Claim Rates Research Articles

National Health Insurance Claim of Pediatric Appendectomy With Mandatory Diagnosis-Related Group Payment System in Korea

IntroductionEnforcement of diagnosis-related group system for appendectomy under the National Health Insurance Service has gradually widened and since July 2013 it has been enforced in all medical institutions in Korea. We have analyzed Health Insurance Review & Assessment Service data to observe changes in claim patterns of pediatric appendectomy during this period. MethodsAll claims data for appendectomy of patients younger than 18 y from 2011 to 2015 were collected. We analyzed the following factors of all cases: age, gender, length of hospital stay, medical cost, method of insurance claim and region. ResultsA total of 112,143 claims were made for appendectomy during the study period. In that, 66,510 (59.3%) were boys and 45,633 (40.7%) were girls. Median length of stay was 5 d and median sum of reimbursement of each claim was 2,198,630 won. Annual number of claims for appendectomy showed a steady decline from 24,888 in 2011 to 19,070 in 2015. Median sum of reimbursement of each claim was 1,862,615, 1,975,500, 2,233,360, 2,376,700, and 2,468,000 won, respectively from 2011 to 2015. Reimbursement for complicated appendectomy increased from 4400 out of 24,888 cases (17.7%) in 2011 to 3865 out of 19,070 cases (20.3%) in 2015. Overall medical cost of all reimbursement for pediatric appendectomy increased from 46,113,202,580 to 47,572,253,300 won. ConclusionsFollowing the universal enforcement of the diagnosis-related group claim system for appendectomy by the National Health Insurance Service, we observed an increase in the median sum of reimbursement per claim and a rise in the rate of claims for complicated appendectomies. These changes were associated with an overall increase in national medical costs.

The effect of age on musculoskeletal injury compensation costs in South Australian professional urban firefighters: A cohort study.

Firefighting is recognised as a physically demanding occupation involving exposure to hazardous environments and activities. An aging workforce combined with the age-related decline in physical fitness may result in increased future workers' compensation expenditure for fire service organisations. The objective of this research was to investigate the costs associated with musculoskeletal sprain and strain injury and the impacts of age and injury location on Workers' Compensation claims submitted by professional urban firefighters. Claim rates, direct costs, and days lost were extracted from a professional Fire Service organisation's workers' compensation claim database for financial years between 2011 to 2018. The mean cost per claim increased with age, with a mean claim cost of the 60-70-year-old group over 10 times more than the 20-29-year-old group. The mean days lost per claim were also higher for claims submitted by firefighters aged over 50. Older firefighters miss more workdays when injured and are associated with increased claims costs, particularly those in the 60-70-year group. With an aging workforce, Fire Service organisations must implement appropriate management and prevention strategies to reduce the potential risks associated with an aging workforce.

The impact of regulatory workplace safety inspections on workers' compensation claim rates.

Studies on the impact of workplace safety inspections on work injuries have found mixed effectiveness. Most studies are from the United States, examining Occupational Health and Safety Administration (OSHA) regulatory inspections in manufacturing firms with more than 10 employees. This study examines whether regulatory inspections in Alberta, Canada, result in reductions in workers' compensation claims rates for inspected firms relative to comparable non-inspected firms. Firm and claim-level data from the Workers' Compensation Board of Alberta were linked with regulatory enforcement data from the Government of Alberta for construction, manufacturing, and transportation firms with at least one full-time employee for 37 consecutive months. A matched difference-in-differences study design was used to estimate changes in lost-time claim rates for work-related injuries and musculoskeletal diseases of inspected and comparable non-inspected firms between the year pre-inspection and 2 years, post-inspection, controlling for firm-level characteristics. Inspections were not effective in reducing firm-level claim rates, with the exception of transportation firms with more than one inspection experiencing a 28% decrease in their claim rate in the second year post-inspection, relative to the change in non-inspected firms. In construction, inspected firms experienced a 12% increase in their claim rate in the first year post-inspection. No effect was observed in the manufacturing sector. Regulatory workplace safety inspections in Alberta generally do not result in greater reductions in firm-level claim rates in the construction, manufacturing, and transportation sectors. Inspections alone may not be sufficient to induce compliance or hazard management changes that lead to reductions in firm-level injuries.

Malpractice rates are lower for women physicians compared to men physicians

Background Previous literature has shown that women physicians are less likely to be involved in medical malpractice litigation than male physicians. Methods This study sought to examine the differences in malpractice experience by provider gender by using closed medical malpractice claims from 2011 through 2020. Results We found that after adjusting for the number of claims and dollar losses per full time equivalents worked, female physicians experienced fewer and less costly claims than male physicians ( p < .001). Specific specialties had a significant relationship between claim frequency and provider gender, which included general surgery ( p = .01), obstetrics ( p = .001), gynecology ( p = .04), internal medicine and family general practice ( p < .001). Conclusion The results from this analysis support the prior findings that male physicians experience a higher rate of malpractice claims. Therefore, there is an opportunity to learn how women providers achieve lower malpractice risk to inform clinical practice recommendations.

Analysis of Claim Frequency and Severity in Auto Insurance Using Generalized Linear Models in Philippines

Abstract Purpose: The aim of the study was to analyze the analysis of claim frequency and severity in auto insurance using generalized linear models in Philippines. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The analysis of claim frequency and severity in auto insurance using Generalized Linear Models (GLMs) in the Philippines revealed that various factors, including driver demographics, vehicle characteristics, and geographic location, significantly impact the likelihood and severity of claims. The GLM approach effectively modeled these relationships, providing insights into risk factors that contribute to higher claim rates and costs. The findings suggest that younger drivers and those in urban areas tend to have higher claim frequencies, while larger vehicles and those with higher engine capacities are associated with more severe claims. Unique Contribution to Theory, Practice and Policy: Utility Theory, Actuarial Fairness Theory & Risk Theory may be used to anchor future studies on analyze the analysis of claim frequency and severity in auto insurance using generalized linear models in Philippines. From a practical perspective, insurers should increasingly adopt telematics and real-time driving data within their GLM frameworks. Policymakers should encourage and potentially mandate the integration of telematics data in auto insurance modeling.

Actuarial implications of prevented planting coverage

AbstractWithin the Federal Crop Insurance Program (FCIP), prevented planting (PP) coverage provides payments for pre‐planting costs associated with crops that ultimately cannot be planted due to adverse weather. PP indemnities, which are not considered production losses within the FCIP rating methodology, influence premium rates differently than typical losses. This study utilizes a panel data set consisting of approximately 77,697 county level observations from RMA's summary of business to identify the relationship between the prevalence of prevent plant use and a number of actuarial related outcomes. Overall, we find that increases in the share of total indemnities attributable to PP claims over the preceding 10 years produce generally negligible changes to loss ratios, but can significantly increase loss ratios among subsets of the FCIP that heavily utilize PP coverage (greater than 20% of total indemnities). This suggests that, despite loss ratios being robust to typical rates of PP claims, actuarial performance can degrade when PP payments are high relative to indemnities from all other perils. Additionally, a simulation is conducted in which prevent plant indemnities are counterfactually treated as production losses when pricing FCIP contracts as opposed to current practice of recovering prevent plant costs via a fixed rate load. Doing so suggests significant improvements in loss ratios for crops that have historically had high shares of prevent plant indemnities, however, these improvements come at the expense of higher premiums and reduced demand for crop insurance.

Incidence, trends and factors associated with psychological injury among health and social care workers in New South Wales, Australia: a retrospective cohort study of workers' compensation claims.

To describe and compare the incidence and trends of workers' compensation (WC) claims for psychological injury: (1) between health and social care (HSC) industry and other industries; (2) among specific occupations in the HSC industry; and (3) to determine if psychological injury claim rates differ by age and gender in the HSC industry and among specific occupations. A retrospective cohort study was conducted using data from the New South Wales WC system. Workers with accepted psychological injury claims between July 2012 and June 2021 were included. Negative binomial regression models were employed to estimate incidence rate ratios and 95% CIs. The HSC industry had a higher incidence (2.4 per 1000 workers) than all other industries combined (1.1 per 1000 workers). In the HSC industry, the incidence increased from 1.8 in 2013-2015 to 3.4 in 2019-2021. Ambulance officers had the highest incidence (24.9 per 1000 workers) and the highest growth rate. Nurses and midwives, and aged and disability care workers also had fast-growing incidence over the 9 years. Risk of psychological injury claims was highest among female workers and older adults. The increasing incidence and trend of psychological injury claims among HSC workers in New South Wales signify a growing public health issue. Greater efforts are needed to prevent work-related psychological injury in the HSC industry and support affected workers. The different patterns of psychological injury claims across occupations suggest that interventions should be tailored to each occupational group.

An Empirical Study of How Tribunals Interpret Stand-Alone FET Clauses regarding Their Relationship with the MST and How It Impacts Findings on Liability

This article provides the first empirical survey since the 2012 UNCTAD Report of how tribunals have addressed a specific type of Fair and Equitable Treatment (FET) clause: stand-alone clauses containing no reference to international law or any other standard. The vast majority of awards did not take a position on the issue of whether that standard offers the same or different level of protection compared to the Minimum Standard of Treatment (MST) under custom. Yet, those that did have overwhelmingly concluded that the clause must be interpreted to have an autonomous character, not related to the MST. These tribunals have also given broad interpretation of the scope and content of the clause which, in turn, had an impact on how they have addressed matters of liability and compensation. The success rate of FET claims is higher for tribunals which have expressly stated that a stand-alone FET clause has an ‘autonomous’ character compared to others which did not take a position on this question (two-thirds versus 50%). Notably, the overall success rate of FET claims under a stand-alone clause (50%) is much higher compared to that of awards examining FET clauses where the standard is expressly linked to the MST.

Analyzing the Relationship Between Socioeconomic Deprivation and Outpatient Medicare Part D Fluroquinolone Claims in Texas

Background: Only a few studies have assessed the relationship between deprivation and excessive antibiotic use. In Texas, antimicrobial prescription is particularly high compared with the rest of the US. This study analyzed the association between local area socioeconomic deprivation and providers’ fluoroquinolone claim rates among beneficiaries 65 years and older in Texas. Method: This ecological study utilized provider- and area-level data from Medicare Part D Prescribers and the Social Deprivation Index (SDI) repositories. To identify geographic patterns and autocorrelation in and between SDI and fluoroquinolone claims, spatial dependence of these two variables was assessed by bivariate Local Indicators of Spatial Association (LISA) cluster mapping along with the global and local Moran’s I analyses. Negative binomial regression models were employed to evaluate the relationship between provider- and area-level characteristics (prescriber’s gender, specialty, rural-urban community area, beneficiaries' demographics, area-level population, and normalized SDI) and fluoroquinolone claim rates per 1,000 beneficiaries. Result: A total of 11,996 providers were included. There was no spatial dependence between SDI and rates of fluoroquinolone claims in Texas (Global Moran’s I =0.01, P=0.618). Bivariant LISA maps showed 85 high-high and 38 low-low spatial clusters. Higher SDI (incidence rate ratio (IRR) 0.98, 95% confidence interval (CI) 0.97-0.99 per 1-unit increment) and male providers (IRR 0.96, 95%CI 0.94-0.99) were associated with lower claim rates. In contrast, several factors were associated with higher claim rates, including non-metropolitan areas (1.04, 95%CI 1.00-1.09), and practices with a high proportion of male patients (IRR 1.12, 95%CI 1.10-1.14), Black patients (IRR 1.05, 95%CI 1.03-1.07), or Medicaid beneficiaries (IRR 1.15, 95%CI 1.12-1.17). Effect modification was observed between SDI and rurality, with higher SDI in non-metropolitan areas associated with higher claim rates, whereas SDI in metropolitan areas was inversely related to claim rates. Conclusion: This study showed that the distribution of high and low SDI and rates of fluoroquinolone claims were more geographically clustered than expected by random chance alone. Lower fluoroquinolone claim rates among Texas Medicare providers were seen in metropolitan areas with higher SDI, indicating potential barriers to care. Conversely, higher claim rates were observed in rural areas with higher SDI, signifying a possible knowledge or attitude gap towards fluoroquinolone use. These findings provide opportunities for public health professionals to explore gaps in the knowledge and attitudes of patients and providers related to antimicrobial use, particularly in rural regions, and investigate barriers to healthcare access in metropolitan areas.

Respiratory-related workers’ compensation claims from private employers — Ohio, 2001–2018

Background: Diseases and conditions related to the respiratory system contribute to work-related morbidity, mortality, and disability. Details on the causes and nature of work-related respiratory disease and the specific industries in which they occur are limited. This study identifies respiratory-related claims in the Ohio Bureau of Workers’ Compensation (OHBWC) system and describes claim and worker characteristics to inform public health surveillance. Methods: We developed a list of respiratory-related International Classification of Diseases Clinical Modification (ICD-CM) diagnosis codes and searched over 2 million claims filed between 2001 and 2018 in the OHBWC system for at least one of these codes. The claim characteristics, rates of claims by employer industry classification, and causes of claims from narrative text were determined for these respiratory-related claims. Results: Among the 23,015 respiratory-related claims (5.8 per 10,000 full-time equivalents [FTE]), 54.6% had at least one ICD-CM code for Allergic Reactions and 30.6% had at least one code for Toxic Effects of Substances Chiefly Non-medicinal as to Source. Claim causes from narrative text included Chemical Exposure (30.3%), Activity Suggesting Exposure (24.4%), and Vapors, Gases, Dusts, or Fumes (VGDF) Exposure (19.3%). The highest overall rates of respiratory-related claims among private employers were for the agriculture, forestry & fishing (11.4 per 10,000), public safety (ambulance services) (11.3), and manufacturing (10.7) industry sectors. Conclusions: Respiratory-related claims in the OHBWC system were often acute in nature and included allergic reactions. Narratives from these claims provide insight into the work-related exposures and events causing claims or the disease and symptom factors surrounding claims.

Workers’ compensation injuries in aviation manufacturing in the state of Kansas, 2014–2022

IntroductionWorkers’ compensation injuries entail burdensome financial and social costs. This study’s objective was to describe cost and frequency of workplace injuries in aviation manufacturing in the state of Kansas using workers’ compensation data. Manufacturing incurs more workers’ compensation claims in Kansas than any other industry, and aviation contributes more of those claims than any other sub sector. MethodWorkers’ compensation insurance and reporting are required in the state of Kansas. Data were provided by the Kansas Department of Labor (KDOL) and included all closed workers’ compensation claims entailing indemnity and medical costs filed in the state from 2014 to 2022. Cost of claim data were normalized to 2022 U.S. dollars and data were analyzed as a function of percentage and claim cost by body part, type of injury, cause of injury, specific musculoskeletal disorder type, and as a function of age and gender injury rates. ResultsAviation claims entailed a median total cost of $26,941 and represented 8% of all closed claims filed in the state from 2014 to 2022. The grand total direct cost over the nine-year period was $75,404,147. Medical costs comprised 48.6% of all costs, indemnity 45.0%, and legal 6.4%. The most frequently injured body part was the hand/wrist (35.9%) followed by the shoulder (20.6%), and the most expensive body parts were related to the back. Overexertion (38.6%) was the most common cause followed by repetitive motion (22.8%). Work-related musculoskeletal disorders were the most common type accounting for 67.4% of all claims. Men and workers aged 55–64 incurred slightly higher claim rates than average. A sharp decrease in number of claims closed in 2021 coincided with production shutdowns the previous year related to the Covid-19 pandemic and design issues. ConclusionsAviation manufacturing is a key industry in Kansas and this study is the first known to describe costs and frequencies of workplace injuries in the sector using workers’ compensation data. Practical applicationsThis guide to the most problematic and costly injuries in aviation manufacturing helps practitioners prioritize prevention strategies to most effectively reduce workplace injury and helps safety and health practitioners in prioritizing prevention efforts to reduce the most severe and costly aviation manufacturing injuries and illnesses. It also brings attention to some special considerations when working with safety data from 2020 to 2022 related to the Covid-19 pandemic.

Ethnic variation in access to publicly funded care for unintentional injuries in older adults in Aotearoa New Zealand: a retrospective study

BackgroundMāori (the Indigenous people of Aotearoa New Zealand (NZ)) are more likely to experience injury than non-Māori, but less likely to have effective access to publicly funded injury care services....

Obstetric claims in Finland 2012-2022-A nationwide patient insurance registry study.

Maternal and infant mortality rates in Finland are among the lowest in the world, yet preventable obstetric injuries occur every year. The aim of this study was to describe obstetric claims, their compensation rates, and temporal trends of claims reported to the Patient Insurance center. A nationwide, register-based study was conducted. Data consisted of obstetric claims reported to the Patient Insurance Center between 2012 and 2022. Data analyzed included the year of injury, compensation criteria, maternal age, birth hospital, delivery method, reported causes of injury, and maternal or neonatal injury. The data were analyzed with descriptive statistics and logistic regression models. A total of n = 849 obstetric claims were filed during the study period, of which n = 224 (26.4%) received compensation. The rate of claims was 0.15%, and the rate of compensation was 0.04% in relation to the total volume of births during the period. Substandard care was the most common (97.3%) criterion for compensation. There was a curvilinear increase in the claims rate and a linear increase in compensation rates from 2013 to 2019. More claims were filed and compensated for cesarean and vacuum-assisted deliveries than for unassisted vaginal deliveries. Delayed delivery (18.7%) and surgical technique failure (10.9%) were the most reported causes of injuries. Retained surgical bodies were the induced cause of injury with the highest rate of compensated claims (86.7%). The most common maternal injury was infection (17.9%) and pain (11.7%). Among neonatal injuries, severe (19.2%) and mild asphyxia (16.6%) were the most frequent. Burn injuries (93.3%) and fetal or neonatal death (60.5%) had the highest rate of compensated claims. The study provided new information on substandard care and injuries in obstetric care in Finland. An increasing trend in claims and compensation rates was found. Identifying contributors to substandard care that lead to fetal asphyxia is important for improving obstetric safety. Further analysis of the association of claims and compensation rates with operative deliveries is needed to determine their causality. Frequent review of obstetric claims would be useful in providing more recent data on substandard care and preventable injuries.

Oil and Gas Extraction Industry Workers' Compensation Claims and Proposed Safety Interventions.

This study analyzed Ohio workers' compensation data to identify potential prevention strategies for common oil and gas extraction industry claims. Claim rates for 2001-2018 were calculated per full-time equivalent employee. Descriptive analyses on free-text descriptions of lost-time (LT) claims (>7 days away from work) identified common characteristics among claims and injured workers. Among 3134 claims, 860 (27%) were LT. The industry group, drilling contractors, experienced the highest LT claims rate, whereas the cost from servicing contractors was the highest. Contact with objects and equipment caused the highest LT claims rate. The most frequent LT occupation was roustabout, and the most frequent LT work activity was material handling. Transportation incidents caused most fatalities and hospitalizations. Over half of LT claims were from short-tenured workers. Both proven and innovative approaches are needed to reduce severe workers' compensation claims in this industry.

Mining Injuries 2012-2019: Using Workers' Compensation Claims Data From 35 States to Identify Rates and Costs Associated by Nature of Injury, Event/Exposure, and Body Part Affected.

This study summarized the frequency and cost of mining-related injuries. Mining-related workers' compensation (WC) claims data from 35 states were summarized to report counts, claim rates, and costs for 2012-2019. These data were compared with Mine Safety and Health Administration injury and employment data for the same period. Despite system differences, both WC and Mine Safety and Health Administration counts and rates declined over time and injury patterns were similar. Total WC costs were approximately $2.325B. Medical-only claims represented 59.4% of the claims by count, but only 3.3% of costs. Lost-time nonfatal claims represented 40.2% of the claims by count, but 90.2% of costs. Claims frequency and costs varied greatly by injury event/exposure, part of body, and nature. Injury frequency has declined but costs remain high. The most costly and disabling cases were identified.

Causes de plaintes après arthroplastie totale primaire de hanche en France : données assurantielles de 240 expertises de 2014 à 2017

Introduction: Total hip arthroplasty (THA) is one of the most frequent orthopedic surgery procedures, and orthopedic surgeons are among the most frequently accused of malpractice by their patients. Identifying the main reasons for malpractice claims after THA is a prior condition to reducing their frequency. The quality of the preoperative risk information given to the patient by the surgeon is crucial for these purposes. Data specific to THA are sparse in France, and we therefore conducted a retrospective study 1) to determine whether the outcome of medico-legal expert appraisal correlated with the quality and traceability of preoperative information, and 2) to identify the most frequent grounds for complaint after primary THA.Hypothesis: The quality of patient information partly determines expert appraisal.Material and Method: A retrospective study was conducted based on data from the Branchet medical professional insurance agency for malpractice claims following THA over the period 2014-2017, with 240 complete files, for 125 women and 115 men. Data comprised: type of procedure, main grounds of complaint (complications), positive or negative expert appraisal, quality of preoperative patient information, amounts of compensation accorded and fees paid, and the practitioner’s liability. We assessed correlations between information quality and liability.Results: Surgical site infection and neurologic deficit were the two main grounds for malpractice claims. In the 240 files, cases for 106 operations (44.2%) were submitted to arbitration, 95 (39.6%) were brought to court, and 39 (16.2%) were settled out of court. The practitioner was held at least partly liable in 40 files (16.7%). Information to the patient was deemed imperfect or poor for 119 files (49.6%) and good in 121 (50.4%). Mean compensation was euro 30,940 (range, euro 0 to euro 198,100).In 27 of the 40 cases of liability (67.5%), the information to the patient was deemed imperfect or poor. Twenty-six of the 40 cases (65%) were settled out of court.In case of poor information, there was a significant risk for the practitioner to be held liable: 7.5% vs 25% (p=0.003).Discussion: The present study listed the main complications underlying malpractice claims after THA: infection, neurologic complications, and limb-length discrepancy. This should enable practitioners to improve patient information so as to reduce the rate of malpractice claims or at least decrease the practitioner’s liability, as the study found a correlation between information quality and expert appraisal.Level of evidence: IV; retrospective study.

Reasons for malpractice claims after primary total hip arthroplasty in France: Insurance data from 240 claims from 2014 to 2017

IntroductionTotal hip arthroplasty (THA) is one of the most frequent orthopedic surgery procedures, and orthopedic surgeons are among the most frequently accused of malpractice by their patients. Identifying the main reasons for malpractice claims after THA is a prior condition to reducing their frequency. The quality of the preoperative risk information given to the patient by the surgeon is crucial for these purposes. Data specific to THA are sparse in France, and we therefore conducted a retrospective study (1) to determine whether the outcome of medico-legal expert appraisal correlated with the quality and traceability of preoperative information, and (2) to identify the most frequent grounds for complaint after primary THA. HypothesisThe quality of patient information partly determines expert appraisal. Material and methodA retrospective study was conducted based on data from the Branchet medical professional insurance agency for malpractice claims following THA over the period 2014–2017, with 240 complete files, for 125 women and 115 men. Data comprised: type of procedure, main grounds of complaint (complications), positive or negative expert appraisal, quality of preoperative patient information, amounts of compensation accorded and fees paid, and the practitioner's liability. We assessed correlations between information quality and liability. ResultsSurgical site infection and neurologic deficit were the two main grounds for malpractice claims. In the 240 files, cases for 106 operations (44.2%) were submitted to arbitration, 95 (39.6%) were brought to court, and 39 (16.2%) were settled out of court. The practitioner was held at least partly liable in 40 files (16.7%). Information to the patient was deemed imperfect or poor for 119 files (49.6%) and good in 121 (50.4%). Mean compensation was €30,940 (range, €0 to €198,100). In 27 of the 40 cases of liability (67.5%), the information to the patient was deemed imperfect or poor. Twenty-six of the 40 cases (65%) were settled out of court. In case of poor information, there was a significant risk for the practitioner to be held liable: 7.5 vs. 25% (p=0.003). DiscussionThe present study listed the main complications underlying malpractice claims after THA: infection, neurologic complications, and limb-length discrepancy. This should enable practitioners to improve patient information so as to reduce the rate of malpractice claims or at least decrease the practitioner's liability, as the study found a correlation between information quality and expert appraisal. Level of evidenceIV; retrospective study.

The association between naloxone claims and proportion of independent versus chain pharmacies: A longitudinal analysis of naloxone claims in the United States

BackgroundExpanding access to naloxone through pharmacies is an important policy goal. Our objective was to characterize national county-level naloxone dispensing of chain versus independent pharmacies. MethodsThe primary exposure in our longitudinal analysis was the proportion of chain pharmacies in a county, identified through the U.S. Department of Homeland Security 2010 Infrastructure Foundation-Level Data. We defined counties as having “higher proportion” of chain pharmacies if at least 50% of pharmacies were large national chains. The primary outcome was quarter-year (2016Q1-2019Q2) rate of pharmacy naloxone claims per 100,000 persons from Symphony Health at the county level. We compared the naloxone dispensing rate between county types using 2-sample t tests. We estimated the association between county-level chain pharmacy proportion and rate of naloxone claims using a linear model with year-quarter fixed effects. ResultsNearly one-third of counties (n = 946) were higher proportion. Higher proportion counties had a significantly higher rate of naloxone claims across the study period, in 4 of 6 urban-rural classifications, and in counties with and without naloxone access laws (NALs). The linear model confirmed that higher proportion counties had a significantly higher rate of naloxone claims, adjusting for urban-rural designation, income, population characteristics, opioid mortality rate, coprescribing laws, and NALs. ConclusionIn this national study, we found an association between naloxone dispensing rates and the county-level proportion of chain (vs. independent) pharmacies. Incentivizing naloxone dispensing through educational, regulatory, or legal efforts may improve naloxone availability and dispensing rates—particularly in counties with proportionately high numbers of independent pharmacies.

Patient characteristics of, and remedial interventions for, complaints and medico-legal claims against doctors: a rapid review of the literature

BackgroundIt is uncertain if patient’s characteristics are associated with complaints and claims against doctors. Additionally, evidence for the effectiveness of remedial interventions on rates of complaints and claims against doctors has not been synthesised.MethodsWe conducted a rapid review of recent literature to answer: Question 1 “What are the common characteristics and circumstances of patients who are most likely to complain or bring a claim about the care they have received from a doctor?” and Question 2 “What initiatives or interventions have been shown to be effective at reducing complaints and claims about the care patients have received from a doctor?”. We used a systematic search (most recently in July 2023) of PubMed, Scopus, Web of Science and grey literature. Studies were screened against inclusion criteria and critically appraised in duplicate using standard tools. Results were summarised using narrative synthesis.ResultsFrom 8079 search results, we reviewed the full text of 250 studies. We included 25 studies: seven for Question 1 (6 comparative studies with controls and one systematic review) and 18 studies for Question 2 (14 uncontrolled pre-post studies, 2 comparative studies with controls and 2 systematic reviews). Most studies were set in hospitals across a mix of medical specialties.Other than for patients with mental health conditions (two studies), no other patient characteristics demonstrated either a strong or consistent effect on the rate of complaints or claims against their treating doctors.Risk management programs (6 studies), and communication and resolution programs (5 studies) were the most studied of 6 intervention types. Evidence for reducing complaints and medico-legal claims, costs or premiums and more timely management was apparent for both types of programs. Only 1 to 3 studies were included for peer programs, medical remediation, shared decision-making, simulation training and continuing professional development, with few generalisable results.ConclusionFew patient characteristics can be reliably related to the likelihood of medico-legal complaints or claims. There is some evidence that interventions can reduce the number and costs of claims, the number of complaints, and the timeliness of claims. However, across both questions, the strength of the evidence is very weak and is based on only a few studies or study designs that are highly prone to bias.

Prevalence of disability secondary to work-related musculoskeletal injuries among orthopaedic surgeons

BackgroundOrthopaedic surgeons encounter many work-place hazards that can lead to musculoskeletal injuries (MSI) and their clinical sequelae. This study aims to evaluate musculoskeletal injuries among orthopaedic surgeons and compare their rates of disability claims and time off work. Additionally, this study provides a perspective on the financial impact of work-related injuries among orthopaedic surgeons. MethodsAn electronic survey was developed to assess work-place hazards among orthopaedic surgeons. The survey included questions on demographics, musculoskeletal injuries, and disabilities. Electronic surveys were emailed to all current members of the American Academy of Orthopaedic Surgeons (AAOS) between March and April 2021 in the United States. Descriptive statistics were run for all variables and chi-squared and t-tests when applicable. Results1645 members of the AAOS completed the survey (7.03 % response rate), and 243 (14.9 %) reported a work-related injury to their place of employment at some point during their career. Of the respondents, 1129 (76.4 %) reported having active disability insurance, and 61 (3.7 %) orthopaedic surgeons filed a disability claim secondary to a work-related injury at some point during their career. Of the surgeons that claimed disability, 39 (66.1 %) returned to work, and 20 (33.9 %) had an early retirement. Foot/ankle injuries led to the highest rates of early retirement overall (62.5 %). ConclusionThis study captures the prevalence of disability claims made by orthopaedic surgeons due to work-place hazards. To our knowledge, this is the first study to broadly compare disability claims amongst orthopaedic surgeons. This data should be used to implement changes in the orthopaedic community to decrease injuries and disability claims.