THE EFFECT OF THRESHOLD AMOUNTS FOR REPORTING MALPRACTICE PAYMENTS TOTHE NATIONAL-PRACTITIONER-DATA-BANK - ANALYSIS USING THE CLOSED CLAIMS DATA-BASE OF THE OFFICE OF THE ASSISTANT SECRETARY-OF-DEFENSE (HEALTH AFFAIRS)

The study determines the extent to which payment thresholds for report ing malpractice claims to the National Practitioner Data Bank identifi es substandard health care delivery in the Department of Defense, Rele vant data were available on 2,291 of 2,576 medical malpractice claims reported to the closed medical malpractice case data base of the Offic e of the Assistant Secretary of Defense (Health Affairs). Amount paid was analyzed as a diagnostic test using standard of care assessment fr om each military Surgeon General office as the criterion, Using differ ent paid threshold amounts per claim as a positive test, the sensitivi ty of identifying substandard care declined from 0.69 for all paid cas es to 0.41 for claims over $40,000. Specificity increased from 0.75 fo r all paid claims to 0.89 for claims over $40,000. Positive and negati ve predictive values and likelihood ratio were similar at all threshol ds, Malpractice case payment was of limited value for identifying subs tandard medical practice, All paid claims missed about 30% of substand ard care, and reported about 25% of acceptable medical practice.