PMID- 28584209
OWN - NLM
STAT- MEDLINE
DCOM- 20180409
LR  - 20181113
IS  - 2542-5641 (Electronic)
IS  - 0366-6999 (Print)
IS  - 0366-6999 (Linking)
VI  - 130
IP  - 12
DP  - 2017 Jun 20
TI  - Analysis of Closed Claims in the Clinical Management of Rheumatoid Arthritis in 
      Japan.
PG  - 1454-1458
LID - 10.4103/0366-6999.207479 [doi]
AB  - BACKGROUND: Despite an increasing awareness of the risk of medical errors, few 
      data sources are available to highlight the characteristics and patterns of 
      medical errors in the clinical management of rheumatoid arthritis (RA). The 
      present study aimed to evaluate medical malpractice claims associated with the 
      management of RA and other autoimmune connective tissue diseases (ACTDs). 
      METHODS: We analyzed 38 ACTD-associated closed claims extracted from a total of 
      8530 claims processed between July 2004 and June 2014 by the Tokyo headquarters 
      office of Sompo Japan Nipponkoa Incorporated, a leading malpractice insurer in 
      Japan. RESULTS: RA was the most common ACTD assessed in this study, accounting 
      for 20 cases. Although the male-to-female ratio among these cases was 5:15, in 
      accordance with the general demographic distribution of RA, the proportion of 
      patients older than 60 years (77.8%) was relatively high as the general range of 
      RA susceptibility is 30-50 years. The analysis of allegation types among RA cases 
      revealed statistically significant differences from non-RA cases (Fisher's exact 
      test) as well as the following key findings: diagnosis-related allegations were 
      absent (P < 0.01), whereas medication-related allegations were distinctively 
      common (P = 0.02). Clinical processes related to the assessment process were most 
      vulnerable to breakdown and leading to negligence identified with subsequent 
      medication-related allegations, particularly among RA cases. CONCLUSIONS: The 
      characteristics of malpractice claims associated with RA management, including 
      the high frequency of medication-related allegations, breakdowns in the 
      assessment process, and high claim numbers among patients older than 60 years, 
      suggest the importance of caution exercised by physicians when administering 
      immunosuppressants for the clinical treatment of RA.
FAU - Otaki, Yasuhiro
AU  - Otaki Y
AD  - General Medical Education and Research Center, Teikyo University, Tokyo 1738605, 
      Japan.
FAU - Ishida, Makiko DaSilva
AU  - Ishida MD
AD  - National Center of Neurology and Psychiatry, Tokyo 1878551, Japan.
FAU - Saito, Yuichi
AU  - Saito Y
AD  - Specialty Claims Department, Sompo Japan Nipponkoa Insurance Incorporated, Tokyo 
      1648608, Japan.
FAU - Oyama, Yasuaki
AU  - Oyama Y
AD  - Specialty Claims Department, Sompo Japan Nipponkoa Insurance Incorporated, Tokyo 
      1648608, Japan.
FAU - Oiso, Giichiro
AU  - Oiso G
AD  - Department of Integrated Human Sciences, Hamamatsu University School of Medicine, 
      Shizuoka 4313192, Japan.
FAU - Moriyama, Mitsuru
AU  - Moriyama M
AD  - Moriyama Management Law Office, Tokyo 1010052, Japan.
LA  - eng
PT  - Journal Article
PL  - China
TA  - Chin Med J (Engl)
JT  - Chinese medical journal
JID - 7513795
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Adult
MH  - *Arthritis, Rheumatoid/drug therapy
MH  - Female
MH  - Humans
MH  - Immunosuppressive Agents/administration & dosage
MH  - Japan
MH  - Male
MH  - Malpractice/*statistics & numerical data
MH  - Middle Aged
MH  - Young Adult
PMC - PMC5463476
COIS- There are conflicts of interest to declare that Yuichi Saito and Yasuaki Oyama 
      are employees of Sompo Japan Nipponkoa Insurance Incorporated, which provided the 
      claim files for the analysis in the present study. Yasuhiro Otaki serves 
      independently as a medical and legal consultant for Sompo Japan Nipponkoa 
      Insurance Incorporated on an as-needed basis receiving appropriate fees.
EDAT- 2017/06/07 06:00
MHDA- 2018/04/10 06:00
PMCR- 2017/06/20
CRDT- 2017/06/07 06:00
PHST- 2017/06/07 06:00 [entrez]
PHST- 2017/06/07 06:00 [pubmed]
PHST- 2018/04/10 06:00 [medline]
PHST- 2017/06/20 00:00 [pmc-release]
AID - ChinMedJ_2017_130_12_1454_207479 [pii]
AID - CMJ-130-1454 [pii]
AID - 10.4103/0366-6999.207479 [doi]
PST - ppublish
SO  - Chin Med J (Engl). 2017 Jun 20;130(12):1454-1458. doi: 10.4103/0366-6999.207479.