Bilimoria Karl Y, Chung Jeanette W, Minami Christina A, Sohn Min-Woong, Pavey Emily S, Holl Jane L, Mello Michelle M
Jt Comm J Qual Patient Saf. 2017 May;43(5):241-250. doi: 10.1016/j.jcjq.2017.02.004. Epub 2017 Mar 27.
One major intent of the medical malpractice system in the United States is to deter negligent care and to create incentives for delivering high-quality health care. A study was conducted to assess whether state-level measures of malpractice risk were associated with hospital quality and patient safety.
In an observational study of short-term, acute-care general hospitals in the United States that publicly reported in the Centers for Medicaid & Medicare Services Hospital Compare in 2011, hierarchical regression models were used to estimate associations between state-specific malpractice environment measures (rates of paid claims, average Medicare Malpractice Geographic Practice Cost Index [MGPCI], absence of tort reform laws, and a composite measure) and measures of hospital quality (processes of care, imaging utilization, 30-day mortality and readmission, Agency for Healthcare Research and Quality Patient Safety Indicators, and patient experience from the Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS]).
No consistent association between malpractice environment and hospital process-of-care measures was found. Hospitals in areas with a higher MGPCI were associated with lower adjusted odds of magnetic resonance imaging overutilization for lower back pain but greater adjusted odds of overutilization of cardiac stress testing and brain/sinus computed tomography (CT) scans. The MGPCI was negatively associated with 30-day mortality measures but positively associated with 30-day readmission measures. Measures of malpractice risk were also negatively associated with HCAHPS measures of patient experience.
Overall, little evidence was found that greater malpractice risk improves adherence to recommended clinical standards of care, but some evidence was found that malpractice risk may encourage defensive medicine.
美国医疗事故责任制度的一个主要目的是威慑疏忽治疗行为，并激励提供高质量的医疗保健服务。开展了一项研究，以评估州一级的医疗事故风险衡量指标是否与医院质量和患者安全相关。
在一项针对2011年在美国医疗保险和医疗补助服务中心医院比较网站上公开报告的短期急性护理综合医院的观察性研究中，使用分层回归模型来估计特定州的医疗事故环境衡量指标（已赔付索赔率、医疗保险医疗事故地理执业成本指数[MGPCI]平均值、无侵权改革法律以及一项综合指标）与医院质量衡量指标（护理过程、影像利用、30天死亡率和再入院率、医疗保健研究与质量局患者安全指标以及医疗服务提供者和系统医院消费者评估[HCAHPS]中的患者体验）之间的关联。
未发现医疗事故环境与医院护理过程衡量指标之间存在一致的关联。MGPCI较高地区的医院，对于下背痛患者，磁共振成像过度使用的调整后几率较低，但心脏负荷试验和脑/鼻窦计算机断层扫描（CT）过度使用的调整后几率较高。MGPCI与30天死亡率衡量指标呈负相关，但与30天再入院率衡量指标呈正相关。医疗事故风险衡量指标也与HCAHPS患者体验衡量指标呈负相关。
总体而言，几乎没有证据表明更高的医疗事故风险能提高对推荐的临床护理标准的遵守情况，但有一些证据表明医疗事故风险可能会助长防御性医疗行为。
