Prevalence and Characteristics of Physicians Prone to Malpractice Claims
Prevalence and Characteristics of Physicians Prone to Malpractice Claims
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DOI：
10.1056/nejmsa1506137
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发表时间：
2016-01-28
影响因子：
158.5
通讯作者：
Spittal, Matthew J.
中科院分区：
文献类型：
--
作者：
Studdert, David M.;Bismark, Marie M.;Spittal, Matthew J.
背景：医疗事故索赔在医生中的分布尚不清楚。如果有索赔倾向的医生在所有索赔中占相当大的份额，那么在早期阶段可靠地识别他们的能力可以指导改善护理的努力。方法使用来自国家从业者数据库的数据，我们分析了2005年至2014年54,099名医生支付的66,426项索赔。我们计算了医生索赔的集中程度。我们使用多变量复发事件生存分析来确定复发索赔高风险医生的特征，并量化风险水平随时间的变化。结果约1%的医生占支付索赔的32%。在有支付索赔的医生中，84%在研究期间只发生了一次索赔（占所有支付索赔的68%），16%至少有两次支付索赔（占索赔的32%），4%至少有三次支付索赔（占索赔的12%）。在调整后的分析中，随着以前支付的索赔数目的增加，再次发生的风险也增加了。例如，与之前有一次支付索赔的医生相比，2160名有三次支付索赔的医生发生另一次索赔的风险是三倍（风险比，3.11；95%置信区间[CI]， 2.84至3.41）；这对应于2年内再次支付索赔的绝对概率为24% （95% CI， 22至26）。复发的风险也因专业不同而有很大差异——例如，神经外科医生的风险是精神科医生的四倍。结论近10年来，少数具有独特特征的医生在医疗事故索赔中占了不成比例的大比例。
BACKGROUNDThe distribution of malpractice claims among physicians is not well understood. If claim-prone physicians account for a substantial share of all claims, the ability to reliably identify them at an early stage could guide efforts to improve care.METHODSUsing data from the National Practitioner Data Bank, we analyzed 66,426 claims paid against 54,099 physicians from 2005 through 2014. We calculated concentrations of claims among physicians. We used multivariable recurrent-event survival analysis to identify characteristics of physicians at high risk for recurrent claims and to quantify risk levels over time.RESULTSApproximately 1% of all physicians accounted for 32% of paid claims. Among physicians with paid claims, 84% incurred only one during the study period ((accounting for 68% of all paid claims), 16% had at least two paid claims ((accounting for 32% of the claims), and 4% had at least three paid claims ((accounting for 12% of the claims). In adjusted analyses, the risk of recurrence increased with the number of previous paid claims. For example, as compared with physicians who had one previous paid claim, the 2160 physicians who had three paid claims had three times the risk of incurring another ((hazard ratio, 3.11; 95% confidence interval [CI], 2.84 to 3.41); this corresponded in absolute terms to a 24% chance ((95% CI, 22 to 26) of another paid claim within 2 years. Risks of recurrence also varied widely according to specialty - for example, the risk among neurosurgeons was four times as great as the risk among psychiatrists.CONCLUSIONSOver a recent 10-year period, a small number of physicians with distinctive characteristics accounted for a disproportionately large number of paid malpractice claims.