Caplan R A, Posner K L, Cheney F W
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA 98111.
JAMA. 1991 Apr 17;265(15):1957-60.
Is a permanent injury more likely to elicit a rating of inappropriate care than a temporary injury? To explore this question, we asked 112 practicing anesthesiologists to judge the appropriateness of care in 21 cases involving adverse anesthetic outcomes. The original outcome in each case was classified as either temporary or permanent. The authors then generated a matching alternate case identical to the original in every respect except that a plausible outcome of opposite severity was substituted. The original and alternate cases were randomly divided into two sets and assigned to reviewers who were blind to the intent of the study. The reviewers were asked to rate independently the care in each case as appropriate, less than appropriate, or impossible to judge, based on their personal (implicit) judgment of reasonable and prudent practice. A significant inverse relationship between severity of outcome and judgments of appropriateness of care was observed in 15 (71%) of the 21 matched pairs of cases. Overall, the proportion of ratings for appropriate care decreased by 31 percentage points when the outcome was changed from temporary to permanent and increased by 28 percentage points when the outcome was changed from permanent to temporary. We conclude that knowledge of the severity of outcome can influence a reviewer's judgment of the appropriateness of care.
永久性损伤比暂时性损伤更有可能引发对不当护理的评级吗？为了探究这个问题，我们让112位执业麻醉医师对21例涉及不良麻醉结果的病例中的护理适宜性进行判断。每个病例的原始结果被分类为暂时性或永久性。然后，作者生成了一个匹配的替代病例，该病例在各个方面都与原始病例相同，只是用了一个严重程度相反的合理结果进行替代。原始病例和替代病例被随机分为两组，并分配给对研究意图不知情的评审人员。要求评审人员根据他们对合理谨慎做法的个人（隐性）判断，独立地将每个病例中的护理评为适当、不太适当或无法判断。在21对匹配病例中的15对（71%）中，观察到结果严重程度与护理适宜性判断之间存在显著的负相关关系。总体而言，当结果从暂时性变为永久性时，适当护理评级的比例下降了31个百分点，而当结果从永久性变为暂时性时，适当护理评级的比例增加了28个百分点。我们得出结论，对结果严重程度的了解会影响评审人员对护理适宜性的判断。
