Gupta Ashwin, Snyder Ashley, Kachalia Allen, Flanders Scott, Saint Sanjay, Chopra Vineet
VA Ann Arbor Healthcare System, Internal Medicine, Ann Arbor, Michigan, USA.
Division of Hospital Medicine, Department of Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA.
BMJ Qual Saf. 2017 Aug 9;27(1). doi: 10.1136/bmjqs-2017-006774.
Little is known about the incidence or significance of diagnostic error in the inpatient setting. We used a malpractice claims database to examine incidence, predictors and consequences of diagnosis-related paid malpractice claims in hospitalised patients.
The US National Practitioner Database was used to identify paid malpractice claims occurring between 1 January 1999 and 31 December 2011. Patient and provider characteristics associated with paid claims were analysed using descriptive statistics. Differences between diagnosis-related paid claims and other paid claim types (eg, surgical, anaesthesia, medication) were assessed using Wilcoxon rank-sum and χ tests. Multivariable logistic regression was used to identify patient and provider factors associated with diagnosis-related paid claims. Trends for incidence of diagnosis-related paid claims and median annual payment were assessed using the Cochran-Armitage and non-parametric trend test.
13 682 of 62 966 paid malpractice claims (22%) were diagnosis-related. Compared with other paid claim types, characteristics significantly associated with diagnosis-related paid claims were as follows: male patients, patient aged 50 years, provider aged <50 years and providers in the northeast region. Compared with other paid claim types, diagnosis-related paid claims were associated with 1.83 times more risk of disability (95% CI 1.75 to 1.91; p<0.001) and 2.33 times more risk of death (95% CI 2.23 to 2.43; p<0.001) than minor injury, after adjusting for patient and provider characteristics. Inpatient diagnostic error accounted for $5.7 billion in payments over the study period, and median diagnosis-related payments increased at a rate disproportionate to other types.
Inpatient diagnosis-related malpractice payments are common and more often associated with disability and death than other claim types. Research focused on understanding and mitigating diagnostic errors in hospital settings is necessary.
对于住院环境中诊断错误的发生率或重要性，人们了解甚少。我们使用一个医疗事故索赔数据库来研究住院患者中与诊断相关的已赔付医疗事故索赔的发生率、预测因素及后果。
利用美国国家从业者数据库识别1999年1月1日至2011年12月31日期间发生的已赔付医疗事故索赔。使用描述性统计分析与已赔付索赔相关的患者和提供者特征。采用Wilcoxon秩和检验及χ检验评估与诊断相关的已赔付索赔和其他已赔付索赔类型（如手术、麻醉、用药）之间的差异。使用多变量逻辑回归来识别与诊断相关的已赔付索赔相关的患者和提供者因素。采用Cochran-Armitage检验和非参数趋势检验评估与诊断相关的已赔付索赔发生率及年支付中位数的趋势。
在62966例已赔付医疗事故索赔中，13682例（22%）与诊断相关。与其他已赔付索赔类型相比，与诊断相关的已赔付索赔显著相关的特征如下：男性患者、年龄50岁的患者、年龄<50岁的提供者以及东北地区的提供者。与其他已赔付索赔类型相比，在对患者和提供者特征进行调整后，与诊断相关的已赔付索赔导致残疾的风险高1.83倍（95%CI 1.75至1.91；p<0.001），导致死亡的风险高2.33倍（95%CI 2.23至2.43；p<0.001），而不是轻伤。在研究期间，住院诊断错误导致的赔付金额达57亿美元，与诊断相关的支付中位数增长速度与其他类型不成比例。
住院诊断相关的医疗事故赔付很常见，与其他索赔类型相比，更常与残疾和死亡相关。有必要开展研究以了解和减少医院环境中的诊断错误。
