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