In 1999 the Washington Medical Quality Commission began categorizing all entering claims against physicians and physician assistants. The project’s purpose was to develop a database to quantify types, and relative frequencies of complaints coming to our initial review panels. A secondary goal was to develop a grid by which cases might be identified by case number, category, and narrative for in-depth analysis and study. This paper describes the data collection system for the trial period of July 2000 to July 2002.
METHODS
Complaints are collected in packets to be distributed to telephone panel members in advance of conferences scheduled at three-week intervals. Each case has a number and a narrative of the complaint. Depending upon the assignment by staff, some reports will contain an investigative summary. Others will have only the entering complaint. Three commissioners (including one public member) will decide only to close or move the case on to a reviewing commissioner. All closures must be unanimous. For the study, we designated 27 categories as listed below in Figure 1.
The selection was based upon our sense of the most common complaint categories that we receive. Assignment is a subjective decision made by the reviewer after reading the complaint narrative. A miscellaneous category (aa) was included for unusual cases. Early on, we recognized that more than one category might be appropriate for a given case. Accordingly, we allow up to three categories for each case.
At the end of each line a short narrative summary written by the reviewer summarizes the essential elements of the case, which are shown below in Figure 2.
RESULTS
Total cases involved: 1,430
On the following page, Figure 3 shows the complaint category totals, and includes a total of 1,796 results among 1,430 cases. Figure 4 shows a breakdown of case conclusion by category in the form of a pie chart.
COMMENT
As the data was being collected, some of the categories stood out in their frequency and current importance. A cluster of large VBAC settlements in 1999 prompted a newsletter article for circulation among Washington physicians. In the article we added our opinions on the issue to other opinions emerging in available literature at that time, warning of the disastrous complications that can result from a ruptured uterus.
Three additional categories were discussed in the newsletter:
“When a Dissatisfied Patient Complains” used several narrative summary statements to illustrate the types of aggravations causing patients to complain about their physicians.
“When Death is the Complaint” called attention to the importance of keeping relatives of the dying patient fully informed and respected.
“When Bad Things Happen” traced the slippery slope of denial when a physician doesn’t react appropriately to surgcal complications.
OTHER USES
As this project passes to the next phase, we expect to be able to focus on specific topics such as those concerning the social transgressions of substance abuse, boundary violations, and disruptive physician behavior. From the raw data, it is possible to quickly gather case numbers under the categories to be studied and then to pull charts from the archives. Additional categories and specialty designations will be in the data collection template as the project goes forward. We anticipate that physician specialty groups will have an interest in feedback concerning issues unique to their practice.
CONCLUSION
A two-year project trial of categorizing Initial Review Panel cases appears to be the foundation for a useful database for analyzing complaint patterns against Washington physicians. We plan to continue the project, making modifications as needed to clarify study objectives.
