The practice of cranial neurosurgery and the malpractice liability environment in the United States
The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery. We performed a retrospective cohort study invo...
Gespeichert in:
| Veröffentlicht in: | PloS one 2015-03, Vol.10 (3), p.e0121191-e0121191 |
|---|---|
| Hauptverfasser: | , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | e0121191 |
|---|---|
| container_issue | 3 |
| container_start_page | e0121191 |
| container_title | PloS one |
| container_volume | 10 |
| creator | Bekelis, Kimon Missios, Symeon Wong, Kendrew MacKenzie, Todd A |
| description | The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery.
We performed a retrospective cohort study involving patients who underwent cranial neurosurgical procedures from 2005-2010, and were registered in the National Inpatient Sample (NIS) database. We used data from the National Practitioner Data Bank (NPDB) from 2005 to 2010 to create measures of volume and size of malpractice claim payments. The association of the latter with the state-level mortality, length of stay (LOS), unfavorable discharge, and hospitalization charges for cranial neurosurgery was investigated.
During the study period, there were 189,103 patients (mean age 46.4 years, with 48.3% females) who underwent cranial neurosurgical procedures, and were registered in NIS. In a multivariable regression, higher number of claims per physician in a state was associated with increased ln-transformed hospitalization charges (beta 0.18; 95% CI, 0.17 to 0.19). On the contrary, there was no association with mortality (OR 1.00; 95% CI, 0.94 to 1.06). We observed a small association with unfavorable discharge (OR 1.09; 95% CI, 1.06 to 1.13), and LOS (beta 0.01; 95% CI, 0.002 to 0.03). The size of the awarded claims demonstrated similar relationships. The average claims payment size (ln-transformed) (Pearson's rho=0.435, P=0.01) demonstrated a positive correlation with the risk-adjusted hospitalization charges but did not demonstrate a correlation with mortality, unfavorable discharge, or LOS.
In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after cranial neurosurgery. In view of the association of malpractice with the economics of healthcare, further research on its impact is necessary. |
| doi_str_mv | 10.1371/journal.pone.0121191 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_plos_</sourceid><recordid>TN_cdi_plos_journals_1667181005</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A422548179</galeid><doaj_id>oai_doaj_org_article_f230ad6ceaa84c0e9a7513bb05eeea46</doaj_id><sourcerecordid>A422548179</sourcerecordid><originalsourceid>FETCH-LOGICAL-c692t-551e3a3857c6db0594492635dca27b4fedcf4871b20b0e9bb97a65c9fa84d443</originalsourceid><addsrcrecordid>eNqNk9uK2zAQhk1p6W7TvkFpDYXSXiS1Dpbtm8Ky9BBYWOimvRVjeZwoKFIqyUvz9lUOG5KyF8UXNtI3_8w_nsmy16SYEFaRT0s3eAtmsnYWJwWhhDTkSXZJGkbHghbs6cn3RfYihGVRlKwW4nl2QcuqqZuGX2ZqtsB87UFFrTB3fa48WA0mtzh4FwY_R7_JwXZ5TOAKzJE1GlptdNzkaO-1d3aFNuba7sCfVkfs8rsIEcPL7FkPJuCrw3uUzb5-mV1_H9_cfpteX92MlWhoHJclQQasLislurYoG84bKljZKaBVy3vsVM_rirS0aAts2rapQJSq6aHmHedslL3dy66NC_LQniCJEBWpydb8KJvuic7BUq69XoHfSAda7g6cn0vwyZxB2VNWQCcUQlJXKR1UJWFtKgsRgYuk9fmQbWhXqbRk3oM5Ez2_sXoh5-5eclYVrGZJ4MNBwLvfA4YoVzooNAYsumFXt6goEyVN6Lt_0MfdHag5JAPa9i7lVVtRecUpLXlNqiZRk0eo9HS40irNUq_T-VnAx7OAxET8E-cwhCCndz_-n739dc6-P2EXCCYugjND1M6Gc5DvQZUGMnjsj00mhdyuwkM35HYV5GEVUtib0x90DHqYffYXDpEFBA</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1667181005</pqid></control><display><type>article</type><title>The practice of cranial neurosurgery and the malpractice liability environment in the United States</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><source>Public Library of Science (PLoS)</source><creator>Bekelis, Kimon ; Missios, Symeon ; Wong, Kendrew ; MacKenzie, Todd A</creator><contributor>Pradilla, Gustavo</contributor><creatorcontrib>Bekelis, Kimon ; Missios, Symeon ; Wong, Kendrew ; MacKenzie, Todd A ; Pradilla, Gustavo</creatorcontrib><description>The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery.
We performed a retrospective cohort study involving patients who underwent cranial neurosurgical procedures from 2005-2010, and were registered in the National Inpatient Sample (NIS) database. We used data from the National Practitioner Data Bank (NPDB) from 2005 to 2010 to create measures of volume and size of malpractice claim payments. The association of the latter with the state-level mortality, length of stay (LOS), unfavorable discharge, and hospitalization charges for cranial neurosurgery was investigated.
During the study period, there were 189,103 patients (mean age 46.4 years, with 48.3% females) who underwent cranial neurosurgical procedures, and were registered in NIS. In a multivariable regression, higher number of claims per physician in a state was associated with increased ln-transformed hospitalization charges (beta 0.18; 95% CI, 0.17 to 0.19). On the contrary, there was no association with mortality (OR 1.00; 95% CI, 0.94 to 1.06). We observed a small association with unfavorable discharge (OR 1.09; 95% CI, 1.06 to 1.13), and LOS (beta 0.01; 95% CI, 0.002 to 0.03). The size of the awarded claims demonstrated similar relationships. The average claims payment size (ln-transformed) (Pearson's rho=0.435, P=0.01) demonstrated a positive correlation with the risk-adjusted hospitalization charges but did not demonstrate a correlation with mortality, unfavorable discharge, or LOS.
In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after cranial neurosurgery. In view of the association of malpractice with the economics of healthcare, further research on its impact is necessary.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0121191</identifier><identifier>PMID: 25798994</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Banks (Finance) ; Brain Injuries - surgery ; Clinical medicine ; Comorbidity ; Correlation ; Correlation analysis ; Data banks ; Discharge ; Feasibility studies ; Female ; Females ; Health aspects ; Health care ; Health care access ; Health care policy ; Hospitalization ; Hospitalization - economics ; Hospitals ; Humans ; Impact analysis ; Legal liability ; Liability ; Liability, Legal ; Male ; Malpractice ; Malpractice - economics ; Malpractice - legislation & jurisprudence ; Malpractice - statistics & numerical data ; Medical care quality ; Medical malpractice ; Medicine ; Middle Aged ; Mortality ; Neurosurgery ; Neurosurgery - economics ; Neurosurgery - legislation & jurisprudence ; Neurosurgery - standards ; Neurosurgery - statistics & numerical data ; Patients ; Payments ; Physicians ; Skull ; Surgery ; United States</subject><ispartof>PloS one, 2015-03, Vol.10 (3), p.e0121191-e0121191</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Bekelis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Bekelis et al 2015 Bekelis et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-551e3a3857c6db0594492635dca27b4fedcf4871b20b0e9bb97a65c9fa84d443</citedby><cites>FETCH-LOGICAL-c692t-551e3a3857c6db0594492635dca27b4fedcf4871b20b0e9bb97a65c9fa84d443</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4370383/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4370383/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2095,2914,23846,27902,27903,53768,53770,79345,79346</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25798994$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Pradilla, Gustavo</contributor><creatorcontrib>Bekelis, Kimon</creatorcontrib><creatorcontrib>Missios, Symeon</creatorcontrib><creatorcontrib>Wong, Kendrew</creatorcontrib><creatorcontrib>MacKenzie, Todd A</creatorcontrib><title>The practice of cranial neurosurgery and the malpractice liability environment in the United States</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery.
We performed a retrospective cohort study involving patients who underwent cranial neurosurgical procedures from 2005-2010, and were registered in the National Inpatient Sample (NIS) database. We used data from the National Practitioner Data Bank (NPDB) from 2005 to 2010 to create measures of volume and size of malpractice claim payments. The association of the latter with the state-level mortality, length of stay (LOS), unfavorable discharge, and hospitalization charges for cranial neurosurgery was investigated.
During the study period, there were 189,103 patients (mean age 46.4 years, with 48.3% females) who underwent cranial neurosurgical procedures, and were registered in NIS. In a multivariable regression, higher number of claims per physician in a state was associated with increased ln-transformed hospitalization charges (beta 0.18; 95% CI, 0.17 to 0.19). On the contrary, there was no association with mortality (OR 1.00; 95% CI, 0.94 to 1.06). We observed a small association with unfavorable discharge (OR 1.09; 95% CI, 1.06 to 1.13), and LOS (beta 0.01; 95% CI, 0.002 to 0.03). The size of the awarded claims demonstrated similar relationships. The average claims payment size (ln-transformed) (Pearson's rho=0.435, P=0.01) demonstrated a positive correlation with the risk-adjusted hospitalization charges but did not demonstrate a correlation with mortality, unfavorable discharge, or LOS.
In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after cranial neurosurgery. In view of the association of malpractice with the economics of healthcare, further research on its impact is necessary.</description><subject>Adult</subject><subject>Banks (Finance)</subject><subject>Brain Injuries - surgery</subject><subject>Clinical medicine</subject><subject>Comorbidity</subject><subject>Correlation</subject><subject>Correlation analysis</subject><subject>Data banks</subject><subject>Discharge</subject><subject>Feasibility studies</subject><subject>Female</subject><subject>Females</subject><subject>Health aspects</subject><subject>Health care</subject><subject>Health care access</subject><subject>Health care policy</subject><subject>Hospitalization</subject><subject>Hospitalization - economics</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Impact analysis</subject><subject>Legal liability</subject><subject>Liability</subject><subject>Liability, Legal</subject><subject>Male</subject><subject>Malpractice</subject><subject>Malpractice - economics</subject><subject>Malpractice - legislation & jurisprudence</subject><subject>Malpractice - statistics & numerical data</subject><subject>Medical care quality</subject><subject>Medical malpractice</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neurosurgery</subject><subject>Neurosurgery - economics</subject><subject>Neurosurgery - legislation & jurisprudence</subject><subject>Neurosurgery - standards</subject><subject>Neurosurgery - statistics & numerical data</subject><subject>Patients</subject><subject>Payments</subject><subject>Physicians</subject><subject>Skull</subject><subject>Surgery</subject><subject>United States</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9uK2zAQhk1p6W7TvkFpDYXSXiS1Dpbtm8Ky9BBYWOimvRVjeZwoKFIqyUvz9lUOG5KyF8UXNtI3_8w_nsmy16SYEFaRT0s3eAtmsnYWJwWhhDTkSXZJGkbHghbs6cn3RfYihGVRlKwW4nl2QcuqqZuGX2ZqtsB87UFFrTB3fa48WA0mtzh4FwY_R7_JwXZ5TOAKzJE1GlptdNzkaO-1d3aFNuba7sCfVkfs8rsIEcPL7FkPJuCrw3uUzb5-mV1_H9_cfpteX92MlWhoHJclQQasLislurYoG84bKljZKaBVy3vsVM_rirS0aAts2rapQJSq6aHmHedslL3dy66NC_LQniCJEBWpydb8KJvuic7BUq69XoHfSAda7g6cn0vwyZxB2VNWQCcUQlJXKR1UJWFtKgsRgYuk9fmQbWhXqbRk3oM5Ez2_sXoh5-5eclYVrGZJ4MNBwLvfA4YoVzooNAYsumFXt6goEyVN6Lt_0MfdHag5JAPa9i7lVVtRecUpLXlNqiZRk0eo9HS40irNUq_T-VnAx7OAxET8E-cwhCCndz_-n739dc6-P2EXCCYugjND1M6Gc5DvQZUGMnjsj00mhdyuwkM35HYV5GEVUtib0x90DHqYffYXDpEFBA</recordid><startdate>20150323</startdate><enddate>20150323</enddate><creator>Bekelis, Kimon</creator><creator>Missios, Symeon</creator><creator>Wong, Kendrew</creator><creator>MacKenzie, Todd A</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20150323</creationdate><title>The practice of cranial neurosurgery and the malpractice liability environment in the United States</title><author>Bekelis, Kimon ; Missios, Symeon ; Wong, Kendrew ; MacKenzie, Todd A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-551e3a3857c6db0594492635dca27b4fedcf4871b20b0e9bb97a65c9fa84d443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Banks (Finance)</topic><topic>Brain Injuries - surgery</topic><topic>Clinical medicine</topic><topic>Comorbidity</topic><topic>Correlation</topic><topic>Correlation analysis</topic><topic>Data banks</topic><topic>Discharge</topic><topic>Feasibility studies</topic><topic>Female</topic><topic>Females</topic><topic>Health aspects</topic><topic>Health care</topic><topic>Health care access</topic><topic>Health care policy</topic><topic>Hospitalization</topic><topic>Hospitalization - economics</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Impact analysis</topic><topic>Legal liability</topic><topic>Liability</topic><topic>Liability, Legal</topic><topic>Male</topic><topic>Malpractice</topic><topic>Malpractice - economics</topic><topic>Malpractice - legislation & jurisprudence</topic><topic>Malpractice - statistics & numerical data</topic><topic>Medical care quality</topic><topic>Medical malpractice</topic><topic>Medicine</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neurosurgery</topic><topic>Neurosurgery - economics</topic><topic>Neurosurgery - legislation & jurisprudence</topic><topic>Neurosurgery - standards</topic><topic>Neurosurgery - statistics & numerical data</topic><topic>Patients</topic><topic>Payments</topic><topic>Physicians</topic><topic>Skull</topic><topic>Surgery</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bekelis, Kimon</creatorcontrib><creatorcontrib>Missios, Symeon</creatorcontrib><creatorcontrib>Wong, Kendrew</creatorcontrib><creatorcontrib>MacKenzie, Todd A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bekelis, Kimon</au><au>Missios, Symeon</au><au>Wong, Kendrew</au><au>MacKenzie, Todd A</au><au>Pradilla, Gustavo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The practice of cranial neurosurgery and the malpractice liability environment in the United States</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-03-23</date><risdate>2015</risdate><volume>10</volume><issue>3</issue><spage>e0121191</spage><epage>e0121191</epage><pages>e0121191-e0121191</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery.
We performed a retrospective cohort study involving patients who underwent cranial neurosurgical procedures from 2005-2010, and were registered in the National Inpatient Sample (NIS) database. We used data from the National Practitioner Data Bank (NPDB) from 2005 to 2010 to create measures of volume and size of malpractice claim payments. The association of the latter with the state-level mortality, length of stay (LOS), unfavorable discharge, and hospitalization charges for cranial neurosurgery was investigated.
During the study period, there were 189,103 patients (mean age 46.4 years, with 48.3% females) who underwent cranial neurosurgical procedures, and were registered in NIS. In a multivariable regression, higher number of claims per physician in a state was associated with increased ln-transformed hospitalization charges (beta 0.18; 95% CI, 0.17 to 0.19). On the contrary, there was no association with mortality (OR 1.00; 95% CI, 0.94 to 1.06). We observed a small association with unfavorable discharge (OR 1.09; 95% CI, 1.06 to 1.13), and LOS (beta 0.01; 95% CI, 0.002 to 0.03). The size of the awarded claims demonstrated similar relationships. The average claims payment size (ln-transformed) (Pearson's rho=0.435, P=0.01) demonstrated a positive correlation with the risk-adjusted hospitalization charges but did not demonstrate a correlation with mortality, unfavorable discharge, or LOS.
In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after cranial neurosurgery. In view of the association of malpractice with the economics of healthcare, further research on its impact is necessary.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>25798994</pmid><doi>10.1371/journal.pone.0121191</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2015-03, Vol.10 (3), p.e0121191-e0121191 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1667181005 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Adult Banks (Finance) Brain Injuries - surgery Clinical medicine Comorbidity Correlation Correlation analysis Data banks Discharge Feasibility studies Female Females Health aspects Health care Health care access Health care policy Hospitalization Hospitalization - economics Hospitals Humans Impact analysis Legal liability Liability Liability, Legal Male Malpractice Malpractice - economics Malpractice - legislation & jurisprudence Malpractice - statistics & numerical data Medical care quality Medical malpractice Medicine Middle Aged Mortality Neurosurgery Neurosurgery - economics Neurosurgery - legislation & jurisprudence Neurosurgery - standards Neurosurgery - statistics & numerical data Patients Payments Physicians Skull Surgery United States |
| title | The practice of cranial neurosurgery and the malpractice liability environment in the United States |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T08%3A46%3A43IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20practice%20of%20cranial%20neurosurgery%20and%20the%20malpractice%20liability%20environment%20in%20the%20United%20States&rft.jtitle=PloS%20one&rft.au=Bekelis,%20Kimon&rft.date=2015-03-23&rft.volume=10&rft.issue=3&rft.spage=e0121191&rft.epage=e0121191&rft.pages=e0121191-e0121191&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0121191&rft_dat=%3Cgale_plos_%3EA422548179%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1667181005&rft_id=info:pmid/25798994&rft_galeid=A422548179&rft_doaj_id=oai_doaj_org_article_f230ad6ceaa84c0e9a7513bb05eeea46&rfr_iscdi=true |