International Journal for Quality in Health Care Advance Access published online on November 30, 2007
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzm065
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Relation of patients' experiences with individual physicians to malpractice risk
1 Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA
2 Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA
3 Harvard Vanguard Medical Associates, Boston, MA
Objective. Patient care experience survey data might be useful for managing individual physician malpractice risk, but available evidence is limited. This study assesses whether patients' experiences with individual physicians, as measured by a validated survey, are associated with patient complaints and malpractice lawsuits.
Design. Random samples of active patients in physicians' panels, with sample sizes adequate to provide highly reliable, stable information about patients' experiences with each physician (n = 19 202, average respondents per physician = 119) were used to assess the relation of patient survey measures to malpractice risk.
Setting. A large multi-specialty physician organization in eastern Massachusetts, USA.
Participants. Physicians providing care for at least 5 years in adult primary care and select high-risk specialty departments between January 1996 and December 2005 (n = 161).
Main outcome meausure(s). Patient complaints (2001–05) and malpractice lawsuits (1996–2005).
Results. Compared to primary care physicians, high-risk specialists had a lower patient complaint rate (0.34 vs. 1.36 complaints per patient care full time equivalent; P < 0.001), but a higher lawsuit rate (0.09 vs. 0.05 lawsuits per patient care full time equivalent; P = 0.02). Irrespective of physician specialty, the quality of physician–patient interactions (IRR = 0.61; P < 0.001) and care coordination (IRR = 0.65; P < 0.001) were inversely associated with patient complaints. Patient survey measures were not associated with malpractice lawsuits.
Conclusions. The results underscore the challenges organizations face when attempting to use patient survey data to manage individual physician medical malpractice risk. Because lawsuits are infrequent events, calibrating these validated patient survey measures to malpractice lawsuit risk will require large physician samples from diverse practices.
Keywords: care coordination, doctor–patient relationship, medical malpractice, patient complaints, risk management
Address reprint requests to: Hector P. Rodriguez, School of Public Health and Community Medicine, University of Washington, Seattle, WA; Tel: +(206) 685-4460; Fax: +(206) 543-3964; E-mail: hrod{at}u.washington.edu
Accepted for publication November 4, 2007.