Are quality indicators predictive of compensated injury claims?

This paper examines the association between patient injury claims and quality indicators with the aim to assess whether claims can be utilized in performance measurement. Data were derived from administrative registers and a pilot study with reference to all filed and compensated claims related to clinical errors occurred in the Region of Lombardy from 2004 to 2006. Specialty (nested-in-Hospital)-level propensity to produce closed claims (propensity condition) and both the propensity condition and the number of closed claims (joint model) were modelled as a function of quality indicators and structural/case-mix characteristics. The merged dataset involved 1,793 specialties (nested in 203 Hospitals and nearly 3.5 million discharges), of which 22.5% yielded at least one closed claim in the mentioned triennium. Results demonstrated that the rate of voluntary demission, the intra-specialty mortality and the rate of patients transferred to other hospitals had a positive and statistically significant association with the likelihood to be in the claim group; whereas, the most significant predictor proved to be the specialty area (particularly surgical specialties). In the joint model both intra-mortality rates and readmission rates for the same Major Diagnostic Category were strongly and positively associated with an increasing number of claims. The results demonstrate that quality measures, easily accessible through administrative data, are highly predictive of claim occurrence and claim intensity, and can be used as a screening tool to identify quality problems in order to prevent malpractice and claims. To our knowledge, no other Italian study has examined claim data and relationships with quality indicators with reference to such large population and breadth of specialties