Original researchReduced medicolegal risk by compliance with obstetric clinical pathways: a case–control study☆
Section snippets
Materials and methods
This research was approved by the institutional review board at Wayne State University.
In 1998, the management team of a $1.8 billion health system, responsible for the delivery of approximately 12,000 infants annually, encouraged the implementation of a clinical pathway for normal vaginal delivery and cesarean delivery. The goal of the pathway project was to develop a clinically efficient and effective care plan to boost the system’s competitiveness through improved clinical quality and
Results
We retrospectively identified 290 delivery-related malpractice claims and 262 controls from among the 118,434 vaginal and cesarean deliveries in the three hospitals during the study period. We completed medical record review for 236 claims (81%) and 240 controls (92%). Some of the medical records were not reviewed owing to the inability to locate or obtain the medical records, which caused a slight difference in the numbers of cases and controls.
There were no significant differences between
Discussion
Clinical pathways are a useful metric for exploring the relationship between health care quality and malpractice because, conceptually, they approximate both the clinical and the legal standards of care. We found empirical support for our first study hypothesis—that quality improvement interventions may have a substantive impact on malpractice risk. Departures from the obstetric pathway were nearly four times more frequent among claims than controls in our retrospective analysis, and
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Cited by (0)
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This study was made possible through a generous grant from the Richard J. Barber Fund for Interdisciplinary Legal Research. DMS was supported in part by grant no. KO2HS11285 from the Agency for Healthcare Research and Quality.