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Background: As part of an interdisciplinary study of medical injury and malpractice litigation, we estimated the incidence of adverse events, defined as injuries caused by medical management, and of the subgroup of such injuries that resulted from negligent or substandard care.

Methods: We reviewed 30,121 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals in New York State in 1984. We then developed population estimates of injuries and computed rates according to the age and sex of the patients as well as the specialities of the physicians.

Results: Adverse events occurred in 3.7 percent of the hospitalizations (95 percent confidence interval, 3.2 to 4.2), and 27.6 percent of the adverse events were due to negligence (95 percent confidence interval, 22.5 to 32.6). Although 70.5 percent of the adverse events gave rise to disability lasting less than six months, 2.6 percent caused permanently disabling injuries and percent led to death. The percentage of adverse events attributable to negligence increased in the categories of more severe injuries (Wald test [chi]2 = 21.04, P<0.0001). Using weighted totals, we estimated that among the 2,671,863 patients discharged from New York hospitals in 1984 there were 98,609 adverse events and 27,179 adverse events involving negligence. Rates of adverse events rose with age (P<0.0001). The percentage of adverse events due to negligence was markedly higher among the elderly (P<0.01). There were significant differences in rates of adverse events among categories of clinical specialties (P<0.0001), but no differences in the percentage due to negligence.

Conclusions: There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care.

: OVER the past decade there has been a steady increase in the number of malpractice claims brought against health care providers1,2 and in the monetary damages awarded to plaintiffs.3-5 This increase has precipitated numerous state programs designed to moderate the number of claims and encourage providers to develop quality-of-care initiatives.6,7 Advocates of tort reform argue that the existing system of malpractice litigation is inefficient in compensating patients injured by medical practice and in deterring the performance of poor-quality care that is sometimes responsible for the injuries.8 Others defend the role of tort litigation.9 These debates will probably [horizontal ellipsis]

Owned, published, and (C) copyrighted, 1991, by the MASSACHUSETTS MEDICAL SOCIETY