Original Article

Patient Complaints and Malpractice Risk in a Regional Healthcare Center

Authors: Gerald B. Hickson, MD, Charles F. Federspiel, PhD, Jennifer Blackford, PhD, James W. Pichert, PhD, Walter Gaska, MD, Michael W. Merrigan, JD, Cynthia S. Miller, MSSW

Abstract

Objective: To study the association between physicians' complaint records and their risk management experiences in a regional healthcare center.


Data Sources: Patient complaints about physicians in a large border state medical center's hospital and outpatient clinics were recorded and coded. The study period was from January 2001 through December 2003. These records were linked to the counterpart physicians' data covered by the institutions' risk management plan through June 2004.


Study Design and Data Collection: All physicians at the institution who had contact with patients during the study period were identified as surgeons or nonsurgeons. Complaints for these physicians were recorded by the institution's Office of Patient Relations (OPR) and independently coded using a standardized protocol to characterize the nature of the problem and to uniquely identify the person complained about. The complaint records were then linked to the risk management files (RMFs) for the defined physician cohort. In addition, these data were supplemented with clinical service values (RVUs) which were available for 338 members (76%) of the 445 member cohort.


Principal Findings: Both patient complaints and risk management events were higher for surgeons than for nonsurgeons. This was true for the number of RMFs, those involving expenditures, and for lawsuits. Logistic regression was used to assess the effects of complaint counts, practice type and volume of clinical activity. All were statistically significant in predicting the number of RMF openings, RMF openings with expenditures and lawsuits. Predictive concordance was 75% or greater for each of the three risk management outcomes.


Conclusions: Expressions of patient dissatisfaction and practice type are significantly related to risk management experiences in a regional medical center. Associations of risk management experiences with volume of clinical activity (RVUs) for surgeons in the regional medical center environment were not as strong as those found in a similar study reported from an academic medical center.


Key Points


* Physician malpractice experience in a regional medical center is associated with patient complaints, practice type (surgeons versus nonsurgeons), and volume of service.


* This finding is similar to that previously demonstrated in an academic medical center.

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References

1. Hickson GB, Federspiel CF, Pichert JW, et al. Patient complaints and malpractice risk. JAMA 2002;287:2951–2957.
 
2. Sloan F, Bovberg R. Medical malpractice, crisis, response, and effects. Health Association of America Research Bulletin. 1989.
 
3. Bovberg R, Petronis R. The relationship between physicians' malpractice claims history and later claims: does the past predict the future? JAMA 1994;272:1421–1426.
 
4. May M, Stengel D. Who sues their doctors? How patients handle medical grievances. Law & Society Review 1990;24:105–119.
 
5. Hickson GB, Clayton E, Githens P, et al. Factors that prompted families to file malpractice claims following perinatal injuries. JAMA 1992;267:1359–1363.
 
6. Levinson W, Roter D, Mullooly J. Physician-patient communication. JAMA 1997;277:553–559.
 
7. Vincent C, Young M, Phillips A. Why do people sue doctors? A study of patients and relatives taking legal action. Lancet 1994;343:1609–1613.
 
8. Hsiao W, Braun P, Dunn D, et al. Resource-based relative values: an overview. JAMA 1988;260:2347–2353.
 
9. Medicare program: physicians Medicare fee schedule for calendar year. 56 Federal Register 59511;1991.
 
10. Hickson GB, Pichert JW, Federspiel CF, et al. Development of an early identification and response model of malpractice prevention. Law Contemp Problems 1997;60:7–29.
 
11. Allison P. Logistic regression using SAS: theory and application. Cary, NC: SAS Institute, Inc, 1999.
 
12. SAS/STAT User's Guide. Version 6, Fourth Edition, Volume 2. Cary, NC: SAS Institute, Inc, 1994.
 
13. Safran D, Taira D, Rogers W, et al. Linking primary care performance to outcomes of care. J Fam Pract 1998;47:213–220.
 
14. Ware J, Davies A. Behavioral consequences of consumer dissatisfaction with medical care. Eval Program Plann 1983;6:291–297.
 
15. Kasteller J, Kane R, Olsen D, et al. Issues underlying prevalence of doctor-shopping behavior. J Health Soc Behav 1976;17:328–339.
 
16. Marquis M, Davies A, Ware J. Patient satisfaction and change in medical care provider: a longitudinal study. Med Care 1983;21:821–829.
 
17. Ray W, Schaffner W, Federspiel CF. Persistence of improvement in antibiotic prescribing in office practice. JAMA 1985;253:1774–1776.
 
18. Eisenberg J. The reasons for doctors' practice patterns and ways to change them. Ann Arbor: Health Administration Press, 1986.
 
19. Soumerai S, Avorn J. Principals of educational outreach to improve clinical decision making. JAMA 1990;263:549–556.
 
20. Pichert JW, Blackford J, Federspiel CF, et al. Using Patient Complaints to Communicate Concerns to Colleagues. Academic Compensation and Production Survey for Faculty & Management. 2004:16–20.