Assessment of Claimant, Clinical, and Financial Characteristics of Teleradiology Medical Malpractice Cases.

Background The increasing use of teleradiology has been accompanied by concerns relating to risk management and patient safety. Purpose To compare characteristics of teleradiology and nonteleradiology radiology malpractice cases and identify contributing factors underlying these cases. Materials and Methods In this retrospective analysis, a national database of medical malpractice cases was queried to identify cases involving telemedicine that closed between January 2010 and March 2022.

The Safety of Inpatient Health Care.

Background: Adverse events during hospitalization are a major cause of patient harm, as documented in the 1991 Harvard Medical Practice Study. Patient safety has changed substantially in the decades since that study was conducted, and a more current assessment of harm during hospitalization is warranted.

Methods: We conducted a retrospective cohort study to assess the frequency, preventability, and severity of patient harm in a random sample of admissions from 11 Massachusetts hospitals during the 2018 calendar year.

Association of Simulation Training With Rates of Medical Malpractice Claims Among Obstetrician-Gynecologists.

Objective: To compare malpractice claim rates before and after participation in simulation training, which focused on team training during a high-acuity clinical case.

Methods: We performed a retrospective analysis comparing the claim rates before and after simulation training among 292 obstetrician-gynecologists, all of whom were insured by the same malpractice insurer, who attended one or more simulation training sessions from 2002 to 2019. The insurer provided malpractice claims data involving study physicians, along with durations of coverage, which we used to calculate claim rates, expressed as claims per 100 physician coverage years.

Rates and Characteristics of Medical Malpractice Claims Against Hospitalists.

Background: Hospitalists practice in high-stakes and litigious settings. However, little data exist about the malpractice claims risk faced by hospitalists.

Objective: To characterize the rates and characteristics of malpractice claims against hospitalists.

Facilitating information extraction without annotated data using unsupervised and positive-unlabeled learning.

Information extraction (IE), the distillation of specific information from unstructured data, is a core task in natural language processing. For rare entities (<1% prevalence), collection of positive examples required to train a model may require an infeasibly large sample of mostly negative ones. We combined unsupervised- with biased positive-unlabeled (PU) learning methods to: 1) facilitate positive example collection while maintaining the assumptions needed to 2) learn a binary classifier from the biased positive-unlabeled data alone.

Characteristics of medical malpractice claims involving emergency medicine physicians.

Background: Identifying characteristics of malpractice claims involving emergency medicine (EM) physicians allows leaders to develop patient safety initiatives to prevent future harm events.

Methods: A retrospective study was performed of paid/unpaid claims closed 2007 to 2016 from Comparative Benchmarking System. Claims were identified by physician specialty involved (EM, internal medicine, general surgery).

The Effect of Clinical Volume on Annual and Per-Patient Encounter Medical Malpractice Claims Risk.

Objectives: The relationship between medical malpractice risk and one of the fundamental characteristics of physician practice, clinical volume, remains undefined. This study examined how the annual and per-patient encounter medical malpractice claims risk varies with clinical volume.

Methods: Clinical volume was determined using health insurance charges and was linked at the physician level to malpractice claims data from a malpractice insurer.

An Examination of Medical Malpractice Claims Involving Physician Trainees.

Purpose: To identify patient-, provider-, and claim-related factors of medical malpractice claims in which physician trainees were directly involved in the harm events.

Method: The authors performed a case-control study using medical malpractice claims closed between 2012-2016 and contributed to the Comparative Benchmarking System database by teaching hospitals. Using the service extender flag, they classified claims as cases if physician trainees were directly involved in the harm events.

Missed diagnosis of cancer in primary care: Insights from malpractice claims data.

Background: In the ambulatory setting, missed cancer diagnoses are leading contributors to patient harm and malpractice risk; however, there are limited data on the malpractice case characteristics for these cases.

Objective: The aim of this study was to examine key features and factors identified in missed cancer diagnosis malpractice claims filed related to primary care and evaluate predictors of clinical and claim outcomes.

Methods: We analyzed 2155 diagnostic error closed malpractice claims in outpatient general medicine.

The Number Needed to Remind: a Measure for Assessing CDS Effectiveness.

Background: Clinical decision support (CDS) is associated with improvement in quality and efficiency in healthcare delivery. The appropriate way to evaluate its effectiveness remains uncertain.

Methods: We analyzed data from our electronic health record (EHR) measuring the display frequency of eight reminders for Coronary Artery disease and Type 2 Diabetes and their associated performance according to a predefined methodology.

Healthcare system effects of pay-for-performance for smoking status documentation.

Objectives: To evaluate the impact on smoking status documentation of a payer-sponsored pay-for-performance (P4P) incentive that targeted a minority of an integrated healthcare delivery system's patients.

Study Design: Three commercial insurers simultaneously adopted P4P incentives to document smoking status of their members with 3 chronic diseases. The healthcare system responded by adding a smoking status reminder to all patients' electronic health records (EHRs).

Lexical concept distribution reflects clinical practice.

It is not known whether narrative medical text directly reflects clinical reality. We have tested the hypothesis that the pattern of distribution of lexical concept of medication intensification in narrative provider notes correlates with clinical practice as reflected in electronic medication records. Over 29,000 medication intensifications identified in narrative provider notes and 444,000 electronic medication records for 82 anti-hypertensive, anti-hyperlipidemic and anti-hyperglycemic medications were analyzed.

Effects of documentation-based decision support on chronic disease management.

Objective: To evaluate whether a new documentation-based clinical decision support system (CDSS) is effective in addressing deficiencies in the care of patients with coronary artery disease (CAD) and diabetes mellitus (DM).

Study Design: Controlled trial randomized by physician.

Methods: We assigned primary care physicians (PCPs) in 10 ambulatory practices to usual care or the CAD/DM Smart Form for 9 months.

An unintended consequence of electronic prescriptions: prevalence and impact of internal discrepancies.

Many e-prescribing systems allow for both structured and free-text fields in prescriptions, making possible internal discrepancies. This study reviewed 2914 electronic prescriptions that contained free-text fields. Internal discrepancies were found in 16.

Prevalence and factors affecting home blood pressure documentation in routine clinical care: a retrospective study.

Background: Home blood pressure (BP) is closely linked to patient outcomes. However, the prevalence of its documentation has not been examined. The objective of this study was to analyze the prevalence and factors affecting documentation of home BP in routine clinical care.

Encounter frequency and blood pressure in hypertensive patients with diabetes mellitus.

The relationship between encounter frequency (average number of provider-patient encounters over a period of time) and blood pressure for hypertensive patients is unknown. We tested the hypothesis that shorter encounter intervals are associated with faster blood pressure normalization. We performed a retrospective cohort study of 5042 hypertensive patients with diabetes mellitus treated at primary care practices affiliated with 2 academic hospitals between 2000 and 2005.

Comparison of information content of structured and narrative text data sources on the example of medication intensification.

OBJECTIVE To compare information obtained from narrative and structured electronic sources using anti-hypertensive medication intensification as an example clinical issue of interest. DESIGN A retrospective cohort study of 5,634 hypertensive patients with diabetes from 2000 to 2005. MEASUREMENTS The authors determined the fraction of medication intensification events documented in both narrative and structured data in the electronic medical record.

Linking test ordering with order tracking: closing the loop in ambulatory care.

Test non-completion decreases quality of care and accounts for many diagnosis-related malpractice claims. Currently, clinicians using Partners' electronic Longitudinal Medical Record (LMR) can track results but lack a mechanism for tracking non-completed tests. This pilot intervention will study an "order tracking" functionality that flags newly-ordered tests and will lead to generation of written patient reminders if tests are not completed within pre-specified timeframes.

Improving physician note entry rates through an incentive program.

The Massachusetts General Hospital Physicians Organization (MGPO) has implemented physician incentives to drive timely entry of notes into the outpatient electronic health record. Data from the Partners Quality Data Warehouse (QDW) were used to refine and produce a note completion metric and to create reports. This initiative has led to a decrease in the average time to complete a note from 197 to 90 hours, in less than a year.

Modeling pediatric vaccination guidelines in a data warehouse.

Frequent updates and complexity of vaccination schedules can make it difficult for pediatric practices to ensure adherence to immunization guidelines. To address this problem, Partners HealthCare System (PHS) has created a quality reporting utility to manage pediatric immunizations and to support quality improvement initiatives. The rules-based solution uses reference database tables to model the logic for each vaccine.

Identification of documented medication non-adherence in physician notes.

Medication non-adherence is common and the physicians awareness of it may be an important factor in clinical decision making. Few sources of data on physician awareness of medication non-adherence are available. We have designed an algorithm to identify documentation of medication non-adherence in the text of physician notes.