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Fewer Preventable Events Equal Lower Medical Malpractice Claims, Says RAND

Cheryl Clark, for HealthLeaders Media, April 15, 2010

If doctors want to reduce medical malpractice claims, they should strengthen efforts to prevent events within hospitals that cause patient harm.

That's the take-home message from a five-year analysis that compared the incidence of 17 types of patient harm, called patient safety indicators or PSIs, with the number of malpractice claims filed in each of 58 California counties for each year between 2001 and 2005.

"What we find is that if in a particular county in a particular year, if the number of adverse events bounces upward, then malpractice claiming will tend to follow upward as well. And if in a given year patient adverse events bounce downward, malpractice claiming will bounce downward too," said Michael Greenberg, the study's lead author, a research psychologist and lawyer with RAND.

The study, released Wednesday, was prepared by researchers for the RAND Institute for Civil Justice and was funded by insurance companies, individuals interested in patient safety, and medical malpractice policy.

The report's authors say their study is the first to demonstrate that taking efforts to improve patient safety could be associated with lower medical malpractice claims, an important theme in healthcare reform and a topic expected to be addressed in numerous pilot projects to reduce malpractice litigation.

One possible weakness in the RAND study, however, is that the researchers looked at medical malpractice claims against doctors, but compared that with incidents that hurt patients that occurred inside hospitals, such as trauma to the mother or infant during labor and delivery, postoperative pulmonary embolism or accidental puncture or laceration. Some of those events involve doctors, but some may also involve other members of the care delivery team or their behaviors, such as poor handwashing that results in an infection.

Also, it is unclear how many medical malpractice claims against physicians occurred because of care they provided to patients in a hospital, as opposed to care in an outpatient setting or their office, for example, failure to correctly diagnose.

But Greenberg says he is confident that the correlation is not a fluke. "It's likely that a substantial portion of the malpractice claims involved a doctor's practice in the hospital," he says.

The researchers are fairly certain of a correlation between increase or decrease of hospital adverse events and a corresponding increase or decrease of medical malpractice claims because the relationship was observed across many California counties over many points in time. For example, a county that experienced 10 fewer safety events in a given year also saw on average a reduction of 3.7 medical malpractice claims during that same year.

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