Malpractice: Ignored Specialties Study (MISS)

描述(由申请人提供)：许多人认为我们目前的医疗责任制度已经被打破，理由包括医疗事故保险费不断上升，对真正受伤的患者进行不及时和不公平的赔偿，以及诉讼对医疗质量、成本和获得医疗服务的可疑影响。这些担忧导致医疗事故成为国家卫生政策舞台上的一个激烈辩论的问题。人们对医疗事故的许多不同方面进行了研究。然而，这项研究是参差不齐的，结果往往是褒贬不一的。总的来说，大多数实证研究要么是整体进行的，要么是集中在少数被视为医疗事故诉讼风险最高的医学专业上，如外科、妇产科、放射科和急诊科。因此，我们真的不清楚我们目前的医疗责任制度是如何影响初级保健专业的，如内科、家庭执业或儿科。这些“被忽视”的专业被迫依赖轶事信息，或从其他专业的实证研究中做出推论，而不是理解自己索赔数据的病因学和流行病学。由于初级保健专科占每年病人就诊的大部分，我们认为重要的是要审视医疗事故的历史趋势以及这类提供者内部的当前状况。我们的研究建议会特别集中在内科、家庭医学和儿科这些“被忽视”的专科，以便更好地了解目前的医疗事故环境对这些专科的影响。更具体地说，这项研究建议的主要目的是更好地了解涉及普通内科医生、家庭医生和儿科医生的医疗事故索赔的发生、频率、类型和结果。为了实现这一点，我们将通过查询向美国医生保险协会(PIAA)数据共享项目报告的数据，来查看被忽视的专科的医疗事故索赔的发生、频率、类型和结果。还将提取数据库中记录的其他专业的比较数据。此外，这项研究提案还有两个次要目标。通过利用为我们的主要目标而收集和分析的流行病学数据，我们希望通过以下方式为进一步的工作和资金做好准备：1)确定我们可以在哪些关键领域开发临床情景，并调查与“被忽视”的专科医生实践防御医学有关的问题；以及2)确定可以降低责任风险和改善这些专科的患者安全的领域。

DESCRIPTION (provided by applicant): Many believe that our current medical liability system is broken, citing issues such as rising medical malpractice premiums, untimely and inequitable compensation for truly injured patients, and the questionable impact that litigation has on health care quality, cost, and access to care. These concerns have led to the emergence of medical malpractice as a hotly debated issue on the national health policy stage. Research has been conducted on many different aspects of medical malpractice. This research, however, is uneven, and has often resulted in mixed findings. In general, the majority of empirical research has either been conducted in the aggregate or has focused on a small number of medical specialties which are viewed as having the highest level of risk for malpractice suits such as surgery, obstetrics and gynecology, radiology and emergency medicine. Therefore, we do not really have a clear understanding of how our current medical liability system is impacting primary care specialties such as internal medicine, family practice, or pediatrics. Instead of understanding the etiology and epidemiology of their own claims data, these "ignored" specialties have been forced to rely on anecdotal information or to make inferences from empirical studies of other specialties. As primary care specialties account for the majority of patient visits each year, we believe that it is important to look at historic trends regarding medical malpractice as well as the current state of affairs within this group of providers. Our research proposal will focus specifically on the "ignored" specialties of internal medicine, family practice and pediatrics, in order to better understand the impact that the current malpractice environment is having on these specialties. More specifically, the primary aim of this research proposal is to understand better the occurrence, frequency, types and results of malpractice claims involving the general internists, family physicians, and pediatricians. In order to accomplish this, we will look at the occurrence, frequency, types and results of malpractice claims for the ignored specialties by querying data reported to the Physician Insurers Association of America's (PIAA) data-sharing project. Comparison data will also be pulled for the other specialties recorded in the database. Additionally, there are two secondary aims of this research proposal. By utilizing the epidemiologic data gathered and analyzed for the purposes of our primary aim, we hope to prepare for further work and funding by: 1) identifying key areas where we could develop clinical scenarios and survey questions pertaining to the practice of defensive medicine by physicians in the "ignored" specialties; and 2) identifying areas where liability risk can be reduced and patient safety can be improved for these specialties.