Development of a composite measure of state-level malpractice environment

Objective: To develop a composite measure of state-level malpractice environment.

Data sources: Public use data from the National Practitioner Data Bank, Medical Liability Monitor, the National Conference of State Legislatures, and the American Bar Association.

Study design: Principal component analysis of state-level indicators (paid claims rate, malpractice premiums, lawyers per capita, average award size, and malpractice laws), with indirect validation of the composite using receiver-operating characteristic curves to determine how accurately the composite could identify states with high-tort activity and costs.

Principal findings: A single composite accounted for over 73 percent of total variance in the seven indicators and demonstrated reasonable criterion validity.

Conclusion: An empirical composite measure of state-level malpractice risk may offer advantages over single indicators in measuring overall risk and may facilitate cross-state comparisons of malpractice environments.