Richard Franki

The pulmonary arterial hypertension drug bosentan had the most reported serious adverse events in 2010, according to a report from the Institute for Safe Medication Practices.

Bosentan (Tracleer) was involved in 4,665 cases reported to the Food and Drug Administration’s Adverse Event Reporting System, also known as MedWatch. In second place is the synthetic opiate analgesic fentanyl, with 3,035 cases reported, the ISMP said.

Three spots in the top 10 are taken by biological products for rheumatoid arthritis and other autoimmune disorders: infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira). There are two psychiatric medications in the top 10: the antipsychotic quetiapine (Seroquel) and the smoking cessation aid varenicline (Chantix), the ISMP reported.

For 2010, a total of 141,829 serious, disabling, and fatal adverse drug events were reported to the FDA, which was up 21.1% from the 2009 total of 117,093. That increase of 24,736 cases represents "the largest absolute 1-year increase since our records began in 1998," the ISMP said.

Note: Based on data from the Food and Drug Administration’s Adverse Event Reporting System.

Source: Institute for Safe Medication Practices

The pulmonary arterial hypertension drug bosentan had the most reported serious adverse events in 2010, according to a report from the Institute for Safe Medication Practices.

Bosentan (Tracleer) was involved in 4,665 cases reported to the Food and Drug Administration’s Adverse Event Reporting System, also known as MedWatch. In second place is the synthetic opiate analgesic fentanyl, with 3,035 cases reported, the ISMP said.

Three spots in the top 10 are taken by biological products for rheumatoid arthritis and other autoimmune disorders: infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira). There are two psychiatric medications in the top 10: the antipsychotic quetiapine (Seroquel) and the smoking cessation aid varenicline (Chantix), the ISMP reported.

For 2010, a total of 141,829 serious, disabling, and fatal adverse drug events were reported to the FDA, which was up 21.1% from the 2009 total of 117,093. That increase of 24,736 cases represents "the largest absolute 1-year increase since our records began in 1998," the ISMP said.

Note: Based on data from the Food and Drug Administration’s Adverse Event Reporting System.

Source: Institute for Safe Medication Practices

The pulmonary arterial hypertension drug bosentan had the most reported serious adverse events in 2010, according to a report from the Institute for Safe Medication Practices.

Bosentan (Tracleer) was involved in 4,665 cases reported to the Food and Drug Administration’s Adverse Event Reporting System, also known as MedWatch. In second place is the synthetic opiate analgesic fentanyl, with 3,035 cases reported, the ISMP said.

Three spots in the top 10 are taken by biological products for rheumatoid arthritis and other autoimmune disorders: infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira). There are two psychiatric medications in the top 10: the antipsychotic quetiapine (Seroquel) and the smoking cessation aid varenicline (Chantix), the ISMP reported.

For 2010, a total of 141,829 serious, disabling, and fatal adverse drug events were reported to the FDA, which was up 21.1% from the 2009 total of 117,093. That increase of 24,736 cases represents "the largest absolute 1-year increase since our records began in 1998," the ISMP said.

Note: Based on data from the Food and Drug Administration’s Adverse Event Reporting System.

Source: Institute for Safe Medication Practices

The first generic version of the blockbuster cholesterol-lowering drug Lipitor was approved by the Food and Drug Administration Nov. 30.

Ranbaxy Laboratories has gained approval to make generic atorvastatin in 10-mg, 20-mg, 40-mg, and 80-mg doses. The drug will be manufactured by Ohm Laboratories in New Brunswick, N.J., the FDA said.

"This medication is widely used by people who must manage their high cholesterol over time, so it is important to have affordable treatment options," Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research, said in a statement.

An agreement between Ranbaxy and Teva Pharmaceuticals USA directs a portion of the profits from sales of atorvastatin during Ranbaxy’s 180-day first-to-file exclusivity period to Teva, according to a statement on the Ranbaxy website.

Lipitor was the best-selling prescription medication in the United States in 2010, with sales of $7.2 billion, and has been the U.S. sales leader since at least 2004, according to data from health care analytics firm IMS Health.

Notes: Based on sales data from IMS Health. Availability dates for first-time generics are subject to significant change.

Source: Medco

The first generic version of the blockbuster cholesterol-lowering drug Lipitor was approved by the Food and Drug Administration Nov. 30.

Ranbaxy Laboratories has gained approval to make generic atorvastatin in 10-mg, 20-mg, 40-mg, and 80-mg doses. The drug will be manufactured by Ohm Laboratories in New Brunswick, N.J., the FDA said.

"This medication is widely used by people who must manage their high cholesterol over time, so it is important to have affordable treatment options," Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research, said in a statement.

An agreement between Ranbaxy and Teva Pharmaceuticals USA directs a portion of the profits from sales of atorvastatin during Ranbaxy’s 180-day first-to-file exclusivity period to Teva, according to a statement on the Ranbaxy website.

Lipitor was the best-selling prescription medication in the United States in 2010, with sales of $7.2 billion, and has been the U.S. sales leader since at least 2004, according to data from health care analytics firm IMS Health.

Notes: Based on sales data from IMS Health. Availability dates for first-time generics are subject to significant change.

Source: Medco

The first generic version of the blockbuster cholesterol-lowering drug Lipitor was approved by the Food and Drug Administration Nov. 30.

Ranbaxy Laboratories has gained approval to make generic atorvastatin in 10-mg, 20-mg, 40-mg, and 80-mg doses. The drug will be manufactured by Ohm Laboratories in New Brunswick, N.J., the FDA said.

"This medication is widely used by people who must manage their high cholesterol over time, so it is important to have affordable treatment options," Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research, said in a statement.

An agreement between Ranbaxy and Teva Pharmaceuticals USA directs a portion of the profits from sales of atorvastatin during Ranbaxy’s 180-day first-to-file exclusivity period to Teva, according to a statement on the Ranbaxy website.

Lipitor was the best-selling prescription medication in the United States in 2010, with sales of $7.2 billion, and has been the U.S. sales leader since at least 2004, according to data from health care analytics firm IMS Health.

Notes: Based on sales data from IMS Health. Availability dates for first-time generics are subject to significant change.

Source: Medco

Two competing devices for transcatheter aortic valve replacement produced good overall outcomes in a study of 305 patients from the Milan registry, Dr. Gill Louise Buchanan and associates reported at Transcatheter Cardiovascular Therapeutics 2011.

The combined 30-day mortality for the devices – Edwards Lifesciences’ Sapien valve (ESV) and Medtronic’s CoreValve ReValving System – was 4.7%. The myocardial infarction rate was 1.3% and the rate of stroke was 1.0%, said Dr. Buchanan of the interventional cardiology unit at San Raffaele Scientific Institute in Milan, and her associates.

"There was no difference in device success (92.5% overall), combined safety end point at 30 days (61.8%) or combined efficacy end point (72.0%) at 1-year follow-up," between the two valves, but there were significant differences in conduction disturbance and/or arrhythmia occurrence and the need for pacemaker (see graph, below), the investigators said.

Note: Based on data from 305 patients treated from November 2007 to April 2011.

Source: Dr. Gill Louise Buchanan and associates

Two competing devices for transcatheter aortic valve replacement produced good overall outcomes in a study of 305 patients from the Milan registry, Dr. Gill Louise Buchanan and associates reported at Transcatheter Cardiovascular Therapeutics 2011.

The combined 30-day mortality for the devices – Edwards Lifesciences’ Sapien valve (ESV) and Medtronic’s CoreValve ReValving System – was 4.7%. The myocardial infarction rate was 1.3% and the rate of stroke was 1.0%, said Dr. Buchanan of the interventional cardiology unit at San Raffaele Scientific Institute in Milan, and her associates.

"There was no difference in device success (92.5% overall), combined safety end point at 30 days (61.8%) or combined efficacy end point (72.0%) at 1-year follow-up," between the two valves, but there were significant differences in conduction disturbance and/or arrhythmia occurrence and the need for pacemaker (see graph, below), the investigators said.

Note: Based on data from 305 patients treated from November 2007 to April 2011.

Source: Dr. Gill Louise Buchanan and associates

Two competing devices for transcatheter aortic valve replacement produced good overall outcomes in a study of 305 patients from the Milan registry, Dr. Gill Louise Buchanan and associates reported at Transcatheter Cardiovascular Therapeutics 2011.

The combined 30-day mortality for the devices – Edwards Lifesciences’ Sapien valve (ESV) and Medtronic’s CoreValve ReValving System – was 4.7%. The myocardial infarction rate was 1.3% and the rate of stroke was 1.0%, said Dr. Buchanan of the interventional cardiology unit at San Raffaele Scientific Institute in Milan, and her associates.

"There was no difference in device success (92.5% overall), combined safety end point at 30 days (61.8%) or combined efficacy end point (72.0%) at 1-year follow-up," between the two valves, but there were significant differences in conduction disturbance and/or arrhythmia occurrence and the need for pacemaker (see graph, below), the investigators said.

Note: Based on data from 305 patients treated from November 2007 to April 2011.

Source: Dr. Gill Louise Buchanan and associates

General pediatricians in group practice had a median of 4,157 ambulatory encounters in 2010, down 4.4% since 2007, according to a survey by the Medical Group Management Association.

Pediatricians in the southern United States had the highest number of ambulatory encounters, 4,840, while those in the West, with 3,402 encounters, had the lowest, the MGMA reported. Male pediatricians had a median of 4,471 ambulatory encounters, while the median for female pediatricians was 3,893.

The MGMA considered an ambulatory encounter to be "documented, face-to-face contact between a patient and a provider" that did not take place in an inpatient hospital and did not involve a surgical procedure.

The 2010 edition of the annual survey, conducted among MGMA members and nonmembers, includes data from 2,846 group practices representing 59,375 physician and nonphysician providers. The MGMA presents highlights of the survey in its In Practice blog.

General pediatricians in group practice had a median of 4,157 ambulatory encounters in 2010, down 4.4% since 2007, according to a survey by the Medical Group Management Association.

Pediatricians in the southern United States had the highest number of ambulatory encounters, 4,840, while those in the West, with 3,402 encounters, had the lowest, the MGMA reported. Male pediatricians had a median of 4,471 ambulatory encounters, while the median for female pediatricians was 3,893.

The MGMA considered an ambulatory encounter to be "documented, face-to-face contact between a patient and a provider" that did not take place in an inpatient hospital and did not involve a surgical procedure.

The 2010 edition of the annual survey, conducted among MGMA members and nonmembers, includes data from 2,846 group practices representing 59,375 physician and nonphysician providers. The MGMA presents highlights of the survey in its In Practice blog.

General pediatricians in group practice had a median of 4,157 ambulatory encounters in 2010, down 4.4% since 2007, according to a survey by the Medical Group Management Association.

Pediatricians in the southern United States had the highest number of ambulatory encounters, 4,840, while those in the West, with 3,402 encounters, had the lowest, the MGMA reported. Male pediatricians had a median of 4,471 ambulatory encounters, while the median for female pediatricians was 3,893.

The MGMA considered an ambulatory encounter to be "documented, face-to-face contact between a patient and a provider" that did not take place in an inpatient hospital and did not involve a surgical procedure.

The 2010 edition of the annual survey, conducted among MGMA members and nonmembers, includes data from 2,846 group practices representing 59,375 physician and nonphysician providers. The MGMA presents highlights of the survey in its In Practice blog.

The average annual expenditure on asthma medications for U.S. children rose from $527 million in 1997-1998 to almost $2.5 billion in 2007-2008, an increase of 367%, according to a report from the Agency for Healthcare Research and Quality.

The increase was driven almost entirely by spending on asthma controller medications, which increased by 651% from 1997-1998 to 2007-2008. (See graph, below.) The average annual proportion of children who were treated for asthma rose from 4.7% to 6.1% in the time period studied, the report noted.

Of the four classes of controllers, average annual use among pediatric patients increased for three: Inhaled corticosteroid use went from 15.5% in 1997-1998 to 40.3% in 2007-2008, inhaled long-acting beta-agonist use rose from 3.0% to 13.2%, and leukotriene receptor antagonist use went from 2.9% to 34.1%. The proportion of children using nonsteroidal antiallergy agents dropped from 15.1% in 1997-1998 to 0.6% in 2007-2008, the AHRQ said.

The average annual expenditure on asthma medications for U.S. children rose from $527 million in 1997-1998 to almost $2.5 billion in 2007-2008, an increase of 367%, according to a report from the Agency for Healthcare Research and Quality.

The increase was driven almost entirely by spending on asthma controller medications, which increased by 651% from 1997-1998 to 2007-2008. (See graph, below.) The average annual proportion of children who were treated for asthma rose from 4.7% to 6.1% in the time period studied, the report noted.

Of the four classes of controllers, average annual use among pediatric patients increased for three: Inhaled corticosteroid use went from 15.5% in 1997-1998 to 40.3% in 2007-2008, inhaled long-acting beta-agonist use rose from 3.0% to 13.2%, and leukotriene receptor antagonist use went from 2.9% to 34.1%. The proportion of children using nonsteroidal antiallergy agents dropped from 15.1% in 1997-1998 to 0.6% in 2007-2008, the AHRQ said.

The average annual expenditure on asthma medications for U.S. children rose from $527 million in 1997-1998 to almost $2.5 billion in 2007-2008, an increase of 367%, according to a report from the Agency for Healthcare Research and Quality.

The increase was driven almost entirely by spending on asthma controller medications, which increased by 651% from 1997-1998 to 2007-2008. (See graph, below.) The average annual proportion of children who were treated for asthma rose from 4.7% to 6.1% in the time period studied, the report noted.

Of the four classes of controllers, average annual use among pediatric patients increased for three: Inhaled corticosteroid use went from 15.5% in 1997-1998 to 40.3% in 2007-2008, inhaled long-acting beta-agonist use rose from 3.0% to 13.2%, and leukotriene receptor antagonist use went from 2.9% to 34.1%. The proportion of children using nonsteroidal antiallergy agents dropped from 15.1% in 1997-1998 to 0.6% in 2007-2008, the AHRQ said.

The infant mortality rate in 2007 for late-term infants (2.07 per 1,000 live births) was 33% lower than for early-term infants (3.09 per 1,000), according to a report from the U.S. Centers for Disease Control and Prevention.

This difference between early (37-38 weeks’ gestation) and late-term (39-41 weeks) mortality was seen among whites, blacks, Hispanics, Asians or Pacific Islanders, and American Indians or Alaska natives. (See graph, below.)

Term infant mortality for both periods was highest for American Indians and Alaska natives – 6.14 at 37-38 weeks and 3.79 at 39-41 weeks – and lowest for Asians and Pacific Islanders – 2.12 at 37-38 weeks and 1.43 at 39-41 weeks, the CDC said.

The report noted, however, that overall infant mortality in 2007 was highest for non-Hispanic blacks (13.31 per 1,000 live births). American Indians and Alaska natives were second at 9.22 per 1,000, and total U.S. infant mortality was 6.75 per 1,000. Overall infant mortality was 5.63 for non-Hispanic whites and 4.78 for Asians and Pacific Islanders.

The infant mortality rate in 2007 for late-term infants (2.07 per 1,000 live births) was 33% lower than for early-term infants (3.09 per 1,000), according to a report from the U.S. Centers for Disease Control and Prevention.

This difference between early (37-38 weeks’ gestation) and late-term (39-41 weeks) mortality was seen among whites, blacks, Hispanics, Asians or Pacific Islanders, and American Indians or Alaska natives. (See graph, below.)

Term infant mortality for both periods was highest for American Indians and Alaska natives – 6.14 at 37-38 weeks and 3.79 at 39-41 weeks – and lowest for Asians and Pacific Islanders – 2.12 at 37-38 weeks and 1.43 at 39-41 weeks, the CDC said.

The report noted, however, that overall infant mortality in 2007 was highest for non-Hispanic blacks (13.31 per 1,000 live births). American Indians and Alaska natives were second at 9.22 per 1,000, and total U.S. infant mortality was 6.75 per 1,000. Overall infant mortality was 5.63 for non-Hispanic whites and 4.78 for Asians and Pacific Islanders.

The infant mortality rate in 2007 for late-term infants (2.07 per 1,000 live births) was 33% lower than for early-term infants (3.09 per 1,000), according to a report from the U.S. Centers for Disease Control and Prevention.

This difference between early (37-38 weeks’ gestation) and late-term (39-41 weeks) mortality was seen among whites, blacks, Hispanics, Asians or Pacific Islanders, and American Indians or Alaska natives. (See graph, below.)

Term infant mortality for both periods was highest for American Indians and Alaska natives – 6.14 at 37-38 weeks and 3.79 at 39-41 weeks – and lowest for Asians and Pacific Islanders – 2.12 at 37-38 weeks and 1.43 at 39-41 weeks, the CDC said.

The report noted, however, that overall infant mortality in 2007 was highest for non-Hispanic blacks (13.31 per 1,000 live births). American Indians and Alaska natives were second at 9.22 per 1,000, and total U.S. infant mortality was 6.75 per 1,000. Overall infant mortality was 5.63 for non-Hispanic whites and 4.78 for Asians and Pacific Islanders.

The number of hospital stays involving septicemia was almost 1.6 million in 2009, an increase of 86% since 2000, according to data from the Agency for Healthcare Research and Quality.

Between 2000 and 2009, stays with a principal diagnosis of septicemia increased 146%, while cases with septicemia as a secondary diagnosis increased by 47%, as determined by a search of AHRQ’s Nationwide Inpatient Sample. (Septicemia stays were identified as having an ICD-9-CM diagnosis code of 003.1, 036.2, 038.0-038.9, 054.5, 449, or 790.7.)

Septicemia was the sixth most common principal reason for hospitalization in 2009, with an average of 4,600 new patients treated per day in U.S. hospitals. Cost per stay increased from an inflation-adjusted $12,800 in 2000 to $18,500 in 2009. The total cost for admissions with a principal diagnosis of septicemia, $15.4 billion, was the highest for any single condition treated in U.S. hospitals in 2009, the AHRQ reported.

The number of hospital stays involving septicemia was almost 1.6 million in 2009, an increase of 86% since 2000, according to data from the Agency for Healthcare Research and Quality.

Between 2000 and 2009, stays with a principal diagnosis of septicemia increased 146%, while cases with septicemia as a secondary diagnosis increased by 47%, as determined by a search of AHRQ’s Nationwide Inpatient Sample. (Septicemia stays were identified as having an ICD-9-CM diagnosis code of 003.1, 036.2, 038.0-038.9, 054.5, 449, or 790.7.)

Septicemia was the sixth most common principal reason for hospitalization in 2009, with an average of 4,600 new patients treated per day in U.S. hospitals. Cost per stay increased from an inflation-adjusted $12,800 in 2000 to $18,500 in 2009. The total cost for admissions with a principal diagnosis of septicemia, $15.4 billion, was the highest for any single condition treated in U.S. hospitals in 2009, the AHRQ reported.

The number of hospital stays involving septicemia was almost 1.6 million in 2009, an increase of 86% since 2000, according to data from the Agency for Healthcare Research and Quality.

Between 2000 and 2009, stays with a principal diagnosis of septicemia increased 146%, while cases with septicemia as a secondary diagnosis increased by 47%, as determined by a search of AHRQ’s Nationwide Inpatient Sample. (Septicemia stays were identified as having an ICD-9-CM diagnosis code of 003.1, 036.2, 038.0-038.9, 054.5, 449, or 790.7.)

Septicemia was the sixth most common principal reason for hospitalization in 2009, with an average of 4,600 new patients treated per day in U.S. hospitals. Cost per stay increased from an inflation-adjusted $12,800 in 2000 to $18,500 in 2009. The total cost for admissions with a principal diagnosis of septicemia, $15.4 billion, was the highest for any single condition treated in U.S. hospitals in 2009, the AHRQ reported.

General psychiatrists in group practice had a median of 1,678 ambulatory encounters in 2010, down 11% from 2007, according to a survey by the Medical Group Management Association.

Psychiatrists in the Eastern United States had the highest number of ambulatory encounters, 2,110, while those in West, with 634 encounters, had the lowest, the MGMA reported. Female psychiatrists had a median of 1,935 ambulatory encounters, while the median for male psychiatrists was 1,868. (The numbers of psychiatrists used to calculate the male/female medians and the overall psychiatry median were not the same.)

The MGMA considered an ambulatory encounter to be "documented, face-to-face contact between a patient and a provider" that did not take place in an inpatient hospital and did not involve a surgical procedure.

The 2010 edition of the annual survey, conducted among MGMA members and nonmembers, includes data from 2,846 group practices representing 59,375 physician and nonphysician providers. The MGMA presents highlights of the survey in its "In Practice" blog.

General psychiatrists in group practice had a median of 1,678 ambulatory encounters in 2010, down 11% from 2007, according to a survey by the Medical Group Management Association.

Psychiatrists in the Eastern United States had the highest number of ambulatory encounters, 2,110, while those in West, with 634 encounters, had the lowest, the MGMA reported. Female psychiatrists had a median of 1,935 ambulatory encounters, while the median for male psychiatrists was 1,868. (The numbers of psychiatrists used to calculate the male/female medians and the overall psychiatry median were not the same.)

The MGMA considered an ambulatory encounter to be "documented, face-to-face contact between a patient and a provider" that did not take place in an inpatient hospital and did not involve a surgical procedure.

The 2010 edition of the annual survey, conducted among MGMA members and nonmembers, includes data from 2,846 group practices representing 59,375 physician and nonphysician providers. The MGMA presents highlights of the survey in its "In Practice" blog.

General psychiatrists in group practice had a median of 1,678 ambulatory encounters in 2010, down 11% from 2007, according to a survey by the Medical Group Management Association.

Psychiatrists in the Eastern United States had the highest number of ambulatory encounters, 2,110, while those in West, with 634 encounters, had the lowest, the MGMA reported. Female psychiatrists had a median of 1,935 ambulatory encounters, while the median for male psychiatrists was 1,868. (The numbers of psychiatrists used to calculate the male/female medians and the overall psychiatry median were not the same.)

The MGMA considered an ambulatory encounter to be "documented, face-to-face contact between a patient and a provider" that did not take place in an inpatient hospital and did not involve a surgical procedure.

The 2010 edition of the annual survey, conducted among MGMA members and nonmembers, includes data from 2,846 group practices representing 59,375 physician and nonphysician providers. The MGMA presents highlights of the survey in its "In Practice" blog.

Physicians in West Virginia had the country’s highest rate of paid malpractice claims in 2010, according to an analysis by the Kaiser Family Foundation.

There were 48.4 paid claims per 1,000 physicians in the state last year, well ahead of the states in second and third place: Louisiana at 35.5 claims per 1,000 and Kansas at 32.0. Rounding out the top five were Pennsylvania (28.7) and New Mexico (27.9). New York physicians, who had the sixth-highest rate (27.1 per 1,000), paid the most overall claims, 1,373.

Wisconsin had the lowest rate – 3.7 paid claims per 1,000 physicians – with Minnesota (4.9) second and South Dakota (5.3) third. South Dakota had the fewest claims overall, with just eight for the year.

The Kaiser analysis was based on data from the National Practitioner Data Bank. The rate for each state was calculated using physician data from the American Medical Association.

Physicians in West Virginia had the country’s highest rate of paid malpractice claims in 2010, according to an analysis by the Kaiser Family Foundation.

There were 48.4 paid claims per 1,000 physicians in the state last year, well ahead of the states in second and third place: Louisiana at 35.5 claims per 1,000 and Kansas at 32.0. Rounding out the top five were Pennsylvania (28.7) and New Mexico (27.9). New York physicians, who had the sixth-highest rate (27.1 per 1,000), paid the most overall claims, 1,373.

Wisconsin had the lowest rate – 3.7 paid claims per 1,000 physicians – with Minnesota (4.9) second and South Dakota (5.3) third. South Dakota had the fewest claims overall, with just eight for the year.

The Kaiser analysis was based on data from the National Practitioner Data Bank. The rate for each state was calculated using physician data from the American Medical Association.

Physicians in West Virginia had the country’s highest rate of paid malpractice claims in 2010, according to an analysis by the Kaiser Family Foundation.

There were 48.4 paid claims per 1,000 physicians in the state last year, well ahead of the states in second and third place: Louisiana at 35.5 claims per 1,000 and Kansas at 32.0. Rounding out the top five were Pennsylvania (28.7) and New Mexico (27.9). New York physicians, who had the sixth-highest rate (27.1 per 1,000), paid the most overall claims, 1,373.

Wisconsin had the lowest rate – 3.7 paid claims per 1,000 physicians – with Minnesota (4.9) second and South Dakota (5.3) third. South Dakota had the fewest claims overall, with just eight for the year.

The Kaiser analysis was based on data from the National Practitioner Data Bank. The rate for each state was calculated using physician data from the American Medical Association.