Liability impact of the hospitalist model of care.

Background: An increasingly large proportion of inpatient care is provided by hospitalists. The care discontinuities inherent to hospital medicine raise concerns about malpractice risk. However, little published data exist on the medical liability risks associated with care by hospitalists.

Primary care closed claims experience of Massachusetts malpractice insurers.

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).

Cognitive errors and logistical breakdowns contributing to missed and delayed diagnoses of breast and colorectal cancers: a process analysis of closed malpractice claims.

Purpose: To erform a process analysis of missed and delayed diagnoses of breast and colorectal cancers to identify: (1) the cognitive and logistical factors that lead to these diagnostic errors, and (2) prevention strategies.

Methods: Using 56 cases (43 breast, 13 colon) of missed and delayed diagnosis, we performed structured analyses to identify specific points in the diagnostic process in which errors occurred. Each error was classified as either a cognitive error or logistical breakdown.

Using malpractice claims to identify risk factors for neurological impairment among infants following non-reassuring fetal heart rate patterns during labour.

Rationale, Aims And Objectives: We sought to use a novel case-selection methodology to identify antenatal or intrapartum risk factors associated with neonatal neurological impairment following non-reassuring fetal heart rate patterns during labour.

Method: We used a retrospective case-control design with bivariate and multivariate conditional logistic regression. Cases were births in which electronic fetal monitoring (EFM) showed non-reassuring patterns and the infant had neurological disability.

Process of care failures in breast cancer diagnosis.

Background: Process of care failures may contribute to diagnostic errors in breast cancer care.

Objective: To identify patient- and provider-related process of care failures in breast cancer screening and follow-up in a non-claims-based cohort.

Design: Retrospective chart review of a cohort of patients referred to two Boston cancer centers with new breast cancer diagnoses between January 1, 1999 and December 31, 2004.

Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims.

Background: Although missed and delayed diagnoses have become an important patient safety concern, they remain largely unstudied, especially in the outpatient setting.

Objective: To develop a framework for investigating missed and delayed diagnoses, advance understanding of their causes, and identify opportunities for prevention.

Design: Retrospective review of 307 closed malpractice claims in which patients alleged a missed or delayed diagnosis in the ambulatory setting.

Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers.

Study Objectives: Diagnostic errors in the emergency department (ED) are an important patient safety concern, but little is known about their cause. We identify types and causes of missed or delayed diagnoses in the ED.

Methods: This is a review of 122 closed malpractice claims from 4 liability insurers in which patients had alleged a missed or delayed diagnosis in the ED.

Analysis of surgical errors in closed malpractice claims at 4 liability insurers.

Background: The relative importance of the different factors that cause surgical error is unknown. Malpractice claim file analysis may help to identify leading causes of surgical error and identify opportunities for prevention.

Methods: We retrospectively reviewed 444 closed malpractice claims, from 4 malpractice liability insurers, in which patients alleged a surgical error.

Claims, errors, and compensation payments in medical malpractice litigation.

Background: In the current debate over tort reform, critics of the medical malpractice system charge that frivolous litigation--claims that lack evidence of injury, substandard care, or both--is common and costly.

Methods: Trained physicians reviewed a random sample of 1452 closed malpractice claims from five liability insurers to determine whether a medical injury had occurred and, if so, whether it was due to medical error. We analyzed the prevalence, characteristics, litigation outcomes, and costs of claims that lacked evidence of error.

Iatrogenic events resulting in intensive care admission: frequency, cause, and disclosure to patients and institutions.

Purpose: To identify the frequency and type of iatrogenic medical events requiring admission to an intensive care unit. To assess the consequences of iatrogenic medical events for patients and institutions. To assess the prevalence of disclosure of iatrogenic medical events to patients, surrogates, and institutions.

Race and family history assessment for breast cancer.

Objective: Studies have demonstrated disparities in breast cancer screening between racial and ethnic groups. Knowledge of a woman's family history of breast cancer is important for initiating early screening interventions. The purpose of this study was to determine whether differences exist in the collection of family history information based on patient race.

Decision making and satisfaction with care in the pediatric intensive care unit: findings from a controlled clinical trial.

Objective: To facilitate critical decision making and improve satisfaction with care among families of patients in a pediatric intensive care unit.

Design: Prospective observational study followed by a nonrandomized controlled trial of a clinical intervention to identify conflicts and facilitate communication between families and the clinical team.

Setting: The pediatric intensive care unit of a Boston teaching hospital.

Results of a clinical trial on care improvement for the critically ill.

Objective: To develop, deploy, and evaluate an intervention designed to identify and mitigate conflict in decision making in the intensive care unit.

Design: Nonrandomized, controlled trial.

Setting: Seven intensive care units at four Boston teaching hospitals.

Nature of conflict in the care of pediatric intensive care patients with prolonged stay.

Objective: To determine the frequency, types, sources, and predictors of conflict surrounding the care of pediatric intensive care unit (PICU) patients with prolonged stay.

Setting: A tertiary care, university-affiliated PICU in Boston.

Participants: All patients admitted over an 11-month period whose stay exceeded 8 days (the 85th percentile length of stay for the PICU under study), and intensive care physicians and nurses who were responsible for their care.

Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors.

Objective: To determine types, sources, and predictors of conflicts among patients with prolonged stay in the ICU.

Design And Setting: We prospectively identified conflicts by interviewing treating physicians and nurses at two stages during the patients' stays. We then classified conflicts by type and source and used a case-control design to identify predictors of team-family conflicts.

Influence of body weight on patients' satisfaction with ambulatory care.

Patients with obesity experience psychosocial consequences because of their weight and report physician bias. We examined whether obesity is associated with lower patient satisfaction with ambulatory care among 2,858 patients seen at 11 academically affiliated primary care practices in Boston. Compared with normal weight patients (body mass index [BMI], 19.

Inconsistent report cards: assessing the comparability of various measures of the quality of ambulatory care.

Background: Report cards based on various performance measures have become increasingly common for rating hospitals and health care plans. However, little has been done to create report cards at the ambulatory clinic level, nor has there been much comparison of the potential components of report cards.

Objectives: To create a report card for ambulatory clinics based on different data collection methods and to assess the correlations of clinic scores across various domains of quality.