Negligent care and malpractice claiming behavior in Utah and Colorado.
ABSTRACT Previous studies relating the incidence of negligent medical care to malpractice lawsuits in the United States may not be generalizable. These studies are based on data from 2 of the most populous states (California and New York), collected more than a decade ago, during volatile periods in the history of malpractice litigation.
The study objectives were (1) to calculate how frequently negligent and nonnegligent management of patients in Utah and Colorado in 1992 led to malpractice claims and (2) to understand the characteristics of victims of negligent care who do not or cannot obtain compensation for their injuries from the medical malpractice system.
We linked medical malpractice claims data from Utah and Colorado with clinical data from a review of 14,700 medical records. We then analyzed characteristics of claimants and nonclaimants using evidence from their medical records about whether they had experienced a negligent adverse event.
The study measures were negligent adverse events and medical malpractice claims.
Eighteen patients from our study sample filed claims: 14 were made in the absence of discernible negligence and 10 were made in the absence of any adverse event. Of the patients who suffered negligent injury in our study sample, 97% did not sue. Compared with patients who did sue for negligence occurring in 1992, these nonclaimants were more likely to be Medicare recipients (odds ratio [OR], 3.5; 95% CI [CI], 1.3 to 9.6), Medicaid recipients (OR, 3.6; 95% CI, 1.4 to 9.0), > or =75 years of age (OR, 7.0; 95% CI, 1.7 to 29.6), and low income earners (OR, 1.9; 95% CI, 0.9 to 4.2) and to have suffered minor disability as a result of their injury (OR, 6.3; 95% CI, 2.7 to 14.9).
The poor correlation between medical negligence and malpractice claims that was present in New York in 1984 is also present in Utah and Colorado in 1992. Paradoxically, the incidence of negligent adverse events exceeds the incidence of malpractice claims but when a physician is sued, there is a high probability that it will be for rendering nonnegligent care. The elderly and the poor are particularly likely to be among those who suffer negligence and do not sue, perhaps because their socioeconomic status inhibits opportunities to secure legal representation.
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ABSTRACT: Objective: Identify clinical opportunities to intervene to prevent a malpractice event and determine the proportion of malpractice claims potentially preventable by clinical decision support (CDS). Materials and Methods: Cross-sectional review of closed malpractice claims over seven years from one malpractice insurance company and seven hospitals in the Boston area. For each event, clinical opportunities to intervene to avert the malpractice event and the presence or absence of CDS that might have a role in preventing the event, were assigned by a panel of expert raters. Compensation paid out to resolve a claim (indemnity), was associated with each CDS type. Results: Of the 477 closed malpractice cases, 359 (75.3%) were categorized as substantiated and 195 (54%) had at least one opportunity to intervene. Common opportunities to intervene related to performance of procedure, diagnosis, and fall prevention. We identified at least one CDS type for 63% of substantiated claims. The 41 CDS types identified included clinically significant test result alerting, diagnostic decision support and electronic tracking of instruments. Cases with at least one associated intervention accounted for $40.3 million (58.9%) of indemnity. Discussion: CDS systems and other forms of health information technology (HIT) are expected to improve quality of care, but their potential to mitigate risk had not previously been quantified. Our results suggest that, in addition to their known benefits for quality and safety, CDS systems within HIT have a potential role in decreasing malpractice payments. Conclusion: More than half of malpractice events and over $40 million of indemnity were potentially preventable with CDS.Applied Clinical Informatics 01/2014; 5(3):746-56. DOI:10.4338/ACI-2014-02-RA-0018 · 0.39 Impact Factor
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ABSTRACT: Quality of health care services is an issue of growing interest. This study describes the fulfillment of essential requirements (Resolution 4252/1996) by private health services of first and second level in Bogotá D.C. With the registers of surveillance and control commissions (july/1998 to may/2000) a descriptive study was realized. The variables analyzed were: locality, local socioeconomic level, local residential density, health service supplies, and fulfillment of essential requirements. In Bogotá there are 12 587 health care centers of first and second level. 72,1 % is in Chapinero, Usaquén, and Teusaquillo localities. Only 6,9 % of these centers obey the essential requirements. The findings of this study suggest an "epidemiology of quality" of health care services in Bogotá. In this profile, the rich people have good health services and the poor population has a poor quality health services.Revista de salud publica (Bogota, Colombia) 06/2001; 3(2):127-142.
- Medicina Clínica 09/2014; DOI:10.1016/j.medcli.2014.07.002 · 1.25 Impact Factor