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医療ミスに対する責任と医療の質: レビュー
Michelle M Mello1,2, Michael D Frakes3, Erik Blumenkranz1
1Stanford Law School, Stanford, California.
JAMA
|January 29, 2020
まとめ
医療の質や患者の安全を 改善することはないようです 現在の損害賠償責任制度は 医療における過失を 効果的に抑止できないかもしれません
科学分野:
- 医療 法 と 倫理
- 医療サービス研究
- 患者の安全
背景:
- 医療損害賠償制度は 負傷した患者を補償し 矯正的な正義を提供し 怠慢を抑止することを目的としています
- 医学的不注意の潜在的結果に対する臨床医の認識に 理論的に依存しています
研究 の 目的:
- 医療の品質と安全性との関連に関する経験的証拠を体系的に検討する.
- 医療ミスに対する責任の増大が臨床実務と患者の結果に影響するかどうかを評価する.
主な方法:
- 1990年から2019年の間に発表された研究の体系的な文献検索が行われました.
- 医療ミス責任のリスクと健康上の結果や品質指標との関係を調べた研究も含まれていた.
- 研究の異質性のために,メタ解析の代わりに定性および記述的合成が行われました.
主要な成果:
- 大半の研究 (37件を含む) は,医療ミスに対する責任リスクと医療の質や安全性との間に有意な関連性を見出さなかった.
- 産科医療に関する証拠は,いくつかの研究では関連性がなく,他の研究は限られた証拠を示した.
- 患者の死亡率,再入院,および患者の安全性指標の分析は,一般的に医療ミス責任のリスクとの関連性を示さなかった.
結論:
- 現状の証拠からすると,医療不良の責任のリスクは,現在の形態では,医療の質の向上と明らかに結びついていないことが示されています.
- 法律上の抑止力と医療のパフォーマンスとの複雑な関係を完全に理解するには,さらなる研究が必要です.
- 患者の安全と医療の質を向上させるのに 有効なメカニズムにはならないかもしれない.
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