美英加澳和中国台湾地区医疗不良事件上报系统管理模式的比较研究  

International Comparative Analyses of Incidents Reporting Systems for Healthcare Risk Management

作　　者：崔小花[1] 孙纽云[2] 李幼平[1] 张宗久[3] 王莉[1] 周军[3] 梁铭会[2] 成岚[1] 高光明[3] 袁强[1] 

机构地区：[1]四川大学华西医院中国循证医学中心,成都610041 [2]卫生部医院管理研究所,北京100083 [3]卫生部医疗服务监管司,北京100044

出　　处：《中国循证医学杂志》2011年第3期237-246,共10页Chinese Journal of Evidence-based Medicine

摘　　要：目的比较分析美、英、加、澳和中国台湾地区医疗风险与预警监测系统管理模式,为我国医疗风险管理提供决策依据和政策建议。方法检索上述四国一区医疗风险管理相关机构官方网站(截止至2010年12月),纳入规范性文件、学术研究报告、综述、官网一般信息等,详细筛选和提取相关资料,并按不同主题进行描述性分析。结果①共纳入142篇文献,美国文献量最大(68篇),质量较高的规范性文件也最多(8篇)。②四国一区上报系统随启动时间长短,上报事件类型、范围不断扩展,从最初用药差错/医院感染事件扩展到近似差错事件,目前已囊括全部病人安全事件。③国家层面的管理模式可归纳为两个体系,即以英国为代表的国家主导模式和以美、加、澳为代表的法律/法规/行业协会协同模式。两种模式在法律/法规、标准化、规范化、资金来源等方面均有自身突出优点。④为特别需求设立的国家级系统分两类,即造成死亡或严重伤害的事件上报系统(包括美国警讯事件数据库和英国严重事件报告与学习框架)及医院感染事件监测系统(美国全国医疗安全网)。其针对性较强,有利于特殊事件的监测、处理和预警。⑤国家二级政府系统的比较研究选取美国印第安纳州政府强制报告内容和程序与台湾病人安全通报系统。后者对事件对象、上报内容定位更广泛系统,兼顾风险管理各环节,值得借鉴;⑥比较四国一区总体上报事件结果表明:目前英国系统最完善,加拿大系统需发展完善的环节最多。结论①英国医疗风险管理系统为国家主导的中央集权管理,是目前最完备的系统;②美国系统启动最早,虽管理范围局限,但依靠其相对最完善的法律/法规保障,仍能有效发挥作用;③加、澳两国借鉴美、英经验,仍在不断发展完善中;④中国台湾地区系统比美国印第安纳州政府系统各方面�Objective To compare administration of incidence reporting systems for healthcare risk management in the United Kingdom,the United States,Canada,Australia,and Taiwan,and to provide evidence and recommendations for healthcare risk management policy in China.Methods We searched the official websites of the healthcare risk management agencies of the four countries and one district for laws,regulatory documents,research reports,reviews,and evaluation forms concerned with healthcare risk management and assessment.Descriptive comparative analysis was performed on relevant documents.Results （1） A total of 142 documents were included in this study.The United States had the most relevant documents（68）.（2） The type of incidents from reporting systems has expanded from medication errors and hospital-acquired infections to near-misses,and now includes all patient safety incidents.（3） The incidence-reporting systems can be grouped into two models： government-led and legal/regulatory/NGO-collaborative.（4） In two cases,reporting systems were established for specific incident types： One for death or serious injury events（the sentinel events database in Britain,SIRL）,and one for healthcare-associated infections（NHSN in America）.（5） Compared to the four countries,Taiwan＇s system put more emphasis on public welfare,confidentiality,and information sharing.The contents of reporting there covered every aspect of risk management to create a more secure environment.Conclusion （1） Britain＇s national reporting and learning system was representative of a government-led model;（2） The United States was the earliest country to have a reporting system,which included a limited range of incident types.Management of incidents became more reliable with increased application of laws,regulations,and guidances;（3） Both the Canadian and the Australian systems drew from the American experience and are still developing;（4） The Taiwan Residents system was comprehensive and is an instructional case.

关 键 词：医疗风险 预警监测 管理模式 比较研究 

分 类 号：R199[医药卫生—卫生事业管理]