title: Analysis of diagnostic error in paid malpractice claims with substandard care in a large healthcare system.
abstract: OBJECTIVE
  Although claims databases are not representative of all care delivery, their predisposition toward serious unintended injury can complement resource-intensive chart reviews and guide patient safety initiatives.
  
  
  METHODS
  Non-Veterans Health Administration (VA) practitioners reviewed 1,949 VA malpractice claims paid during fiscal years 1998 through 2003. The portion associated with substandard care, the severity of harm, and types of negligence were identified.
  
  
  RESULTS
  Negligent adverse events occurred in 37% (n = 723) of paid VA malpractice claims. These had high proportions of serious injury (55%) and morbidity (37%). Diagnostic negligent adverse events were most frequent (45%) and with 41% associated morbidity. The annual incidence of diagnosis-related paid VA malpractice claims was 1.95 per 100,000 patients and predicts that 122 of every 100,000 patients may have diagnostic negligent adverse events. Comparisons against non-VA data suggest this to be a healthcare industry problem.
  
  
  CONCLUSIONS
  Diagnosis-related negligent adverse events are a serious problem in the healthcare industry.
authors.affiliation: National Institutes of Health, Bethesda, MD, USA.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Holohan
authors.forename: Janice
authors.initials: J
authors.lastname: Colestro
authors.forename: John
authors.initials: J
authors.lastname: Grippi
authors.forename: Jane
authors.initials: J
authors.lastname: Converse
authors.forename: Michael
authors.initials: M
authors.lastname: Hughes
mesh_terms: D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008318:Malpractice; D019300:Medical Errors / Q000706:statistics & numerical data; D011787:Quality of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs