Malpractice-Avoidance Strategies Apparently Aren't Improving Care Quality

By Joe Elia

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Efforts designed to reduce physicians' malpractice liability aren't improving health care quality, according to a systemic review in JAMA. Editorialists, while praising the review, don't consider the case closed.

Researchers examined 37 studies, searching for evidence that measures to address malpractice liability, such as increases in physician insurance premiums or state-level tort reforms, were improving the quality of care (as evidenced by improvements in, for example, patient mortality or hospital readmission rates).

Among 16 studies focused on obstetrical care, there was limited or no evidence suggesting an association between malpractice-avoidance strategies and care quality. Similarly, 15 of 20 studies regarding non-obstetrical care found no significant relationship.

The editorialists note that the medical care ecosystem is moving away from an individual-physician focus and toward more complexity. Research on medical errors, they write, "has elevated organizational issues over individual inattention or malfeasance as root causes."