Yang Qian, Zhang Cathy, Hines Kristen, Calder Lisa A
Canadian Medical Protective Association (Yang, Zhang, Hines, Calder); Ottawa Hospital Research Institute (Calder); Department of Emergency Medicine (Calder), University of Ottawa, Ottawa, Ont.
CMAJ Open. 2018 Nov 19;6(4):E561-E566. doi: 10.9778/cmajo.20180077. Print 2018 Oct-Dec.
Few empirical studies have validated the relation between medicolegal risk and hospital patient safety performance. We sought to determine whether there was a relation between in-hospital patient safety events and medicolegal cases involving Canadian physicians.
In this ecological study, we used Poisson regression to compare data from the Canadian Institute for Health Information's Discharge Abstract Database and the database of the Canadian Medical Protective Association (CMPA) of medicolegal cases over 10 years (2005/06 to 2014/15). We identified incidents and cases based on 15 Agency for Healthcare Research and Quality patient safety indicators within the Canadian Institute for Health Information and CMPA data sets. We performed subgroup analyses for obstetrical and surgical cases.
We found a statistically significant positive association between volume changes in patient safety indicator events ( = 339 741) and medicolegal cases ( = 15 180) (parameter estimate 1.15, 95% confidence interval [CI] 0.4 to 1.9). This association suggests that, on average, a 10% decrease in events would correspond to a decrease of 11% in medicolegal cases. The degree of positive association varied by practice type, with obstetrics (97 982 patient safety indicator events, 865 cases) showing a 25% decrease in medicolegal cases for every 10% decrease in events (parameter estimate 2.9, 95% CI 0.5 to 5.3) and surgery (168 886 patient safety indicator events, 4568 cases) showing a decrease of 9% for every 10% decrease in events (parameter estimate 0.9, 95% CI 0.2 to 1.7).
The statistically significant positive association between patient safety indicator events and medicolegal cases quantifies a relation between patient safety and physician medicolegal risk in Canadian hospitals. This suggests new, practical uses for both medicolegal and patient safety indicator data in system-level quality-improvement efforts.
很少有实证研究验证法医学风险与医院患者安全绩效之间的关系。我们试图确定住院患者安全事件与涉及加拿大医生的法医学案件之间是否存在关联。
在这项生态学研究中，我们使用泊松回归来比较加拿大卫生信息研究所出院摘要数据库和加拿大医学保护协会（CMPA）法医学案件数据库10年（2005/06至2014/15）的数据。我们根据加拿大卫生信息研究所和CMPA数据集中的15个医疗保健研究与质量机构患者安全指标确定事件和案件。我们对产科和外科病例进行了亚组分析。
我们发现患者安全指标事件（=339741）的数量变化与法医学案件（=15180）之间存在统计学上显著的正相关（参数估计值1.15，95%置信区间[CI]0.4至1.9）。这种关联表明，平均而言，事件减少10%将对应法医学案件减少11%。正相关程度因执业类型而异，产科（97982例患者安全指标事件，865例案件）显示事件每减少10%，法医学案件减少25%（参数估计值2.9，95%CI0.5至5.3），外科（168886例患者安全指标事件，4568例案件）显示事件每减少10%，减少9%（参数估计值0.9，95%CI0.2至1.7）。
患者安全指标事件与法医学案件之间统计学上显著的正相关量化了加拿大医院患者安全与医生法医学风险之间的关系。这表明法医学和患者安全指标数据在系统层面的质量改进工作中有新的实际用途。
