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Analysis of Closed Claims in the Clinical Management of Rheumatoid Arthritis in Japan

Chinese Medical Journal 2017年第12期130卷 1454-1458页

作者： Yasuhiro Otaki Makiko DaSilva Ishida Yuichi Saito Yasuaki Oyama giichiro oiso Mitsuru Moriyama General Medical Education and Research Center Teikyo University Tokyo 1738605 Japan National Center of Neurology and Psychiatry Tokyo 1878551 Japan Specialty Claims Department Sompo Japan Nipponkoa Insurance Incorporated Tokyo 1648608 Japan Department of Integrated Human Sciences Hamamatsu University School of Medicine Shizuoka 4313192 Japan Moriyama Management Law Office Tokyo 1010052 Japan

Background： Despite an increasing awareness of the risk of medical errors, few data sources are available to highlight the characteristics and patterns of medical errors in the clinical management of rheumatoid arthritis （RA）. The present study aimed to evaluate medical malpractice claims associated with the management of RA and other atltoimmune connective tissue diseases （ACTDs）. Methods： We analyzed 38 ACTD-associated closed claims extracted from a total of 8530 claims processed between July 2004 and June 2014 by the Tokyo headquarters office of Sompo Japan Nipponkoa Incorporated, a leading malpractice insurer in Japan. Results： RA was the most common ACTD assessed in this study, accounting for 20 cases. Although the male-to-female ratio among these cases was 5：15, in accordance with the general demographic distribution of RA, the proportion of patients older than 60 years （77.8%） was relatively high as the general range of RA susceptibility is 30-50 years. The analysis of allegation types among RA cases revealed statistically significant differences from non-RA cases （Fisher＇s exact test） as well as the following key findings： diagnosis-related allegations were absent （P 〈 0.01 ）, whereas medication-related allegations were distinctively common （P=0.02）. Clinical processes related to the assessment process were most vulnerable to breakdown and leading to negligence identified with subsequent medication-related allegations, particularly among RA cases. Conclusions： The characteristics of malpractice claims associated with RA management, including the high frequency of medication-related allegations, breakdowns in the assessment process, and high claim numbers among patients older than 60 years, suggest the importance of caution exercised by physicians when administering immunosuppressants for the clinical treatment of RA.

关键词： Autoinlmune Connective Tissue Disease Closed Claim Rheumatoid Arthritis

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