Relationship between Quality of Care and Negligence Litigation in Nursing Homes

Untangling the relationship between the quality of health care and the risk of negligence litigation is a crucial challenge in medicolegal research. Although previous studies have probed this relationship, an important question for clinicians and health care institutions remains unanswered: does the delivery of high-quality care reduce the risk of being sued?

Methodologic and data problems have frustrated attempts to answer this question empirically. Malpractice claims are typically too rare among individual physicians to allow meaningful assessments of risk. Physician-level quality measures also have substantial limitations. Measures of litigation risk and quality at the hospital level are more robust, but physicians, not hospitals, are the chief defendants in most medical malpractice claims. The absence of a comprehensive national repository of data on all filed malpractice claims adds to the difficulties; it generally forces a choice between limiting investigations to a few institutions and pulling back to ecologic analyses at the area level.

These methodologic constraints are less problematic in the long-term care setting. The vast majority of claims alleging negligence in the delivery of nursing home care target the facility, not the individual clinicians who work in the facility. Quality measures for nearly all nursing homes in the United States are collected routinely, are detailed, and are widely used in research. In addition, the predominance of large nursing home chains provides natural points of convergence for information on many claims from many facilities.

Historically, rates of litigation against nursing homes were low. That changed in the middle-to-late 1990s, with sharp spikes in rates noted in several regions. We linked indicators of the quality of care in nearly 1500 nursing homes in 48 states to data on the incidence of negligence claims against them. Our goal was to compare the litigation experiences of high-performing and of low-performing facilities.

Claims data:
Five of the largest nursing home chains in the United States provided us with data on tort claims brought against their facilities. The facilities operated in 48 states, and the claim periods varied by chain: 2000–2006 for chain 1, 1998–2005 for chain 2, 1998–2005 for chain 3, 1998–2005 for chain 4, and 2000–2005 for chain 5. Every claim in each period was included, regardless of whether it was resolved in or out of court and whether it resulted in a payment to the plaintiff. We defined a claim as a written demand for compensation for injury.

Full Article and Source:
The New England Journal of Medicine: Health Policy and Reform