Malpractice claims data as a quality improvement tool; II. Is targeting effective?

Article Abstract:

Health care can be improved either by identifying and educating physicians who provide substandard care or by a plan of continuous quality improvement. The solution depends on whether a few practitioners make most of the errors, or whether a few errors are made by many different practitioners. If the latter is true, targeting individual physicians is a less efficient strategy than investigating clinical processes. Other studies have found that the risk of malpractice claims varies among specialties and among individuals within specialties. Malpractice data from 1,371 physician claims were used to find out if error-prone physicians could be identified, and what factors were associated with errors. In addition, hospital characteristics were studied to determine if they were associated with types of clinical errors. Past claims were only moderately predictive of future malpractice claims, although physicians with many past claims were likely to incur many more. Other ways to determine negligence-prone physicians must be found, such as sampling office records of practitioners who have made especially serious errors or who are in high-risk specialties. Part of the difficulty with using malpractice claims is that they are actually very rare. Within hospitals, specialty was the most important predictor of physician error pattern, followed by ratio of hospital staff to admissions. Negligence claims do not provide a good basis for targeting individual physicians, but may identify some very incompetent physicians. They may be even more useful on a national basis for identifying clinical errors, and leading to improved clinical processes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hospitals, Malpractice

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Quality health care

Article Abstract:

The cost-consciousness of the managed care era has led to a focus on quality of care. Managed care organizations collect data on performance to justify their existence to employers, but this information is never fed back to the doctors. The Agency for Health Care Policy and Research has published a report that can help physicians use clinical practice guidelines to create performance measures. The agency has also developed a database called CONQUEST to collect clinical performance measures. Using practice guidelines to create performance measures will allow physicians to compare health care quality across different groups. Medicare is also developing a Medicare Quality Indicator Set that can be used by peer review organizations and hospitals. The Foundation for Accountability and the American Medical Association have also developed guidelines for measuring clinical performance.

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