title: Liability impact of the hospitalist model of care.
abstract: BACKGROUND
  An increasingly large proportion of inpatient care is provided by hospitalists. The care discontinuities inherent to hospital medicine raise concerns about malpractice risk. However, little published data exist on the medical liability risks associated with care by hospitalists.
  
  
  OBJECTIVE
  We sought to determine the risks and outcomes of malpractice claims against hospitalists in internal medicine.
  
  
  METHODS
  Retrospective observational analysis.
  
  
  METHODS
  Using claims data from a liability insurer-maintained database of over 52,000 malpractice claims, we measured the rates of malpractice claims against hospitalists compared to other physician specialties, types of allegations against hospitalists, contributing factors, and the severity of injury in and outcomes of these claims.
  
  
  RESULTS
  Hospitalists had a malpractice claims rate of 0.52 claims per 100 physician coverage years (PCYs), which was significantly lower than that of nonhospitalist internal medicine physicians (1.91 claims per 100 PCYs), emergency medicine physicians (3.50 claims per 100 PCYs), general surgeons (4.70 claims per 100 PCYs), and obstetricians-gynecologists (5.56 claims per 100 PCYs) (P < 0.001 for all comparisons). The most common allegation types made against hospitalists were for errors in medical treatment (41.5%) and diagnosis (36.0%). The most common contributing factors underlying claims were deficiencies in clinical judgment (54.4%) and communication (36.4%). Of the claims made against hospitalists, 50.4% involved the death of the patient.
  
  
  CONCLUSIONS
  Despite fears of increased liability from the hospitalist model of care, hospitalists in internal medicine are subject to medical malpractice claims less frequently when compared to other internal medicine physicians and specialties.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Schaffer
authors.forename: Ann Louise
authors.initials: AL
authors.lastname: Puopolo
authors.forename: Supriya
authors.initials: S
authors.lastname: Raman
authors.forename: Allen
authors.initials: A
authors.lastname: Kachalia
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual / Q000639:trends; D005260:Female; D020445:Hospitalists; D006801:Humans; D007388:Internal Medicine / Q000191:economics* / Q000331:legislation & jurisprudence / Q000639:trends; D008297:Male; D008318:Malpractice / Q000191:economics* / Q000331:legislation & jurisprudence / Q000639:trends; D008875:Middle Aged; D012189:Retrospective Studies