Preventing ethical disasters in the practice of medicine

描述（由申请人提供）：“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”定义为医生严重的专业错误行为，引起了重大的公众关注。伦理灾难损害了人们对医学的信任，浪费了稀缺的卫生保健资金，减少了及时就医的机会，从而加剧了健康差距。三种较为常见的严重不法行为是滥用处方特权（APPs）、欺诈性不必要程序（FUPs）和对患者的性虐待（sap）。拟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。我们的数据源将是1992年或之后225个案例的概要——APP、FUP和SAP各75个。我们将使用医疗实践中14种不法行为的分类法对案例中所代表的不法行为进行分类，并将描述各种不法行为如何聚集在一起。（虽然APP、FUP和SAP是我们的主要关注点，但我们的初步数据表明，大多数公开的案例涉及3种或更多类型的不法行为。）我们将提取有关违法者的数据，一系列环境预测变量，以及案件如何结束。环境因素包括经济利益冲突、监管失败和弱势患者群体（包括老年人）。目标2：确定哪些因素在统计上可以预测APP、FUP和SAP。通过对APP、FUP和SAP各75个案例进行多元逻辑回归，我们将确定预测每种不法行为的变量。利用我们的动机、手段和机会的理论因果模型（MMO），我们将从概念上分析个人因素和环境因素在提供严重不法行为的动机、手段和机会方面的相对作用。目标3：确定研究数据表明哪些有希望的研究政策、监督和教育实践。这一目标通过吸引专家和利益攸关方参与，促进成果的传播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，我们将使用幻灯片展示研究结果，以便在电话会议上讨论数据对政策、监管和教育的影响。会议将以建立协商一致意见的方式举行。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.