Waters T M, Lefevre F V, Budetti P P
Center for Health Services Research, The University of Tennessee Health Science Center, Memphis, TN 38163, USA.
Qual Saf Health Care. 2003 Oct;12(5):330-6. doi: 10.1136/qhc.12.5.330.
Following earlier research which showed that certain types of physicians are more likely to be sued for malpractice, this study explored (1). whether graduates of certain medical schools have consistently higher rates of lawsuits against them, (2). if the rates of lawsuits against physicians are associated with their school of graduation, and (3). whether the characteristics of the medical school explain any differences found.
Retrospective analysis of malpractice claims data from three states merged with physician data from the AMA Masterfile (n=30288).
All US medical schools with at least 5% of graduates practising in three study states (n=89).
Proportion of graduates from a medical school for a particular decade sued for medical malpractice between 1990 and 1997 and odds ratio for lawsuits against physicians from high and low outlier schools; correlations between the lawsuit rates of successive cohorts of graduates of specific medical schools.
Medical schools that are outliers for malpractice lawsuits against their graduates in one decade are likely to retain their outlier status in the subsequent decade. In addition, outlier status of a physician's medical school in the decade before his or her graduation is predictive of that physician's malpractice claims experience (p<0.01). All correlations of cohorts were relatively high and all were statistically significant at p<0.001. Comparison of outlier and non-outlier schools showed that some differences exist in school ownership (p<0.05), years since established (p<0.05), and mean number of residents and fellows (p<0.01).
Consistent differences in malpractice experience exist among medical schools. Further research exploring alternative explanations for these differences needs to be conducted.
早期研究表明某些类型的医生更有可能面临医疗事故诉讼,本研究探讨了:(1)某些医学院校的毕业生是否一直面临更高的诉讼率;(2)医生的诉讼率是否与其毕业院校有关;(3)医学院校的特征是否能解释所发现的差异。
对来自三个州的医疗事故索赔数据与美国医学协会主文件中的医生数据进行回顾性分析(n = 30288)。
所有在美国三个研究州执业的毕业生中至少有5%毕业于该校的美国医学院校(n = 89)。
1990年至1997年期间,某医学院校特定十年毕业的学生因医疗事故被起诉的比例,以及来自高异常值和低异常值院校的医生的诉讼比值比;特定医学院校连续几届毕业生的诉讼率之间的相关性。
在某十年中,针对其毕业生的医疗事故诉讼为异常值的医学院校,在随后的十年中可能仍保持其异常值地位。此外,医生毕业前十年其医学院校的异常值地位可预测该医生的医疗事故索赔经历(p<0.01)。各届学生之间的所有相关性都相对较高,且在p<0.001时均具有统计学意义。异常值院校与非异常值院校的比较表明,在学校所有权(p<0.05)、建校年限(p<0.05)以及住院医师和研究员的平均数量(p<0.01)方面存在一些差异。
医学院校在医疗事故经历方面存在持续差异。需要开展进一步研究以探索这些差异的其他解释。