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Primary care closed claims experience of Massachusetts malpractice insurers
Gordon D Schiff1, Ann Louise Puopolo, Anne Huben-Kearney
1Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts2Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Importance:
Despite prior focus on high-impact inpatient cases, there are increasing data and awareness that malpractice in the outpatient setting, particularly in primary care, is a leading contributor to malpractice risk and claims.
Objective:
To study patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project.
Design, Setting, And Participants:
Retrospective review of pooled closed claims data of 2 malpractice carriers covering most Massachusetts physicians during a 5-year period (January 1, 2005, through December 31, 2009). Data were harmonized between the 2 insurers using a standardized taxonomy. Primary care practices in Massachusetts. All malpractice claims that involved primary care practices insured by the 2 largest insurers in the state were screened. A total of 551 claims from primary care practices were identified for the analysis.
Main Outcomes And Measures:
Numbers and types of claims, including whether claims involved primary care physicians or practices; classification of alleged malpractice (eg, misdiagnosis or medication error); patient diagnosis; breakdown in care process; and claim outcome (dismissed, settled, verdict for plaintiff, or verdict for defendant).
Results:
During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. Allegations were related to diagnosis in 397 (72.1%), medications in 68 (12.3%), other medical treatment in 41 (7.4%), communication in 15 (2.7%), patient rights in 11 (2.0%), and patient safety or security in 8 (1.5%). Leading diagnoses were cancer (n = 190), heart diseases (n = 43), blood vessel diseases (n = 27), infections (n = 22), and stroke (n = 16). Primary care cases were significantly more likely to be settled (35.2% vs 20.5%) or result in a verdict for the plaintiff (1.6% vs 0.9%) compared with non-general medical malpractice claims (P < .001).
Conclusions And Relevance:
In Massachusetts, most primary care claims filed are related to alleged misdiagnosis. Compared with malpractice allegations in other settings, primary care ambulatory claims appear to be more difficult to defend, with more cases settled or resulting in a verdict for the plaintiff.
Insights
Primary care malpractice claims in Massachusetts primarily involve misdiagnosis, leading to higher settlement rates. These findings highlight the need for improved diagnostic accuracy and patient safety in outpatient settings.
Area of Science:
- Medical Malpractice Law
- Patient Safety
- Primary Care Medicine
Background:
- Malpractice in outpatient settings, especially primary care, is a significant contributor to malpractice risk.
- Prior research has focused on inpatient cases, overlooking outpatient trends.
Observation:
- A 5-year review (2005-2009) of 551 primary care malpractice claims in Massachusetts was conducted.
- Claims data were analyzed for types of allegations, diagnoses, care breakdowns, and outcomes.
Findings:
- Diagnosis-related allegations (72.1%) were most common, particularly for cancer, heart disease, and stroke.
- Primary care claims were more likely to be settled or result in a verdict for the plaintiff compared to other medical malpractice claims.
- Medication errors and other medical treatments constituted the second and third most frequent allegations.
Implications:
- Primary care malpractice claims, especially those involving misdiagnosis, are challenging to defend.
- Findings underscore the need for enhanced diagnostic strategies and patient safety protocols in primary care.
- This study provides critical data for risk management and safety improvement initiatives in ambulatory care settings.
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