Enhancing the Disclosure of Medical Errors to Patients

描述（由申请人提供）：尽管我们尽了最大的努力，医疗错误是不可避免的。当错误发生时，一个关键问题是是否以及如何向患者披露错误。虽然披露是病人所希望的，尊重道德原则，并要求认证标准，错误披露可能是罕见的。初步工作表明，一个关键的障碍，错误披露可能是病人和医生的根本不同的观点如何披露应该发生。目前的机构政策可能进一步阻碍充分披露错误。有效的错误披露可以提高患者的安全性，增加患者的信任度和满意度，并减少诉讼。候选人提出了一系列改善医疗差错披露的项目，具体目标如下：1）描述医生对差错披露的态度，并确定这些态度是否与个人特征有关（例如，人口统计学、专业、实践时间）以及它们是否与披露医疗错误的意图一致; 2）描述患者对错误披露的态度并确定这些态度是否与个人特征（例如，社会人口统计学，过去的经验，医疗保健的看法），以及它们如何与重要的结果，如信任，满意度，并打算改变提供者或起诉; 3）评估目前的机构政策是否支持充分披露医疗差错;和4）制定和传播机构错误披露政策范本，并评估该政策对医疗保健提供者对医疗保健服务的态度和经验的影响。错误披露。具体目标1和2将通过对2 000名医生和2 000名病人的邮寄调查来实现。 对于具体目标3，候选人将分析200个机构错误披露政策的代表性样本。具体目标4涉及在三个西雅图学术和社区医疗中心创建和传播模型错误披露政策。该政策的影响将通过在政策实施前后对300名卫生保健工作者进行调查来确定。该项目将由具有生物伦理学和医患沟通背景的医生领导。他的职业发展将由Stephan D. Fihn，医学博士，M.P.H.沿着的还有一组在病人安全、医患沟通和生物伦理学方面具有专长的共同导师：大卫贝茨，医学博士; Wendy Levinson，医学博士; Eric Larson，医学博士;和Bernard Lo医学博士职业发展计划包括调查设计，定性研究方法，医疗事故以及关键文本的指导阅读课程。该项目将在卫生服务研究的领先机构华盛顿大学进行。

DESCRIPTION (provided by the applicant): Despite our best efforts, medical errors are inevitable. When an error happens, a key question is whether and how the error should be disclosed to the patient. While disclosure is desired by patients, respects ethical principles, and is required by accreditation standards, error disclosure may be uncommon. Preliminary work suggests that one key barrier to error disclosure may be patients' and physicians' fundamentally different perspectives on how disclosure should occur. Current institutional policies may further discourage full error disclosure. Effective error disclosure could enhance patient safety, increase patient trust and satisfaction, and reduce lawsuits. The candidate proposes a series of projects to improve medical error disclosure with the following specific aims: 1) to describe the attitudes of physicians towards error disclosure and determine whether these attitudes are related to personal characteristics (e.g., demographics, specialty, time in practice) and whether they are consistent with intentions for disclosing medical errors; 2) to describe the attitudes of patients towards error disclosure and determine whether these attitudes are related to personal characteristics (e.g., socio-demographics, past experiences, perceptions of medical care) and how they relate to important outcomes such as trust, satisfaction, and intent to change providers or to sue; 3) to assess whether current institutional policies support full disclosure of medical errors; and 4) to develop and disseminate a model institutional error disclosure policy and assess the policy's impact on health care providers' attitudes towards and experience with error disclosure. Specific Aims 1 and 2 will be accomplished through mailed surveys of 2,000 doctors and 2,000 patients. For Specific Aim 3, the candidate will analyze a representative sample of 200 institutional error disclosure policies. Specific Aim 4 involves creating and disseminating a model error disclosure policy at three Seattle academic and community medical centers. The policy's impact will be determined by surveying 300 health care workers before and after the policy's implementation. The project will be led by the candidate who is a physician with a background in bioethics and doctor-patient communication. His career development will be guided by Stephan D. Fihn, M.D., M.P.H., along with a panel of co-mentors with expertise in patient safety, doctor-patient communication, and bioethics: David Bates, M.D.; Wendy Levinson, M.D.; Eric Larson, M.D.; and Bernard Lo, M.D. The career development plan includes coursework in survey design, qualitative research methods, and medical malpractice as well as the guided reading of key texts. The project will take place at the University of Washington, a leading institution in health services research.