Fanaeian N, Merwin E
Health Evaluation Sciences Program, University of Virginia School of Medicine, VA, USA.
Am J Med Qual. 2001 Mar-Apr;16(2):43-57. doi: 10.1177/106286060101600202.
The National Practitioner Data Bank (NPDB) began operation in September 1990 as a clearinghouse for adverse action, licensure, and malpractice information in an effort to protect consumers and promote quality in health care. This study analyzed 66,107 and 1291 records of payments made for 50,396 physicians and 1218 nurses, respectively, from 1994 through 1998, to describe characteristics, trends, and risk factors of malpractice payment for physicians and nurses. The median payments, more often settlements paid by insurance companies than judgments in courts of law, were higher for physicians than for nurses. Mean payments were higher for residents than for non-resident physicians; median payments for residents were slightly lower than other physicians when adjusted for number of providers included in the payment. On the state level, correlation analyses suggested a significant positive association between the nurse rate of malpractice payments that were made and median per capita income, number of physicians per 1000 residents, and number of attorneys per 1000 residents; analysis revealed a significant negative association between this rate and the percentage of residents residing in rural areas and the number of nurses per 1000 residents. Although findings suggested that payment trends remained stable, there was great regional variation in the risk of malpractice payment for both physicians and nurses. The physician risk ranged from a low of 0.73% per physician per year in Alabama to a high of 3.7% in Wyoming, and the nurse risk ranged from a low of 0% per nurse per year in Vermont to a high of 0.075% in the District of Columbia. If the quality of health care provided by physicians and nurses does not vary geographically in the United States, then such a great discrepancy seems to challenge the notion that the risk of malpractice litigation consistently promotes the quality of health care.
国家从业者数据银行（NPDB）于1990年9月开始运营，作为一个收集不良行为、执照和医疗事故信息的信息交换中心，旨在保护消费者并提高医疗保健质量。本研究分析了1994年至1998年期间分别针对50396名医生和1218名护士支付的66107笔和1291笔款项记录，以描述医生和护士医疗事故支付的特征、趋势和风险因素。支付的中位数（保险公司支付的和解款比法院判决更为常见）医生高于护士。住院医生的平均支付额高于非住院医生；考虑到支付中包含的提供者数量进行调整后，住院医生的支付中位数略低于其他医生。在州层面，相关性分析表明，护士医疗事故支付率与人均收入中位数、每1000名居民中的医生数量以及每1000名居民中的律师数量之间存在显著正相关；分析还显示，该比率与农村地区居民百分比以及每1000名居民中的护士数量之间存在显著负相关。尽管研究结果表明支付趋势保持稳定，但医生和护士医疗事故支付风险在地区上存在很大差异。医生的风险范围从阿拉巴马州每年每位医生0.73%的低水平到怀俄明州3.7%的高水平，护士的风险范围从佛蒙特州每年每位护士0%的低水平到哥伦比亚特区0.075%的高水平。如果美国医生和护士提供的医疗保健质量在地理上没有差异，那么如此大的差异似乎对医疗事故诉讼风险始终能提高医疗保健质量这一观念提出了挑战。
