Learning from malpractice claims about negligent, adverse events in primary care in the United States
- 1The Robert Graham Center: Policy Studies in Family Practice and Primary Care, Washington, DC 20036, USA
- 2Loss Prevention and Research, Physician Insurers Association of America, Rockville, MD 20850, USA
- 3University of Colorado Department of Family Medicine, Denver, CO 80262, USA
- Correspondence to: Dr R L Phillips Jr The Robert Graham Center: Policy Studies in Family Practice and Primary Care, 1350 Connecticut Avenue NW, Suite 201, Washington, DC 20036, USA;
- Received 19 December 2003
Background: The epidemiology, risks, and outcomes of errors in primary care are poorly understood. Malpractice claims brought for negligent adverse events offer a useful insight into errors in primary care.
Methods: Physician Insurers Association of America malpractice claims data (1985–2000) were analyzed for proportions of negligent claims by primary care specialty, setting, severity, health condition, and attributed cause. We also calculated risks of a claim for condition-specific negligent events relative to the prevalence of those conditions in primary care.
Results: Of 49 345 primary care claims, 26 126 (53%) were peer reviewed and 5921 (23%) were assessed as negligent; 68% of claims were for negligent events in outpatient settings. No single condition accounted for more than 5% of all negligent claims, but the underlying causes were more clustered with “diagnosis error” making up one third of claims. The ratios of condition-specific negligent event claims relative to the frequency of those conditions in primary care revealed a significantly disproportionate risk for a number of conditions (for example, appendicitis was 25 times more likely to generate a claim for negligence than breast cancer).
Conclusions: Claims data identify conditions and processes where primary health care in the United States is prone to go awry. The burden of severe outcomes and death from malpractice claims made against primary care physicians was greater in primary care outpatient settings than in hospitals. Although these data enhance information about error related negligent events in primary care, particularly when combined with other primary care data, there are many operating limitations.
See editorial commentary, p 90
Conflict of interest: BH is a member of the doctors group of the Association of Victims of Medical Accidents (AVMA).
The research reported in this paper was conducted in the Robert Graham Center: Policy Studies in Family Practice and Primary Care, American Academy of Family Physicians. The information and opinions contained in research from The Graham Center do not necessarily reflect the views or policy of The American Academy of Family Physicians.
Supported by The Robert Graham Center: Policy Studies in Family Practice and Primary Care, and The Physician Insurers Association of America (data and writing, not financial).