TY - JOUR
T1 - Association between state medical malpractice environment and surgical quality and cost in the United States
AU - Bilimoria, Karl Y
AU - Sohn, Min Woong
AU - Chung, Jeanette W
AU - Minami, Christina A.
AU - Oh, Elissa H.
AU - Pavey, Emily S.
AU - Holl, Jane Louise
AU - Black, Bernard
AU - Mello, Michelle M.
AU - Bentrem, David Jason
N1 - Funding Information:
This study was supported by AHRQ R21HS021857 and a Center Development Award from Northwestern University and Northwestern Memorial Hospital to Dr. Bilimoria.
Publisher Copyright:
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016
Y1 - 2016
N2 - Context: The US medical malpractice system is designed to deter negligence and encourage quality of care through threat of liability. Objective: To examine whether state-level malpractice environment is associated with outcomes and costs of colorectal surgery. Design, Setting, and Patients: Observational study of 116,977 Medicare feefor-service beneficiaries who underwent colorectal surgery using administrative claims data. State-level malpractice risk was measured using mean general surgery malpractice insurance premiums; paid claims per surgeon; state tort reforms; and a composite measure. Associations between malpractice environment and postoperative outcomes and price-standardized Medicare payments were estimated using hierarchical logistic regression and generalized linear models. Main Outcome Measures: thirty-day postoperative mortality; complications (pneumonia, myocardial infarction, venous thromboembolism, acute renal failure, surgical site infection, postoperative sepsis, any complication); readmission; total price-standardized Medicare payments for index hospitalization and 30-day postdischarge episode-of-care. Results: Few associations between measures of state malpractice risk environment and outcomes were identified. However, analyses using the composite measure showed that patients treated in states with greatest malpractice risk were more likely than those in lowest risk states to experience any complication (OR: 1.31; 95% CI: 1.22-1.41), pneumonia (OR: 1.36; 95%: CI, 1.16-1.60), myocardial infarction (OR: 1.44; 95% CI: 1.22-1.70), venous thromboembolism (OR:2.11; 95% CI: 1.70-2.61), acute renal failure (OR: 1.34; 95% CI; 1.22-1.47), and sepsis (OR: 1.38; 95% CI: 1.24-1.53; all P < 0.001). There were no consistent associations between malpractice environment and Medicare payments. Conclusions: There were no consistent associations between state-level malpractice risk and higher quality of care or Medicare payments for colorectal surgery.
AB - Context: The US medical malpractice system is designed to deter negligence and encourage quality of care through threat of liability. Objective: To examine whether state-level malpractice environment is associated with outcomes and costs of colorectal surgery. Design, Setting, and Patients: Observational study of 116,977 Medicare feefor-service beneficiaries who underwent colorectal surgery using administrative claims data. State-level malpractice risk was measured using mean general surgery malpractice insurance premiums; paid claims per surgeon; state tort reforms; and a composite measure. Associations between malpractice environment and postoperative outcomes and price-standardized Medicare payments were estimated using hierarchical logistic regression and generalized linear models. Main Outcome Measures: thirty-day postoperative mortality; complications (pneumonia, myocardial infarction, venous thromboembolism, acute renal failure, surgical site infection, postoperative sepsis, any complication); readmission; total price-standardized Medicare payments for index hospitalization and 30-day postdischarge episode-of-care. Results: Few associations between measures of state malpractice risk environment and outcomes were identified. However, analyses using the composite measure showed that patients treated in states with greatest malpractice risk were more likely than those in lowest risk states to experience any complication (OR: 1.31; 95% CI: 1.22-1.41), pneumonia (OR: 1.36; 95%: CI, 1.16-1.60), myocardial infarction (OR: 1.44; 95% CI: 1.22-1.70), venous thromboembolism (OR:2.11; 95% CI: 1.70-2.61), acute renal failure (OR: 1.34; 95% CI; 1.22-1.47), and sepsis (OR: 1.38; 95% CI: 1.24-1.53; all P < 0.001). There were no consistent associations between malpractice environment and Medicare payments. Conclusions: There were no consistent associations between state-level malpractice risk and higher quality of care or Medicare payments for colorectal surgery.
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U2 - 10.1097/SLA.0000000000001538
DO - 10.1097/SLA.0000000000001538
M3 - Review article
C2 - 27167562
AN - SCOPUS:84971617643
SN - 0003-4932
VL - 263
SP - 1126
EP - 1132
JO - Annals of surgery
JF - Annals of surgery
IS - 6
ER -