Malpractice Claims Data as a Quality Improvement Tool

This Note attempts to evaluate the usefulness of malpractice claims data for identifying (1) physicians who are prone to negligent errors and (2) physician and hospital characteristics associated with particular kinds of errors. It is based on a retrospective review of physician malpractice claim records of a large New Jersey insurer of physicians practicing in obstetrics and gynecology, general surgery, anesthesiology, or radiology during any portion of the period between 1977 and 1989. The authors classified the claims into 11 clinical error categories in three broad groups: (1) patient management, (2) technical performance, and (3) staff coordination. Outcomes were expressed as per-physician frequency of claims due to negligence and proportion of claims associated with various types of errors. Using five years of claims history to predict long-term claims proneness was more accurate than chance alone by 57 percent in obstetrics and gynecology, 33 percent in general surgery, 11 percent in anesthesiology, and 15 percent in radiology. Cross-validated recursive partitioning showed that among physician characteristics, only specialty was predictive of physician error profiles. For physician claims arising in acute care hospitals, hospital size and location in addition to hospital services discriminated among different error profiles; the cross-validated accuracy of this method was 69 percent compared with 22 percent accuracy achieved by random prediction. The authors conclude that using physicians' malpractice claims histories to target individuals for education or sanctions is problematic because of the only modest predictive power of such claims histories.