High Quality Care Does Not Reduce Litigation Exposure
Providing high quality care is not strongly associated with a reduction in litigation exposure according to a recent study published in the New England Journal of Medicine. The results of this study, while frustrating to some, reaffirm our belief that litigation has more to do with the process of care rather than the quality of care; I have written about this point in the past.
The New England Journal authors sought to assess “whether high-quality health care institutions are less likely to be sued for negligence than their low-performing counterparts.” Although this premise may seem logical, its validity has been questioned by many studies.
In this recent study, the authors compared 1465 nursing homes in terms of quality indicators and demands for compensation for injury. The authors chose nursing homes because quality data on those facilities is widely available and standardized. Hospital data is less available and standard. Additionally, the incidence of malpractice claims against institutions is not widely available. For this study, the authors were able to look to five of the largest nursing home chains in the United States to obtain information related to the incidence of claims against their facilities.
To define which nursing homes provided “high quality care,” the study authors selected 10 specific quality indicators to compare across facilities, such as the incidence of falls or fractures, the development of pressure ulcers, and staffing. They questioned whether those facilities with better quality indicators faced a lower incidence of malpractice claims.
Some will find their results frustrating. Although the authors found an inverse relationship between nursing home performance and litigation risk for several of the measured quality indicators, the associations were weak. The authors observed
[T]he levels of litigation were only fractionally lower for the best-performing nursing homes than for their worst-performing counterparts.
Intuitively, we like to think that increases in quality of care will lead to lower risk of litigation. However, this recent New England Journal study does not demonstrate that this is necessarily true. Although quality care is certainly important, health care providers need to remember that the process of providing care is equally important. Refining that process of care may help to lower the risk of negligence litigation.