Gupta A, Snyder A, Kachalia A, Flanders S, Saint S, Chopra V, et al.
BMJ quality & safety. Date of publication 2017 Aug 9;volume 27(1):.
1. BMJ Qual Saf. 2017 Aug 9;27(1):bmjqs-2017-006774. doi:
10.1136/bmjqs-2017-006774. Online ahead of print.
Malpractice claims related to diagnostic errors in the hospital.
Gupta A(1)(2), Snyder A(2), Kachalia A(3), Flanders S(2), Saint S(1)(2), Chopra
V(1)(2).
Author information:
(1)VA Ann Arbor Healthcare System, Internal Medicine, Ann Arbor, Michigan, USA.
(2)Division of Hospital Medicine, Department of Medicine, University of Michigan
Hospital, Ann Arbor, Michigan, USA.
(3)Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts,
USA.
BACKGROUND: Little is known about the incidence or significance of diagnostic
error in the inpatient setting. We used a malpractice claims database to examine
incidence, predictors and consequences of diagnosis-related paid malpractice
claims in hospitalised patients.
METHODS: The US National Practitioner Database was used to identify paid
malpractice claims occurring between 1 January 1999 and 31 December 2011.
Patient and provider characteristics associated with paid claims were analysed
using descriptive statistics. Differences between diagnosis-related paid claims
and other paid claim types (eg, surgical, anaesthesia, medication) were assessed
using Wilcoxon rank-sum and χ2 tests. Multivariable logistic regression was used
to identify patient and provider factors associated with diagnosis-related paid
claims. Trends for incidence of diagnosis-related paid claims and median annual
payment were assessed using the Cochran-Armitage and non-parametric trend test.
RESULTS: 13 682 of 62 966 paid malpractice claims (22%) were diagnosis-related.
Compared with other paid claim types, characteristics significantly associated
with diagnosis-related paid claims were as follows: male patients, patient aged
>50 years, provider aged <50 years and providers in the northeast region.
Compared with other paid claim types, diagnosis-related paid claims were
associated with 1.83 times more risk of disability (95% CI 1.75 to 1.91;
p<0.001) and 2.33 times more risk of death (95% CI 2.23 to 2.43; p<0.001) than
minor injury, after adjusting for patient and provider characteristics.
Inpatient diagnostic error accounted for $5.7 billion in payments over the study
period, and median diagnosis-related payments increased at a rate
disproportionate to other types.
CONCLUSION: Inpatient diagnosis-related malpractice payments are common and more
often associated with disability and death than other claim types. Research
focused on understanding and mitigating diagnostic errors in hospital settings
is necessary.
© Article author(s) (or their employer(s) unless otherwise stated in the text of
the article) 2017. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.
DOI: 10.1136/bmjqs-2017-006774
PMID: 28794243
Conflict of interest statement: Competing interests: None declared.
