How Denmark Dumped Medical Malpractice and Improved Patient Safety
http://www.truthdig.com/report/item/how_denmark_dumped_medical_malpractice_a
nd_improved_patient_safety_20160103/
Posted on Jan 3, 2016
By Olga Pierce and Marshall Allen / ProPublica
Shutterstock
This piece originally ran on ProPublica.
COPENHAGEN It was a distressingly close call. A patient had been sent home
from the hospital with instructions to take a common medication at a dose
that would have poisoned her.
When Dr. Ole Hamberg heard about the mistake, he decided to investigate.
Hamberg, the head liver specialist at Rigshospitalet, the Danish national
hospital, soon found something troubling. The hospitals electronic
prescribing system was mistakenly prompting doctors to give the drug,
methotrexate, for daily use when it is safely taken only once or twice a
week.
Patients throughout Denmark were being poisoned, Hamberg learned, thanks to
the medical error. At his hospital, Hamberg made sure prescribing protocols
were fixed and doctors and patients were informed. The problem quickly
abated.
Hamberg was able to rapidly see a dangerous pattern because of something
that doesnt exist in the United States: A comprehensive national program to
compensate victims of patient harm and to learn from them by collecting
and analyzing the data their experiences provide.
Patients whod been overdosed filed claims under the compensation program,
which makes its data available to hospitals and researchers. Of course I
use this information in my department, Hamberg said. We discuss how we can
avoid this injury the next time.
The Danish system offers lessons for policymakers in the United States,
where medical harm remains widespread and the mechanisms for addressing it
are often cumbersome and adversarial. The Danes primary focus is on helping
patients who have been hurt by the health care system. While the reams of
data gathered from claims arent used to publicly rate doctors and
hospitals, or to systematically search for bad actors, they can help flag
providers who have repeat errors and may pose a risk.
For the past three years, ProPublica has asked patients whove been harmed
and their family members for their stories. Weve heard the same things time
and time again: After a medical error comes a struggle to get straight
answers and accountability. Financial compensation for additional care,
pain, disability or lost work is reserved only for a relative few.
The U.S. system for compensating injured patients medical malpractice
lawsuits effectively shuts out patients when the potential damages are
small. Proving negligence, the usual standard for winning compensation, is
difficult. There are scant incentives for doctors and hospitals to
apologize, reveal details about what happened, or report errors that might
unveil a pattern.
Denmark offers a radically different alternative, as do similar programs in
other Scandinavian countries and New Zealand. To be sure, these countries
have nationalized health care systems, unlike the public-private model in
the U.S. But alternative responses to patient harm have been tried on a
smaller scale. Virginia, for example, has a program designed to compensate
for severe neurological childbirth injuries that is similar in some ways to
the Danish system.
Common to all these programs is a commitment to provide information and
compensation to patients regardless of whether negligence is involved. That
lowers the bar of entry for patients and doesnt pit doctors against them,
enabling providers to be open about what happened.
Its not easy to discuss a mistake, but there has to be a very safe
relationship between doctor and patient, Hamberg said. The most important
thing in patient safety is to talk about it.
Denmarks compensation program has been in place since 1992, replacing a
lawsuit-based approach much like that in the U.S. The change followed a
series of high-profile cases in which patients werent able to get
compensation through the courts because it was too difficult to prove their
doctor did something wrong. The Danish parliament adopted a system similar
to those used in Norway and Sweden.
Today, medical injury claims arent handled by the Danish court system but
by medical and legal experts who review cases at no charge to patients.
Patients get answers and can participate in the process whether or not they
ultimately receive a monetary award.
Filing a claim is free. Patients are assigned a caseworker to shepherd them
through the process. The hospital or doctor is required to file a detailed
response, which patients may rebut. Patients have access to their complete
medical record and a detailed explanation of the medical reviewers
decisions. All of this is available for patients and their families through
an online portal, which alerts them when there are developments in their
claims process.
Compensation is awarded if reviewers determine the care could have been
better, or if the patient experienced a rare and severe complication that
was more extensive than the patient should reasonably have to endure.
Reviewers most often apply one of two criteria, said Peter Jakobsen, chief
consultant for legal affairs at the Patient Compensation Association, the
body that adjudicates claims. The first is the specialist rule: How did
the treatment compare to care an experienced specialist would provide?
The patient is entitled to compensation if not treated at this level,
Jakobsen said. You can have a situation with compensation where the doctor
did a normal, good job, but not at the specialist level.
A second common criterion is the fairness rule. If the patient experienced
a severe medical event that occurs less than 2 percent of the time, he or
she is eligible for an award. An unusual drug reaction or an infection after
a knee replacement are examples.
Patients may file an appeal at no cost if their claim is rejected. Appeals
are reviewed by a seven-member board of doctors, patient representatives, an
attorney and two representatives of the Danish health care system. Patients
may request district court review after an unsuccessful appeal, although
that happens in only about 2 percent of claims.
If a patient believes negligence was involved, it can be reported to a
parallel system for professional discipline.
Overall, about one in three patients who file a claim is compensated. The
minimum eligible claim is under $2,000, and the average paid out is $30,000,
or about 15 percent of the typical amount awarded in lawsuits against U.S.
doctors.
However, its estimated that more than seven times as many claims are filed
per capita in Denmark, and about four times as many patients per capita
receive some award. A claim for a few thousand dollars would not be worth it
in the U.S. system because of the high cost of pursuing lawsuits.
The Danish health care system helps patients file medical injury claims by
providing an independent nurse with legal training to assist at every
hospital. Because physicians dont have the threat of malpractice hanging
over them, they also can be helpful to patients who have been harmed.
Danish doctors are known to file compensation claims on behalf of patients,
which occurs in about 10 percent of the cases. All Danish physicians are
legally required to tell patients when theyve been harmed during medical
care. That is not always the case in the United States, where state
disclosure laws vary and almost never cover the information patients most
desire.
Hamberg said he recently saw a patient whose liver was damaged from taking a
medication for too long, a decision made by her doctor. It was very natural
for me to say, You have been treated not to the best standard, he said.
Hamberg told her she could seek compensation, and I hope she does, he
said.
The Danish system is not perfect. Although the data collected from claims is
freely shared with researchers, injury and error rates are not published so
that patients could use them to select providers. By design, there is not
communication between the claims and disciplinary systems.
The case of 59-year-old Jørgen Hemmer illustrates other potential
difficulties for patients.
After surviving a bout with colon cancer in 2007, Hemmer underwent CT scans
every six months. In July 2009, he was pronounced cancer free. Then, six
months later, blood appeared in his urine. Doctors said he needed
chemotherapy for cancer in his bladder and on his pelvis.
Those treatments failed, and Hemmer was told his best hope was surgery: He
would lose his right hip and leg, and his bladder.
The rapid change in prognosis from cheery to grim in a few months made
Hemmer suspicious, and he requested his medical records. He went through
them at his dining room table and made a frustrating discovery: The Danish
government had subcontracted reading of CT scans to a firm in Barcelona. A
note from 2010 in his file indicated the subcontractors radiologist had
missed the cancer.
Just getting answers about what went wrong brought him some closure, Hemmer
said, but he also wanted compensation for the drastic change in his life. A
soldier in the Danish army, Hemmer had been transferred to a job he could
still perform as an amputee. But in a year, he will face mandatory military
retirement and will need other work.
Theres a lot more in me, a lot more left, he said. They took away some
of my possibilities.
In the summer of 2010, he filed a compensation claim. Hemmer was shocked
when he was rejected on grounds that the system wasnt responsible for an
error by a subcontractor outside of Denmark. It was just as difficult to
understand as when they told me, We have to take your leg, he said.
The Danish Cancer Society agreed to help him file an appeal, which initially
was rejected as well. But the compensation appeals board later reconsidered
and offered him $5,000. With guidance from an attorney affiliated with the
Cancer Society, he filed an appeal to district court. Finally, five years
after his initial filing, the court concluded an error had occurred, and the
Patient Compensation Association agreed to pay him $110,000.
Hemmer said the amount isnt what he hoped for. But the government helps in
other ways, by providing aides to help with household chores and to tend his
garden. Most of his medical expenses are covered by the government health
care system, which is free to Danish citizens.
Grafting a program like Denmarks onto the U.S. health care system would be
a profound departure, but some experts say its possible and has some
precedents.
Virginia and Florida have compensation programs that cover the lifetime
costs of infants who are harmed by certain neurological injuries during
birth, regardless of negligence. In Virginia, hospitals and obstetricians in
the state pay into a central fund, which then pays out to successful
claimants. Nearly all births in the state are covered by this system.
Dr. Allen Kachalia, the chief quality officer at Brigham and Womens
Hospital in Boston, has researched Denmarks program and others like it. He
said something similar merits introduction and testing on a small scale in a
single state or privately-owned health care organization. Funding could come
from savings in the inefficient malpractice system, he said.
According to a 2010 study by the Harvard School of Public Health, $5.7
billion is spent annually in the U.S. on malpractice claim payments, but
almost as much $4 billion goes toward administrative and other claims
expenses. That overhead rate is much higher than Denmarks, which is
estimated to be less than 20 percent.
Proposed alternatives to the U.S. medical malpractice system have been
strongly opposed by some powerful interest groups, most prominently trial
lawyers.
Scott Eldredge, an attorney in Englewood, Colorado, and president of the
National Medical Malpractice Trial Lawyers Association, said he is
completely opposed to a compensation system like Denmarks. Eldredge
acknowledged that the U.S. malpractice system is tilted in favor of
medical providers, and that most patients cant get an attorney because
their cases arent worth enough money. He said he turns down 98 out of 100
of cases he reviews.
But Eldredge said jury trials ultimately are more transparent and fair
because patients are represented by experienced attorneys and have their
claims decided by peers. Compensation for successful cases would likely be
less with a Danish-style system, he said.
My fear would be that those with economically viable cases would take
pennies on the dollar when their case is worth substantially more, he said.
Theoretically it sounds good, but in practice I dont see a benefit.
Lisa McGiffert, project director for the Consumer Reports Safe Patient
Project, said a system like Denmarks could offer important benefits. Most
U.S. patients are never told the full story about what happened to them, she
said, and lawsuits are only an option for a tiny fraction.
Larger awards would be necessary, however, to fairly compensate patients,
McGiffert said. Thats because unlike Denmark, U.S. patients still need to
pay for medical care and have a less comprehensive social safety net if they
are disabled or out of work.
Alternative ways of redressing medical injuries can give patients better
access to compensation and at the same time address the fears and stress
that the system causes on physicians, Kachalia said. And if we designed
this proactively, we can design it to collect information about what types
of errors occur most often in our system so that providers can focus our
safety efforts.
In Denmark, Kim Mikkelsen, an epidemiologist, is responsible for the
database of 120,000 claims housed at the Patient Compensation Association.
In minutes he can query a massive amount of useful data, as he demonstrated
on a recent visit to his office, housed in a modern structure overlooking
the South Harbor with a panoramic view of central Copenhagen.
In less than five minutes Mikkelsen pulled a record of every hospital fall
injury reported in Denmark during the last five years. Falls are a major
problem in U.S. hospitals, but theres no such centralized data that would
allow researchers to identify patterns.
The Denmark data has revealed many areas for improvement. One cluster of
cases involved osteoporosis related to a common type of hormone therapy.
Doctors determined that the issue could be largely addressed by giving
patients calcium and Vitamin D. Another analysis identified a pattern of
missed breast cancer diagnoses that paved the way for new practices.
We help direct focus on preventable, serious and widespread types of
injuries, Mikkelsen said.
The association itself has limited resources to analyze its data, but
researchers like Dr. Morten Hedegaard, head of obstetrics at the national
hospital, are able to dig in.
In November, as Hedegaard walked along his busy ward more than 5,000
infants were born at the hospital in 2015 it is clear he is passionate
about delivering babies. Its so meaningful, he said. As a trained
epidemiologist, however, Hedegaards second passion is finding patterns in
data.
Using 10 years of compensation claims, Hedegaard conducted a study of birth
injuries. He determined that doctors and midwives were not properly reading
fetal monitoring strips, which led to delays in care. The finding resulted
in a nationwide program to retrain and recertify all 2,000 providers who
deliver babies in Denmark.
Now Hedegaard has a Ph.D. student using data to see if recertification
worked.
The data could be used even more effectively, Hedegaard said. For example,
it could be monitored in real time to identify individual hospitals or
clinicians who do not have the quality they should have. One private
hospital with a high rate of complications after knee replacements was
identified using claims data, Hedegaard said, but only after several years.
Hedegaard and Hamberg said that if a doctor in their departments had
multiple claims for mistakes, they would intervene. This is a less direct
way that the data can be used to hold doctors accountable, Hedegaard said.
Its certain there are many more clues in the claims data that could help
make patients safer, Hedegaard said. Without such data, he said, that
knowledge is lost.
Read more of ProPublicas reporting on patient safety and patient privacy.
ProPublica is a Pulitzer Prize-winning investigative newsroom.
http://www.truthdig.com/ http://www.truthdig.com/
How Denmark Dumped Medical Malpractice and Improved Patient Safety
http://www.truthdig.com/report/item/how_denmark_dumped_medical_malpractice_a
nd_improved_patient_safety_20160103/
Posted on Jan 3, 2016
By Olga Pierce and Marshall Allen / ProPublica
Shutterstock
This piece originally ran on ProPublica.
COPENHAGEN It was a distressingly close call. A patient had been sent home
from the hospital with instructions to take a common medication at a dose
that would have poisoned her.
When Dr. Ole Hamberg heard about the mistake, he decided to investigate.
Hamberg, the head liver specialist at Rigshospitalet, the Danish national
hospital, soon found something troubling. The hospitals electronic
prescribing system was mistakenly prompting doctors to give the drug,
methotrexate, for daily use when it is safely taken only once or twice a
week.
Patients throughout Denmark were being poisoned, Hamberg learned, thanks to
the medical error. At his hospital, Hamberg made sure prescribing protocols
were fixed and doctors and patients were informed. The problem quickly
abated.
Hamberg was able to rapidly see a dangerous pattern because of something
that doesnt exist in the United States: A comprehensive national program to
compensate victims of patient harm and to learn from them by collecting
and analyzing the data their experiences provide.
Patients whod been overdosed filed claims under the compensation program,
which makes its data available to hospitals and researchers. Of course I
use this information in my department, Hamberg said. We discuss how we can
avoid this injury the next time.
The Danish system offers lessons for policymakers in the United States,
where medical harm remains widespread and the mechanisms for addressing it
are often cumbersome and adversarial. The Danes primary focus is on helping
patients who have been hurt by the health care system. While the reams of
data gathered from claims arent used to publicly rate doctors and
hospitals, or to systematically search for bad actors, they can help flag
providers who have repeat errors and may pose a risk.
For the past three years, ProPublica has asked patients whove been harmed
and their family members for their stories. Weve heard the same things time
and time again: After a medical error comes a struggle to get straight
answers and accountability. Financial compensation for additional care,
pain, disability or lost work is reserved only for a relative few.
The U.S. system for compensating injured patients medical malpractice
lawsuits effectively shuts out patients when the potential damages are
small. Proving negligence, the usual standard for winning compensation, is
difficult. There are scant incentives for doctors and hospitals to
apologize, reveal details about what happened, or report errors that might
unveil a pattern.
Denmark offers a radically different alternative, as do similar programs in
other Scandinavian countries and New Zealand. To be sure, these countries
have nationalized health care systems, unlike the public-private model in
the U.S. But alternative responses to patient harm have been tried on a
smaller scale. Virginia, for example, has a program designed to compensate
for severe neurological childbirth injuries that is similar in some ways to
the Danish system.
Common to all these programs is a commitment to provide information and
compensation to patients regardless of whether negligence is involved. That
lowers the bar of entry for patients and doesnt pit doctors against them,
enabling providers to be open about what happened.
Its not easy to discuss a mistake, but there has to be a very safe
relationship between doctor and patient, Hamberg said. The most important
thing in patient safety is to talk about it.
Denmarks compensation program has been in place since 1992, replacing a
lawsuit-based approach much like that in the U.S. The change followed a
series of high-profile cases in which patients werent able to get
compensation through the courts because it was too difficult to prove their
doctor did something wrong. The Danish parliament adopted a system similar
to those used in Norway and Sweden.
Today, medical injury claims arent handled by the Danish court system but
by medical and legal experts who review cases at no charge to patients.
Patients get answers and can participate in the process whether or not they
ultimately receive a monetary award.
Filing a claim is free. Patients are assigned a caseworker to shepherd them
through the process. The hospital or doctor is required to file a detailed
response, which patients may rebut. Patients have access to their complete
medical record and a detailed explanation of the medical reviewers
decisions. All of this is available for patients and their families through
an online portal, which alerts them when there are developments in their
claims process.
Compensation is awarded if reviewers determine the care could have been
better, or if the patient experienced a rare and severe complication that
was more extensive than the patient should reasonably have to endure.
Reviewers most often apply one of two criteria, said Peter Jakobsen, chief
consultant for legal affairs at the Patient Compensation Association, the
body that adjudicates claims. The first is the specialist rule: How did
the treatment compare to care an experienced specialist would provide?
The patient is entitled to compensation if not treated at this level,
Jakobsen said. You can have a situation with compensation where the doctor
did a normal, good job, but not at the specialist level.
A second common criterion is the fairness rule. If the patient experienced
a severe medical event that occurs less than 2 percent of the time, he or
she is eligible for an award. An unusual drug reaction or an infection after
a knee replacement are examples.
Patients may file an appeal at no cost if their claim is rejected. Appeals
are reviewed by a seven-member board of doctors, patient representatives, an
attorney and two representatives of the Danish health care system. Patients
may request district court review after an unsuccessful appeal, although
that happens in only about 2 percent of claims.
If a patient believes negligence was involved, it can be reported to a
parallel system for professional discipline.
Overall, about one in three patients who file a claim is compensated. The
minimum eligible claim is under $2,000, and the average paid out is $30,000,
or about 15 percent of the typical amount awarded in lawsuits against U.S.
doctors.
However, its estimated that more than seven times as many claims are filed
per capita in Denmark, and about four times as many patients per capita
receive some award. A claim for a few thousand dollars would not be worth it
in the U.S. system because of the high cost of pursuing lawsuits.
The Danish health care system helps patients file medical injury claims by
providing an independent nurse with legal training to assist at every
hospital. Because physicians dont have the threat of malpractice hanging
over them, they also can be helpful to patients who have been harmed.
Danish doctors are known to file compensation claims on behalf of patients,
which occurs in about 10 percent of the cases. All Danish physicians are
legally required to tell patients when theyve been harmed during medical
care. That is not always the case in the United States, where state
disclosure laws vary and almost never cover the information patients most
desire.
Hamberg said he recently saw a patient whose liver was damaged from taking a
medication for too long, a decision made by her doctor. It was very natural
for me to say, You have been treated not to the best standard, he said.
Hamberg told her she could seek compensation, and I hope she does, he
said.
The Danish system is not perfect. Although the data collected from claims is
freely shared with researchers, injury and error rates are not published so
that patients could use them to select providers. By design, there is not
communication between the claims and disciplinary systems.
The case of 59-year-old Jørgen Hemmer illustrates other potential
difficulties for patients.
After surviving a bout with colon cancer in 2007, Hemmer underwent CT scans
every six months. In July 2009, he was pronounced cancer free. Then, six
months later, blood appeared in his urine. Doctors said he needed
chemotherapy for cancer in his bladder and on his pelvis.
Those treatments failed, and Hemmer was told his best hope was surgery: He
would lose his right hip and leg, and his bladder.
The rapid change in prognosis from cheery to grim in a few months made
Hemmer suspicious, and he requested his medical records. He went through
them at his dining room table and made a frustrating discovery: The Danish
government had subcontracted reading of CT scans to a firm in Barcelona. A
note from 2010 in his file indicated the subcontractors radiologist had
missed the cancer.
Just getting answers about what went wrong brought him some closure, Hemmer
said, but he also wanted compensation for the drastic change in his life. A
soldier in the Danish army, Hemmer had been transferred to a job he could
still perform as an amputee. But in a year, he will face mandatory military
retirement and will need other work.
Theres a lot more in me, a lot more left, he said. They took away some
of my possibilities.
In the summer of 2010, he filed a compensation claim. Hemmer was shocked
when he was rejected on grounds that the system wasnt responsible for an
error by a subcontractor outside of Denmark. It was just as difficult to
understand as when they told me, We have to take your leg, he said.
The Danish Cancer Society agreed to help him file an appeal, which initially
was rejected as well. But the compensation appeals board later reconsidered
and offered him $5,000. With guidance from an attorney affiliated with the
Cancer Society, he filed an appeal to district court. Finally, five years
after his initial filing, the court concluded an error had occurred, and the
Patient Compensation Association agreed to pay him $110,000.
Hemmer said the amount isnt what he hoped for. But the government helps in
other ways, by providing aides to help with household chores and to tend his
garden. Most of his medical expenses are covered by the government health
care system, which is free to Danish citizens.
Grafting a program like Denmarks onto the U.S. health care system would be
a profound departure, but some experts say its possible and has some
precedents.
Virginia and Florida have compensation programs that cover the lifetime
costs of infants who are harmed by certain neurological injuries during
birth, regardless of negligence. In Virginia, hospitals and obstetricians in
the state pay into a central fund, which then pays out to successful
claimants. Nearly all births in the state are covered by this system.
Dr. Allen Kachalia, the chief quality officer at Brigham and Womens
Hospital in Boston, has researched Denmarks program and others like it. He
said something similar merits introduction and testing on a small scale in a
single state or privately-owned health care organization. Funding could come
from savings in the inefficient malpractice system, he said.
According to a 2010 study by the Harvard School of Public Health, $5.7
billion is spent annually in the U.S. on malpractice claim payments, but
almost as much $4 billion goes toward administrative and other claims
expenses. That overhead rate is much higher than Denmarks, which is
estimated to be less than 20 percent.
Proposed alternatives to the U.S. medical malpractice system have been
strongly opposed by some powerful interest groups, most prominently trial
lawyers.
Scott Eldredge, an attorney in Englewood, Colorado, and president of the
National Medical Malpractice Trial Lawyers Association, said he is
completely opposed to a compensation system like Denmarks. Eldredge
acknowledged that the U.S. malpractice system is tilted in favor of
medical providers, and that most patients cant get an attorney because
their cases arent worth enough money. He said he turns down 98 out of 100
of cases he reviews.
But Eldredge said jury trials ultimately are more transparent and fair
because patients are represented by experienced attorneys and have their
claims decided by peers. Compensation for successful cases would likely be
less with a Danish-style system, he said.
My fear would be that those with economically viable cases would take
pennies on the dollar when their case is worth substantially more, he said.
Theoretically it sounds good, but in practice I dont see a benefit.
Lisa McGiffert, project director for the Consumer Reports Safe Patient
Project, said a system like Denmarks could offer important benefits. Most
U.S. patients are never told the full story about what happened to them, she
said, and lawsuits are only an option for a tiny fraction.
Larger awards would be necessary, however, to fairly compensate patients,
McGiffert said. Thats because unlike Denmark, U.S. patients still need to
pay for medical care and have a less comprehensive social safety net if they
are disabled or out of work.
Alternative ways of redressing medical injuries can give patients better
access to compensation and at the same time address the fears and stress
that the system causes on physicians, Kachalia said. And if we designed
this proactively, we can design it to collect information about what types
of errors occur most often in our system so that providers can focus our
safety efforts.
In Denmark, Kim Mikkelsen, an epidemiologist, is responsible for the
database of 120,000 claims housed at the Patient Compensation Association.
In minutes he can query a massive amount of useful data, as he demonstrated
on a recent visit to his office, housed in a modern structure overlooking
the South Harbor with a panoramic view of central Copenhagen.
In less than five minutes Mikkelsen pulled a record of every hospital fall
injury reported in Denmark during the last five years. Falls are a major
problem in U.S. hospitals, but theres no such centralized data that would
allow researchers to identify patterns.
The Denmark data has revealed many areas for improvement. One cluster of
cases involved osteoporosis related to a common type of hormone therapy.
Doctors determined that the issue could be largely addressed by giving
patients calcium and Vitamin D. Another analysis identified a pattern of
missed breast cancer diagnoses that paved the way for new practices.
We help direct focus on preventable, serious and widespread types of
injuries, Mikkelsen said.
The association itself has limited resources to analyze its data, but
researchers like Dr. Morten Hedegaard, head of obstetrics at the national
hospital, are able to dig in.
In November, as Hedegaard walked along his busy ward more than 5,000
infants were born at the hospital in 2015 it is clear he is passionate
about delivering babies. Its so meaningful, he said. As a trained
epidemiologist, however, Hedegaards second passion is finding patterns in
data.
Using 10 years of compensation claims, Hedegaard conducted a study of birth
injuries. He determined that doctors and midwives were not properly reading
fetal monitoring strips, which led to delays in care. The finding resulted
in a nationwide program to retrain and recertify all 2,000 providers who
deliver babies in Denmark.
Now Hedegaard has a Ph.D. student using data to see if recertification
worked.
The data could be used even more effectively, Hedegaard said. For example,
it could be monitored in real time to identify individual hospitals or
clinicians who do not have the quality they should have. One private
hospital with a high rate of complications after knee replacements was
identified using claims data, Hedegaard said, but only after several years.
Hedegaard and Hamberg said that if a doctor in their departments had
multiple claims for mistakes, they would intervene. This is a less direct
way that the data can be used to hold doctors accountable, Hedegaard said.
Its certain there are many more clues in the claims data that could help
make patients safer, Hedegaard said. Without such data, he said, that
knowledge is lost.
Read more of ProPublicas reporting on patient safety and patient privacy.
ProPublica is a Pulitzer Prize-winning investigative newsroom.
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