The consistency of experts' evaluation of obstetric claims for compensation

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Abstract

Objective

The aim of this study was to investigate the consistency of experts' evaluation of different types of obstetric claims for compensation.

Design

Inter-rater reliability study of obstetric claims for compensation.

Setting

Medical experts' evaluation in The Norwegian System of Compensation to Patients, a no-blame system.

Sample

The 15 most frequently used medical experts were asked to evaluate 12 obstetric claims applied for compensation.

Methods

Inter-rater agreement was assessed by absolute agreement, Fleiss' kappa statistic and Gwet's AC1.

Main outcome measures

Consistency in the evaluation of negligence (carelessness without intention to harm) and causality (relation between care and injury) between negligence and patient injury.

Results

The experts demonstrated moderate consistency in their evaluation of negligence (Fleiss' kappa = 0.53/AC1 = 0.54) and causality (Fleiss' kappa = 0.41/AC1 = 0.54). There was a higher level of agreement in clinical scenarios with well-documented diagnostic criteria and guidelines, including shoulder dystocia and asphyxia with low Apgar score and metabolic acidosis.

Conclusion

We found a moderate level of agreement in experts' evaluation of negligence and causality between the injury and provided health care, the two most important questions to be answered in obstetric claims for compensation.

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