Physicians who study malpractice claims data can keep history from repeating itself. Or at least that's the theory behind a growing number of programs that use malpractice-claims data for educational purposes.

According to the Wall Street Journal, managed-care giant Kaiser Permanente relies on close tracking and follow-up of patients with abnormal test results to avoid missed diagnoses. Over the past 15 years, it has identified 420,000 abnormal biopsies and 320,000 abnormal mammograms. As a result, 450 patients were found to have a new or recurrent cancer or an abnormal biopsy "who would not have been found if we did not bring them in proactively," said breast cancer surgeon Susan Kutner.

And while it is becoming increasingly common to see electronic alerts and reminders to order tests and follow up on lab reports, the Veterans Health Administration is looking for ways to combat the negating effects of 'alert fatigue.' Hardeep Singh, chief of the health quality and policy program at the Houston VA research center, said its studies also show that if both a primary-care doctor and a specialist get test results, each assumes the other will follow up.

In the meantime, Crico/RMF, a malpractice insurer that covers Harvard University-affiliated hospitals and doctors, is offering CME credits to doctors who study its analysis of the closed malpractice cases. And in a program it is co-sponsoring at Brigham and Women's Hospital in Boston, researchers are working with 16 primary-care practices in Massachusetts, using lessons from the claims to help them avoid common pitfalls such as failing to order diagnostic tests or follow up on abnormal results.

"These errors may be less visible and dramatic than getting the wrong leg cut off, but a delay in diagnosis can adversely affect a patient's long-term outcome," says Dr. Gordon Schiff, associate director of patient safety research at Brigham's. Malpractice cases "let us drill down and learn deeper lessons, like what could have been done differently," Schiff says.

To learn more:
- read the article in the Wall Street Journal

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