Baldwin L M, Hart L G, Lloyd M, Fordyce M, Rosenblatt R A
Department of Family Medicine, University of Washington, School of Medicine, Seattle 98195-5304, USA.
JAMA. 1995;274(20):1606-10.
To test the hypothesis that physicians with greater malpractice claims exposure, either through personal experience or in their practice environment, will use more prenatal resources and have a higher cesarean delivery rate than physicians with lesser claims exposure.
Retrospective cohort study using county malpractice defendant rate data from the Washington State Physicians Insurance and Exchange Association and prenatal care, delivery method, and self-reported obstetric suit experience data from the Content of Obstetrical Care Study database.
Washington State obstetric practices.
Stratified random samples of obstetrician-gynecologists and family physicians.
The rates of obstetric ultrasound use, referral and consultation, prenatal care resource use, and cesarean delivery.
After controlling for patient, physician, and sociodemographic characteristics, we found no difference in prenatal resource use or cesarean delivery rate for low-risk patients between physicians with more and less exposure to malpractice claims.
This study does not support an association between the malpractice experience or exposure of individual physicians and an increase in the use of prenatal resources or ceserean deliveries for the care of low-risk obstetric patients.
检验以下假设，即无论是通过个人经历还是在其执业环境中，面临更多医疗事故索赔风险的医生，相较于面临较少索赔风险的医生，会使用更多的产前资源且剖宫产率更高。
回顾性队列研究，使用来自华盛顿州医师保险与交换协会的县级医疗事故被告率数据，以及来自产科护理研究数据库内容的产前护理、分娩方式和自我报告的产科诉讼经历数据。
华盛顿州的产科医疗机构。
妇产科医生和家庭医生的分层随机样本。
产科超声使用、转诊与会诊、产前护理资源使用以及剖宫产的发生率。
在控制了患者、医生和社会人口学特征后，我们发现面临较多和较少医疗事故索赔风险的医生在低风险患者的产前资源使用或剖宫产率方面没有差异。
本研究不支持个体医生的医疗事故经历或风险暴露与低风险产科患者护理中产前资源使用增加或剖宫产之间存在关联。
