Wu Chun-Ying, Lai Huei-Jen, Chen Rong-Chi
Division of Gastroenterology, Taichung Veterans General Hospital, and Law Department, Social Science College, Tunghai University, Taichung, Taiwan.
J Formos Med Assoc. 2009 Feb;108(2):126-34. doi: 10.1016/S0929-6646(09)60043-7.
BACKGROUND/PURPOSE: A better understanding of the risk factors for medical malpractice is essential for implementing long-term prevention strategies. Certain physician characteristics have been reported to be associated with malpractice litigation. However, patient characteristics have not been fully investigated.
We conducted a hospital-based case-control study. We reviewed a total of 147 cases in the inpatient risk management file (RMF) and 44,045 inpatient controls. The RMF was opened if the patient's complaint may have led to legal action. We compared demographic data of RMF cases and controls to investigate the risk factors for filing a complaint. Outcomes of the RMF cases were classified as resolution, compensation, and lawsuit.
RMF cases were associated with admission via the emergency room (odds ratio [OR]=1.62, p=0.005), surgical specialty (OR=1.86, p=0.001) and living in an urban area (OR=1.93, p<0.001). Once RMF cases were filed, living in an urban area was the only independent factor for filing a lawsuit (OR=4.10, p=0.007). RMF cases with medical injury were more likely to reach compensation (OR=10.51, p<0.001) and to receive significantly higher compensation (p=0.007). The severity of medical injury was correlated positively with the likelihood of reaching compensation and the amount of compensation. Only 15.0% of RMF cases entered the litigation phase.
Patients with certain characteristics tend to file complaints, receive compensation, or bring a case to court. Understanding of patient characteristics may be useful for predicting occurrence and outcome of complaints against physicians.
背景/目的：更好地了解医疗事故的风险因素对于实施长期预防策略至关重要。据报道，某些医生特征与医疗事故诉讼相关。然而，患者特征尚未得到充分研究。
我们进行了一项基于医院的病例对照研究。我们共查阅了住院风险管理档案（RMF）中的147例病例和44,045例住院对照。如果患者的投诉可能导致法律诉讼，则会开启RMF。我们比较了RMF病例和对照的人口统计学数据，以调查投诉的风险因素。RMF病例的结果分为解决、赔偿和诉讼。
RMF病例与通过急诊室入院（优势比[OR]=1.62，p=0.005）、外科专业（OR=1.86，p=0.001）以及居住在城市地区（OR=1.93，p<0.001）相关。一旦提交RMF病例，居住在城市地区是提起诉讼的唯一独立因素（OR=4.10，p=0.007）。发生医疗伤害的RMF病例更有可能获得赔偿（OR=10.51，p<0.001），并且获得的赔偿显著更高（p=0.007）。医疗伤害的严重程度与获得赔偿的可能性和赔偿金额呈正相关。只有15.0%的RMF病例进入诉讼阶段。
具有某些特征的患者倾向于提出投诉、获得赔偿或提起诉讼。了解患者特征可能有助于预测针对医生投诉的发生和结果。
