Diagnostic imaging rates for head injury in the ED and states' medical malpractice tort reforms
Abstract Objective Physicians' fears of being sued may lead to defensive medical practices, such as ordering nonindicated medical imaging. We investigated the association between states' medical malpractice tort reforms and neurologic imaging rates for patients seen in the emergency depart...
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| Veröffentlicht in: | The American journal of emergency medicine 2011-07, Vol.29 (6), p.656-664 |
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| creator | Smith-Bindman, Rebecca, MD McCulloch, Charles E., PhD Ding, Alex, MD, MS Quale, Christopher, PhD Chu, Philip W., PhD |
| description | Abstract Objective Physicians' fears of being sued may lead to defensive medical practices, such as ordering nonindicated medical imaging. We investigated the association between states' medical malpractice tort reforms and neurologic imaging rates for patients seen in the emergency department with mild head trauma. Methods We assessed neurologic imaging among a national sample of 8588 women residing in 10 US states evaluated in an emergency setting for head injury between January 1, 1992, and December 31, 2001. We assessed the odds of imaging as it varied by the enactment of medical liability reform laws. Results The medical liability reform laws were significantly associated with the likelihood of imaging. States with laws that limited monetary damages (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.40-0.99), mandated periodic award payments (OR, 0.64; 95% CI, 0.43-0.97), or specified collateral source offset rules (OR, 0.62; 95% CI, 0.40-0.96) had an approximately 40% lower odds of imaging, whereas states that had laws that limited attorney's contingency fees had significantly higher odds of imaging (OR, 1.5; 95% CI, 0.99-2.4), compared to states without these laws. When we used a summation of the number of laws in place, the greater the number of laws, the lower the odds of imaging. In the multivariate analysis, after adjusting for individual and community factors, the total number of laws remained significantly associated with the odds of imaging, and the effect of the individual laws was attenuated, but not eliminated. Conclusion The tort reforms we examined were associated with the propensity to obtain neurologic imaging. If these results are confirmed in larger studies, tort reform might mitigate defensive medical practices. |
| doi_str_mv | 10.1016/j.ajem.2010.01.038 |
| format | Article |
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We investigated the association between states' medical malpractice tort reforms and neurologic imaging rates for patients seen in the emergency department with mild head trauma. Methods We assessed neurologic imaging among a national sample of 8588 women residing in 10 US states evaluated in an emergency setting for head injury between January 1, 1992, and December 31, 2001. We assessed the odds of imaging as it varied by the enactment of medical liability reform laws. Results The medical liability reform laws were significantly associated with the likelihood of imaging. States with laws that limited monetary damages (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.40-0.99), mandated periodic award payments (OR, 0.64; 95% CI, 0.43-0.97), or specified collateral source offset rules (OR, 0.62; 95% CI, 0.40-0.96) had an approximately 40% lower odds of imaging, whereas states that had laws that limited attorney's contingency fees had significantly higher odds of imaging (OR, 1.5; 95% CI, 0.99-2.4), compared to states without these laws. When we used a summation of the number of laws in place, the greater the number of laws, the lower the odds of imaging. In the multivariate analysis, after adjusting for individual and community factors, the total number of laws remained significantly associated with the odds of imaging, and the effect of the individual laws was attenuated, but not eliminated. Conclusion The tort reforms we examined were associated with the propensity to obtain neurologic imaging. If these results are confirmed in larger studies, tort reform might mitigate defensive medical practices.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2010.01.038</identifier><identifier>PMID: 20630679</identifier><identifier>CODEN: AJEMEN</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Craniocerebral Trauma - diagnosis ; Craniocerebral Trauma - economics ; Defensive Medicine - economics ; Defensive Medicine - legislation & jurisprudence ; Diagnostic Imaging - economics ; Diagnostic Imaging - utilization ; Emergency ; Emergency medical care ; Emergency medical services ; Female ; Head injuries ; Health care policy ; Health Care Reform - legislation & jurisprudence ; Hospitals ; Humans ; Intensive care medicine ; Investigative techniques, diagnostic techniques (general aspects) ; Liability ; Liability, Legal - economics ; Logistic Models ; Malpractice - economics ; Malpractice - legislation & jurisprudence ; Medical malpractice ; Medical sciences ; Medicare ; Medicare - economics ; Multivariate analysis ; Physicians ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Respiratory system ; Severity of Illness Index ; Torts ; United States</subject><ispartof>The American journal of emergency medicine, 2011-07, Vol.29 (6), p.656-664</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c468t-c2a7ea8b0a88ed3cac66230570318ac05c3fdc15b7e45c96658fa4323c85cff33</citedby><cites>FETCH-LOGICAL-c468t-c2a7ea8b0a88ed3cac66230570318ac05c3fdc15b7e45c96658fa4323c85cff33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1030940537?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24332943$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20630679$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smith-Bindman, Rebecca, MD</creatorcontrib><creatorcontrib>McCulloch, Charles E., PhD</creatorcontrib><creatorcontrib>Ding, Alex, MD, MS</creatorcontrib><creatorcontrib>Quale, Christopher, PhD</creatorcontrib><creatorcontrib>Chu, Philip W., PhD</creatorcontrib><title>Diagnostic imaging rates for head injury in the ED and states' medical malpractice tort reforms</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Abstract Objective Physicians' fears of being sued may lead to defensive medical practices, such as ordering nonindicated medical imaging. We investigated the association between states' medical malpractice tort reforms and neurologic imaging rates for patients seen in the emergency department with mild head trauma. Methods We assessed neurologic imaging among a national sample of 8588 women residing in 10 US states evaluated in an emergency setting for head injury between January 1, 1992, and December 31, 2001. We assessed the odds of imaging as it varied by the enactment of medical liability reform laws. Results The medical liability reform laws were significantly associated with the likelihood of imaging. States with laws that limited monetary damages (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.40-0.99), mandated periodic award payments (OR, 0.64; 95% CI, 0.43-0.97), or specified collateral source offset rules (OR, 0.62; 95% CI, 0.40-0.96) had an approximately 40% lower odds of imaging, whereas states that had laws that limited attorney's contingency fees had significantly higher odds of imaging (OR, 1.5; 95% CI, 0.99-2.4), compared to states without these laws. When we used a summation of the number of laws in place, the greater the number of laws, the lower the odds of imaging. In the multivariate analysis, after adjusting for individual and community factors, the total number of laws remained significantly associated with the odds of imaging, and the effect of the individual laws was attenuated, but not eliminated. Conclusion The tort reforms we examined were associated with the propensity to obtain neurologic imaging. If these results are confirmed in larger studies, tort reform might mitigate defensive medical practices.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Craniocerebral Trauma - diagnosis</subject><subject>Craniocerebral Trauma - economics</subject><subject>Defensive Medicine - economics</subject><subject>Defensive Medicine - legislation & jurisprudence</subject><subject>Diagnostic Imaging - economics</subject><subject>Diagnostic Imaging - utilization</subject><subject>Emergency</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Female</subject><subject>Head injuries</subject><subject>Health care policy</subject><subject>Health Care Reform - legislation & jurisprudence</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Liability</subject><subject>Liability, Legal - economics</subject><subject>Logistic Models</subject><subject>Malpractice - economics</subject><subject>Malpractice - legislation & jurisprudence</subject><subject>Medical malpractice</subject><subject>Medical sciences</subject><subject>Medicare</subject><subject>Medicare - economics</subject><subject>Multivariate analysis</subject><subject>Physicians</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Respiratory system</subject><subject>Severity of Illness Index</subject><subject>Torts</subject><subject>United States</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kk2LFDEQhoMo7rj6BzxIQGRPM1Y6SScNIsh-qLDgQT2HTHX1bNr-GJNuYf69aWbWhT2YS0F46qXqSRh7LWAjQJTv241vqd8UkC9AbEDaJ2wltCzWVhjxlK3ASL0ujTZn7EVKLYAQSqvn7KyAUkJpqhVzV8HvhjFNAXno_S4MOx79RIk3Y-R35GsehnaOh1z4dEf8-or7oeZpWqAL3lMd0He8990-eswxxKcxTjxSDujTS_as8V2iV6d6zn7eXP-4_LK-_fb56-Wn2zWq0k5rLLwhb7fgraVaoseyLCRoA1JYj6BRNjUKvTWkNFZlqW3jlSwkWo1NI-U5uzjm7uP4e6Y0uT4kpK7zA41zctZIKWSldCbfPiLbcY5DHs4JkFAp0NJkqjhSGMeU8jJuH7OfeMiQW-y71i323WLfgXDZfm56c4qet1nMv5Z73Rl4dwJ8ytaa6AcM6YFTUhaVWrb5cOQoK_sTKLqEgQbMsiPh5Oox_H-Oj4_asQvD8k6_6EDpYV-XCgfu-_JPlm8iIB8FlfwLI122pA</recordid><startdate>20110701</startdate><enddate>20110701</enddate><creator>Smith-Bindman, Rebecca, MD</creator><creator>McCulloch, Charles E., PhD</creator><creator>Ding, Alex, MD, MS</creator><creator>Quale, Christopher, PhD</creator><creator>Chu, Philip W., PhD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><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>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20110701</creationdate><title>Diagnostic imaging rates for head injury in the ED and states' medical malpractice tort reforms</title><author>Smith-Bindman, Rebecca, MD ; McCulloch, Charles E., PhD ; Ding, Alex, MD, MS ; Quale, Christopher, PhD ; Chu, Philip W., PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c468t-c2a7ea8b0a88ed3cac66230570318ac05c3fdc15b7e45c96658fa4323c85cff33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Craniocerebral Trauma - diagnosis</topic><topic>Craniocerebral Trauma - economics</topic><topic>Defensive Medicine - economics</topic><topic>Defensive Medicine - legislation & jurisprudence</topic><topic>Diagnostic Imaging - economics</topic><topic>Diagnostic Imaging - utilization</topic><topic>Emergency</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Female</topic><topic>Head injuries</topic><topic>Health care policy</topic><topic>Health Care Reform - legislation & jurisprudence</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Liability</topic><topic>Liability, Legal - economics</topic><topic>Logistic Models</topic><topic>Malpractice - economics</topic><topic>Malpractice - legislation & jurisprudence</topic><topic>Medical malpractice</topic><topic>Medical sciences</topic><topic>Medicare</topic><topic>Medicare - economics</topic><topic>Multivariate analysis</topic><topic>Physicians</topic><topic>Radiodiagnosis. 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We investigated the association between states' medical malpractice tort reforms and neurologic imaging rates for patients seen in the emergency department with mild head trauma. Methods We assessed neurologic imaging among a national sample of 8588 women residing in 10 US states evaluated in an emergency setting for head injury between January 1, 1992, and December 31, 2001. We assessed the odds of imaging as it varied by the enactment of medical liability reform laws. Results The medical liability reform laws were significantly associated with the likelihood of imaging. States with laws that limited monetary damages (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.40-0.99), mandated periodic award payments (OR, 0.64; 95% CI, 0.43-0.97), or specified collateral source offset rules (OR, 0.62; 95% CI, 0.40-0.96) had an approximately 40% lower odds of imaging, whereas states that had laws that limited attorney's contingency fees had significantly higher odds of imaging (OR, 1.5; 95% CI, 0.99-2.4), compared to states without these laws. When we used a summation of the number of laws in place, the greater the number of laws, the lower the odds of imaging. In the multivariate analysis, after adjusting for individual and community factors, the total number of laws remained significantly associated with the odds of imaging, and the effect of the individual laws was attenuated, but not eliminated. Conclusion The tort reforms we examined were associated with the propensity to obtain neurologic imaging. If these results are confirmed in larger studies, tort reform might mitigate defensive medical practices.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20630679</pmid><doi>10.1016/j.ajem.2010.01.038</doi><tpages>9</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Craniocerebral Trauma - diagnosis Craniocerebral Trauma - economics Defensive Medicine - economics Defensive Medicine - legislation & jurisprudence Diagnostic Imaging - economics Diagnostic Imaging - utilization Emergency Emergency medical care Emergency medical services Female Head injuries Health care policy Health Care Reform - legislation & jurisprudence Hospitals Humans Intensive care medicine Investigative techniques, diagnostic techniques (general aspects) Liability Liability, Legal - economics Logistic Models Malpractice - economics Malpractice - legislation & jurisprudence Medical malpractice Medical sciences Medicare Medicare - economics Multivariate analysis Physicians Radiodiagnosis. Nmr imagery. Nmr spectrometry Respiratory system Severity of Illness Index Torts United States |
| title | Diagnostic imaging rates for head injury in the ED and states' medical malpractice tort reforms |
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