殺人放火金腰帶 造橋鋪路無屍骸-- nursing home品質好不見得不被告

Does High-Quality Care Protect Against Litigation?

Not much: Good nursing homes were sued only slightly less often than bad ones.

Legal theory holds that personal-injury litigation serves a social purpose, improving overall medical care by punishing substandard practice. However, a correlation between bad care and litigation risk has been difficult to establish, either for individual practitioners or for institutions.

Researchers tallied tort claims filed against 1465 nursing homes belonging to five large U.S. chains during 1998–2006. Overall, weak but significant inverse correlations were found between risk for being sued and 5 of 10 commonly accepted measures of quality care, including compliance with federal standards, staffing ratios, and clinical indicators such as rates of pressure ulcers and falls. These correlations persisted in low-litigation environments but vanished in high-litigation environments. Further, the actual numerical differences were quite small: The overall best nursing homes faced an estimated 40% annual risk for suit, while the worst faced a 47% annual risk. For specific clinical measures, the best-quality nursing homes had absolute litigation risks that were only 2%–7% lower than the worst.

Comment: This thought-provoking study suggests that institutional litigation risk has little to do with overall quality of care. If confirmed, this finding casts doubt on many of the principles underlying modern medical care, including the now widely accepted premise that risk management and quality assurance are two sides of the same coin.

— Abigail Zuger, MD

Published in Journal Watch General Medicine April 12, 2011

Citation(s):

Studdert DM et al. Relationship between quality of care and negligence litigation in nursing homes. N Engl J Med 2011 Mar 31; 364:1243. (http://dx.doi.org/10.1056/NEJMsa1009336)

Medline abstract (Free)

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