DEFENSIVE MEDICINE AND OBSTETRICS
DEFENSIVE MEDICINE AND OBSTETRICS
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DOI：
10.1001/jama.274.20.1606
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发表时间：
1995-11-22
影响因子：
120.7
通讯作者：
ROSENBLATT, RA
中科院分区：
文献类型：
--
作者：
BALDWIN, LM;HART, LG;ROSENBLATT, RA
客观。-为了验证这一假设，即具有更大的医疗事故索赔暴露的医生，无论是通过个人经验还是在他们的实践环境中，都会使用更多的产前资源，并且比索赔较少的医生有更高的剖宫产率。回顾性队列研究，使用来自华盛顿州医生保险和交流协会的县医疗事故被告率数据和产前护理，分娩方法和来自产科护理研究数据库内容的自我报告的产科诉讼经验数据。华盛顿州产科实践。内裤。分层随机抽样的妇产科医生和家庭医生。主要结果的措施。产科超声使用率、转诊和咨询率、产前护理资源使用率和剖宫产率。在控制了患者、医生和社会人口学特征后，我们发现，在产前资源使用或低风险患者的剖腹产率方面，医生接触医疗事故索赔的次数较多和较少的患者之间没有差异。这项研究不支持个别医生的医疗事故经验或暴露与使用产前资源或剖腹产护理低风险产科患者的增加之间的关联，
Objective.-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.Design.-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.Setting.-Washington State obstetric practices.Participants.-Stratified random samples of obstetrician-gynecologists and family physicians.Main Outcome Measures.-The rates of obstetric ultrasound use, referral and consultation, prenatal care resource use, and cesarean delivery.Results.-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.Conclusions.-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 cesarean deliveries for the care of low-risk obstetric patients,