Preventing ethical disasters in the practice of medicine

描述(申请人提供)：“预防医学实践中的道德灾难”摘要我们将“医学中的道德灾难”定义为医生的严重职业不当行为引起重大宣传的案件。道德灾难损害了人们对药物的信任，浪费了稀缺的医疗保健资金，并减少了及时获得医生的机会，这可能会加剧健康差距。三种更常见的严重不当行为形式是滥用处方权(APP)、欺诈性不必要程序(FUP)和性虐待患者(SAP)。提议的项目有三个具体目标：目标1：确定哪些因素最能描述APP、FUP和SAP的实例。我们的数据来源将是1992年或以后225个案例的摘要-APP、FUP和SAP各75个。我们将使用医疗实践中14种不当行为的分类法对案件中代表的不当行为进行分类，并描述各种不当行为如何聚集在一起。(尽管APP、FUP和SAP是我们的主要关注点，但我们的初步数据显示，大多数已公布的案件涉及3种或更多种不当行为。)我们将提取有关违法者、一系列环境预测变量以及案件如何结束的数据。环境因素包括经济利益冲突、监管失误和脆弱的患者群体，包括老年人。目的2：确定哪些因素在统计学上可以预测APP、FUP和SAP。通过对APP、FUP和SAP各75例的多元Logistic回归分析，我们将识别出预测每种错误行为的变量。使用我们的动机、手段和机会(MMO)的理论因果模型，我们将从概念上分析个人和环境因素在提供严重不当行为的动机、手段和机会方面的相对作用。目标3：确定这项研究的数据表明，在研究政策、监督和教育方面哪些有希望的做法。这一目标通过让专家和利益攸关方参与，促进传播成果并将其转化为改进的医疗实践。我们将招募两个专家小组参加网络研讨会会议，在会议期间，我们将使用幻灯片介绍研究结果，以便于通过电话会议讨论数据对政策、监管和教育的影响。会议将以建立共识的方式举行。这些小组的建议将被纳入本研究发表的论文中。

DESCRIPTION (provided by applicant): Summary for "Preventing Ethical Disasters in the Practice of Medicine" We define "ethical disasters in medicine" as cases of serious professional wrongdoing by physicians that attract significant publicity. Ethical disasters harm trust in medicine, waste scarce health care dollars, and reduce timely access to physicians, which can exacerbate health disparities. Three of the more common forms of serious wrongdoing are abuse of prescription privileges (APPs), fraudulent unnecessary procedures (FUPs), and sexual abuse of patients (SAPs). The proposed project has three specific aims: AIM 1: Determine which factors best describe instances of APP, FUP, and SAP. Our data sources will be synopses of 225 cases-75 each of APP, FUP, and SAP-from 1992 or later. We will categorize the kinds of wrongdoing represented in the case using a taxonomy of 14 kinds of wrongdoing in medical practice and will describe how kinds of wrongdoing cluster together. (Although APP, FUP, and SAP are our primary focus, our preliminary data indicate most published cases involve 3 or more kinds of wrongdoing.) We will extract data on the wrongdoer, a series of environmental predictor variables, and how the case concluded. Environmental factors include financial conflicts of interest, oversight failures, and vulnerable patient populations, including older adults. AIM 2: Determine which factors statistically predict APP, FUP, and SAP. Using multivariate logistic regression with 75 cases each of APP, FUP, and SAP, we will identify the variables that predict each kind of wrongdoing. Using our theoretical causal model of motive, means, and opportunity (MMO), we will conceptually analyze the relative role of individual and environmental factors in providing the motive, means and opportunity for serious wrongdoing. AIM 3: Determine which promising practices for research policy, oversight, and education are indicated by the study's data. This aim fosters the dissemination of results and their translation into improved medical practice by engaging experts and stakeholders. We will recruit two panels of experts to participate in webinar meetings, during which we will present study findings using slides to facilitate teleconference discussion of the implications of the data for policy, oversigh and education. Meetings will be conducted using a consensus-building approach. Recommendations from these panels will be incorporated into papers published from this study.