Paid Malpractice Claims for Adverse Events in Inpatient and Outpatient Settings | Law and Medicine | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.170.64.36. Please contact the publisher to request reinstatement.
1.
Kohn LT, ed, Corrigan JM, ed, Donaldson MS, edTo Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 1999
2.
Wachter RM. Patient safety at 10: unmistakable progress, troubling gaps.  Health Aff (Millwood). 2010;29(1):165-17319952010PubMedGoogle ScholarCrossref
3.
Gandhi TK, Lee TH. Patient safety beyond the hospital.  N Engl J Med. 2010;363(11):1001-100320825311PubMedGoogle ScholarCrossref
4.
Wachter RM. Is ambulatory patient safety just like hospital safety, only without the “stat”?  Ann Intern Med. 2006;145(7):547-54917015874PubMedGoogle ScholarCrossref
5.
Rosenthal MB. Nonpayment for performance? Medicare's new reimbursement rule.  N Engl J Med. 2007;357(16):1573-157517942869PubMedGoogle ScholarCrossref
6.
McKinsey and Company Global Institute.  Accounting for the Cost of US Healthcare: A New Look at Why Americans Spend MoreDecember 2008. http://www.mckinsey.com/mgi/reports/pdfs/healthcare/US_healthcare_report.pdf. Accessed January 3, 2011
7.
National Center for Health Statistics.  Ambulatory care use and physician visits. http://www.cdc.gov/nchs/fastats/docvisit.htm. Accessed January 3, 2011
8.
Kistler CE, Walter LC, Mitchell CM, Sloane PD. Patient perceptions of mistakes in ambulatory care.  Arch Intern Med. 2010;170(16):1480-148720837835PubMedGoogle ScholarCrossref
9.
Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital.  Ann Intern Med. 2003;138(3):161-16712558354PubMedGoogle ScholarCrossref
10.
Gandhi TK, Burstin HR, Cook EF,  et al.  Drug complications in outpatients.  J Gen Intern Med. 2000;15(3):149-15410718894PubMedGoogle ScholarCrossref
11.
Gandhi TK, Kachalia A, Thomas EJ,  et al.  Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims.  Ann Intern Med. 2006;145(7):488-49617015866PubMedGoogle ScholarCrossref
12.
Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG, Bates DW. Communication breakdown in the outpatient referral process.  J Gen Intern Med. 2000;15(9):626-63111029676PubMedGoogle ScholarCrossref
13.
Gandhi TK, Weingart SN, Borus J,  et al.  Adverse drug events in ambulatory care.  N Engl J Med. 2003;348(16):1556-156412700376PubMedGoogle ScholarCrossref
14.
Studdert DM, Mello MM, Gawande AA,  et al.  Claims, errors, and compensation payments in medical malpractice litigation.  N Engl J Med. 2006;354(19):2024-203316687715PubMedGoogle ScholarCrossref
15.
Brennan TA, Leape LL, Laird NM,  et al.  Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I.  N Engl J Med. 1991;324(6):370-3761987460PubMedGoogle ScholarCrossref
16.
Brennan TA, Sox CM, Burstin HR. Relation between negligent adverse events and the outcomes of medical-malpractice litigation.  N Engl J Med. 1996;335(26):1963-19678960477PubMedGoogle ScholarCrossref
17.
Localio AR, Lawthers AG, Brennan TA,  et al.  Relation between malpractice claims and adverse events due to negligence: results of the Harvard Medical Practice Study III.  N Engl J Med. 1991;325(4):245-2512057025PubMedGoogle ScholarCrossref
18.
Kravitz RL, Rolph JE, McGuigan K. Malpractice claims data as a quality improvement tool, I: epidemiology of error in 4 specialties.  JAMA. 1991;266(15):2087-20921920696PubMedGoogle ScholarCrossref
19.
Phillips RL Jr, Bartholomew LA, Dovey SM, Fryer GE Jr, Miyoshi TJ, Green LA. Learning from malpractice claims about negligent, adverse events in primary care in the United States.  Qual Saf Health Care. 2004;13(2):121-12615069219PubMedGoogle ScholarCrossref
20.
Carroll AE, Buddenbaum JL. Malpractice claims involving pediatricians: epidemiology and etiology.  Pediatrics. 2007;120(1):10-1717606556PubMedGoogle ScholarCrossref
21.
Department of Health and Human Services.  The Data Bank: National Practitioner Healthcare Integrity and Protection Public Use Data File. http://www.npdb-hipdb.hrsa.gov/resources/publicData.jsp. Accessed January 6, 2010
22.
 Health Care Quality Improvement Act, Pub L No. 99-660, title IV, §432 (1986), 100 Stat 3794 
23.
US Department of Labor.  CPI inflation calculator. http://www.bls.gov/data/inflation_calculator.htm. Accessed April 29, 2011
24.
Pagano M, Gaucreau K. Principles of Biostatistics. 2nd ed. Pacific Grove, CA: Duxbury; 2000
25.
Casalino LP, Dunham D, Chin MH,  et al.  Frequency of failure to inform patients of clinically significant outpatient test results.  Arch Intern Med. 2009;169(12):1123-112919546413PubMedGoogle ScholarCrossref
26.
Berner ES, Miller RA, Graber ML. Missed and delayed diagnoses in the ambulatory setting.  Ann Intern Med. 2007;146(6):47017371899PubMedGoogle ScholarCrossref
27.
Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine.  Arch Intern Med. 2005;165(13):1493-149916009864PubMedGoogle ScholarCrossref
28.
Schiff GD, Hasan O, Kim S,  et al.  Diagnostic error in medicine: analysis of 583 physician-reported errors.  Arch Intern Med. 2009;169(20):1881-188719901140PubMedGoogle ScholarCrossref
29.
Newman-Toker DE, Pronovost PJ. Diagnostic errors—the next frontier for patient safety.  JAMA. 2009;301(10):1060-106219278949PubMedGoogle ScholarCrossref
30.
Singh H, Graber M. Reducing diagnostic error through medical home-based primary care reform.  JAMA. 2010;304(4):463-46420664048PubMedGoogle ScholarCrossref
31.
Singh H, Thomas EJ, Khan MM, Petersen LA. Identifying diagnostic errors in primary care using an electronic screening algorithm.  Arch Intern Med. 2007;167(3):302-30817296888PubMedGoogle ScholarCrossref
32.
Casalino LP. The unintended consequences of measuring quality on the quality of medical care.  N Engl J Med. 1999;341(15):1147-115010511617PubMedGoogle ScholarCrossref
33.
White HA. Heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity.  Econometrica. 1980;48(4):817-838Google ScholarCrossref
34.
General Accounting Office.  National Practitioner Data Bank: Major Improvements Are Needed to Enhance Data Bank's ReliabilityWashington, DC; 2000. Publication GAO-01-130
35.
Chandra A, Nundy S, Seabury SA. The growth of physician medical malpractice payments: evidence from the National Practitioner Data Bank.  Health Aff (Millwood). 2005;(suppl Web exclusives)  W5-240-W5-24915928255PubMedGoogle Scholar
Original Contribution
June 15, 2011

Paid Malpractice Claims for Adverse Events in Inpatient and Outpatient Settings

Author Affiliations

Author Affiliations: Division of Outcomes and Effectiveness, Department of Public Health (Drs Bishop, Ryan, and Casalino) and Department of Medicine (Dr Bishop), Weill Cornell Medical College, New York, New York.

JAMA. 2011;305(23):2427-2431. doi:10.1001/jama.2011.813
Abstract

Context An analysis of paid malpractice claims may provide insight into the prevalence and seriousness of adverse medical events in the outpatient setting.

Objective To report and compare the number, magnitude, and type of paid malpractice claims for events in inpatient and outpatient settings.

Design and Setting Retrospective analysis of malpractice claims paid on behalf of physicians in outpatient and inpatient settings using data from the National Practitioner Data Bank from 2005 through 2009. We evaluated trends in claims paid by setting, characteristics of paid claims, and factors associated with payment amount.

Main Outcome Measures Number of paid claims, mean and median payment amounts, types of errors, and outcomes of errors.

Results In 2009, there were 10 739 malpractice claims paid on behalf of physicians. Of these paid claims, 4910 (47.6%; 95% confidence interval [CI], 46.6%-48.5%) were for events in the inpatient setting, 4448 (43.1%; 95% CI, 42.1%-44.0%) were for events in the outpatient setting, and 966 (9.4%; 95% CI, 8.8%-9.9%) involved events in both settings. The proportion of payments for events in the outpatient setting increased by a small but statistically significant amount, from 41.7% (95% CI, 40.9%-42.6%) in 2005 to 43.1% (95% CI, 42.1%-44.0%) in 2009 (P < .001 for trend across years). In the outpatient setting, the most common reason for a paid claim was diagnostic (45.9%; 95% CI, 44.4%-47.4%), whereas in the inpatient setting the most common reason was surgical (34.1%; 95% CI, 32.8%-35.4%). Major injury and death were the 2 most common outcomes in both settings. Mean payment amount for events in the inpatient setting was significantly higher than in the outpatient setting ($362 965; 95% CI, $348 192-$377 738 vs $290 111; 95% CI, $278 289-$301 934; P < .001).

Conclusion In 2009, the number of paid malpractice claims reported to the National Practitioner Data Bank for events in the outpatient setting was similar to the number in the inpatient setting.

×