Association Between Physician Characteristics and Surgical Errors in U.S. Hospitals

The high incidence of medical and surgical errors in U.S. hospitals and clinics affects patients\u27 safety. Not enough is known about the relationship between physician characteristics and medical error rates. The purpose of this quantitative correlational study was to examine the relationship between selected physician characteristics and surgical errors in U.S. hospitals. The ecological model was used to understand personal and systemic factors that might be related to the incidence of surgical errors. Archived data from the National Practitioner Data Bank database of physician surgical errors were analyzed using bivariate and multivariate logistic regression analyses. Independent variables included physicians\u27 home state, state of license, field of license, age group, and graduation year group. The dependent variable was surgical medical errors. Physicians\u27 field of license and state of license were significantly associated with surgical error. Findings contribute to the knowledge base regarding the relationship between physician characteristics and surgical medical errors, and findings may be used to improve patient safety and medical care

Bridging the Relational-Regulatory Gap: A Pragmatic Information Policy for Patient Safety and Medical Malpractice

The medical malpractice crisis of the last few years has tapped a lot of scholarly energy. Time not spent on original research-adding to the store of knowledge about the medical malpractice system-is often spent communicating with policymakers and the public. These experiences have led us to think a lot about the amount and quality of information circulating within or concerning the medical malpractice system, and about public policy reforms that would improve information flow in the future. No grand theory has emerged from this meditation. Instead, we have formed definite, though not immutable, opinions about a desirable information policy for patient safety and medical malpractice. Two specific recommendations convey a sense of our view. First, the mandatory malpractice payment reporting provisions of the National Practitioner Data Bank should be repealed. Second, confidential settlements of tort claims in medical malpractice cases should be prohibited, except perhaps as to the dollar amount of the payment. But aren\u27t these inconsistent? The former would reduce available information, while the latter would increase it. Furthermore, wouldn\u27t combining the two reforms be self-defeating, with a net result of reconstructing national data simply by aggregating individual settlements? We hope to persuade readers of this Article that these recommendations should receive a more favorable descriptor: pragmatic. For reasons explained below, any seamless information policy is likely to reflect a foolish consistency-perhaps political ideology, perhaps tunnel vision regarding policy goals or regulatory silos-and should be avoided. Rather, information policy should be incremental and contextual. That is, it should be sensitive to the complicated, contentious history and psychology of health care quality oversight and medical liability. One can model malpractice information policy by envisioning a signal pathway that divides the disclosure process into segments. Beginning from a medical incident, the critical steps in conveying information are content (signal), packaging (categorization), accessing (transmission), and interpretation (processing) of malpractice-related information about health care providers. Each stage of the pathway modifies the signal as it moves forward. Therefore, significant variables at each stage can affect the end result: what content is chosen, how it is categorized, who has access to it, and the final impression it creates

Why do Nigerian manufacturing firms take action on AIDS?

Objective: To identify differences between manufacturing firms in Nigeria that have undertaken HIV/AIDS prevention activities and those that have not as a step toward improving the targeting of HIV policies and interventions. Methods: A survey of a representative sample of registered manufacturing firms in Nigeria, stratified by location, workforce size, and industrial sector. The survey was administered to managers of 232 firms representing most major industrial areas and sectors in March-April 2001. Results: 45.3 percent of the firms’ managers received information about HIV/AIDS from a source outside the firm in 2000; 7.7 percent knew of an employee who was HIV-positive at the time of the survey; and 13.6 percent knew of an employee who had left the firm and/or died in service due to AIDS. Only 31.7 percent of firms took any action to prevent HIV among employees in 2000, and 23.9 percent had discussed the epidemic as a potential business concern. The best correlates of having taken action on HIV were knowledge of an HIV-positive employee or having lost an employee to AIDS (odds ratio [OR] 6.36, 95% confidence interval [CI]: 2.30, 17.57) and receiving information about the disease from an outside source (OR 7.83, 95% CI: 3.46, 17.69). Conclusions: Despite a nationwide HIV seroprevalence of 5.8 percent, as of 2001 most Nigerian manufacturing firm managers did not regard HIV/AIDS as a serious problem and had neither taken any action on it nor discussed it as a business issue. Providing managers with accurate, relevant information about the epidemic and practical prevention interventions might strengthen the business response to AIDS in countries like Nigeria

UCTx: a multi-agent system to assist a transplant coordination unit

We present a system called UCTx, designed to model and automate some of the tasks performed by a Transplant Coordination Unit (UCTx) inside a Hospital. The aim of this work is to show how a multi-agent approach allows us to describe and implement the model, and how UCTx is capable of dealing with another multi-agent (Carrel, an Agent Mediated Institution for the exchange of Human Tissues among Hospitals for Transplantation) in order to meet its own goals, acting as the representative of the hospital in the negotiation. As an example we introduce the use of this Agency in the case of Cornea Transplantation.Postprint (published version

An Examination of the Maternal Health Quality of Care Landscape in India

India has made significant strides in maternal health over the past several decades, reducingits maternal mortality ratio (MMR) from 556 to 174 maternal deaths per 100,000 live births from1990 to 2015 (World Bank 2016a). Policies and initiatives to increase access to maternal healthservices largely account for this progress. However, the rate of improvement has slowed, and thecountry continues to contribute almost one-quarter of maternal deaths globally (Nair 2011). Inaddition, India is home to a high but difficult to measure rate of so-called near-miss maternaldeaths that often lead to maternal morbidity. Although the incidence of maternal morbidity inIndia is largely unknown due to the country's lack of diagnoses and under-reporting, it isestimated that millions of Indian women experience pregnancy-related morbidity; the GlobalBurden of Disease estimates that India contributes one-fifth of the disability-adjusted life yearslost globally due to maternal health conditions (World Health Organization 2008). These patternssuggest there is still progress to be made in maternal health in India.The John D. and Catherine T. MacArthur Foundation seeks to continue its more than 20-year history supporting population and reproductive health in India and accelerate the country'sadvancement in maternal health. It has chosen to fund a three-and-a-half-year grantmakingstrategy to improve maternal health quality of care, which has emerged as a key means to furtherreduce MMR and related outcomes. This review is intended to describe current issues andinterventions in the delivery of maternal health care and provide a backdrop for the Foundation'sgrantmaking effort

BUREAUCRATS AS PURCHASERS OF HEALTH SERVICES: LIMITATIONS OF THE PUBLIC SECTOR FOR CONTRACTING

Contracting out of health services increasingly involves a new role for governments as purchasers of services. To date, emphasis has been on contractual outcomes and the contracting process, which may benefit from improvements in developing countries, has been understudied. This article uses evidence from wide scale NGO contracting in Pakistan and examines the performance of government purchasers in managing the contracting process; draws comparisons with NGO managed contracting; and identifies purchaser skills needed for contracting NGOs. We found that the contracting process is complex and government purchasers struggled to manage the contracting process despite the provision of well-designed contracts and guidelines. Weaknesses were seen in three areas: (i) poor capacity for managing tendering; (ii) weak public sector governance resulting in slow processes, low interest and rent seeking pressures; and (iii) mistrust between government and the NGO sector. In comparison parallel contracting ventures managed by large NGOs generally resulted in faster implementation, closer contractual relationships, drew wider participation of NGOs and often provided technical support. Our findings do not dilute the importance of government in contracting but front the case for an independent purchasing agency, for example an experienced NGO, to manage public sector contracts for community based services with the government role instead being one f larger oversight. © 2011 John Wiley & Sons, Ltd.

Why do Nigerian manufacturing firms take action on AIDS?

This repository item contains a single issue of the Health and Development Discussion Papers, an informal working paper series that began publishing in 2002 by the Boston University Center for Global Health and Development. It is intended to help the Center and individual authors to disseminate work that is being prepared for journal publication or that is not appropriate for journal publication but might still have value to readers.OBJECTIVE: To identify differences between manufacturing firms in Nigeria that have undertaken HIV/AIDS prevention activities and those that have not as a step toward improving the targeting of HIV policies and interventions. METHODS: A survey of a representative sample of registered manufacturing firms in Nigeria, stratified by location, workforce size, and industrial sector. The survey was administered to managers of 232 firms representing most major industrial areas and sectors in March-April 2001. RESULTS: 45.3 percent of the firms’ managers received information about HIV/AIDS from a source outside the firm in 2000; 7.7 percent knew of an employee who was HIV-positive at the time of the survey; and 13.6 percent knew of an employee who had left the firm and/or died in service due to AIDS. Only 31.7 percent of firms took any action to prevent HIV among employees in 2000, and 23.9 percent had discussed the epidemic as a potential business concern. The best correlates of having taken action on HIV were knowledge of an HIV-positive employee or having lost an employee to AIDS (odds ratio [OR] 6.36, 95% confidence interval [CI]: 2.30, 17.57) and receiving information about the disease from an outside source (OR 7.83, 95% CI: 3.46, 17.69). CONCLUSIONS: Despite a nationwide HIV seroprevalence of 5.8 percent, as of 2001 most Nigerian manufacturing firm managers did not regard HIV/AIDS as a serious problem and had neither taken any action on it nor discussed it as a business issue. Providing managers with accurate, relevant information about the epidemic and practical prevention interventions might strengthen the business response to AIDS in countries like Nigeria

Issues and Challenges of HIV/AIDS Prevention and Treatment Programme in Nepal

This paper explores some of the key issues and challenges of government HIV/AIDS prevention and treatment programme in Nepal. Providing HIV/AIDS prevention and treatment services in Nepal is associated with a number of issues and challenges which are shaped mostly on cultural and managerial issues from grass root to policy level. Numerous efforts have been done and going on by Nepal government and non-government organization but still HIV prevention and treatment service is not able to reach all the most at risk populations because cultural issues and managerial issues are obstructing the services. The existing socio-cultural frameworks of Nepal do not provide an environment for any safe disclosure for person who is HIV infected. Thus, there is an urgent need to address those issues and challenges and strengthen the whole spectrums of health systems through collaborative approach to achieve the millennium development goals. It will be the purpose of this paper to contribute to the policy makers by exploring the pertinent issues and challenges in the HIV/AIDS programme

No. 58: The Disengagement of the South African Medical Diaspora

Conventional wisdom holds that the ‘brain drain’ of health professionals from Africa is deeply damaging to the continent. Recently, a group of North American and European neo-liberal economists has challenged this conventional wisdom, variously arguing that the negative impacts are highly exaggerated and the compensating benefits many. The benefits include various forms of “diaspora engagement” in which those who have left then engage through sending remittances, direct investment, knowledge and skills transfer, return migration and involvement in diaspora associations. A previous SAMP study of Zimbabwean physicians outside the country provided clear evidence for the “diaspora engagement” hypothesis (see No 56 in this series). This paper examines the case of South African physicians who have left South Africa. South Africa provides an ideal case for examining the conflicting viewpoints on the health brain drain given the significant loss of physicians the country has experienced over the past two decades. A 2000 global survey of the location of physicians found that as many as 7,363 South African-trained doctors (or 21% of the total number in practice) were living and practising abroad. In 2005, the OECD estimated that more than 13,000 South African trained physicians were working in OECD countries, of whom 7,718 were in the United Kingdom, 2,215 in the United States, 1,877 in Canada and 1,022 in New Zealand. More recent data from Canada indicates that there were 2,193 South African physicians in that country in 2009. The research reported in this paper consists of a survey of 415 South African doctors in Canada conducted in 2009-10 (representing almost 20% of the total number working in Canada.) More than half of the survey respondents (58%) had acquired Canadian citizenship since leaving South Africa. Of the rest, around one quarter (26%) were permanent residents in Canada and only 16% were on work permits. At the same time, 70% still hold South African citizenship. This raised the possibility that they want to retain their South African citizenship because they feel a strong affinity with South Africa. Nearly 90% agreed with the statement that “being from South Africa is an important part of how I view myself” and 81% with the statement that “I feel strong ties with people from South Africa.” The vast majority (over 80%) buy or make South African foods, listen to South African music and want their children to know about South Africa. Some 80% regularly consult South African newspapers online. As many as 60% want their children to learn a South African language. Forty percent say that their best friends in Canada are South Africans. Family links with South Africa also remain strong. As many as 81% have siblings still living in South Africa and 71% still have parents there. About 95% of the respondents had visited South Africa since migrating to Canada. More than 75% visit South Africa at least every 2-3 years, with 28% visiting once a year. However, despite all this evidence of a persistent South African identity and the maintenance of strong links with the country, the vast majority (80%) disagreed with the statement that they had “an important role to play in the development of South Africa.” Only 16% said they are likely to send money for development projects in South Africa, 15% said they would participate in educational and other exchanges with South Africa, while 13% would participate in fundraising projects in South Africa. Only 10% said they would invest in a business in South Africa and just 8% might work for a period of time in South Africa. By most standards, the physicians surveyed were high income earners. As many as two-thirds earn above CAN$200,000 (ZAR 1.6 million) per annum and fewer than 5$100,000 (ZAR 800,000) annually. In general, remitting is often positively correlated with income: the more a migrant earns the greater the amount that they tend to remit. However, despite their high earnings South African physicians in Canada are not significant remitters: Only half (52%) had sent money to South Africa in the previous year and only 19% can be considered regular remitters who send money to South Africa at least once a month. A considerable number do not remit regularly (21% do so less than once a year) and 28% have never sent remittances to South Africa. Less than a third (27%) had sent more than CAN$5,000 (ZAR40,000) to South Africa. The median amount sent by remitters was only CAN$4,250 (ZAR 33,000) per annum, which falls to only CAN$1,000 (ZAR8,000) per annum for the whole sample. Such small amounts are unlikely to yield significant development outcomes in the country of origin or compensate the country for the loss of skills incurred in the brain drain. The majority of the remitters (82$1,000 (ZAR8,000) annually. The mean value of goods sent by the physicians was CAN$340 (ZAR2,430) annually. In other words, the amounts remitted by South African physicians are small in comparison to their incomes and remitting is infrequent. The South African physicians differ markedly in their remitting behaviour from physicians from other African countries and from African diasporas in general. Further evidence of the disengagement of the South African physician diaspora is provided by patterns of property ownership and other investments in South Africa. As many as 57% of the physicians maintain an active bank account in South Africa but these are funds ostensibly for use during their visits. Only 25% have substantial savings in their bank accounts. At the same time 17% own property, 35% have investments and 27% have a house in South Africa. However, these are generally acquired before leaving. Only 5% had bought a house or property in South Africa and only 4% had invested in a South African business in the year prior to the survey. The vast majority of those still holding these assets in South Africa are recent (post 2000) immigrants to Canada. There is a consistent pattern of decline in South African asset ownership over time as the physicians sell their property, close their bank accounts and disinvest. In order to gauge the potential for return migration, the respondents were asked whether they had considered returning to South Africa. About 36% have never considered the possibility of returning while 21% had given it hardly any thought. About 43% indicated that they have considered returning to South Africa. However, only 7% said they are likely to return within the next two years and another 10% within the next five years. Few had taken any concrete steps to return. Less than 2% had applied for a job in South Africa in the previous year. While this group of South African professionals are proud to think of themselves as South African and take a relatively keen interest in events in that country, they are disengaged from any serious diasporic interest in and commitment (beyond contact with and some limited support for family members who remain). Almost without exception, they paint a very negative picture of life in South Africa and they do not see any role for themselves in helping address South Africa’s deep social and economic inequalities and needs. Neo-liberal economists and proponents of diaspora engagement will find little to support their arguments in the views of this particular component of the South African diaspora

HIV Prevention in the Era of Expanded Treatment Access

Makes recommendations on how to forge a comprehensive response to the global AIDS epidemic by integrating prevention interventions into expanding treatment programs, and on new approaches to prevention that will be required as treatment access expands