In a word Baycol ... ever heard ofit? I bet you haven't. That's because of the
white wall of silence we have here in the U.S.
Frank
-----Original Message-----
From: blind-democracy-bounce@xxxxxxxxxxxxx
[mailto:blind-democracy-bounce@xxxxxxxxxxxxx] On Behalf Of Miriam Vieni
Sent: Monday, January 4, 2016 12:33 PM
To: blind-democracy@xxxxxxxxxxxxx
Subject: [blind-democracy] How Denmark Dumped Medical Malpractice and Improved
Patient Safety
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 hospital's 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
doesn't 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 who'd 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 aren't 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 who've been harmed and
their family members for their stories. We've 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 doesn't pit doctors against them,
enabling providers to be open about what happened.
"It's 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."
Denmark's 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 weren't 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 aren't 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, it's 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 don't 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 they've 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 subcontractor's 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.
"There's 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 wasn't 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 isn't 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 Denmark's onto the U.S. health care system would be a
profound departure, but some experts say it's 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 Women's Hospital
in Boston, has researched Denmark's 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 Denmark's, 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 Denmark's. Eldredge acknowledged that
the U.S. malpractice system is "tilted in favor" of medical providers, and that
most patients can't get an attorney because their cases aren't 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 don't see a benefit."
Lisa McGiffert, project director for the Consumer Reports Safe Patient Project,
said a system like Denmark's 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. That's 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 there's 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. "It's so meaningful," he said. As a trained epidemiologist,
however, Hedegaard's 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.
It's 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 ProPublica's 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 hospital's 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
doesn't 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 who'd 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 aren't 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 who've been harmed and
their family members for their stories. We've 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 doesn't pit doctors against them,
enabling providers to be open about what happened.
"It's 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."
Denmark's 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 weren't 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 aren't 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, it's 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 don't 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 they've 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 subcontractor's 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.
"There's 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 wasn't 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 isn't 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 Denmark's onto the U.S. health care system would be a
profound departure, but some experts say it's 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 Women's Hospital
in Boston, has researched Denmark's 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 Denmark's, 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 Denmark's. Eldredge acknowledged that
the U.S. malpractice system is "tilted in favor" of medical providers, and that
most patients can't get an attorney because their cases aren't 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 don't see a benefit."
Lisa McGiffert, project director for the Consumer Reports Safe Patient Project,
said a system like Denmark's 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. That's 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 there's 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. "It's so meaningful," he said. As a trained epidemiologist,
however, Hedegaard's 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.
It's 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 ProPublica's reporting on patient safety and patient privacy.
ProPublica is a Pulitzer Prize-winning investigative newsroom.
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