Xu Ping, Fan Zhenlin, Li Ting, Wang Lijie, Sun Qingwen, Du Xia, Lian Bin, Zhang Lulu
Department of Health Service Management, Second Military Medical University, 800 Xiangyin Road, 200433, Shanghai, China.
Department of Medical Education, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
BMC Health Serv Res. 2015 Jan 22;15:5. doi: 10.1186/s12913-014-0671-5.
Medical disputes have become a serious issue in China. A crisis cannot usually be predicted and managed through a cost-benefit strategy; therefore, researchers believe that prevention is better than containment and post-crisis resolution. This study aimed to identify solutions to prevent medical disputes in surgical cases through early warning and intervention of potential cases.
A case-control study was conducted to identify early detection indicators of medical disputes in the surgical treatment of liver cancer through Delphi consultation and logistic regression on the basis of which interventions were undertaken to prevent potential cases.
The dispute detection model was composed of patient age (P = 0.08), frequency of hospitalization (P = 0.003), length of hospital stay (P < 0.001), terminal condition (P = 0.004), unplanned reoperation (P = 0.048), blood transfusion volume (P = 0.006), and arrearage (P < 0.001). Risk management interventions through quality improvement and enhanced communication in cases with an abnormal performance indicator proved effective in practice.
This study explored the use of an evidence-based medical risk management strategy for medical disputes that involved early detection and intervention and could potentially be adopted by hospitals to prevent medical disputes.
医疗纠纷在中国已成为一个严重问题。危机通常无法通过成本效益策略来预测和管理；因此，研究人员认为预防胜于控制和危机后解决。本研究旨在通过对潜在病例的早期预警和干预，确定预防外科病例医疗纠纷的解决方案。
进行了一项病例对照研究，通过德尔菲咨询和逻辑回归确定肝癌手术治疗中医疗纠纷的早期检测指标，并在此基础上采取干预措施以预防潜在病例。
纠纷检测模型由患者年龄（P = 0.08）、住院频率（P = 0.003）、住院时间（P < 0.001）、终末期状况（P = 0.004）、非计划再次手术（P = 0.048）、输血量（P = 0.006）和欠费（P < 0.001）组成。在绩效指标异常的病例中，通过质量改进和加强沟通进行风险管理干预在实践中被证明是有效的。
本研究探索了一种基于证据的医疗风险管理策略用于医疗纠纷，该策略涉及早期检测和干预，医院有可能采用该策略来预防医疗纠纷。
