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.

目的：医疗渎职改革是一个很高的国家优先事项。 AHCPR的医疗责任会议建议“高风险”行为在医师沟通中作为研究领域。这个建议专门解决了这一确定的需求。我们建议探索与医师的沟通模式和渎职风险有关的问题在两个级别上。首先，我们将研究医生的常规方面增强或破坏医生的沟通方式关系和影响医生对渎职索赔的风险。其次，我们将调查医生之间的关系据报道，感知到潜在渎职的威胁 “防御性医疗”及其沟通方式。参与者：初级保健和外科医师的一百位医生俄勒冈州和科罗拉多州实践中的专业将参加学习。医师顾问委员会将招募医生参与者医生将根据事先的渎职行为选择索赔历史记录，没有索赔，有50个，有两个或两个以上的索赔，在实践和专业中分层时间长度。方法：该研究将同时使用定量和定性方法。对于每位医生，将记录10个录音带例行办公室访问，这些录音带将形成数据库分析。此外，信息将直接从医师反映医生对渎职的恐惧的医生，报告关于“防御性中等医学”的实践，对社会心理的态度患者护理和工作满意度的各个方面。十名患者医师将填写出口问卷，医生也将访问的各个方面，例如访问的理由；病人的身体，情感和功能状态；并满意相遇。定量分析将基于使用转子相互作用的使用 Debra Roter博士的监督下的分析系统。定性分析将利用微接个性的框架和方法在理查德·弗兰克尔（Richard Frankel）博士的指导下进行分析。结果定量和定性分析将通过系列进行比较研究人员之间的讨论。统计方法将包括使用嵌套Manova，嵌套的ANOVA和判别分析测试研究假设。未来的研究：这项研究的长期目标是应用分析导致建立持续医学教育（CME）课程该专门针对发现的“高风险”沟通行为与渎职风险增加最密切相关。未来研究将严格测试这些继续CME的功效改变医师沟通行为的计划，反过来将提高护理质量并降低医疗事故风险。