DOCTOR PATIENT COMMUNICATIONS AND MEDICAL MALPRACTICE

医患沟通和医疗事故

基本信息

批准号：
2236002
负责人：
WENDY LEVINSON
金额：
$ 44.47万
依托单位：
GOOD SAMARITAN HOSP & MED CTR(PRTLND,OR)
依托单位国家：
美国
项目类别：
财政年份：
1992
资助国家：
美国
起止时间：
1992-09-30 至 1996-09-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/2236002
关键词：
audiotape communication behavior human subject job performance job satisfaction malpractice /misconduct patient care personnel attitude physicians questionnaires

项目摘要

OBJECTIVE: Medical malpractice reform is a high national priority. AHCPR's Conference on Medical Liability recommended "high-risk" behaviors in physician communication as an area for research. This proposal specifically addresses this identified need. We propose to explore issues related to physicians' communication patterns and malpractice risk on two levels. First, we will examine routine aspects of physicians' communication styles that either enhance or undermine the doctor-patient relationship and influence physicians' risk for malpractice claims. Second, we will investigate the relationship between physicians' perceived threat of potential malpractice, reported practice of "defensive-medicine," and their communication patterns. PARTICIPANTS: One-hundred physicians in primary care and surgical specialties in practice in Oregon and Colorado, will participate in the study. An Advisory Board of physicians will recruit physician participants Physicians will be selected based on prior malpractice claims history, 50 with no claims and 50 with two or more claims, stratified for length of time in practice and specialty. METHODS: The study will utilize both quantitative and qualitative methods. For each physician, 10 audiotapes will be recorded during routine office visits, and these audiotapes will form the database for analysis. In addition, information will be gathered directly from physicians to reflect physicians' perceived fear of malpractice, report of "defensive-medicine" practice, attitudes regarding psychosocial aspects of patient care, and job satisfaction. Ten patients per physician will complete exit questionnaires, as will the physicians, on aspects of the visit, such as reason for visit; patient's physical, emotional, and functional status; and satisfaction with the encounter. Quantitative analysis will be based on use of the Roter interactional Analysis System under the supervision of Dr. Debra Roter. Qualitative analysis will utilize the framework and methods of microinteractional analysis under the direction of Dr. Richard Frankel. Results of the quantitative and qualitative analysis will be compared through a series of discussions between the investigators. Statistical methods will include the use of nested MANOVA, nested ANOVA, and discriminant analysis to test the study hypotheses. FUTURE STUDIES: The long-term goal of this study is to apply the analytic results in formulating a continuing medical education (CME) curriculum that specifically targets the "high-risk" communication behaviors found to be most closely associated with increased malpractice risk. Future studies will rigorously test the efficacy of these continuing CME programs in changing physician communication behaviors which, in turn, will improve quality of care and reduce malpractice risk.

目标：医疗事故改革是国家的高度优先事项。 AHCPR 医疗责任会议建议“高风险”行为医生沟通作为一个研究领域。这个提议专门解决这一已确定的需求。我们建议探索与医生沟通模式和医疗事故风险相关的问题在两个层面上。首先，我们将检查医生的常规方面加强或削弱医患关系的沟通方式关系并影响医生医疗事故索赔的风险。其次，我们要调查医生之间的关系。感知到潜在不当行为的威胁，报告的做法 “防御医学”及其沟通模式。参与者：一百名初级保健和外科医师俄勒冈州和科罗拉多州的实践专业，将参加学习。医生顾问委员会将招募医生参与者医生将根据之前的医疗事故情况进行选择索赔历史记录，50 次无索赔，50 次有两次或以上索赔，根据实践和专业的时间长度进行分层。方法：本研究将采用定量和定性相结合的方法方法。每位医生将在治疗过程中录制 10 盘录音带例行的办公室访问，这些录音带将构成数据库分析。此外，信息将直接从报告称，医生反映了医生对医疗事故的恐惧的“防御医学”实践，对心理社会的态度患者护理和工作满意度等方面。每人十名患者医生将完成退出调查问卷，医生也将在访问的各个方面，例如访问原因；患者的体质，情绪和功能状态；以及对这次相遇的满足。定量分析将基于 Roter 交互的使用 Debra Roter 博士监督下的分析系统。定性分析将利用微交互的框架和方法在理查德·弗兰克尔博士的指导下进行分析。结果将通过一系列的定量和定性分析进行比较调查人员之间的讨论。统计方法将包括使用嵌套多元方差分析、嵌套方差分析和判别分析检验研究假设。未来的研究：这项研究的长期目标是应用分析制定继续医学教育（CME）课程的结果专门针对发现的“高风险”沟通行为与医疗事故风险增加密切相关。未来研究将严格测试这些持续的 CME 的功效改变医生沟通行为的计划，反过来，将提高护理质量并降低医疗事故风险。