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Bismark M, Tibble H, Moore JS, Morris JM, Paterson R, Fletcher M, Studdert D. Eyes and Ears on Patient Safety: Sources of Notifications About the Health, Performance, and Conduct of Health Practitioners. J Patient Saf 2021; 17:e800-e805. [PMID: 30480651 DOI: 10.1097/pts.0000000000000544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to describe the sources of notifications of concern ("notifications") regarding the health, performance, and conduct of health practitioners from 14 registered professions in Australia. METHODS This retrospective cohort study analyzed 43,256 notifications lodged with the Australian Health Practitioner Regulation Agency and the Health Professional Councils Authority between 2011 and 2016. We used descriptive statistical analysis to describe the characteristics of these notifications, including their source, issue and domain, and subject. RESULTS Patients and their relatives lodged more than three-quarters (78%) of notifications regarding clinical performance, including diagnosis, treatment, and communication. Fellow practitioners were a common source of notifications about advertising and titles. Self-reports commonly related to health impairments, such as mental illness or substance use. Other agencies played a role in reporting concerns about prescribing or supply of medicines. CONCLUSIONS Various actors in the healthcare system play different roles in sketching the picture of healthcare quality and safety that notifications present to regulators. Improved understanding of which sources are most likely to raise which concerns may enhance regulators' ability to identify and respond to patient safety risks.
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Affiliation(s)
- Marie Bismark
- From the Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Holly Tibble
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
| | | | - Jennifer Michelle Morris
- From the Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | | | - Martin Fletcher
- Australian Health Practitioner Regulation Agency, Melbourne, Victoria, Australia
| | - David Studdert
- Stanford University School of Medicine and Stanford Law School, Stanford, California
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Kavanagh AM, Aitken Z, Emerson E, Sahabandu S, Milner A, Bentley R, LaMontagne AD, Pirkis J, Studdert D. Inequalities in socio-economic characteristics and health and wellbeing of men with and without disabilities: a cross-sectional analysis of the baseline wave of the Australian Longitudinal Study on Male Health. BMC Public Health 2016; 16:1042. [PMID: 28185560 PMCID: PMC5103237 DOI: 10.1186/s12889-016-3700-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internationally, men with disabilities have higher rates of social and economic disadvantage and poorer health and wellbeing than men without disabilities. No single study has provided comprehensive, population-level information about the magnitude of such differences among adult men using a well-validated instrument to measure disability. METHODS We analysed baseline data from Ten to Men - an Australian longitudinal study of male health. Ten to Men used a stratified multi-stage cluster random sample design to recruit a national sample of males aged 10 to 55 years residing in private dwellings. Data were collected between October 2013 and July 2014 from 15,988 males. This analysis was restricted to 18-55 year old participants with data available on age and disability (n = 13,569). We compared the demographic, socio-economic characteristics and health and wellbeing of men with and without disabilities using chi squared tests for proportions and t tests for continuous variables. Linear regression adjusted for age was used to assess the association between disability status and health and wellbeing, which were measured using the SF-12 mental and physical health component scores and the Personal Wellbeing Index. RESULTS Men with disabilities were older and more likely to be born in Australia, speak English at home, be Aboriginal and Torres Strait Islander and were less likely to be married or de facto, or to live in urban areas. They were less likely to have completed secondary school, be employed and live in affordable housing, and were more likely to live on low incomes, in more socio-economically disadvantaged areas, and in rental accommodation and to experience shortages of money. Among employed men, those with disabilities were less likely to be in high skilled jobs, worked less hours on average, and were more likely to report that they would prefer to work more. Men with disabilities had lower levels of social support and community participation and poorer mental and physical health and overall wellbeing. CONCLUSION Adult men with disabilities experience marked social and economic disadvantage and poorer health and wellbeing. Improving the health and wellbeing of disabled men should be a priority for public health researchers and policy-makers.
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Affiliation(s)
- Anne M Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia.
| | - Zoe Aitken
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Eric Emerson
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Lidcombe, 2141, Australia.,Centre for Disability Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
| | - Sash Sahabandu
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Allison Milner
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia.,School of Health & Social Development, Deakin University, Burwood, 3125, Australia
| | - Rebecca Bentley
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Anthony D LaMontagne
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia.,School of Health & Social Development, Deakin University, Burwood, 3125, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - David Studdert
- Centre for Health Policy/PCOR, Stanford University School of Medicine, Stanford, 94305, CA, USA.,Stanford Law School, Stanford, 94305, CA, USA
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Wintemute GJ, Beckett L, Kass PH, Tancredi D, Studdert D, Pierce G, Braga AA, Wright MA, Cerdá M. Evaluation of California's Armed and Prohibited Persons System: study protocol for a cluster-randomised trial. Inj Prev 2016; 23:358. [DOI: 10.1136/injuryprev-2016-042194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 11/03/2022]
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Pirkis J, Currier D, Carlin J, Degenhardt L, Dharmage SC, Giles-Corti B, Gordon IR, Gurrin LC, Hocking JS, Kavanagh A, Keogh L, Koelmeyer R, LaMontagne AD, Patton G, Sanci L, Spittal MJ, Schlichthorst M, Studdert D, Williams J, English DR. Cohort Profile:Ten to Men(the Australian Longitudinal Study on Male Health). Int J Epidemiol 2016; 46:793-794i. [DOI: 10.1093/ije/dyw055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 11/13/2022] Open
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Pirkis J, Spittal MJ, Cox G, Robinson J, Cheung YTD, Studdert D. The effectiveness of structural interventions at suicide hotspots: a meta-analysis. Int J Epidemiol 2013; 42:541-8. [PMID: 23505253 DOI: 10.1093/ije/dyt021] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Certain sites have gained notoriety as 'hotspots' for suicide by jumping. Structural interventions (e.g. barriers and safety nets) have been installed at some of these sites. Individual studies examining the effectiveness of these interventions have been underpowered. METHOD We conducted a meta-analysis, pooling data from nine studies. RESULTS Following the interventions, there was an 86% reduction in jumping suicides per year at the sites in question (95% CI 79% to 91%). There was a 44% increase in jumping suicides per year at nearby sites (95% CI 15% to 81%), but the net gain was a 28% reduction in all jumping suicides per year in the study cities (95% CI 13% to 40%). CONCLUSIONS Structural interventions at 'hotspots' avert suicide at these sites. Some increases in suicide are evident at neighbouring sites, but there is an overall gain in terms of a reduction in all suicides by jumping.
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Affiliation(s)
- Jane Pirkis
- Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia.
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Abstract
There are worldwide concerns that pro-suicide web sites may trigger suicidal behaviors among vulnerable individuals. In 2006, Australia became the first country to criminalize such sites, sparking heated debate. Concerns were expressed that the law casts the criminal net too widely; inappropriately interferes with the autonomy of those who wish to die; and has jurisdictional limitations, with off-shore web sites remaining largely immune. Conversely, proponents point out that the law may limit access to domestic pro-suicide web sites, raise awareness of Internet-related suicide, mobilize community efforts to combat it, and serve as a powerful expression of societal norms about the promotion of suicidal behavior.
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Affiliation(s)
- Jane Pirkis
- Center for Health Policy, Programs and Economics, School of Population Health, The University of Melbourne, Victoria, Australia.
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Affiliation(s)
- Thomas H Gallagher
- Department of Medicine, University of Washington, Seattle, WA 98105-4608, USA.
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Affiliation(s)
| | | | | | - Troyen Brennan
- University of Melbourne, Melbourne, Australia Harvard School of Public Health, Boston, Massachusetts Brigham and Women’s Hospital, Boston, Massachusetts Aetna Hartford, Connecticut
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Bismark M, Dauer E, Paterson R, Studdert D. Accountability sought by patients following adverse events from medical care: the New Zealand experience. CMAJ 2006; 175:889-94. [PMID: 17030939 PMCID: PMC1586070 DOI: 10.1503/cmaj.060429] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Unlike Canada's medical malpractice system, patients in New Zealand who are dissatisfied with the quality of their care may choose between 2 well-established medicolegal paths: one leads to monetary compensation and the other to nonmonetary forms of accountability. We compared the forms of accountability sought by patients and families in New Zealand who took different types of legal action following a medical injury. This study offers insights into the forms of accountability sought by injured patients and may help to inform tort-reform initiatives. METHODS We reviewed compensation claims submitted to the Accident Compensation Corporation (ACC), New Zealand's national no-fault insurer, following injuries associated with admission to a public hospital in 1998 (n = 582). We also reviewed complaint letters (n = 254) submitted to the national Health and Disability Commissioner (HDC) that same year to determine the forms of accountability sought by injured patients. We used univariable and multivariable analyses to compare sociodemographic and socioeconomic characteristics of patients who sought nonmonetary forms of accountability with those of patients who claimed compensation. RESULTS Of 154 injured patients whose complaints were sufficiently detailed to allow coding, 50% sought corrective action to prevent similar harm to future patients (45% system change, 6% review of involved clinician's competence) and 40% wanted more satisfying communication (34% explanation, 10% apology). The odds that patients would seek compensation were significantly increased if they were in their prime working years (aged between 30 and 64 years) (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.14-2.41) or had a permanent disability as a result of their injury (OR 1.75, 95% CI 1.14-2.70). When injuries resulted in death, the odds of a compensation claim to the ACC were about one-eighth those of a complaint to the HDC (OR 0.13, 95% CI 0.08-0.23). INTERPRETATION Injured patients who pursue medicolegal action seek various forms of accountability. Compensation is important to some, especially when economic losses are substantial (e.g., with injury during prime working years or severe nonfatal injuries). However, others have purely nonmonetary goals, and ensuring alternative options for redress would be an efficient and effective response to their needs.
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Affiliation(s)
- Troyen A Brennan
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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Fitzjohn J, Studdert D. A compensation perspective on error prevention: is the ACC medical misadventure scheme compensating the right sort of injury? N Z Med J 2001; 114:432-4. [PMID: 11700754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Studdert D. A comment on the "collaborative planning" model. Adv Mind Body Med 2000; 15:101-4; discussion 105-10. [PMID: 10367494 DOI: 10.1054/ambm.1999.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Saphier CJ, Thomas EJ, Studdert D, Brennan TA, Acker D. Applying no-fault compensation criteria to obstetric malpractice claims. Prim Care Update Ob Gyns 1998; 5:208-209. [PMID: 10838396 DOI: 10.1016/s1068-607x(98)00151-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective: To determine in obstetric malpractice cases the incidence of adverse events (AE), defined in the litigation literature as an injury caused by medical management, and to determine the proportion of cases that would meet no-fault criteria.Methods: In a retrospective cohort design, all neonatal outcome claims (n = 47) occurring between January 1992 and December 1993 were reviewed from carriers in Massachusetts, Colorado, and Utah. Two obstetricians determined whether an AE occurred, as defined above. The cases were then reevaluated according to Swedish Compensatory Event (SCE) criteria, which compensate AEs due to avoidable or substandard care, and to Florida Neurological Injury Compensation Association (NICA) criteria, which compensate neurologic injury following peripartum oxygen deprivation or mechanical injury.Results: An AE occurred in only 23/47 claims, representing 49% (95% CI 34-64%). SCE criteria were met in all 23 of the cases with an AE. NICA criteria were met in 9/23, or 39% (95% CI 19-61%), of the cases with an AE. Neither SCE nor NICA criteria were satisfied in any of the 24 cases without an AE. There were strong relationships between an occurrence of an adverse event and fulfilling criteria for SCE (P <.001) and NICA (P <.001).Conclusion: Neonatal injury caused by medical management occurs in less than half of the obstetric malpractice claims. No-fault compensation criteria can be successfully applied to claims, and both the SCE and NICA methods are specific in avoiding compensation to claims without an AE. The SCE criteria are more sensitive than the NICA criteria for compensating AEs. Applying the SCE system to claims would result in a larger proportion of claims successfully meeting no-fault criteria than using the NICA system.
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Affiliation(s)
- CJ Saphier
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Brigham and Women's Hospital and Harvard Medical School, Massachusetts, Boston, USA
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