2008年至2012年美国放射科医疗事故索赔：特点与影响

Radiology Malpractice Claims in the United States From 2008 to 2012: Characteristics and Implications.

作者信息

Harvey H Benjamin, Tomov Elena, Babayan Astrid, Dwyer Kathy, Boland Sam, Pandharipande Pari V, Halpern Elkan F, Alkasab Tarik K, Hirsch Joshua A, Schaefer Pamela W, Boland Giles W, Choy Garry

机构信息

Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.

CRICO Risk Management Foundation, Cambridge, Massachusetts.

出版信息

J Am Coll Radiol. 2016 Feb;13(2):124-30. doi: 10.1016/j.jacr.2015.07.013. Epub 2015 Oct 9.

DOI:10.1016/j.jacr.2015.07.013

PMID:26454772

Abstract

PURPOSE

The aim of this study was to compare the frequency and liability costs associated with radiology malpractice claims relative to other medical services and to evaluate the clinical context and case disposition associated with radiology malpractice claims.

METHODS

This HIPAA-compliant study was exempted from institutional review board approval. The Comparative Benchmarking System database, a repository of more than 300,000 medical malpractice cases in the United States, was queried for closed claims over a five-year period (2008-2012). Claims were categorized by the medical service primarily responsible for the claim and the paid total loss. For all cases in which radiology was the primary responsible service, the case abstracts were evaluated to determine injury severity, claimant type by setting, claim allegation, process of care involved, case disposition, modality involved, and body section. Intracategory comparisons were made on the basis of the frequency of indemnity payment and total indemnity payment for paid cases, using χ(2) and Wilcoxon rank-sum tests.

RESULTS

Radiology was the eighth most likely responsible service to be implicated in a medical malpractice claim, with a median total paid loss (indemnity payment plus defense cost plus administrative expense) per closed case of $30,091 (mean, $205,619 ± $508,883). Radiology claims were most commonly associated with high- and medium-severity injuries (93.3% [820 of 879]; 95% confidence interval [CI], 91.7%-94.95%), the outpatient setting (66.3% [581 of 876]; 95% CI, 63.0%-69.2%), and diagnosis-related allegations (ie, failure to diagnose or delayed diagnosis) (57.3% [504 of 879]; 95% CI, 54.0%-60.6%). A high proportion of claims pertained to cancer diagnoses (44.0% [222 of 504]; 95% CI, 39.7%-48.3%). A total of 62.3% (548 of 879; 95% CI, 59.1%-65.5%) of radiology claims were closed without indemnity payments; 37.7% (331 of 879; 95% CI, 34.5%-40.9%) were closed with a median indemnity payment of $175,000 (range, $112-$6,691,762; mean $481,094 ± $727,636).

CONCLUSIONS

Radiology malpractice claims most commonly involve diagnosis-related allegations in the outpatient setting, particularly cancer diagnoses, with approximately one-third of claims resulting in payouts to the claimants.

摘要

目的

本研究旨在比较与放射科医疗事故索赔相关的频率和责任成本与其他医疗服务的差异，并评估与放射科医疗事故索赔相关的临床背景和案件处理情况。

方法

这项符合《健康保险流通与责任法案》（HIPAA）的研究无需经过机构审查委员会的批准。查询了美国超过30万起医疗事故案件的比较基准系统数据库，以获取五年期间（2008 - 2012年）已结案的索赔。索赔按对索赔主要负责的医疗服务和已支付的总损失进行分类。对于所有放射科为主要责任服务的案件，评估案件摘要以确定损伤严重程度、按环境划分的索赔人类型、索赔指控、所涉及的护理过程、案件处理情况、所涉及的检查方式以及身体部位。根据已赔付案件的赔偿支付频率和总赔偿支付情况进行类别内比较，使用卡方检验和威尔科克森秩和检验。

结果

放射科是医疗事故索赔中第八个最有可能涉及的责任服务，每个已结案案件的总支付损失中位数（赔偿支付加上辩护成本加上行政费用）为30,091美元（均值为205,619 ± 508,883美元）。放射科索赔最常与高严重度和中等严重度损伤相关（93.3% [879例中的820例]；95%置信区间[CI]，91.7% - 94.95%）、门诊环境（66.3% [876例中的581例]；95% CI，63.0% - 69.2%）以及与诊断相关的指控（即未能诊断或延迟诊断）（57.3% [879例中的504例]；95% CI，54.0% - 60.6%）。很大一部分索赔涉及癌症诊断（44.0% [504例中的222例]；95% CI，39.7% - 48.3%）。总共62.3%（879例中的548例；95% CI，59.1% - 65.5%）的放射科索赔在未支付赔偿的情况下结案；37.7%（879例中的331例；95% CI, 34.5% - 40.9%）的索赔以赔偿支付中位数175,000美元结案（范围为112 - 6,691,762美元；均值为481,094 ± 727,636美元）。