T A Brennan

..Recent developments in the domain of quality dealing with medical errors can be used to illustrate this synergy, and provide a set of mandates for the new professional commitment to quality...

..We conclude that a physician's current certification status should be among the evidence-based measures used in the quality movement...

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..We propose a policy under which academic medical centers would take the lead in eliminating the conflicts of interest that still characterize the relationship between physicians and the health care industry...

..The generalizability of these findings is unknown and has been questioned by other studies...

..These studies are based on data from 2 of the most populous states (California and New York), collected more than a decade ago, during volatile periods in the history of malpractice litigation...

..CONCLUSIONS: Implications of hospitalwide implementation of discharge planning-related services attempted on one unit are being considered...

..8 to 13.3). CONCLUSION: Failure of physicians to acknowledge patient concerns, provide explanations of care, and spend sufficient time with patients may contribute to patients' decisions to discontinue care at their usual site of care...

..They conclude that it is in the best interests of all concerned to modify the current counterproductive incentives that promote the problems they have described...

..To evaluate women's health centers as alternatives to traditional internal medicine practices...

..To determine if type of hospital ownership is associated with preventable adverse events...

..Hence, substantial underclaiming occurs in both negligence and no-fault systems. The disproportionately low propensity of elderly, poor and minority patients to seek compensation also appears to be pervasive...

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..A policy question more pressing than whether moving toward routine disclosure will expand litigation is the question of how large such an expansion might be...

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..First, perceptions influence behavior with respect to practice environment and clinical decision making. Second, perceptions influence the physician-patient relationship and the interpersonal quality of care...

..To identify the communication factors that are significantly associated with appropriate short-term follow-up of abnormal mammograms...

..With constrained health-care resources, there is a need to understand barriers to cost-effective medication use...

..Importantly, all three nations are harnessing their systems' power to improve patient safety, and the avoidability standard appears to be well suited for this task...

..To assess the consequences of iatrogenic medical events for patients and institutions. To assess the prevalence of disclosure of iatrogenic medical events to patients, surrogates, and institutions...

..The Quality in Australian Health Care Study (QAHCS) reported that 16.6% of admissions were associated with adverse events (AE), whereas the Utah, Colorado Study (UTCOS) reported a rate of 2.9%...

..Such systems make feasible implementation of care improvement and cost reduction initiatives on a scale which could not previously be considered...

..The authors conclude that the program has succeeded in giving incentives for academic PCPs to achieve under the growing demands for revenue self-sufficiency, managed care performance, quality of care, and academic commitment...

..Controversy has erupted over these trials, particularly over their use of placebo controls. Do differences in healthcare needs and budgets justify different ethical standards in the developed and the developing world?..

..It concludes by connecting these trends to larger medical malpractice policy issues...

..In the current debate over tort reform, critics of the medical malpractice system charge that frivolous litigation--claims that lack evidence of injury, substandard care, or both--is common and costly...

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..To investigate specialist physicians' practice decisions in response to liability concerns and their perceptions of the impact of the malpractice environment on patient access to care...

..Medical monitoring arms the courts with a new mechanism for addressing harms proactively rather than reactively, which could yield new victories for public health...

..To identify predictors and outcomes associated with frequent emergency department (ED) users...

..Our results indicate a need for better communication about potential side effects of medications, especially for patients with multiple medical problems...

..The relatively low propensity to complain among patients who are elderly, socioeconomically deprived, or of Pacific ethnicity suggests troubling disparities in access to and utilisation of complaints processes...

..Further study of the impact of patient characteristics and method of data collection should be conducted before the comparison of unadjusted satisfaction results becomes the accepted standard...

..Case--control analysis of medical-malpractice claims may identify and quantify risk factors for specific types of errors...

..001). CONCLUSIONS: Systems factors play a critical role in most surgical errors, including technical errors. Closed claims analysis can help to identify priority areas for intervening to reduce errors...

..To determine types, sources, and predictors of conflicts among patients with prolonged stay in the ICU...

..We discuss methodological issues that could explain the disparate findings regarding physician supply effects in studies using administrative data sets and survey data...

..Awareness of the most common types of breakdowns and factors could help efforts to identify and prioritize strategies to prevent diagnostic errors...

..By doing so, we aim to stimulate dialogue about the appropriateness of such roles and promote physician engagement with pressing health issues in the public arena...

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..They propose targeted reforms that could improve the functioning of the system and create incentives to improve safety and quality...

..Although retrospective identification of adverse events is time-consuming, whether they are present and/or expected is often readily apparent to providers during the provision of care...

..To determine the frequency, types, sources, and predictors of conflict surrounding the care of pediatric intensive care unit (PICU) patients with prolonged stay...

..Obesity is associated with only modest decreases in satisfaction scores with the most recent visit, which were explained largely by higher illness burden among obese patients...

..CONCLUSIONS: Report cards that emphasize only one domain of quality or use limited data collection methods may provide incomplete or inconsistent information to health care consumers about the overall quality of an outpatient clinic...

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..Diagnostic errors in the emergency department (ED) are an important patient safety concern, but little is known about their cause. We identify types and causes of missed or delayed diagnoses in the ED...

..Little is known about how physicians resolve this contradiction...

..Because this disruption appears to have decreased the proportion of questionable claims receiving compensation, the NPDB actually may have increased overall tort system specificity...

..Many health care providers now disseminate advisories telling patients what they can do to avoid errors and harms in their care...

..The lessons learned from the experience with this intervention should be helpful in ongoing efforts to improve care and to achieve outcomes desired by critically ill patients, their families, and critical care clinicians...

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..This undesirable potential outcome compounds the importance of selecting these standards with the utmost care...

..Most healthcare in the US is delivered in the ambulatory care setting, but the epidemiology of errors and adverse events in ambulatory care is understudied...

..The purpose of this study was to determine whether differences exist in the collection of family history information based on patient race...

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..Reluctance to disclose preventable harms was twice as likely to occur at hospitals having major concerns about the malpractice implications of disclosure...

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