医疗错误责任和医疗保健质量:一个审查
Michelle M Mello1,2, Michael D Frakes3, Erik Blumenkranz1
1Stanford Law School, Stanford, California.
JAMA
|January 29, 2020
概括
这项审查发现,医疗不当责任风险似乎没有改善医疗保健质量或患者安全. 目前的侵权责任制度可能无法有效阻止医疗环境中的疏忽.
科学领域:
- 医学法律与道德
- 医疗服务研究
- 患者安全
背景情况:
- 医疗侵权责任制度旨在赔偿受伤的患者,提供纠正正义,并阻止疏忽.
- 威理论上依赖于临床医生对医疗疏忽的潜在后果的认识.
研究的目的:
- 系统地审查关于不当行为责任风险与医疗保健质量和安全之间的经验证据.
- 评估医疗失误责任的增加是否影响临床实践和患者的结果.
主要方法:
- 对1990年至2019年间发表的研究进行了系统的文献搜索.
- 包含了检查不良行为责任风险指标与健康结果或质量指标之间的关系的研究.
- 由于研究异质性,进行了定性和描述性综合,而不是元分析.
主要成果:
- 大多数研究 (包括37项) 没有发现医疗不当责任风险与医疗保健质量或安全结果之间的显著关联.
- 关于产科护理的证据显示出混合的结果,一些研究没有发现关联,而其他研究证据则有限.
- 对患者死亡率,再入院和患者安全指标的分析通常没有发现与医疗不当责任风险的联系.
结论:
- 目前的证据表明,目前形式的医疗不当责任风险与改善医疗保健质量没有明显联系.
- 需要进一步的研究才能充分理解法律威和医疗保健绩效之间的复杂关系.
- 调查结果表明,侵权责任可能不是提高患者安全和护理质量的有效机制.
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