Project: Research project

Project Details


Although it has not yet been satisfactorily defined, the problem of
defensive medicine has received much recent attention. One aspect of
defensive medicine is the practice of ordering diagnostic tests and
monitoring procedures solely to reduce the chances of being sued.
Although few data are available, the costs of such practices are thought
to be high. This study is designed to provide an objective index of the
pressures promoting defensive medicine in 15 medical and surgical
specialties. The research will focus on malpractice claims associated
with omission of diagnostic tests and physiologic monitoring; such claims
are conceptualized as-the driving force behind many defensive medical
practices. Using existing data from the files of the largest physician malpractice
insurance carrier in New Jersey, the proposed research aims to: (1)
determine the proportion of claims associated with diagnostic and
monitoring omissions in 15 specialties, (2) compare (within specialty)
indemnity payments and severity of patient injuries for
diagnostic/monitoring omissions vs. other kinds of claims, (3) describe
the particular diagnostic/monitoring omissions commonly encountered in
each specialty, (4) determine whether the proportion of claims ascribed
to diagnostic/monitoring omissions has changed with time and/or the
introduction of new technologies, and (5) assess whether physicians'
demographic and practice characteristics and/or the characteristics of
the hospitals where they practice can predict their propensity to incur
claims for diagnostic or monitoring omissions. Malpractice claims filed with the carrier between 1977 and 1989 will be
sorted by specialty and screened for the occurrence of diagnostic or
monitoring omissions. The proportion of claims associated with such
omissions will be calculated by specialty, with separate calculations for
claims filed but not pursued, claims pursued but not paid or otherwise
ascribed to negligence, and claims paid or judged by peers as resulting
from negligence. The association of physician and hospital
characteristics with omission-related claims will be assessed using
categorical analysis, multivariate regression, and recursive partitioning
(classification trees).
Effective start/end date8/1/921/31/94


  • National Institutes of Health


  • Medicine(all)


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