Bilimoria KY, Chung JW, Minami CA, Sohn MW, Pavey ES, Holl JL, Mello MM, et al.
Joint Commission journal on quality and patient safety. Date of publication 2017 May 1;volume 43(5):241-250.
1. Jt Comm J Qual Patient Saf. 2017 May;43(5):241-250. doi:
10.1016/j.jcjq.2017.02.004. Epub 2017 Mar 27.
Relationship Between State Malpractice Environment and Quality of Health Care in
the United States.
Bilimoria KY, Chung JW, Minami CA, Sohn MW, Pavey ES, Holl JL, Mello MM.
BACKGROUND: One major intent of the medical malpractice system in the United
States is to deter negligent care and to create incentives for delivering
high-quality health care. A study was conducted to assess whether state-level
measures of malpractice risk were associated with hospital quality and patient
safety.
METHODS: In an observational study of short-term, acute-care general hospitals
in the United States that publicly reported in the Centers for Medicaid &
Medicare Services Hospital Compare in 2011, hierarchical regression models were
used to estimate associations between state-specific malpractice environment
measures (rates of paid claims, average Medicare Malpractice Geographic Practice
Cost Index [MGPCI], absence of tort reform laws, and a composite measure) and
measures of hospital quality (processes of care, imaging utilization, 30-day
mortality and readmission, Agency for Healthcare Research and Quality Patient
Safety Indicators, and patient experience from the Hospital Consumer Assessment
of Healthcare Providers and Systems [HCAHPS]).
RESULTS: No consistent association between malpractice environment and hospital
process-of-care measures was found. Hospitals in areas with a higher MGPCI were
associated with lower adjusted odds of magnetic resonance imaging
overutilization for lower back pain but greater adjusted odds of overutilization
of cardiac stress testing and brain/sinus computed tomography (CT) scans. The
MGPCI was negatively associated with 30-day mortality measures but positively
associated with 30-day readmission measures. Measures of malpractice risk were
also negatively associated with HCAHPS measures of patient experience.
CONCLUSIONS: Overall, little evidence was found that greater malpractice risk
improves adherence to recommended clinical standards of care, but some evidence
was found that malpractice risk may encourage defensive medicine.
Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights
reserved.
DOI: 10.1016/j.jcjq.2017.02.004
PMID: 28434458 [Indexed for MEDLINE]
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