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首页> 外文期刊>Transactions of the American Ophthalmological Society. >Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery.
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Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery.

机译：进行LASIK和PRK手术的眼科医生的医疗事故预测指标和危险因素。

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PURPOSE: To identify physician predictors in laser-assisted in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) surgery that correlate with a higher risk for malpractice liability claims and lawsuits. METHODOLOGY: A retrospective, longitudinal, cohort study comparing physician characteristics of 100 consecutive Ophthalmic Mutual Insurance Company (OMIC) LASIK and PRK claims and suits to demographic and practice pattern data for all active refractive surgeons insured by OMIC between 1996 and 2002. Background information and data were obtained from OMIC underwriting applications, a physician practice pattern survey, and claims file records. Using an outcome of whether or not a physician had a prior history of a claim or suit, logistic regression analyses were used separately for each predictor as well as controlling for refractive surgery volume. RESULTS: Logistic regression analysis demonstrated that the most important predictor of filing a claim was surgical volume, with those performing more surgery having a greater risk of incurring a claim (odds ratio [OR], 31.4 for >1,000/year versus 0 to 20/year; 95% confidence interval [CI], 7.9 - 125; P = .0001). Having one or more prior claims was the only other predictor examined that remained statistically significant after controlling for patient volume (OR, 6.4; 95% CI 2.5 - 16.4; P = .0001). Physician gender, advertising, preoperative time spent with patient, and comanagement appeared to be strong predictors in multivariate analyses when surgical volume was greater than 100 cases per year. CONCLUSION: The chances of incurring a malpractice claim or suit for PRK or LASIK correlates significantly with higher surgical volume and a history of a prior claim or suit. Additional risk factors that increase in importance with higher surgical volume include gender, advertising, preoperative time spent with patient, and comanagement with optometrists. These findings may be used in the future to help improve the quality of care for patients undergoing refractive surgery and provide data for underwriting criteria and risk management protocols to proactively manage and reduce the risk of claims and lawsuits against refractive surgeons.
机译：目的：确定在激光辅助原位角膜磨镶术（LASIK）和光折射性角膜切除术（PRK）手术中与不良责任索赔和诉讼风险较高相关的医生预测因素。方法：一项回顾性纵向队列研究，比较了1996年至2002年间由OMIC保险的所有活跃屈光外科医师连续100次连续进行眼科互助保险公司（OMIC）LASIK和PRK索赔的医生特征，并适合人口统计和实践模式数据。数据来自OMIC承保申请，医师执业模式调查和索赔文件记录。利用医生是否有过索偿或诉讼的既往史的结果，对每个预测变量分别进行逻辑回归分析，并控制屈光手术量。结果：Logistic回归分析表明，提出索赔的最重要预测因素是手术量，而进行更多手术的人发生索赔的风险更大（赔率[OR]，> 1,000 /年，赔率[OR]为31.4，0至20 /年; 95％置信区间[CI]，7.9-125; P = .0001）。拥有一项或多项先前的权利要求是唯一在控制患者体积后仍具有统计学显着性的其他预测指标（OR，6.4; 95％CI 2.5-16.4; P = .0001）。在每年手术量大于100例的多变量分析中，医师性别，广告，与患者共度的术前时间和共同管理似乎是重要的预测因素。结论：发生针对PRK或LASIK的医疗事故索赔或诉讼的机会与更高的手术量以及先前的索赔或诉讼的历史显着相关。随着手术量的增加，其他风险因素也越来越重要，包括性别，广告，患者术前花费的时间以及与验光师的共同管理。这些发现可能会在将来用于帮助提高屈光手术患者的护理质量，并为承保标准和风险管理协议提供数据，以主动管理和降低针对屈光外科医师的索赔和诉讼风险。

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