Luo Jin, Liu Huanzhong, Liu Yuanli, Jiang Feng, Tang Yi-Lang
Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China.
Risk Manag Healthc Policy. 2021 Sep 13;14:3767-3774. doi: 10.2147/RMHP.S328046. eCollection 2021.
Medical disturbances (MD), a severe type of medical disputes, are common in Chinese hospitals. Medical liability insurances were introduced to establish a new system of conflict resolution and risk management. However, data are scarce on the effects of medical liability insurance coverage and MD in psychiatric hospitals. This study was set to address it based on a nationwide survey.
A national cross-sectional survey was conducted in March 2019. Physicians in 41 tertiary psychiatric hospitals participated in a smartphone based anonymous questionnaire. Experience of MD, sociodemographic and occupational characteristics, and job satisfaction information were reported by physicians. The hospital medical liability insurance status was reported by participating hospitals. Multi-level logistic regression analysis was used to examine the association between medical liability insurance coverage and MD.
In total, 4511 physicians completed the survey, 3760/4511 (83.35%) physicians in 32 hospitals had medical liability insurance coverage, and 1401/4511 (31.06%) physicians had encountered medical disturbances in the previous year. After adjusting for confounding factors, medical liability insurance coverage was not significantly associated with MD (OR=1.28, 95% CI: 0.93-1.76). Female gender, working in West China, and higher job satisfaction were protective factors for MD. Higher outpatient volume/week (>50 patients/week) and longer working hours/week were risk factors for MD.
Nearly one-third of physicians in Chinese top-tier psychiatric hospitals reported experience of MD. There was no significant association between medical liability insurance coverage and MD experienced among physicians in Chinese psychiatric hospitals. Policymakers and hospital administrators need to tailor the scope of medical liability insurance and to focus on other factors to reduce MD, including reducing workload and improving the doctor-patient relationship.
医疗纠纷是一种严重的医疗争议类型，在中国医院中很常见。引入医疗责任保险以建立新的冲突解决和风险管理体系。然而，关于医疗责任保险覆盖范围与精神病医院医疗纠纷之间影响的数据很少。本研究旨在基于全国性调查来解决这一问题。
2019年3月进行了一项全国性横断面调查。41家三级精神病医院的医生参与了一项基于智能手机的匿名问卷调查。医生报告了医疗纠纷经历、社会人口学和职业特征以及工作满意度信息。参与调查的医院报告了医院医疗责任保险状况。采用多水平逻辑回归分析来检验医疗责任保险覆盖范围与医疗纠纷之间的关联。
共有4511名医生完成了调查，32家医院的3760/4511（83.35%）名医生有医疗责任保险覆盖，1401/4511（31.06%）名医生在前一年遇到过医疗纠纷。在调整混杂因素后，医疗责任保险覆盖范围与医疗纠纷无显著关联（OR = 1.28，95%CI：0.93 - 1.76）。女性、在中国西部工作以及较高的工作满意度是医疗纠纷的保护因素。每周门诊量较高（>50例/周）和每周工作时间较长是医疗纠纷的危险因素。
中国顶级精神病医院近三分之一的医生报告有医疗纠纷经历。中国精神病医院医生所经历的医疗纠纷与医疗责任保险覆盖范围之间无显著关联。政策制定者和医院管理人员需要调整医疗责任保险范围，并关注其他因素以减少医疗纠纷，包括减轻工作量和改善医患关系。
