Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia.
Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia.
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DOI：
10.1136/bmjqs-2012-001691
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发表时间：
2013-07
影响因子：
5.4
通讯作者：
Studdert DM
中科院分区：
文献类型：
--
作者：
Bismark MM;Spittal MJ;Gurrin LC;Ward M;Studdert DM
(1)确定澳大利亚医疗队伍中正式患者投诉的分布；(2)确定复发投诉高风险医生的特征。我们收集了澳大利亚11年间18907例患者向卫生服务监察员（“委员会”）对医生提出的正式投诉的全国样本。我们分析了执业医生投诉的分布情况。然后，我们使用复发事件生存分析来确定复发投诉高风险医生的特征，并估计每个医生未来发生投诉的风险。医生之间的投诉分布是高度倾斜的：3%的澳大利亚医务人员占投诉的49%，1%的人占投诉的四分之一。短期复发风险在不同医生之间存在显著差异：与既往主诉次数存在强烈的剂量-反应关系，且因医生专业和性别而存在显著差异。在从业人员水平上，风险差异很大，从2年内再次投诉风险<10%的医生到2年内再次投诉风险为80%的医生。一小部分医生占了向澳大利亚委员会提交的所有患者投诉的一半。在不久的将来，预测哪些医生更有可能招致更多的投诉是可行的。广泛使用这种方法来识别高风险医生和目标质量改进工作，加上有效的干预措施，可以帮助减少卫生系统中的不良事件和患者不满。
(1) To determine the distribution of formal patient complaints across Australia's medical workforce and (2) to identify characteristics of doctors at high risk of incurring recurrent complaints. We assembled a national sample of all 18 907 formal patient complaints filed against doctors with health service ombudsmen (‘Commissions’) in Australia over an 11-year period. We analysed the distribution of complaints among practicing doctors. We then used recurrent-event survival analysis to identify characteristics of doctors at high risk of recurrent complaints, and to estimate each individual doctor's risk of incurring future complaints. The distribution of complaints among doctors was highly skewed: 3% of Australia's medical workforce accounted for 49% of complaints and 1% accounted for a quarter of complaints. Short-term risks of recurrence varied significantly among doctors: there was a strong dose-response relationship with number of previous complaints and significant differences by doctor specialty and sex. At the practitioner level, risks varied widely, from doctors with <10% risk of further complaints within 2 years to doctors with >80% risk. A small group of doctors accounts for half of all patient complaints lodged with Australian Commissions. It is feasible to predict which doctors are at high risk of incurring more complaints in the near future. Widespread use of this approach to identify high-risk doctors and target quality improvement efforts coupled with effective interventions, could help reduce adverse events and patient dissatisfaction in health systems.
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DOI：
10.1056/nejmsa1012370
发表时间：
2011-08-18
期刊：
The New England journal of medicine
影响因子：
--
作者：
Jena AB;Seabury S;Lakdawalla D;Chandra A
通讯作者：
Chandra A
影响因子：
8.4
作者：
DANZON, PM
通讯作者：
DANZON, PM
影响因子：
0.8
作者：
Fallberg, Lars;Mackenney, Stephen
通讯作者：
Mackenney, Stephen
影响因子：
11.4
作者：
Elkin, Katie;Spittal, Matthew J.;Studdert, David M.
通讯作者：
Studdert, David M.
影响因子：
--
作者：
Bismark, MM;Brennan, TA;Studdert, DM
通讯作者：
Studdert, DM