Malpractice claim reports can help direct prevention of medical errors, study says

FOR IMMEDIATE RELEASE

Contact: Maureen Maxwell
(202) 232-9033 or (800) 274-2237, ext. 2560
mmaxwell@aafp.org

WASHINGTON—Malpractice claims can help identify where primary health care in the United States is prone to go awry. A new analysis concludes that, with limitations, reports of these claims could help identify areas where extra effort to prevent medical errors would be especially effective. The research from the Robert Graham Center: Policy Studies in Family Practice and Primary Care in Washington, D.C., is published in the April edition of the Quality and Safety in Health Care.

"Our research shows the actual location where people are being harmed and that’s in the outpatient setting more often than in hospitals," said Robert L. Phillips, Jr., MD, lead author and assistant director of the Graham Center. "The overwhelming majority of health care in the United States is delivered outside of hospitals and we cannot assume that medical errors in outpatient settings are less harmful than those in hospitals."

In the study "Learning from Malpractice Claims about Negligent, Adverse Events in Primary Care in the United States," the researchers looked at malpractice claims in primary care settled between 1985 and 2000 in the United States. The study focused on a subset of 5,921 claims that could most clearly be identified as errors. The research reveals:

68 percent were for negligent events in outpatient settings and resulted in more than 1,200 deaths.

Negligent, adverse events were more likely to have severe outcomes when they occurred in hospitals, but the total number of high severity outcomes and death was larger in the outpatient setting.

The researchers examined the 10 most prevalent medical conditions with error-related claims and found that no single condition accounted for more than five percent of all negligent claims.

However, diagnostic error accounted for more than one-third of the claims.

Some conditions were more prevalent among claims than among office visits. Conditions that appeared proportionately more often in malpractice claims than as reasons for office visits included brain damaged infant, appendicitis, acute myocardial infarction, and lung cancer. The authors pointed out the potential biases that may arise from how lucrative certain diagnoses are when bad outcomes occur.

No single condition accounted for more than five percent of all negligent claims. The ten most common medical conditions associated with negligent, adverse events collectively accounted for one fifth of the claims. Acute myocardial infarction accounted for five percent. The next nine most comment conditions were lung cancer, breast cancer, colon cancer, brain damaged infant, appendicitis, meningitis, pulmonary embolism, diabetes, and symptoms involving abdomen and pelvis. The authors pointed out that the prominence of acute myocardial infarction and cancer is likely due in part to their prevalence as major causes of disease and death in the United States.

The underlying cause "diagnostic error" alone accounted for over one-third of claims. "The category ‘diagnostic error’ doesn’t give us enough information to fix the problems," explained Phillips. "For example, it doesn’t tell us whether the wrong diagnoses resulted from a lab report that did not reach the physician or if a piece of information was placed in the wrong medical file or if the physician made an erroneous decision that could have been avoided with better training."

The data analysis also identified contributing factors that suggest system-problems that need safety improvement. "Problems with records" was fairly evenly distributed across the outcome severity categories (low, moderate and high severity, and death). "Communication between providers" was skewed more toward the high severity outcomes and death. Both suggested that frequent errors in primary care that are thought to be trivial can contribute to bad health outcomes for patients and should not be ignored. However, the researchers wrote that malpractice data might be more useful for patient safety purposes if the information about contributing factors was more thoroughly and consistently reported.

The researchers compared error-related malpractice claims to patient visits to primary care physicians for the same health conditions. This comparison revealed that some diseases and conditions result in error-related claims far more often than they are seen in primary care. "This comparison suggests that some conditions are either more error-prone, more likely to lead to a lawsuit, or both," said Phillips. "The information offers a way to prioritize further investigation into how errors and resulting lawsuits might be reduced."

"This study is just the start of the conversation. This data would have greater value if the review processes that identify negligence, root causes and contributing, system-related factors were improved. If we can identify categories or specific conditions that signal to physicians that these are especially high risk categories medically, then they can act promptly if certain symptoms are observed," said Phillips.