CME/CE: Examining Proneness to Malpractice Claims

CME/CE: Examining Proneness to Malpractice Claims
Author Information (click to view)

David M. Studdert, LLB, ScD, MPH

Professor, Medicine
Primary Care Outcomes Research
Stanford Medicine
Professor of Law
Stanford Law School

David M. Studdert, LLB, ScD, MPH, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians and nurses.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Review the results of a study that sought to characterize the distribution of paid malpractice claims among physicians throughout the U.S. and aimed to identify specific physician characteristics that are associated with incurring multiple paid claims.

Method of Participation(click to view)

Release Date: 03/17/2017
Expiration Date: 03/17/2018

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at akhcme.com/akhcme/lessons/15.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants
NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME.

 

Nursing
AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is awarded 0.5 contact hours.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
David M. Studdert, LLB, ScD, MPH
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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David M. Studdert, LLB, ScD, MPH (click to view)

David M. Studdert, LLB, ScD, MPH

Professor, Medicine
Primary Care Outcomes Research
Stanford Medicine
Professor of Law
Stanford Law School

David M. Studdert, LLB, ScD, MPH, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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A study has found that a small number of physicians with distinctive characteristics accounted for a disproportionately large number of paid malpractice claims.
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Medical malpractice continues to be a significant issue for physicians from all walks throughout the United States, and there are long-standing concerns about those who are claim-prone and complaint-prone. “Medical malpractice claims are one useful indicator of patient safety,” explains David M. Studdert, LLB, ScD, MPH. “In the past, researchers have compared physicians who have multiple claims against them with other doctors who have few or no claims. These analyses have identified systematic differences with regard to age, sex, specialty, training and certification, claim and complaint histories, and quality of care. However, only a few studies have looked at the nature of the maldistribution itself.”

Previous research has been generally limited to claims data from single insurers or states and date back to several decades ago. If claim-prone physicians account for a substantial share of all claims, it would be valuable to reliably identify them before they accumulate troubling track records. Unfortunately, attempts to predict malpractice claims have had mixed results, leading the medical malpractice system to be reactive more than proactive because the focus is placed on dealing with the aftermath of care that has gone wrong.

 

Characterizing Distribution

Dr. Studdert and colleagues recently had a study published in the New England Journal of Medicine that sought to characterize the distribution of paid malpractice claims among physicians throughout the U.S. and aimed to identify specific physician characteristics that are associated with incurring multiple paid claims. Using data from the National Practitioner Data Bank, the study group analyzed in excess of 66,000 claims paid against more than 54,000 physicians from 2005 through 2014. They calculated concentrations of claims among physicians and used a multivariable recurrent-event survival analysis to identify characteristics of physicians at high risk for recurrent claims and quantify risk levels over time.

“Our results showed that about 1% of all physicians accounted for approximately one-third of paid claims,” says Dr. Studdert. “Our finding that a small number of physicians with distinctive characteristics accounted for a disproportionately large number of paid malpractice claims demonstrates the need to find strategies that can help us reliably predict who is at risk for further claims. Several physician characteristics—most notably the number of previous claims and the physician’s specialty—were significantly associated with recurrence of claims.”

Among physicians with paid claims, 84% incurred only one from 2005 to 2014, accounting for 68% of all paid claims. The study team also found that 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. Physicians who reached a third paid claim had a 24% chance of another paid claim within 2 years and a 37% chance of another within 4 years. Doctors who reached a sixth paid claim had a 62% chance of another within 2 years and a 79% chance of another within 4 years. In general, physicians’ risk of incurring additional claims was highest in the year after a payment was made and declined gradually thereafter.

Risks of recurrence of paid claims also varied widely according to specialty, according to the analysis (Figure), and the range of risk across specialties was substantial. For example, psychiatrists with one or more paid claims had a 5% chance of incurring another one within 2 years and an 8% chance of another within 4 years. On the other hand, neurosurgeons with one or more paid claims had a 16% chance of incurring another one within 2 years and a 26% chance of another within 4 years.

 

Looking Forward

Institutions that handle a large number of patient complaints and claims should understand the distribution of these events within their own at-risk populations, according to Dr. Studdert. It appears that few institutions actually accomplish this objective, and even fewer systematically identify and intervene with practitioners who are at high risk for future claims. “Ultimately, we need strategies that directly address the underlying problems that lead to many claims,” says Dr. Studdert.

The analysis suggests—but does not establish—the feasibility of predicting proneness to malpractice claims. “If we can reliably predict these claims, it may be possible for liability insurers and healthcare organizations to use this information constructively,” Dr. Studdert says. “Such data could inform collaborations on interventions to address the risks posed by claim-prone physicians using various approaches, such as peer counseling, training, and/or supervision. Future research should also explore unpaid malpractice claims and patient complaints to gain a better understanding of physicians who may be at risk. This could become an exciting opportunity for liability and risk-management enterprises to join forces and mainstream efforts to improve healthcare quality.”

Readings & Resources (click to view)

Studdert DM, Bismark MM, Mello MM, Singh H, Spittal MJ. Prevalence and characteristics of physicians prone to malpractice claims. N Engl J Med. 2016;374:354-362. Available at: http://www.nejm.org/doi/full/10.1056/NEJMsa1506137.

Studdert DM, Mello MM, Gawande AA, et al. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. 2006;354:2024-2033.

Mello MM, Chandra A, Gawande AA, Studdert DM. National costs of the medical liability system. Health Aff (Millwood). 2010;29:1569-1577.

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