Weill Cornell Medical College, New York, New York, USA.
BMJ Open. 2013 Jun 20;3(6):e002985. doi: 10.1136/bmjopen-2013-002985.
An analysis of paid malpractice claims judged in court compared with those settled out of court may help explain perceptions of malpractice risk.
A retrospective analysis and cross-sectional comparison of malpractice claims. Evaluated trends in the number and proportion of paid claims, and mean payment amount by resolution type; identified patient, physician and claim characteristics associated with each resolution type. Examined the effects of resolution type on payment amount and time to claim resolution.
Claims paid on behalf of US physicians reported in the National Practitioner Data Bank (NPDB) from 2005 to 2009.
Type of resolution, claim characteristics, payment amount and time to resolution.
Between 2005 and 2009, there were 58 667 claims paid on behalf of US physicians. Of these paid claims, 56 850 (96.9%) were settled outside court, and 1817 (3.1%) were judged in court. There was no significant change in the proportion of paid claims resolved by settlement versus judgement over time (p=0.83); nor was there a significant change in the mean payment amount in either resolution group (settlement, p=0.94; judgement, p=0.36). The claims in which the physicians were under 50, had prior malpractice reports, which were paid by a state malpractice programme, for adverse events to a fetus, and for surgical or obstetric error were more likely to be judged in court. The mean payment amount (US$592 283 vs US$317 447, p<0.01), per cent of payments over US$1 million (41.82% vs 15.43%, p<0.01), and time to decision (6.50 years vs 4.93 years, p<0.01) were significantly higher in judged claims.
Although only a very small percentage of paid malpractice claims in the USA are judged in court, a number of characteristics differ between settled and judged claims. Such differences may influence perceptions of malpractice risk and future reform efforts.
对法庭判决的医疗事故赔偿案例与庭外和解的案例进行分析，可能有助于解释对医疗事故风险的认知。
对医疗事故赔偿案例的回顾性分析和横截面比较。评估了按解决方式分类的已支付赔偿案例数量和比例的变化趋势，以及按解决方式分类的平均赔偿金额；确定了与每种解决方式相关的患者、医生和索赔特征。考察了解决方式对赔偿金额和索赔解决时间的影响。
2005 年至 2009 年代表美国医生在全国医生数据库（NPDB）中支付的索赔。
解决方式、索赔特征、赔偿金额和解决时间。
2005 年至 2009 年，有 58667 件代表美国医生的索赔得到支付。在这些已支付的索赔中，56850 件（96.9%）通过庭外和解解决，1817 件（3.1%）通过法庭判决解决。随着时间的推移，通过和解解决的索赔比例与通过判决解决的索赔比例之间没有显著变化（p=0.83）；在任何解决方式下，平均赔偿金额都没有显著变化（和解，p=0.94；判决，p=0.36）。年龄在 50 岁以下、有既往医疗事故报告、由州医疗事故计划支付、针对胎儿不良事件以及外科或产科错误的索赔更有可能通过法庭判决解决。判决索赔的平均赔偿金额（592283 美元比 317447 美元，p<0.01）、支付金额超过 100 万美元的比例（41.82%比 15.43%，p<0.01）和决策时间（6.50 年比 4.93 年，p<0.01）显著更高。
尽管在美国，只有很小比例的医疗事故赔偿案例通过法庭判决，但庭外和解和法庭判决的索赔之间存在一些差异。这些差异可能会影响对医疗事故风险的认知和未来的改革努力。
