州级医疗事故法与肩袖撕裂和肱骨近端骨折的外科治疗应用：一项观察性队列研究。
State medical malpractice laws and utilization of surgical treatment for rotator cuff tear and proximal humerus fracture: an observational cohort study.
机构信息
Department of Health Services Policy and Management, University of South Carolina, 915 Greene Street Suite 354, Columbia, SC, 29205, USA.
Department of Pharmacy Practice and Science, University of Iowa, 345 CPB, 180 South Grand Ave, Iowa City, IA, 52242, USA.
出版信息
BMC Health Serv Res. 2021 May 28;21(1):516. doi: 10.1186/s12913-021-06544-8.
BACKGROUND
How much does the medical malpractice system affect treatment decisions in orthopaedics? To further this inquiry, we sought to assess whether malpractice liability is associated with differences in surgery rates among elderly orthopaedic patients.
METHODS
Medicare data were obtained for patients with a rotator cuff tear or proximal humerus fracture in 2011. Multivariate regressions were used to assess whether the probability of surgery is associated with various state-level rules that increase or decrease malpractice liability risks.
RESULTS
Study results indicate that lower liability is associated with higher surgery rates. States with joint and several liability, caps on punitive damages, and punitive evidence rule had surgery rates that were respectively 5%-, 1%-, and 1%-point higher for rotator cuff tears, and 2%-, 2%- and 1%-point higher for proximal humerus fractures. Conversely, greater liability is associated with lower surgery rates, respectively 6%- and 9%-points lower for rotator cuff patients in states with comparative negligence and pure comparative negligence.
CONCLUSIONS
Medical malpractice liability is associated with orthopaedic treatment choices. Future research should investigate whether treatment differences result in health outcome changes to assess the costs and benefits of the medical liability system.
背景
医疗事故制度对骨科治疗决策有多大影响？为了进一步探究这一问题，我们评估了医疗事故责任是否与老年骨科患者手术率的差异有关。
方法
我们获取了 2011 年患有肩袖撕裂或肱骨近端骨折的 Medicare 患者数据。采用多元回归分析评估了各种增加或降低医疗事故责任风险的州级法规是否与手术概率有关。
结果
研究结果表明，责任越低，手术率越高。在实行连带责任、惩罚性赔偿金上限和惩罚性证据规则的州，肩袖撕裂的手术率分别高出 5%、1%和 1%，肱骨近端骨折的手术率分别高出 2%、2%和 1%。相反，责任越高，手术率越低，在实行比较过失和纯粹比较过失的州，肩袖撕裂患者的手术率分别低 6%和 9%。
结论
医疗事故责任与骨科治疗选择有关。未来的研究应调查治疗差异是否导致健康结果的变化，以评估医疗责任制度的成本和收益。
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