March 14, 2018 | Today’s News

Report: Diagnosis-related events linked to plurality of medical liability claims

A report from medical liability insurer Coverys finds diagnosis-related events to be the single largest root cause of medical liability claims. The researchers analyzed 10,618 closed medical professional liability claims from the period 2013 to 2017 and among other things, found that:

• 3,466 closed claims with diagnosis-related claims accounted for 33 percent of all claims and 47 percent of indemnity payments
• 54 percent of diagnosis-related claims were high-severity cases, and 36 percent resulted in death
• 35 percent of diagnostic errors occurred in nonemergency department, outpatient settings
• 33 percent of diagnosis-related claims alleged a decision-making breakdown linked to a failure during patient evaluation
• 53 percent of diagnosis-related claims included risk management issues involving poor clinical decision making

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Study: Triamcinolone injection for knee OA linked to increase in intraocular pressure

Findings from a study published online in the journal Clinical Orthopaedics and Related Research suggest that triamcinolone injection of the knee may be linked to an increase in intraocular pressure. The authors conducted a prospective, cohort study of 62 patients with primary osteoarthritis (OA) of the knee, of whom 31 (50 percent) were treated with triamcinolone and 31 (50 percent) were treated with hyaluronic acid At one-week follow-up, they found that mean intraocular pressure increased by 2.79 mm Hg in the triamcinolone cohort, but did not change among patients in the hyaluronic acid cohort. Overall, nine of 29 patients in the triamcinolone cohort displayed a ≥7 mm Hg intraocular pressure elevation at one week, and of those, four of five triamcinolone patients available at one-month follow-up remained elevated >7 mm Hg from baseline. “Further larger scale randomized investigations are warranted to determine the longevity of this pressure elevation as well as long-term clinical implications, including optic nerve damage and visual field loss,” the authors write.

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According to data presented at the American Orthopaedic Society for Sports Medicine Specialty Day meeting, osteochondral allograft (OCA) transplantation with dowel-type grafts may be effective for treatment of certain isolated femoral condyle cartilage lesions. Members of the research team reviewed information on 187 patients (200 knees) who underwent OCA transplantation for isolated cartilage lesions on the femoral condyle. A single graft was used in 145 knees (72.5 percent) and two grafts were used in 55 knees (27.5 percent). At mean 6.7-year follow-up (range: 1.9 to 16.5 years), they found that International Knee Documentation Committee scores improved from 5.5 to 2.7 for pain, 3.4 to 7.3 for function, and 43.7 to 76.2 for total score. Similarly, Knee injury and Osteoarthritis Outcome Score for pain improved from 66.5 to 85.3 and activities of daily living score improved from 74.5 to 91.1. Overall, 89 percent of patients reported satisfaction with their outcomes. The researchers note that further surgery was required in 52 knees (26 percent), of which 16 knees (8 percent of total cohort) were defined as OCA failures. Median time to failure was 4.9 years (range: 0.3 to 16.1 years). OCA survivorship was 95.6 percent at 5 years and 91.2 percent at 10 years.

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According to Modern Healthcare, members of the U.S. House of Representatives Committee on Energy and Commerce have launched an investigation into the hospital accreditation process in the wake of reports that The Joint Commission (TJC) accredited hospitals with major safety issues. The committee has issued letters to the U.S. Centers for Medicare & Medicaid Services (CMS), TJC, the Bureau of Healthcare Facilities Accreditation, the Center for Improvement in Healthcare Quality, and DNV GL Healthcare requesting detailed information on how hospitals and other facilities are accredited. The committee asked the organizations to provide copies of hospital applications for Medicare accreditation; copies of performance reviews, survey feedback, corrective action plans and responses to those plans; and any correspondence with CMS.

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The New York Times reports that the U.S. House of Representatives has defeated a bill that, if enacted, would have expanded the options for patients with terminal illnesses to try unproven, experimental treatments. The bill was considered under fast-track procedures that required a two-thirds majority for passage, but with a 259-140 vote, it failed to pass. It is expected that the bill may come up for consideration again under rules that would require a simple majority for passage. Supporters of the legislation say that it would expand treatment options for terminal patients; opponents argue that patients could be harmed through the use of unapproved treatments.

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A study published in the March 13 issue of The Journal of the American Medical Association examines healthcare spending and suggests that prices of labor and goods, as well as administrative costs may be the major drivers of a difference in overall cost between the United States and other high-income countries. The researchers analyzed 2013 to 2016 data from the United States, the United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark, and found that in 2016, the United States spent 17.8 percent of its gross domestic product on health care, while spending in other countries ranged from 9.6 percent in Australia to 12.4 percent in Switzerland. The proportion of the population with health insurance was 90 percent in the United States, and between 99 percent and 100 percent in the other countries. The United States did not differ substantially from the other countries in physician workforce, nursing workforce, or numbers of hospital beds per capita, but had higher utilization of advanced imaging. Administrative costs of care accounted for 8 percent of U.S. spending, compared to 1 percent to 3 percent for other countries. Pharmaceutical spending per capita was $1,443 in the United States, and ranged from $466 to $939 in the other countries. In addition, salaries of physicians and nurses were higher in the United States than in comparator nations.

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Call for volunteers: Shoulder & Elbow Evaluation Committee

April 13 is the last day to apply for chair of the Shoulder & Elbow Evaluation Committee. Members of the Evaluation Committees write questions for the orthopaedic self-assessment examinations. Applicants for this position must be active or emeritus fellows with extensive knowledge and experience in shoulder and elbow.

Learn more and submit your application…  (member login required)