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中国医院分类及其在医疗纠纷解决中的应用。

A taxonomy of Chinese hospitals and application to medical dispute resolutions.

机构信息

School of Public Administration, Southwestern University of Finance and Economics, 555 Liutai Street, Chengdu, 611130, China.

Institute of Health Policy and Hospital Management, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.

出版信息

Sci Rep. 2022 Oct 29;12(1):18234. doi: 10.1038/s41598-022-23147-3.

Abstract

Medical disputes can be viewed as a negative indicator of health care quality and patient satisfaction. However, dispute prevention from the perspective of systematic supervision is unexplored. This study examines hospital clustering based on diagnosis-related group (DRG) indicators and explores the association between hospital clusters and medical disputes. Health administrative data from Sichuan Province in 2017 were used. A twostep cluster analysis was performed to cluster hospitals based on DRG indicators. A multiple regression analysis was conducted to evaluate the relationship between clusters and the incidence/number of medical disputes. The 1660 hospitals were grouped into three DRG clusters: basic (62.5%, n = 1038), diverse (31.0%, n = 515), and lengthy (6.4%, n = 107). After adjusting for covariates, the diverse hospitals were associated with an increased probability of having medical disputes (OR 5.24, 95% CI 2.97-9.26), while the diverse and lengthy hospitals were associated with a greater number of medical disputes (IRR 10.67, 95% CI 6.58-17.32; IRR 4.06, 95% CI 1.22-13.54). Our findings highlighted that the cluster-level performance of hospitals can be monitored. Future studies could examine this relationship using a longitudinal design and explore ways to reduce medical disputes in hospitals.

摘要

医疗纠纷可以被视为医疗质量和患者满意度的负面指标。然而,从系统监督的角度预防纠纷尚未得到探索。本研究基于疾病诊断相关分组(DRG)指标考察了医院聚类,并探讨了医院聚类与医疗纠纷之间的关系。使用了 2017 年四川省的卫生行政数据。基于 DRG 指标对医院进行两步聚类分析。采用多元回归分析评估聚类与医疗纠纷发生率/数量之间的关系。1660 家医院被分为三组 DRG 聚类:基础型(62.5%,n=1038)、多样化型(31.0%,n=515)和冗长型(6.4%,n=107)。在调整了混杂因素后,多样化型医院发生医疗纠纷的概率更高(OR 5.24,95%CI 2.97-9.26),而多样化型和冗长型医院发生的医疗纠纷数量更多(IRR 10.67,95%CI 6.58-17.32;IRR 4.06,95%CI 1.22-13.54)。研究结果强调了可以监测医院的聚类水平表现。未来的研究可以使用纵向设计来检验这种关系,并探讨减少医院医疗纠纷的方法。

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