Journal of Clinical Pathways. 2017;3(5):25-26.
Using Complaint Data to Predict Postoperative Complications
The rising number of malpractice claims filed against medical providers has captured the attention of both the medical community and the public. Discussions of malpractice management have centered around what steps practitioners can take to reduce the risks for malpractice lawsuits in the future. A study by Studdert and colleagues published in The New England Journal of Medicine found that approximately 1% of medical practitioners accounted for nearly 32% of all surveyed malpractice claims, and that the risk for recurrence of malpractice filings increased among providers with multiple paid claims.1 Prior research has further linked the receipt of unsolicited patient observations with an increased risk for malpractice filings.2
Because unsolicited patient claims can potentially predict whether malpractice lawsuits are eventually filed, researchers have wondered whether they could also
be used to determine the risk for treatment-related complications. A retrospective cohort study published in American Journal of Medical Quality found a significant interaction between the number of complaints received by a surgeon and the potential for adverse surgical outcomes (P < .01).3 Additionally, a study published in Journal of the American College of Surgeons showed that poor teamwork in the operating room correlated with adverse surgical outcomes.4 If these factors could be managed, could surgical outcomes be improved?
Researchers led by William O Cooper, MD, MPH, Cornelius Vanderbilt Professor of pediatrics and professor of health policy at Vanderbilt University School of Medicine (Nashville, TN), hypothesized that surgeon
complaint records could be used to determine whether
patients faced an increased risk for postsurgical complications. In a paper published in JAMA Surgery,5 Dr Cooper and colleagues observed a significant association between prior unsolicited communications and increased risk for any complications (odds ratio [OR] = 1.0063; 95% CI, 1.0004-1.0123; P = .03), any surgical complications (OR = 1.0104; 95% CI, 1.0022-1.0186; P = .01), any medical complications (OR = 1.0079; 95% CI, 1.0009-1.0148; P = .03), and hospital readmission (OR = 1.0088; 95% CI, 1.0024-1.0151; P = .007). Multivariable analyses that controlled
for patient, surgeon, and procedural characteristics still showed significantly higher increased risks in all areas for patients whose surgeons had high unsolicited complaint rates. After adjustment, the researchers found the risk for complications among patients whose surgeons were in the highest quartile of unsolicited communications was 13.9% higher than patients whose surgeons were in the lowest quartile.
Journal of Clinical Pathways spoke with Dr Cooper to get a better understanding of how past observations can influence future outcomes, and how patients, providers, and the health care system in general can use these data to improve the consistency and quality of overall care.
What was the impetus to conduct this research?
There is a body of research over the past 20 years that examines the risk for malpractice lawsuits for physicians, which has found over and over that a small number of physicians account for a disproportionate share of lawsuits. Because some of that research has suggested that we can identify these individuals also from the number of patient complaints they receive, we wondered whether patients were picking up on some way that physicians may be interacting with both patients and their teams that might lead to poor overall quality.
And this is important because malpractice claims have the potential to negatively impact the entire health care system?
Definitely. Malpractice is bad for the patient, bad for the provider, and bad for everyone overall. So we should always be sure that we are taking whatever steps we can to stop potential problems in their tracks by providing high-quality care from the beginning.