Mello Michelle M, Hemenway David
Department of Health Policy and Management, Harvard School of Public Health, 667 Huntington Avenue, Boston, MA 02115, USA.
Soc Sci Med. 2004 Jul;59(1):39-46. doi: 10.1016/j.socscimed.2003.09.034.
The notion that the tort liability system deters negligence in health care has been invoked to make the "business case for patient safety." However, existing data on the relationship between hospital adverse events and malpractice claims typically are interpreted as evidence that the tort system does not deter negligence because of the poor fit between those who are negligently injured and those who sue. Using a familiar analogy from epidemiology--the problem of false positives in screening tests for rare diseases--and data from two large studies of medical injuries and malpractice claims in the United States, this paper presents an argument that the standard interpretation overlooks a complexity in the data. Although most malpractice claims do not actually involve a negligent injury, a patient who suffers a negligent injury is more than 20 times more likely, on average, to file a claim than a patient who does not. However, because malpractice claiming is a rare event with many false positives, for the average hospital or group practice, even substantial improvements in rates of negligent injury will not lead to a large reduction in claims rates. These findings suggest that the strength of the business case for patient safety depends on the perspective from which one views the data.
侵权责任制度能遏制医疗保健中的疏忽行为这一观念，已被用来论证“患者安全的商业理由”。然而，关于医院不良事件与医疗事故索赔之间关系的现有数据，通常被解释为侵权制度无法遏制疏忽行为的证据，原因在于遭受疏忽伤害的人与起诉者之间的匹配度很低。本文运用流行病学中一个常见的类比——罕见疾病筛查测试中的假阳性问题——以及来自美国两项关于医疗伤害和医疗事故索赔的大型研究的数据，提出一种观点，即标准解释忽略了数据中的复杂性。虽然大多数医疗事故索赔实际上并不涉及疏忽伤害，但平均而言，遭受疏忽伤害的患者提出索赔的可能性是未受伤害患者的20多倍。然而，由于医疗事故索赔是一个罕见事件，存在许多假阳性情况，对于普通医院或团体医疗机构来说，即使疏忽伤害率有大幅改善，索赔率也不会大幅下降。这些发现表明，患者安全商业理由的说服力取决于看待数据的视角。
