Risk Management in Obstetric Care for Family Physicians: Results of a 10-Year Project

Abstract

Background: Malpractice issues within the United States remain a critical factor for family physicians providing obstetric care. Although tort reform is being widely discussed, little has been written regarding the malpractice crisis from a risk management perspective.Methods: Between 1989 and 1998, a 10-year risk management study at the UC Davis Health System provided a unique collaboration between researchers, a mutual insurance carrier and family physicians practicing obstetrics. Physicians were asked to comply with standardized clinical guidelines, attend continuing medical education (CME) seminars, and submit obstetric medical records for review. Feedback analysis was provided to each physician on their records, and the insurance carrier tracked interim malpractice claims.

Risk adjustment in maternity care: the use of indirect standardization

“…Second, our method of selecting risk factors for the indirect standardization procedure may have identified underlying risk factors that are not usually understood to be associated with cesarean delivery but that are more commonly found in the practices of family physicians. For example, anemia and substance abuse have been described as important risk factors for cesarean delivery,30,31 yet these risk factors are not usually included in the strategies that direct family physicians to co-manage or refer their pregnant patients to obstetrician-specialists 1,2. Furthermore, because anemia and substance abuse may be more prevalent in socio-economically disadvantaged groups, and because family physicians often have higher percentage of socio-economically disadvantaged patients in their practices than obstetrics-specialists,21 it is reasonable to consider that the practices of family physicians may contain higher levels of certain mild-moderate risk for cesarean delivery in a systematic way.…”

“…In keeping with this assumption, a variety of recommendations currently exist that outline the degree of involvement a family physician should take in maternity cases with increased risk 1,2. At low levels of risk patients can be routinely managed by family physicians.…”

“…At moderate levels of risk patients should be considered for referral for consultation with an obstetrician-specialist, but co-management remains an option. At high levels of risk most recommendations call for outright referral or transfer of the woman to an obstetrician-specialist 1,2…”

Model testing on the crisis interventions and actions to prevent medical disputes: a Taiwanese nursing perspective

“…Nesbitt et al. (2003) asserted that well‐designed risk management programmes can help decrease the number of medical disputes/errors as well as prevent a crisis from worsening and becoming disastrous.…”

“…Nesbitt et al. (2003) studied the risk management programme for family physicians who provided obstetric care over a 10‐year period in the US.…”