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Patient complaints and malpractice risk in a regional healthcare center
Gerald B Hickson1, Charles F Federspiel, Jennifer Blackford
1Center for Patient and Professional Advocacy, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. gerald.hickson@vanderbilt.edu
Insights
Physician patient complaints and practice type, especially for surgeons, are linked to increased risk management events. This study highlights the importance of patient feedback in healthcare risk assessment.
Area of Science:
- Healthcare Management
- Medical Risk Assessment
- Patient Safety
Background:
- Patient complaints and risk management events are critical indicators of healthcare quality.
- Understanding the relationship between patient feedback and institutional risk can improve patient safety and resource allocation.
Purpose of the Study:
- To investigate the association between physicians' patient complaint records and their risk management experiences.
- To determine if practice type (surgeon vs. non-surgeon) influences this association.
Main Methods:
- A retrospective analysis of patient complaints and risk management files (RMFs) from January 2001 to June 2004.
- Physicians were categorized as surgeons or non-surgeons, and complaint data were linked to RMFs.
- Logistic regression analyzed the predictive power of complaint counts, practice type, and clinical activity volume (RVUs) on RMF outcomes.
Main Results:
- Surgeons experienced higher rates of patient complaints and risk management events, including RMFs, expenditures, and lawsuits.
- Complaint counts, practice type, and clinical activity volume were all statistically significant predictors of risk management outcomes.
- Predictive concordance for risk management outcomes exceeded 75%.
Conclusions:
- Patient dissatisfaction and practice type are significantly associated with risk management experiences in a regional medical center.
- The association between risk management and clinical activity volume for surgeons was weaker than in academic settings, suggesting contextual differences.
Objective:
To study the association between physicians' complaint records and their risk management experiences in a regional healthcare center.
Data Sources:
Patient complaints about physicians in a large border state medical center's hospital and outpatient clinics were recorded and coded. The study period was from January 2001 through December 2003. These records were linked to the counterpart physicians' data covered by the institutions' risk management plan through June 2004.
Study Design And Data Collection:
All physicians at the institution who had contact with patients during the study period were identified as surgeons or non-surgeons. Complaints for these physicians were recorded by the institution's Office of Patient Relations (OPR) and independently coded using a standardized protocol to characterize the nature of the problem and to uniquely identify the person complained about. The complaint records were then linked to the risk management files (RMFs) for the defined physician cohort. In addition, these data were supplemented with clinical service values (RVUs) which were available for 338 members (76%) of the 445 member cohort.
Principal Findings:
Both patient complaints and risk management events were higher for surgeons than for non-surgeons. This was true for the number of RMFs, those involving expenditures, and for lawsuits. Logistic regression was used to assess the effects of complaint counts, practice type and volume of clinical activity. All were statistically significant in predicting the number of RMF openings, RMF openings with expenditures and lawsuits. Predictive concordance was 75% or greater for each of the three risk management outcomes.
Conclusions:
Expressions of patient dissatisfaction and practice type are significantly related to risk management experiences in a regional medical center. Associations of risk management experiences with volume of clinical activity (RVUs) for surgeons in the regional medical center environment were not as strong as those found in a similar study reported from an academic medical center.
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