Preventing ethical disasters in the practice of medicine

预防医学实践中的伦理灾难

• 批准号: 8667968
• 负责人: James M Dubois
• 金额: $ 29.35万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8667968
• 关键词: Age; Attention; Behavior; Benchmarking; Cluster Analysis; Complex; Consensus; Consultations; Data; Data Sources; Development; Disasters; Education; Elderly; Environmental Risk Factor; Ethics; Failure; Fostering; Foundations; Fraud; Grant; Guidelines; Health; Health Services Research; Healthcare; Individual; Informed Consent; Life; Logistic Regressions; Medical; Medical Education; Medicine; Methods; Modeling; Paper; Patients; Physicians; Policies; Policy Research; Procedures; Publishing; Recommendation; Recruitment Activity; Regression Analysis; Relative (related person); Research; Research Design; Research Project Grants; Review Literature; Role; Sampling; Seeds; Series; Sexual abuse; Slide; Substance Addiction; Taxonomy; Teleconferences; Testing; Training; Translations; Trust; Unnecessary Procedures; adjudicate; base; case control; financial conflict of interest; health disparity; improved; innovation; medical specialties; meetings; member; patient population; prevent; public health relevance; remediation; research study; sex; wasting

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.

描述（由申请人提供）：“预防医学实践中的道德灾难”的摘要我们将“医学中的道德灾难”定义为医生严重的专业不当行为的案例，这些灾难引起了重大宣传。道德灾难会损害对医学的信任，浪费稀缺的医疗保健收入，并减少与医生的及时接触，这可能会加剧健康差异。严重不法行为的三种形式是滥用处方特权（应用程序），欺诈性不必要的程序（FUP）和对患者的性虐待（SAPS）。拟议的项目具有三个特定的目的：目标1：确定哪些因素最能描述应用程序，FUP和SAP的实例。我们的数据源将是225个案例的概要-75个App，FUP和SAP-From 1992或更高版本。我们将使用在医学实践中的14种不法行为的分类法对案例中所代表的各种不法行为进行分类，并将描述如何将各种不当行为集群在一起。 （尽管应用程序，FUP和SAP是我们的主要重点，但我们的初步数据表明大多数已发表的案例涉及3种或更多种类的不法行为。）我们将提取有关不法事故的数据，一系列的环境预测变量以及该案件的结论。环境因素包括财务冲突，监督失败和脆弱的患者人群，包括老年人。 AIM 2：确定哪些因素在统计上预测应用程序，FUP和SAP。使用APP，FUP和SAP的每种情况，使用多元逻辑回归，我们将确定预测每种不法行为的变量。使用我们的理论因果模型，手段和机会（MMO），我们将概念上分析个人和环境因素在提供严重不当行为的动机，手段和机会中的相对作用。 AIM 3：确定研究政策，监督和教育的哪些有希望的实践由研究的数据表示。这个目标通过吸引专家和利益相关者来促进结果的传播及其转化为改进的医学实践。我们将招募两个专家小组参加网络研讨会会议，在此期间，我们将使用幻灯片提出研究结果，以促进有关数据对政策，高度和教育的含义的关注讨论。会议将使用共识的方法进行。这些面板的建议将纳入本研究中发表的论文中。