RELATIONSHIP BETWEEN MALPRACTICE CLAIMS AND CESAREAN DELIVERY

被引:152
作者
LOCALIO, AR
LAWTHERS, AG
BENGTSON, JM
HEBERT, LE
WEAVER, SL
BRENNAN, TA
LANDIS, JR
机构
[1] PENN STATE UNIV,MILTON S HERSHEY MED CTR,COLL MED,CTR BIOSTAT & EPIDEMIOL,HERSHEY,PA 17033
[2] HARVARD UNIV,SCH PUBL HLTH,DEPT HLTH POLICY & MANAGEMENT,BOSTON,MA 02115
[3] BRIGHAM & WOMENS HOSP,DEPT OBSTET & GYNECOL,BOSTON,MA 02115
[4] BRIGHAM & WOMENS HOSP,DEPT MED,BOSTON,MA 02115
[5] RUSH PRESBYTERIAN ST LUKES MED CTR,CTR RES HLTH & AGING,CHICAGO,IL 60612
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 1993年 / 269卷 / 03期
关键词
D O I
10.1001/jama.269.3.366
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective.-To investigate whether an association exists between the probability of a cesarean delivery and the level of malpractice claims risk faced by hospitals and physicians. Design.-Survey of computerized discharge data linked with physician and hospital malpractice claims records based on stratified, random sample of hospitals. Setting.-Acute care hospitals in New York State in 1984. Population.-All deliveries (60490) at 31 hospitals. Results.-After controlling for the clinical risk of a cesarean delivery, patient socioeconomic status, and physician and hospital characteristics, cesarean delivery was positively associated with physician malpractice premiums (odds ratio [OR], 3.00; 95% confidence interval [CI], 2.13 to 4.24 for the difference between upstate and New York City levels), with the number of physician claims opened per 100 physicians at the hospital level (OR, 1.15; 95% CI, 1.02 to 1.30 for a 1-SD change), and with the number of hospital claims opened per 1000 discharges (OR, 1.26; 95% CI, 1.10 to 1.43 for a 1-SD change). Measures of physician-perceived risk of suit also showed a significant association with cesarean delivery (OR, 1.96; 95% CI, 1.53 to 2.52, upstate vs New York City). Within hospitals, there was no significant association (OR, 1.15; P=.126) between the odds of cesarean delivery and the claims history (none vs one or more) of an individual physician. Conclusion.-Results support previous speculations of a positive association between malpractice claims risk and the rate of cesarean delivery.
引用
收藏
页码:366 / 373
页数:8
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