Localio A R, Lawthers A G, Brennan T A, Laird N M, Hebert L E, Peterson L M, Newhouse J P, Weiler P C, Hiatt H H
Center for Biostatistics and Epidemiology, Penn State University College of Medicine, Hershey 17033.
N Engl J Med. 1991 Jul 25;325(4):245-51. doi: 10.1056/NEJM199107253250405.
By matching the medical records of a random sample of 31,429 patients hospitalized in New York State in 1984 with statewide data on medical-malpractice claims, we identified patients who had filed claims against physicians and hospitals. These results were then compared with our findings, based on a review of the same medical records, regarding the incidence of injuries to patients caused by medical management (adverse events).
We identified 47 malpractice claims among 30,195 patients' records located on our initial visits to the hospitals, and 4 claims among 580 additional records located during follow-up visits. The overall rate of claims per discharge (weighted) was 0.13 percent (95 percent confidence interval, 0.076 to 0.18 percent). Of the 280 patients who had adverse events caused by medical negligence as defined by the study protocol, 8 filed malpractice claims (weighted rate, 1.53 percent; 95 percent confidence interval, 0 to 3.2 percent). By contrast, our estimate of the statewide ratio of adverse events caused by negligence (27,179) to malpractice claims (3570) is 7.6 to 1. This relative frequency overstates the chances that a negligent adverse event will produce a claim, however, because most of the events for which claims were made in the sample did not meet our definition of adverse events due to negligence.
Medical-malpractice litigation infrequently compensates patients injured by medical negligence and rarely identifies, and holds providers accountable for, substandard care.
通过将1984年在纽约州住院的31429名患者的随机样本病历与全州医疗事故索赔数据进行匹配，我们确定了对医生和医院提出索赔的患者。然后，基于对相同病历的审查，将这些结果与我们关于医疗管理导致患者受伤（不良事件）发生率的研究结果进行比较。
在我们首次走访医院时查阅的30195份患者病历中，我们确定了47起医疗事故索赔，在后续走访中查阅的另外580份病历中有4起索赔。每次出院的总体索赔率（加权）为0.13%（95%置信区间为0.076%至0.18%）。在按照研究方案定义的由医疗过失导致不良事件的280名患者中，有8人提出了医疗事故索赔（加权率为1.53%；95%置信区间为0至3.2%）。相比之下，我们估计全州因过失导致的不良事件（27179起）与医疗事故索赔（3570起）的比例为7.6比1。然而，这种相对频率夸大了过失性不良事件导致索赔的可能性，因为样本中提出索赔的大多数事件不符合我们对因过失导致的不良事件的定义。
医疗事故诉讼很少对因医疗过失受伤的患者进行赔偿，而且很少识别出不合格护理并让提供者对此负责。
