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#Grand Rounds

Is There a Link Between Greater Risk of Malpractice Liability and Better Quality Health Care?

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BACKGROUND AND PURPOSE:

  • Mello et al. (JAMA, 2020) assessed whether there is an association between malpractice liability risk and health care quality and safety

METHODS:

  • Systematic review and meta-analysis
  • Study inclusion criteria
    • Published between 1990 and 2019
    • Data includes relationship between malpractice liability risk measures and health outcomes or structural and process indicators of health care quality
  • Study design
    • Data extracted by two reviewers
    • Studies summarized descriptively and assessed qualitatively
  • Exposure measures
    • Physicians’ malpractice insurance premiums
    • State tort reforms
    • Frequency of paid claims and average claim payment
    • Physicians’ claims history
    • Total malpractice payments
    • Jury awards
    • Presence of an immunity from malpractice liability
    • CMS malpractice geographic practice cost index
    • Composite of above
  • Outcome measures
    • Patient mortality
    • Hospital readmissions, avoidable admissions, and prolonged length of stay
    • Receipt of cancer screening
    • AHRQ patient safety indicators and other adverse event measures
    • Measures of hospital and nursing home quality
    • Patient satisfaction
  • Primary outcomes
    • Associations between malpractice risk measures and health care quality and safety outcomes

RESULTS:

  • Obstetrical care (16 studies)
    • No significant association between liability risk and outcomes (e.g. Apgar score and birth injuries): 9 studies
    • Limited evidence for association: 7 studies
  • Non-obstetrical care settings (20 studies)
    • No significant association with liability risk: 15 studies
    • Limited evidence for association: 5 studies
  • Hospital readmissions and avoidable initial hospitalizations (7 studies)
    • No significant association with liability risk: 7 studies
  • Other measures, such as patient safety indicators, process-of-care quality measures, patient satisfaction (12 studies)
    • No significant association with liability risk: 7 studies
    • Significant associations in some analyses: 5 studies
      • Results were mixed: E.g., looking at cancer screening rates, 1 study found association between mean malpractice claim payments and mammography rates, while another study found no relationship between tort reforms and cancer screening rates

CONCLUSION:

  • Majority of studies did not show a relationship between liability risk and outcomes, especially in obstetrics
  • Authors recognize limitations, including some studies reporting vague information with varying detail
  • Despite some evidence gaps, the authors conclude that greater tort liability is unlikely to be a deterrent or result in better health outcomes

Learn More – Primary Sources:

Malpractice Liability and Health Care Quality – A Review

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Does Medical Malpractice Reform Change Practice Patterns?
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