Stimson C J, Karrass Jan, Dmochowski Roger R, Pichert James W
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.
Urol Pract. 2017 Nov;4(6):437-443. doi: 10.1016/j.urpr.2016.11.002. Epub 2016 Nov 16.
Previous research reveals associations between patient complaints and urological subspecialty, but relationships between complaints and practice environments have gone untested. In this study we explored whether associations exist between the types and rates of patient complaints filed against urological surgeons and their practice environments, defined as academic (medical school faculty) or community (independent medical group members). Complaints are a surrogate for malpractice litigation risk, so understanding the variables that drive complaints may suggest risk reduction interventions.
In this retrospective, exploratory study we examined 2,883 unsolicited patient complaints about 357 urologists affiliated with organizations partnering with the Vanderbilt Center for Patient and Professional Advocacy. Overall 222 (62%) urologists were practicing in 16 academic medical center systems and 135 (38%) in 11 community systems that recorded complaints from January 1, 2011 through December 31, 2014. Specific concerns about urologists were counted. Complaint type profiles were generated using a standardized coding system. Statistical analyses tested associations among practice environment (academic vs community), complaint counts and distribution of complaints by type.
Academic urologists had more complaints per physician than their community colleagues (Z = 2.53, p <0.05). They also had more complaints about care/treatment, communication (p <0.05) and access issues (p <0.001).
Academic urologists are associated with more patient complaints than community urologists, suggesting greater exposure to medical malpractice claims. Concerns regarding access, communication and the care that patients received appear to drive this discrepancy. Personal practice and clinical management solutions designed to improve these elements of patient experiences, especially access, may help reduce medical malpractice claims related activity.
先前的研究揭示了患者投诉与泌尿外科亚专业之间的关联，但投诉与执业环境之间的关系尚未得到检验。在本研究中，我们探讨了针对泌尿外科医生提出的患者投诉的类型和发生率与其执业环境（定义为学术型（医学院教员）或社区型（独立医疗组成员））之间是否存在关联。投诉是医疗事故诉讼风险的一个替代指标，因此了解导致投诉的变量可能会提示降低风险的干预措施。
在这项回顾性探索性研究中，我们检查了与范德比尔特患者与专业倡导中心合作的组织所属的357名泌尿科医生收到的2883份患者主动投诉。总体而言，222名（62%）泌尿科医生在16个学术医疗中心系统执业，135名（38%）在11个社区系统执业，这些系统记录了2011年1月1日至2014年12月31日期间的投诉。统计了对泌尿科医生的具体关注事项。使用标准化编码系统生成投诉类型概况。统计分析检验了执业环境（学术型与社区型）、投诉数量以及投诉类型分布之间的关联。
学术型泌尿科医生人均投诉比社区同行更多（Z = 2.53，p <0.05）。他们在护理/治疗、沟通（p <0.05）和就医问题（p <0.001）方面也有更多投诉。
与社区泌尿科医生相比，学术型泌尿科医生收到的患者投诉更多，这表明他们面临更高的医疗事故索赔风险。对就医、沟通以及患者所接受护理的担忧似乎导致了这种差异。旨在改善患者体验这些方面，尤其是就医体验的个人执业和临床管理解决方案，可能有助于减少与医疗事故索赔相关的活动。
