Abstract
Diagnostic errors are prevalent and associated with increased economic burden; however, little is known about their characteristics at the national level in Japan. This study aimed to investigate clinical outcomes and indemnity payment in cases of diagnostic errors using Japan's largest database of national claims. We analyzed characteristics of diagnostic error cases closed between 1961 and 2017, accessed through the national Japanese malpractice claims database. We compared diagnostic error-related claims (DERC) with non-diagnostic error-related claims (non-DERC) in terms of indemnity, clinical outcomes, and factors underlying physicians' diagnostic errors. All 1,802 malpractice claims were included in the analysis. The median patient age was 33 years (interquartile range = 10-54), and 54.2% were men. Deaths were the most common outcome of claims (939/1747; 53.8%). In total, 709 (39.3%, 95% CI: 37.0%-41.6%) DERC cases were observed. The adjusted total billing amount, acceptance rate, adjusted median claims payments, and proportion of deaths were significantly higher in DERC than non-DERC cases. Departments of internal medicine and surgery were 1.42 and 1.55 times more likely, respectively, to have DERC cases than others. Claims involving the emergency room (adjusted odds ratio [OR] = 5.88) and outpatient office (adjusted OR = 2.87) were more likely to be DERC than other cases. The initial diagnoses most likely to lead to diagnostic error were upper respiratory tract infection, non-bleeding digestive tract disease, and "no abnormality." Cases of diagnostic errors produced severe patient outcomes and were associated with high indemnity. These cases were frequently noted in general exam and emergency rooms as well as internal medicine and surgery departments and were initially considered to be common, mild diseases.
Highlights
According to the landmark report titled Improving Diagnosis in Health Care, [1] cases of diagnostic errors are common, but it is difficult to measure them; they are frequently overlooked
Several studies have revealed a substantial incidence and economic burden associated with diagnostic error. [1,2,3,4,5] One study estimated the outpatient diagnostic error rate in the US as 5.08%, which translates to approximately 12 million adults per year
[7] Diagnostic errors are a common reason for malpractice claims, [8,9,10,11,12,13,14,15] and claims data could provide vital information from patients’ viewpoints. [2,3] For instance, Tokuda and colleagues summarized the findings from 274 malpractice claims filed at two local district courts in Tokyo and Osaka, and found that cognitive errors were the most common errors associated with these medical claims. [12]
Summary
According to the landmark report titled Improving Diagnosis in Health Care, [1] cases of diagnostic errors are common, but it is difficult to measure them; they are frequently overlooked. Diagnostic errors can be studied using several means, including data from: 1) malpractice claims, 2) autopsies, 3) questionnaire surveys, 4) case reviews, 5) hospital incident reports, 6) patient surveys, and 7) secondary reviews. Little is known regarding diagnostic error-related malpractice claims at the national level in Japan. The objective of the present study was to better characterize the negative impact of diagnostic errors reported in malpractice claims, including the magnitude of indemnity payment and severity of patient outcomes. Diagnostic errors are prevalent and associated with increased economic burden; little is known about their characteristics at the national level in Japan. This study aimed to investigate clinical outcomes and indemnity payment in cases of diagnostic errors using Japan’s largest database of national claims
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