Abstract
BACKGROUND: Medical professional liability claims are a marker of conflict between a patient and a health care provider.
OBJECTIVES: The purpose of this study was to evaluate the contributing factors (CFs) associated with medical professional liability claims.
METHODS: A total of 764 cardiovascular-related closed claims with 1,945 CFs were identified from a large insurer (The Doctor's Company) from 2010 to 2023.
RESULTS: Three clinical CFs: technical performance (329; 43% of claims), patient assessment (242; 32%), and management/selection of therapy (216; 28%) were the most frequently cited CFs. Patient factors, mainly due to nonadherence to medications or instructions, were identified in 171 claims (22%). Nonclinical CFs (987) were more frequent than clinical CFs (787) and patient factors (patient: 171). Nonclinical CFs were very diverse but the most frequent were communication between providers and patient (20%), communication among providers (16%), insufficient documentation (11%), and off-shift/weekend hours (10%). Payment was less common in claims with technical performance or patient factor CFs and more common in claims with patient assessment, selection/management of therapy, and in the 4 most frequent nonclinical CFs. Nonclinical CFs were more commonly observed in claims with payment (1.1/claim) when compared to claims without (0.64/claim). No differences among the different cardiovascular subspecialties were identified. Closed claims were identified in 3% of covered cardiovascular providers over the last reliable portion of the study period.
CONCLUSIONS: Clinical and nonclinical CFs are equally important for malpractice claims. While focusing on clinical quality is important, implementing strategies that also account for nonclinical issues, with a particular focus on communication, documentation, and off-shift/weekend coverage could have significant benefits.