Frisch P R, Charles S C, Gibbons R D, Hedeker D
Oregon Medical Association, Portland 97201, USA.
West J Med. 1995 Oct;163(4):346-50.
We analyzed the medical malpractice claims data of 1,903 physicians between 1981 and 1990 to assess the efficacy--a reduced incidence of future claims and decreased payout in the event of a claim--of risk-management education for office-based physicians. Physicians were participants in the Oregon Medical Association's medical liability program and represented all recognized specialties and all geographic areas of the state. Each physician's claim and payout history before and after 4 sequential risk-management education programs was entered into a random-effects probit model that allowed for a longitudinal rather than a cross-sectional analysis. For most physicians, there was increased claim vulnerability following 1 or 2 risk-management education courses but decreased vulnerability after additional courses. Among all physicians, having a previous claim substantially increased the risk for a future claim. Risk for an additional claim doubled (from 7% to 14%) for physicians who had a claim in the previous year. Of all specialists who have had claims, anesthesiologists (reduction in claims incidence from 18.8% to 9.1% and in payout from 14.6% to 5%) and obstetrician-gynecologists (reduction in claims incidence from 23.3% to 15.2% and in payout from 11.6% to 4.2%) benefit most from cumulative risk-management education.
我们分析了1981年至1990年间1903名医生的医疗事故索赔数据，以评估针对门诊医生的风险管理教育的效果——降低未来索赔发生率以及在发生索赔时减少赔付金额。这些医生参与了俄勒冈州医学协会的医疗责任项目，代表了该州所有认可的专业领域和所有地理区域。将每位医生在4个连续风险管理教育项目前后的索赔和赔付历史录入一个随机效应概率模型，该模型允许进行纵向而非横断面分析。对于大多数医生来说，在参加1或2次风险管理教育课程后，索赔易发性增加，但在参加更多课程后易发性降低。在所有医生中，之前有过索赔会大幅增加未来索赔的风险。前一年有过索赔的医生，再次索赔的风险翻倍（从7%增至14%）。在所有有过索赔的专科医生中，麻醉医生（索赔发生率从18.8%降至9.1%，赔付从14.6%降至5%）和妇产科医生（索赔发生率从23.3%降至15.2%，赔付从11.6%降至4.2%）从累积风险管理教育中受益最大。
