Trends in malpractice awards and adverse actions (e.g., revocation of provider license) following an act or omission constituting medical error or negligence were examined. The National Practitioner Data Bank was used to compare rates of malpractice reports and adverse actions for physicians, physician assistants (PAs), and nurse practitioners (NPs). During 2005 through 2014, there ranged from 11.2 to 19.0 malpractice payment reports per 1,000 physicians, 1.4 to 2.4 per 1,000 PAs, and 1.1 to 1.4 per 1,000 NPs. Physician median payments ranged from 1.3 to 2.3 times higher than PAs or NPs. Diagnosis-related malpractice allegations varied by provider type, with physicians having significantly fewer reports (31.9%) than PAs (52.8%) or NPs (40.6%) over the observation period. Trends in malpractice payment reports may reflect policy enactments to decrease liability.

We assessed whether physician assistant (PA) and nurse practitioner (NP) utilization increases liability. In total, 17 years of data compiled in the United States National Practitioner Data Bank (NPDB) was used to compare and analyze malpractice incidence, payment amount and other measures of liability among doctors, PAs and advanced practice nurses (APNs). From 1991 through 2007, 324,285 NPDB entries were logged, involving 273,693 providers of interest. Significant differences were found in liability reports among doctors, PAs and APNs. Physicians made, on average, malpractice payments twice that of PAs but less than that of APNs. During the study period the probability of making a malpractice payment was 12 times less for PAs and 24 times less for APNs. For all three providers, missed diagnosis was the leading reason for malpractice report, and female providers incurred higher payments than males. Trend analysis suggests that the rate of malpractice payments for physicians, PAs and APNs has been steady and consistent with the growth in the number of providers. There were no observations or trends to suggest that PAs and APNs increase liability. If anything, they may decrease the rate of reporting malpractice and adverse events. From a policy standpoint, it appears that the incorporation of PAs and APNs into American society has been a safe and beneficial undertaking, at least when compared to doctors.

How familliar are they with regular healthcare management terms?

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A high proportion of the US primary care workforce reports burnout, which is associated with negative consequences for clinicians and patients. The literature on patient-centered medical home (PCMH) and burnout is limited, with most fi ndings based on small-scale demonstration projects among physicians. A study determined if components of PCMH related to team-based care were associated with lower burnout among primary care team members participating in the US Department of Veterans Affairs (VA) Patient Aligned Care Team (PACT). The study design included a web-based, cross-sectional survey of 4,539 VA primary care personnel. The dependent variable was burnout, and the independent variables were measures of team-based care: team functioning, time spent in huddles, team staffi ng, delegation of clinical responsibilities, working to top of competency, and collective self-effi cacy. Overall, 39% of respondents reported burnout. Participatory decisionmaking and having a fully staffed PACT were associated with lower burnout; higher burnout was associated with being assigned to a PACT, spending time on work that someone with less training could do, and having a stressful, fast-moving work environment. Lower burnout may be achieved by PCMHs that are appropriately staffed, emphasize anticipatory decisionmaking, and increase the proportion of time team members spend working to the top of their competency level. 1 REFERENCE 1. Helfrich CD1, Dolan ED, Simonetti J, et al. Elements of teambased care in a patient-centered medical home are associated with lower burnout among VA primary care employees. ABSTRACTCohort data from the 2009-2010 Acute Physiology and Chronic Health Evaluation clinical information system and an ICU-level survey included patients admitted to 29 adult medical and mixed medical-surgical ICUs in 22 US hospitals. The primary exposure was admission to an ICU where NPs and PAs participated in patient care; the outcome was patient level in-hospital mortality. We used multivariable relative ABSTRACT Evolving state law, professional societies, and national guidelines, including those of the American Medical Association and the Joint Commission, recommend that patients receive