title: Development of a composite measure of state-level malpractice environment.
abstract: OBJECTIVE
  To develop a composite measure of state-level malpractice environment.
  
  
  METHODS
  Public use data from the National Practitioner Data Bank, Medical Liability Monitor, the National Conference of State Legislatures, and the American Bar Association.
  
  
  METHODS
  Principal component analysis of state-level indicators (paid claims rate, malpractice premiums, lawyers per capita, average award size, and malpractice laws), with indirect validation of the composite using receiver-operating characteristic curves to determine how accurately the composite could identify states with high-tort activity and costs.
  
  
  RESULTS
  A single composite accounted for over 73 percent of total variance in the seven indicators and demonstrated reasonable criterion validity.
  
  
  CONCLUSIONS
  An empirical composite measure of state-level malpractice risk may offer advantages over single indicators in measuring overall risk and may facilitate cross-state comparisons of malpractice environments.
authors.affiliation: Division of Surgical Oncology and the Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Jeanette W
authors.initials: JW
authors.lastname: Chung
authors.forename: Min-Woong
authors.initials: MW
authors.lastname: Sohn
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Merkow
authors.forename: Elissa H
authors.initials: EH
authors.lastname: Oh
authors.forename: Christina
authors.initials: C
authors.lastname: Minami
authors.forename: Bernard S
authors.initials: BS
authors.lastname: Black
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
mesh_terms: D006291:Health Policy; D033241:Lawyers / Q000706:statistics & numerical data; D008318:Malpractice / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D008511:Medicine / Q000706:statistics & numerical data; D025341:Principal Component Analysis; D012372:ROC Curve; D014481:United States
keywords: State health policies; health policy; observational data