Obstetric claims in Finland 2012-2022-A nationwide patient insurance registry study.

INTRODUCTION: Maternal and infant mortality rates in Finland are among the lowest in the world, yet preventable obstetric injuries occur every year. The aim of this study was to describe obstetric claims, their compensation rates, and temporal trends of claims reported to the Patient Insurance center. MATERIAL AND METHODS: A nationwide, register-based study was conducted. Data consisted of obstetric claims reported to the Patient Insurance Center between 2012 and 2022. Data analyzed included the year of injury, compensation criteria, maternal age, birth hospital, delivery method, reported causes of injury, and maternal or neonatal injury. The data were analyzed with descriptive statistics and logistic regression models. RESULTS: A total of n = 849 obstetric claims were filed during the study period, of which n = 224 (26.4%) received compensation. The rate of claims was 0.15%, and the rate of compensation was 0.04% in relation to the total volume of births during the period. Substandard care was the most common (97.3%) criterion for compensation. There was a curvilinear increase in the claims rate and a linear increase in compensation rates from 2013 to 2019. More claims were filed and compensated for cesarean and vacuum-assisted deliveries than for unassisted vaginal deliveries. Delayed delivery (18.7%) and surgical technique failure (10.9%) were the most reported causes of injuries. Retained surgical bodies were the induced cause of injury with the highest rate of compensated claims (86.7%). The most common maternal injury was infection (17.9%) and pain (11.7%). Among neonatal injuries, severe (19.2%) and mild asphyxia (16.6%) were the most frequent. Burn injuries (93.3%) and fetal or neonatal death (60.5%) had the highest rate of compensated claims. CONCLUSIONS: The study provided new information on substandard care and injuries in obstetric care in Finland. An increasing trend in claims and compensation rates was found. Identifying contributors to substandard care that lead to fetal asphyxia is important for improving obstetric safety. Further analysis of the association of claims and compensation rates with operative deliveries is needed to determine their causality. Frequent review of obstetric claims would be useful in providing more recent data on substandard care and preventable injuries.

Machine Learning Classification of Psychiatric Data Associated with Compensation Claims for Patient Injuries.

BACKGROUND: Adverse events are common in health care. In psychiatric treatment, compensation claims for patient injuries appear to be less common than in other medical specialties. The most common types of patient injury claims in psychiatry include diagnostic flaws, unprevented suicide, or coercive treatment deemed as unnecessary or harmful. OBJECTIVES: The objective was to study whether it is possible to form different categories of patient injury types associated with the psychiatric evaluations of compensation claims and to base machine learning classification on these categories. Further, the binary classification of positive and negative decisions for compensation claims was the other objective. METHODS: Finnish psychiatric specialist evaluations for the compensation claims of patient injuries were classified into six different categories called classes applying the machine learning methods of artificial intelligence. In addition, another classification of the same data into two classes was performed to test whether it was possible to classify data cases according to their known decisions, either accepted or declined compensation claim. RESULTS: The former classification task produced relatively good classification results subject to separating between different classes. Instead, the latter was more complex. However, classification accuracies of both tasks could be improved by using the generation of artificial data cases in the preprocessing phase before classifications. This preprocessing improved the classification accuracy of six classes up to 88% when the method of random forests was used for classification and that of the binary classification to 89%. CONCLUSION: The results show that the objectives defined were possible to solve reasonably.

Patterns of malpractice claims and compensation after surgical procedures: a retrospective analysis of 8,901 claims from the Finnish patient insurance registry.

BACKGROUND: Invasive surgical procedures carry risk of harm to patients. In addition to avoidable harm, disparities between patient expectations and the outcome of a procedure may lead to patient injury claims. The follow-up of claims and compensation is an important entity for patient safety. The number of claims should be related to the surgical volume, so that a healthcare provider can benchmark with similar organizations and see if its trends are developing favourably or deteriorating. Our objective was to find out the claims and compensation rates due to surgery in an insurance-based system. METHODS: Data related to surgical claims and reference volume in the period 2011-2015 were collected from the claim register of the Finnish Patient Insurance Centre and benchmarking community register of Finnish operating departments. The data included age, gender, hospital, year of surgery, surgical code, and outcome of the claim. RESULTS: There were 8,901 claims related to the corresponding reference group of 1,470,435 surgical procedures. The claims rate was 0.61% and compensation rate was 0.22%. Trends for claims and compensation rates decreased over the study period. In high volume procedures, a low compensation rate was detected for excision of tonsils and adenoids, Caesarean section and extracapsular cataract operations using the phacoemulsification technique. A high compensation rate was detected for primary prosthetic replacement of the hip and knee joints and decompression of spinal cord and nerve roots. Unreasonable injury (death or permanent deterioration of health) was compensated in 2.4 per 100,000 procedures. CONCLUSIONS: Register data research in a no-fault patient insurance system revealed a claims rate of 6 per 1,000 procedures and compensation rate of 2 per 1,000 procedures. A decreasing trend in both rates over the study period was detected. Different surgical procedures exhibit varying claims and compensation rates.

TUFT1, a novel candidate gene for metatarsophalangeal osteoarthritis, plays a role in chondrogenesis on a calcium-related pathway.

Osteoarthritis (OA) is the most common degenerative joint disorder and genetic factors have been shown to have a significant role in its etiology. The first metatarsophalangeal joint (MTP I) is highly susceptible to development of OA due to repetitive mechanical stress during walking. We used whole exome sequencing to study genetic defect(s) predisposing to familial early-onset bilateral MTP I OA inherited in an autosomal dominant manner. A nonsynonymous single nucleotide variant rs41310883 (c.524C>T, p.Thr175Met) in TUFT1 gene was found to co-segregate perfectly with MTP I OA. The role of TUFT1 and the relevance of the identified variant in pathogenesis of MTP I OA were further assessed using functional in vitro analyses. The variant reduced TUFT1 mRNA and tuftelin protein expression in HEK293 cells. ATDC5 cells overexpressing wild type (wt) or mutant TUFT1 were cultured in calcifying conditions and chondrogenic differentiation was found to be inhibited in both cell populations, as indicated by decreased marker gene expression when compared with the empty vector control cells. Also, the formation of cartilage nodules was diminished in both TUFT1 overexpressing ATDC5 cell populations. At the end of the culturing period the calcium content of the extracellular matrix was significantly increased in cells overexpressing mutant TUFT1 compared to cells overexpressing wt TUFT1 and control cells, while the proteoglycan content was reduced. These data imply that overexpression of TUFT1 in ATDC5 inhibits chondrogenic differentiation, and the identified variant may contribute to the pathogenesis of OA by increasing calcification and reducing amount of proteoglycans in the articular cartilage extracellular matrix thus making cartilage susceptible for degeneration and osteophyte formation.

Association between height and osteoarthritis of the knee and hip: The Northern Finland Birth Cohort 1966 Study.

OBJECTIVES: To investigate whether height at the age of 31 is associated with the incidence of knee and hip osteoarthritis (OA) in the following 15 years. METHODS: Participants in The Northern Finland Birth Cohort 1966 (NFBC1966) diagnosed with knee or hip OA between the ages of 31 and 46 were used as OA cases. Study subjects without knee and hip OA were used as the controls. Height and weight were measured in a clinical examination at the age of 31 (baseline). Mean heights for the OA cases and the controls were compared by an independent samples t-test. Cox regression analysis was performed to calculate the risk for OA for different height quartiles. The results were adjusted for body mass index/weight, education, smoking and leisure-time physical activity at baseline. Additionally, a Kaplan-Meier analysis was performed. RESULTS: Men with knee OA were 2.6 cm taller (P < 0.001) and women with knee OA 1.2 cm taller (P = 0.048) than the controls. Hip OA cases were found to be slightly shorter than the controls, but no statistically significant differences were observed. The adjusted hazard ratios (HRs) for knee OA and hip OA in the highest quartile were 2.5 (95% CI 1.4-4.5) and 1.0 (95% CI 0.3-3.4) for men and 1.8 (95% CI 1.0-3.1) and 0.7 (95% CI 0.2-2.3) for women. CONCLUSIONS: Height at the age of 31 was associated with incidence of early knee OA, diagnosed prior to age 46. However, the low incidence of hip OA made our results for hip OA inconclusive.