Incidence Of Claims Research Articles

Emergency department encounters for opioid abuse, adverse events, poisoning, and dependence among members of a community-based health insurance plan\u2014Central Texas, 2016\u20132018

BackgroundThe United States appears to be in the midst of an opioid epidemic. National data indicate a rise in emergency department visits for opioid-related causes over the past decade. This data, while important in helping to explain the magnitude of the epidemic nationally offers only a glimpse of what can be expected to occur locally. The objective of this secondary data analysis was to describe the impact that opioid abuse, adverse events, poisoning, and dependence have on emergency department utilization for individuals who purchased health insurance under the Affordable Care Act in Central Texas from a community-based health maintenance organization.MethodsIndividuals who purchased health insurance from Sendero Health Plans in calendar years 2016, 2017, and 2018 were eligible for participation if they had both an emergency department encounter and an opioid-related ICD-10-CM diagnosis. Eligible individuals were assessed to determine if they were dispensed an opioid agonist or opioid antagonist prescription during the year of their emergency department encounter. Sendero medical claims data for calendar years 2016, 2017, and 2018 were used to calculate both the incidence and ratio of emergency department visits per 100,000-person Sendero member population. Sendero data were compared to available national data estimates.ResultsA total of 55 individuals had an emergency department encounter with a primary or secondary opioid-related diagnosis from January 1, 2016 through December 31, 2018. These 55 individuals had 69 unique emergency department encounters during this time period. The incidence of new claims per 100,000-member Sendero population was 67.1, 64.5, and 62.6 in 2016, 2017, and 2018 respectively. The ratio of unique emergency department encounters per 100,000-member Sendero population was 95.9, 82.6, and 66.5 in 2016, 2017, and 2018 respectively.ConclusionHealth insurance claims data from a community-based health plan can be used as a source of local information by policy makers and officials as they seek to address the impact of opioid abuse, adverse events, poisoning, and dependence in Central Texas as national data may not represent the local impact of this epidemic.

Differences in Health: The Influence of Gender and Institutional Settings on Sickness Claims in Gothenburg, Sweden (1898-1950).

SummarySickness funds information has given conflicting evidence on the evolution of morbidity during the mortality decline. Evidence on increased morbidity has been explained by an actual increase of morbidity, a cultural inflation of morbidity or changing institutional settings, however, morbidity rates have also been shown to be stable over time when age composition of members is controlled for. Most previous studies have been confined to data on men; however, in an earlier article, Castenbrandt found large gender differences in historical sick leave by using national statistics on both men and women. To move forward, this article aims to analyse trends in sickness claims during the mortality decline in the early twentieth century using individual level data from Swedish sickness funds covering the period 1898–1950. Concretely, we investigate gender differences in sickness claims (incidence and duration) and how institutional settings (member composition and fund-specific regulations) affected the sick leave patterns.

Assisted reproductive technologies and metabolic syndrome complications: medico-legal reappraisal.

In the last 40 years, the number of elderly patients that require Assisted Reproductive Technologies (ART) has risen enormously, especially after heterolougus fertilization techniques have become available. In recent years, the incidence of peripartum cardiomyopathy (PPCM) has substantially grown, as a consequence of the combined effect of increased maternal age, consequent high prevalence of hypertension and metabolic syndrome (MS). That cohort of women may be exposed to a greater number of cardiac, obstetric and anesthesio-logical complications, therefore the incidence of medico-legal issues, litigation, liabilities and claims over the past years has significantly risen. Cardiovascular and hormonal changes during pregnancy can challenge even the healthiest of individuals, and in that pregnant population the risk is even greater. These patients should be monitored before the ART, during pregnancy, delivery and puerperium, to avoid heart failure, thrombotic problems, embolic complications, stroke and death. Management issues regarding pregnancy and delivery are elaborate, including anesthesia considerations. This new population of women needs an accurate cardiac risk stratification with a thorough cardiovascular history and examination, 12 lead ECG, and transthoracic echocardiogram. Therefore, a comprehensive multidisciplinary assessment and management can provide the best opportunity to improve maternal and neonatal outcomes.

Work-related asthma surveillance in Washington State: time trends, industry rates, and workers’ compensation costs, 2002–2016

Objective: Washington State’s work-related asthma (WRA) surveillance program utilizes workers’ compensation (WC) data as its primary data source and has spanned a 15-year time period. This study analyses trends for WRA claim incidence rates compared to all WC claim incidence rates. WRA claim incidence rates and WC costs are analyzed by industry. Methods: Potential WRA cases were identified through the WC system and through direct provider report and classified by industry, age, and year of illness onset. WRA claim rates by industry and year were calculated using total work hours reported by employers covered by the WC system. Claim costs for accepted claims were compared by industry and year. Results: WRA claim incidence rates decreased 8.9% (95% CI: –10.6, –7.2) annually for the time period 2002–2016. The decline in WRA claim incidence rate is slightly faster than the incidence rate for all WC claims which had its steepest decrease from 2007 to 2010 at an estimated annual 8.4% decrease (95% CI: –11.8, –5.0). WRA claim rates were highest for workers in Public Administration, Manufacturing, and the Agricultural, Forestry, Fishing and Hunting industries. Median claim costs for WRA did not change significantly by year (p = 0.2, range $595–$1442) and the distribution of WRA WC claim costs by industry were highest in Manufacturing (21.3%) and Construction (16.4%) industries. Conclusion: WRA claim incidence rates are declining in Washington State. The cause for the decline is unclear. Workers across all industries in Washington remain at risk for WRA.

Evaluation of a Psychoeducational Intervention in the Development of Social and Communication Skills for Incoming Medical Students at a Bilingual University

Abstract Concerns about social skills in academic and professional settings are rarely considered. Undergraduate students and professionals without social and communication skills lead to an increase in the incidence of malpractice claims and interpersonal conflicts. The study is aimed at evaluating a psychoeducational intervention focused on improving social skills for incoming medical students at a bilingual university. A psychoeducational intervention was conducted in a required course from first academic term with 57 incoming medical students from Brazil and other Latin America Countries whose average age was 21.28 (SD = 4.04). The psychoeducational intervention occurred fortnightly for seven sessions which aimed to develop theoretical knowledge about communication and interpersonal relationships in academic and professional settings, interpersonal patterns, teamwork, and interpersonal problem solving. Prior and after the intervention, the students answered two self-report instruments to identify social skills and their academic experience. After the intervention, there was a significant average increase in scores related to social skills and academic experience. These increases were evident in the dimension/factor scores, as well as the total scores. The results demonstrated the importance of early and short-term interventions as a way to develop social and communication skills.

Can spinal surgery in England be saved from litigation: a review of 978 clinical negligence claims against the NHS.

The aim of this study is to evaluate the true incidence of all clinical negligence claims against spinal surgery performed by orthopaedic spinal surgeons and neurosurgeons in the National Health Service (NHS) in England, including both open and closed claims. This study was a retrospective review of 978 clinical negligence claims held by NHS Resolution against spinal surgery cases identified from claims against 'Neurosurgery' and 'Orthopaedic Surgery'. This category included all emergency, trauma and elective work and all open and closed cases without exclusion between April 2012 and April 2017. Clinical negligence claims in spinal surgery were estimated to cost £535.5 million over this five-year period. There is a trend of both increasing volume and estimated costs of claims. The most common causes for claims were 'judgement/timing' (512 claims, 52.35%), 'interpretation of results/clinical picture' (255 claims, 26.07%), 'unsatisfactory outcome to surgery' (192 claims, 19.63%), 'fail to warn/informed consent' (80 claims, 8.13%) and 'never events' including 'wrong site surgery' or 'retained instrument post-operation' (26 claims, 2.66%). A sub-analysis of 3years including 574 claims revealed the most prevalent pathologies were iatrogenic nerve damage (132 claims, 23.00%), cauda equina syndrome (CES) (131 claims, 22.82%), inadequate decompression (91 claims, 15.85%), iatrogenic cord damage (72 claims, 12.54%), and infection (51 claims, 8.89%). The volume and costs of clinical negligence claims is threatening the future of spinal surgery. If spinal surgery is to continue to serve the patients who need it, most thorough investigation, implementation and sharing of lessons learned from litigation claims must be systematically carried out. These slides can be retrieved under Electronic Supplementary Material.

Malpractice risk at the physician level: Claim-prone physicians

Professional liability and patient safety are worldwide concerns and efforts to identify claimed physicians' characteristics cross borders. Interventions with “at risk populations” would help to better address the underlying problems that lead to many claims.We analyzed physicians' characteristics of every paid claim between 2005 and 2014 in Catalonia region (Spain). We identified 808 physicians involved in 725 paid claims. A total of 12.38% physicians had at least two paid claims over the study period. Physicians' risk of future paid claims was increased if they had more than one previous paid claim (hazard ratio, 1.87; 95% confidence interval [CI], 1.67–2,1). More than half the claims were accounted for by physicians in four specialty groups: obstetrics and gynecology (20.4%), traumatology and orthopedic Surgery (17.5%), plastic surgery (10%) and general surgery (9.7%). The risk of recurrence was higher among surgery-related specialties than among non-surgery-related specialties.Specialty is a particularly strong determinant of claim incidence, so the risk issue may not be so individually determined, but conditioned by the kind of medicine or procedures we practice. Nevertheless, physicians' risk of future paid-claims increases after the second claim. Management systems should take advantage of this information, in order to prevent patient safety events and malpractice claims. Our results support both specialty-based interventions in high-risk specialties, such us Plastic Surgery, as well as interventions at a physician level in those physicians with more than one paid claim.

Characteristics of Medical Professional Liability Claims in Pediatric Orthopedics.

Medical malpractice is burdensome to the U.S. healthcare system. The following is an epidemiological analysis of the closed medical professional liability (MPL) claims in pediatric orthopedics using data maintained by the Physician Insurers Association of America. The Physician Insurers Association of America registry of MPL claims from 1985 to 2013 for all specialties included 286,021 closed claims in the United States. All closed MPL claims for orthopedic surgery in patients younger than 18 years were retrospectively reviewed (N = 2,671). The error categories, result of the claim, the most common procedures, severity of injury, and the most common presenting and resultant medical conditions were reported with the paid-to-close ratios, average indemnity payment, and average cost of litigation. The pediatric orthopedic population was compared with all orthopedics. The data were adjusted for inflation and trended for the 29-year period. Of the 2671 pediatric orthopedic claims, 881 resulted in a payment and the average indemnity was U.S. $317,574 with adjustment for inflation - significantly higher than for all of orthopedics at U.S. $268,817 (P = 0.0013). The paid-to-close ratio was 33.0%, compared with 28.7% for all of orthopedics (P = 0.023). Costs to defend individual medical malpractice claims and the average indemnity payment per claim have both increased over time, and pediatric (versus adult) orthopedic claims are more likely to result in payment and result in a higher payment. Knowledge of the details of liability claims should assist practicing general and pediatric orthopedic surgeons in improving patient safety and quality of care, reducing patient injury, and reducing the incidence of MPL claims.

The Narrow Road to Exoneration - the Incidence, Characteristics and Outcomes of Wrongful Conviction Claims in Sweden over a One-Year Period

One way of investigating the phenomenon of wrongful convictions is to study the road to exoneration. In some respects, the post-conviction review process lies at the heart of the wrongful conviction issue, since this is where alleged miscarriages of justice are either acknowledged or rejected. However, the number and characteristics of the criminal cases that pass through the Swedish post-conviction review process are unknown. Against this background, the overarching objective of the present article is to provide an empirical basis for an informed discussion of wrongful convictions. More specifically, this article examines wrongful conviction claims and the judicial outcomes of these claims over a one-year period. The findings are discussed in relation to the view that the operation of the post-conviction process may be understood as a means by which the legal system may preserve its legitimacy. It is also discussed why there is a need for more transparency in this particular part of the criminal justice system.

Precision Matters in Behavioral Health, Too

Abstract Behavioral health terminology is an area beset by imprecision that results from confusing claim determinations, unnecessary evaluations, and poor outcomes that result from inappropriate treatment. In medical evaluation reports, one notes references to depression, anxiety, and stress, which are not diagnoses but often are treated as such. Behavioral factors can affect claims in four ways: the presence of a formal clinical diagnosis that meets specific criteria, psychological symptoms, difficult life circumstances, and behavioral overlays. Only the first of these can be attributed to a workplace injury or illness, and determining a causal relationship requires, at minimum, a precise diagnosis. For example, by depression does the health provider mean major depressive disorder with specifiers, persistent depressive/dysthymic disorder, adjustment disorder with depressed mood, or some other specific condition? The behavioral layers can affect the outcome of the claims process and may or may not be appropriate targets of an evidence-informed intervention aimed at returning an injured or ill worker to a higher level of function. The point is not to argue whether or not behavioral interventions are appropriate in workers’ compensation, personal injury, and other claims; the point, rather, is that precise language is the first, necessary step in sorting out the myriad ways in which behavior affects claim incidence, duration, and cost.

The Legal Life of the Areeda-Turner Test

Few works of legal scholarship have had the impact enjoyed by Areeda and Turner's 1975 article on predatory pricing. Proof of predatory pricing under the Areeda-Turner test requires two things. The plaintiff must show a market structure such that the predator could rationally foresee "recouping the losses through higher profits earned in the absence of competition." This requirement, typically called "recoupment," requires the plaintiff to show that, looking from the beginning of the predation campaign, the predator can reasonably anticipate that the costs of predation will be more than offset by the present value of a future period of monopoly profits, making the strategy a sound investment. Second, the plaintiff must show that the defendant's prices over substantial sales were below a relevant measure of cost, presumptively average variable cost (AVC) or, in some cases, marginal costs over a relatively short run.The effects of Areeda and Turner's predation test occurred in two waves, both devastating for plaintiffs. For the first fifteen years the courts focused overwhelmingly on price-cost relationship, and it quickly became clear that proving predatory pricing under an AVC test is extremely difficult. The second wave occurred after the Supreme Court's formulation of the recoupment requirement in the Brooke Group case. Few plaintiffs have won a case, and the incidence of classical predatory pricing claims has declined dramatically.That so many courts embraced the Areeda-Turner AVC test might seem surprising, given that contemporary assessments from economists were quite negative. The criticisms can be grouped into three categories. Even assuming that short run marginal cost is a useful legal test for predatory pricing, AVC is a reasonable surrogate for marginal cost only in equilibrium. "Classic" predatory pricing is not an equilibrium strategy, however, but rather a nonsustainable high output strategy. In this range AVC and MC diverge, making the Areeda-Turner test a "defendant's paradise."The AVC test is particularly underdeterrent in markets characterized by high fixed costs, which are also the markets that are most conducive to predation. Because strictly defined AVC excludes fixed costs, many nonsustainable pricing strategies are identified as legal, even though many of these might be considered anticompetitive under a more holistic approach.The most fundamental critique of the Areeda-Turner test is that, whether or not AVC is a workable surrogate for short run marginal cost, short-run measures are deficient because they exclude other types of strategic pricing behavior. Longer run strategies may involve fully sustainable pricing.Most recent antitrust complaints about exclusionary pricing have sought to avoid Areeda-Turner by focusing on more complex pricing strategies, such as market share or bundled discounts. Plaintiffs have had some but limited success in convincing courts to analogize these practices to exclusive dealing or tying rather than pricing as such. This permits condemnation even on prices above cost. But these cases also present serious problems of complexity that the courts have not yet addressed, particularly when more than two goods are in a bundle or they can be used in varying proportions. What the Areeda-Turner test promised in exchange for its deficiencies was a query that narrowed the fact finder's focus and was easier to administer. While the test largely succeeded on the first of these, ease of administration has proven elusive. The test nonetheless survives. First, it tends to keep predatory pricing cases out of court and away from juries, two properties that make it attractive to judges. Second, no one has produced something better. A superior test would have to correct for Areeda-Turner’s false negatives without going too far in the other direction. Second, it would have to be administrable by the full range of tribunals authorized to hear predatory pricing cases, which today includes jury trials.

Lawsuits After Primary and Revision Total Hip Arthroplasties: A Malpractice Claims Analysis

BackgroundAs the prevalence of total hip arthroplasty (THA) expands, so too will complications and patient dissatisfaction. The goal of this study was to identify the common etiologies of malpractice suits and costs of claims after primary and revision THAs. MethodsAnalysis of 115 malpractice claims filed for alleged neglectful primary and revision THA surgeries by orthopedic surgeons insured by a large New York state malpractice carrier between 1983 and 2011. ResultsThe incidence of malpractice claims filed for negligent THA procedures is only 0.15% per year in our population. In primary cases, nerve injury (“foot drop”) was the most frequent allegation with 27 claims. Negligent surgery causing dislocation was alleged in 18 and leg length discrepancy in 14. Medical complications were also reported, including 3 thromboembolic events and 6 deaths. In revision cases, dislocation and infection were the most common source of suits. The average indemnity payment was $386,153 and the largest single settlement was $4.1 million for an arterial injury resulting in amputation after a primary hip replacement. The average litigation cost to the insurer was $61,833. ConclusionNerve injury, dislocation, and leg length discrepancy are the most common reason for malpractice after primary THA. Orthopedic surgeons should continue to focus on minimizing the occurrence of these complications while adequately incorporating details about the risks and limitations of surgery into their preoperative education.

Investigation of musculoskeletal symptoms in a manufacturing company in Brazil: a cross-sectional study

BackgroundMusculoskeletal disorders are prevalent and represent the most common health problem among the working population in industrially-developing countries, with considerable costs and impact on quality of life. Despite the high incidence of disability insurance claims among Brazilian manufacturing-sector workers, only a few studies assessed musculoskeletal disorders prevalence. ObjectiveTo provide information on the prevalence of musculoskeletal disorders among manufacturing-sector workers and to explore the relationship between musculoskeletal disorders and sociodemographic and occupational characteristics in a medium metallurgical company located in Brazil. MethodsA cross-sectional study was carried out. Data was collected through the use of a specifically-designed questionnaire and the items used to collect musculoskeletal disorders data were based on the Nordic Musculoskeletal Questionnaire. Descriptive statistics were used and multivariate logistic regression analysis (p<0.02) was performed to explore the associations between musculoskeletal disorders and potential risk factors. ResultsThe upper limb was the most frequently affected body region among manufacturing-sector workers: shoulder (24.8%), elbow and/or forearm (15.5%), wrist and/or hand (19.0%). Adjusted logistic regression analysis showed that company experience (p=0.02), presence of sleep disorders (p=0.00), self-reported general health state (p=0.00) and perform work pause (p=0.00) were significant risk factors for development of musculoskeletal disorders. ConclusionSociodemographic and work-related aspects are influential risk factors for musculoskeletal disorders. These results add comprehension about musculoskeletal disorders prevalence and suggest a need for greater emphasis on prevention strategies.

Work-related musculoskeletal disorder surveillance using the Washington state workers' compensation system: Recent declines and patterns by industry, 1999-2013.

Work-related musculoskeletal disorders (WMSDs) are common and place large economic and social burdens on workers and their communities. We describe recent WMSD trends and patterns of WMSD incidence among the Washington worker population by industry. We used Washington State's workers' compensation compensable claims from 1999 to 2013 to describe incidence and cost of WMSD claims by body part and diagnosis, and to identify high-risk industries. WMSD claim rates declined by an estimated annual 5.4% (95% CI: 5.0-5.9%) in Washington State from 1999 to 2013, but WMSDs continue to account for over 40% of all compensable claims. High risk industries identified were Construction; Transportation and Warehousing; Health Care and Social Assistance; and Manufacturing. As documented in other North American contexts, this study describes an important decline in the incidence of WMSDs. The Washington State workers' compensation system provides a rich data source for the surveillance of WMSDs.

The Impact of Changes to the Unemployment Rate on Australian Disability Income Insurance Claim Incidence

We explore the extent to which claim incidence in Disability Income Insurance (DII) is affected by changes in the unemployment rate in Australia. Using data from 1986 to 2001, we fit a hurdle model to explore the presence and magnitude of the effect of changes in unemployment rate on the incidence of DII claims, controlling for policy holder characteristics and seasonality. We find a clear positive association between unemployment and claim incidence, and we explore this further by gender, age, deferment period, and occupation. A multinomial logistic regression model is fitted to cause of claim data in order to explore the relationship further, and it is shown that the proportion of claims due to accident increases markedly with rising unemployment. The results suggest that during periods of rising unemployment, insurers may face increased claims from policy holders with shorter deferment periods for white-collar workers and for medium and heavy manual workers. Our findings indicate that moral hazard may have a material impact on DII claim incidence and insurer business in periods of declining economic conditions.

Accelerated Cervical Fusion of Silicon Nitride versus PEEK Spacers: A Comparative Clinical Study

Introduction: The ideal material for the manufacture of cervical fusion cages used in anterior cervical discectomy and fusion (ACDF) is undetermined. Spacers made of polyether-ether-ketone (PEEK) are commonly used, although metal and ceramic devices are also commercially available. This observational study compared outcomes of ACDF using two different biomaterial spacers (i.e., PEEK and silicon nitride, Si3N4). Methods: Twenty consecutive patients who underwent ACDF with Si3N4 were retrospectively compared to a group previously implanted with PEEK spacers. Patient demographics, neck pain visual analog scale (VAS) and the neck disability index (NDI) scores were recorded for all enrollees. Cervical radiographs, including flexion-extension views, were examined to determine fusion at 3, 6, 12, 24, and 36 months post-operatively. Results: Patient demographics were essentially identical between groups, except for a slightly higher incidence of worker compensation claims in the PEEK group (p=0.27), and increased prevalence of cervical myelopathy in the Si3N4 group (p=0.12). There were no differences in the number of cervical levels treated (p=0.65) or hospital length of stay (p=0.65). No cage failures or infections occurred in either group. At 3, 6, and 12 months, the average flexionextension angular rotation was lower for the Si3N4 group as compared to the PEEK cohort. However, these data were not statistically significant. Nevertheless, the incidence of fusion was consistently higher in the Si3N4 group at all follow-up visits except 36 months; both groups reached 100% fusion at the 3-year time-point. Conclusion: By 36 months, there were no differences in ACDF with PEEK or Si3N4 as measured by NDI, VAS, and radiographic fusion of cervical segments. Earlier time points suggested a trend toward enhanced fusion with Si3N4. The interim differences may reflect the enhanced bioactive surface of the silicon nitride spacers and/or the radiographic characteristics of each biomaterial.

What? A Resident as an Expert Witness?

What? A Resident as an Expert Witness?

Occupational management in the workplace and impact on Workers' Compensation Board claims, duration, and cost: a prospective longitudinal cohort.

Few workplaces have prospectively reviewed workplace and worker issues simultaneously and assessed their impact on Workers’ Compensation Board (WCB) claims. In January of 2014, each worker in a large workplace in Saskatchewan, Canada, was prospectively followed for 1 year to determine factors that impact injury claim incidence, recovery, and costs. In total, 207 out of 245 workers agreed to complete the baseline survey (84.5%). In 2014, 82.5% of workers had self-reported pain, but only 35.5% submitted a WCB claim. Binary logistic regression was used to compare those with pain who did not submit a WCB injury claim to those with pain who did initiate a WCB claim. Independent risk factors associated with WCB claim incidence included depressed mood (odds ratio [OR] =2.75, 95% confidence interval [CI] 1.44–9.78) and lower job satisfaction (OR =1.70, 95% CI 1.08–10.68). Higher disability duration was independently associated with higher depressed mood (OR =1.60, 95% CI 1.05–4.11) and poor recovery expectation (OR =1.31, 95% CI 1.01–5.78). Higher cost disability claims were independently associated with higher depressed mood (OR =1.51, 95% CI 1.07–6.87) and pain catastrophizing (OR =1.11, 95% CI 1.02–8.11). Self-reported pain, physically assessed injury severity, and measured ergonomic risk of workstation did not significantly predict injury claim incidence, duration, or costs. In January 2015, the workplace implemented a new occupational prevention and management program. The injury incidence rate ratio reduced by 58% from 2014 to 2015 (IRR =1.58, 95% CI =1.28–1.94). The ratio for disability duration reduced by 139% from 2014 to 2015 (RR =2.39, 95% CI =2.16–2.63). Costs reduced from $114,149.07 to $56,528.14 per year. In summary, WCB claims are complex. Recognizing that nonphysical factors, such as depressed mood, influence injury claim incidence, recovery, and costs, can be helpful to claims management.

Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices.

Objective:The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees.Methods:A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants.Results:Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P < 0.05). Absenteeism was positively impacted overall for the intervention group. Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being.Conclusion:Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction.

Hip Arthroplasty Malpractice Claims in the Netherlands: Closed Claim Study 2000-2012

BackgroundA total hip arthroplasty (THA) is a successful and reliable operation with few complications. These complications however, do form a potential source for compensation claims. In the Netherlands, there are no studies available concerning filed claims after THA. The aim of this study was to determine the incidence of claims related to THAs in the Netherlands and the reasons to claim, which claims lead to compensation, the costs involved for the insurer, and the demographics of the claimants. MethodsIn this observational study, we analyzed all closed claims from 2000 to 2012 from the national largest insurer of medical liability and compared it to data from our national implant registry in the Netherlands. With the intention to contribute to prevention, we have identified the demographics of the claimant, the reasons for filing claims, and the outcome of claims. ResultsOverall, 516 claims were expressed in 280 closed claim files after THA. Claims were most often related to sciatic nerve injury (19.6%). Most claimants were women (71.6%) with an average age of 63.1 years. The median cost per compensated claim is €5.921. ConclusionThe claimant is more likely to be female and to be younger than the average patient receiving a THA. The incidence of a claim after a THA is 0.14%-0.30%. Nerve damage is the most common reason to file for compensation. The distribution in reasons to claim does not resemble the complication rate in literature after a THA. The outcome of this study can be used to improve patient care, safety, and costs.