Learning from malpractice claims about negligent, adverse events in primary care in the United States
Learning from malpractice claims about negligent, adverse events in primary care in the United States
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DOI：
10.1136/qshc.2003.008029
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发表时间：
2004-04-01
影响因子：
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通讯作者：
Green, LA
中科院分区：
文献类型：
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作者：
Phillips, RL;Bartholomew, LA;Green, LA
背景：对初级保健中错误的流行病学、风险和结局知之甚少。医疗事故索赔带来的疏忽不良事件提供了一个有用的洞察错误在primary care.Methods：美国医师保险协会医疗事故索赔数据（1985-2000年）进行了分析的比例疏忽索赔的初级保健专业，设置，严重程度，健康状况，归因于原因。我们还计算了风险的索赔条件特定的疏忽事件相对于这些条件的患病率在primary care.Results：49 345初级保健索赔，26 126（53%）同行评议和5921（23%）被评估为疏忽; 68%的索赔是在门诊设置的疏忽事件。没有一种疾病占所有疏忽索赔的5%以上，但潜在原因更集中，其中“诊断错误”占索赔的三分之一。特定条件的疏忽事件索赔的比率相对于这些条件在初级保健的频率显示了显着不成比例的风险，一些条件（例如，阑尾炎是25倍更有可能产生的索赔疏忽比乳腺癌）。结论：索赔数据确定的条件和过程中，初级卫生保健在美国是容易出错。在初级保健门诊环境中，对初级保健医生提出的医疗事故索赔的严重后果和死亡的负担比医院更大。尽管这些数据增强了有关初级保健中与错误相关的疏忽事件的信息，特别是当与其他初级保健数据相结合时，但存在许多操作限制。
Background: The epidemiology, risks, and outcomes of errors in primary care are poorly understood. Malpractice claims brought for negligent adverse events offer a useful insight into errors in primary care.Methods: Physician Insurers Association of America malpractice claims data (1985-2000) were analyzed for proportions of negligent claims by primary care specialty, setting, severity, health condition, and attributed cause. We also calculated risks of a claim for condition-specific negligent events relative to the prevalence of those conditions in primary care.Results: Of 49 345 primary care claims, 26 126 (53%) were peer reviewed and 5921 (23%) were assessed as negligent; 68% of claims were for negligent events in outpatient settings. No single condition accounted for more than 5% of all negligent claims, but the underlying causes were more clustered with "diagnosis error'' making up one third of claims. The ratios of condition-specific negligent event claims relative to the frequency of those conditions in primary care revealed a significantly disproportionate risk for a number of conditions (for example, appendicitis was 25 times more likely to generate a claim for negligence than breast cancer).Conclusions: Claims data identify conditions and processes where primary health care in the United States is prone to go awry. The burden of severe outcomes and death from malpractice claims made against primary care physicians was greater in primary care outpatient settings than in hospitals. Although these data enhance information about error related negligent events in primary care, particularly when combined with other primary care data, there are many operating limitations.