Patient complaints and malpractice risk in a regional healthcare center.
OBJECTIVE
To study the association between physicians' complaint records and their risk management experiences in a regional healthcare center.


METHODS
Patient complaints about physicians in a large border state medical center's hospital and outpatient clinics were recorded and coded. The study period was from January 2001 through December 2003. These records were linked to the counterpart physicians' data covered by the institutions' risk management plan through June 2004.


METHODS
All physicians at the institution who had contact with patients during the study period were identified as surgeons or non-surgeons. Complaints for these physicians were recorded by the institution's Office of Patient Relations (OPR) and independently coded using a standardized protocol to characterize the nature of the problem and to uniquely identify the person complained about. The complaint records were then linked to the risk management files (RMFs) for the defined physician cohort. In addition, these data were supplemented with clinical service values (RVUs) which were available for 338 members (76%) of the 445 member cohort.


RESULTS
Both patient complaints and risk management events were higher for surgeons than for non-surgeons. This was true for the number of RMFs, those involving expenditures, and for lawsuits. Logistic regression was used to assess the effects of complaint counts, practice type and volume of clinical activity. All were statistically significant in predicting the number of RMF openings, RMF openings with expenditures and lawsuits. Predictive concordance was 75% or greater for each of the three risk management outcomes.


CONCLUSIONS
Expressions of patient dissatisfaction and practice type are significantly related to risk management experiences in a regional medical center. Associations of risk management experiences with volume of clinical activity (RVUs) for surgeons in the regional medical center environment were not as strong as those found in a similar study reported from an academic medical center.
Hickson
Gerald B
GB
Center for Patient and Professional Advocacy, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. gerald.hickson@vanderbilt.edu
Federspiel
Charles F
CF
Blackford
Jennifer
J
Pichert
James W
JW
Gaska
Walter
W
Merrigan
Michael W
MW
Miller
Cynthia S
CS
D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D006766:Hospitals, County / Q000706:statistics & numerical data*; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008318:Malpractice / Q000706:statistics & numerical data*; D008923:Missouri; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012308:Risk Management / Q000706:statistics & numerical data*; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D013714:Tennessee