David M Studdert

..Expert opinion has not been used as a basis for comparing different forms of health insurance, in part because this perspective may not be appropriately sensitive to aspects of care that consumers value...

..Drawing on findings from our previous study of nursing home litigation, we outline these features and argue for careful attention to them as policymakers evaluate options for reform...

..To determine the frequency, types, sources, and predictors of conflict surrounding the care of pediatric intensive care unit (PICU) patients with prolonged stay...

..To determine types, sources, and predictors of conflicts among patients with prolonged stay in the ICU...

..How often physicians alter their clinical behavior because of the threat of malpractice liability, termed defensive medicine, and the consequences of those changes, are central questions in the ongoing medical malpractice reform debate...

..In the current debate over tort reform, critics of the medical malpractice system charge that frivolous litigation--claims that lack evidence of injury, substandard care, or both--is common and costly...

..A policy question more pressing than whether moving toward routine disclosure will expand litigation is the question of how large such an expansion might be...

..Medical monitoring arms the courts with a new mechanism for addressing harms proactively rather than reactively, which could yield new victories for public health...

..The findings should help to target dissemination and support activities, designed to help workers take advantage of antidiscrimination protections, at the subgroups of workers who need them most...

..Use of sliding scales of damages instead of or in conjunction with caps would mitigate their adverse impacts on fairness...

..Congress and state legislatures are considering patient bills of rights that seek to strengthen opportunities for patients to have denials of coverage reconsidered by their health plans. Little is publicly known about such appeals systems...

..To investigate specialist physicians' practice decisions in response to liability concerns and their perceptions of the impact of the malpractice environment on patient access to care...

..First, perceptions influence behavior with respect to practice environment and clinical decision making. Second, perceptions influence the physician-patient relationship and the interpersonal quality of care...

..Medical school faculty could benefit from additional guidance about what their institution views as acceptable parameters for industry-sponsored clinical trial agreements...

..Importantly, all three nations are harnessing their systems' power to improve patient safety, and the avoidability standard appears to be well suited for this task...

..To identify the most prevalent patterns of technical errors in surgery, and evaluate commonly recommended interventions in light of these patterns...

..We discuss methodological issues that could explain the disparate findings regarding physician supply effects in studies using administrative data sets and survey data...

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..Awareness of the most common types of breakdowns and factors could help efforts to identify and prioritize strategies to prevent diagnostic errors...

..To facilitate critical decision making and improve satisfaction with care among families of patients in a pediatric intensive care unit...

..It concludes by connecting these trends to larger medical malpractice policy issues...

..001). CONCLUSIONS: Systems factors play a critical role in most surgical errors, including technical errors. Closed claims analysis can help to identify priority areas for intervening to reduce errors...

..Communication breakdowns are a common threat to surgical safety, but there are little data to guide initiatives to improve communication...

..Hence, substantial underclaiming occurs in both negligence and no-fault systems. The disproportionately low propensity of elderly, poor and minority patients to seek compensation also appears to be pervasive...

..Diagnostic errors in the emergency department (ED) are an important patient safety concern, but little is known about their cause. We identify types and causes of missed or delayed diagnoses in the ED...

..Current site-verification protocols could have prevented only two thirds of the examined cases. Many protocols involve considerable complexity without clear added benefit...

..American policymakers may find many of the elements of these countries' systems to be transferable to demonstration projects in the U.S...

..The success rate among retrospective appeals involving emergency room services--95 percent at both plans--was particularly striking...

..It is unknown whether physicians and scientists who have such conflicts of interest adequately disclose such relationships in the scientific publications they author...

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..Case--control analysis of medical-malpractice claims may identify and quantify risk factors for specific types of errors...

..Work hour restrictions and a growing understanding of the role of organizational factors in contributing to and preventing medical injury may increase the legal expectations imposed on GME programs...

..Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending...

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..The program adjudicates complaints against AANS members for their work as expert witnesses in medical malpractice litigation...

..We sought to describe characteristics of physicians who frequently act as expert witnesses in neurologic birth injury litigation...

..However, the scope of off-label marketing remains poorly characterized. We developed a typology for the strategies and practices that constitute off-label marketing...

..6 billion (39%) of total recoveries. This study illuminates the scope and characteristics of qui tam fraud litigation and the whistleblowers who animate this important tool for addressing waste in the health care sector...

..We sought to use a novel case-selection methodology to identify antenatal or intrapartum risk factors associated with neonatal neurological impairment following non-reassuring fetal heart rate patterns during labour...

..We studied institutional standards regarding contractual provisions that restrict investigators' control over trials...

..To erform a process analysis of missed and delayed diagnoses of breast and colorectal cancers to identify: (1) the cognitive and logistical factors that lead to these diagnostic errors, and (2) prevention strategies...

..This undesirable potential outcome compounds the importance of selecting these standards with the utmost care...

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..Process of care failures may contribute to diagnostic errors in breast cancer care...

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..In this paper we consider the reasonableness of the claims against fast-food companies and discuss several social effects that the litigation may have irrespective of its outcome in court...

..Reluctance to disclose preventable harms was twice as likely to occur at hospitals having major concerns about the malpractice implications of disclosure...

..We conclude by examining conditions that may facilitate or impede progress toward establishing demonstration projects of health courts...

..These findings elevate concerns about quality of nursing home care and indicate that litigation diverts resources from resident care, which may fuel quality problems...

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..The lessons learned from the experience with this intervention should be helpful in ongoing efforts to improve care and to achieve outcomes desired by critically ill patients, their families, and critical care clinicians...

..Because this disruption appears to have decreased the proportion of questionable claims receiving compensation, the NPDB actually may have increased overall tort system specificity...

..We describe the characteristics and outcomes of enrollee-health plan disputes over insurance coverage for emergency department (ED) services at 2 large health maintenance organizations (HMOs) that apply the prudent layperson standard...

..To describe the characteristics of and factors contributing to trainee errors, we analyzed malpractice claims in which trainees were judged to have played an important role in harmful errors...

..We conclude with four lessons about law's role in the health sphere-lessons that stress the power of legal conflict to shape perceptions and to thereby change behavior before legal change occurs...