成都市某两家医院医疗纠纷预测模型构建及评价研究  

Research on Construction and Evaluation of Medical Dispute Prediction Model of Two Hospitals in Chengdu

作　　者：王晓刚 谢雪[1] 何睿[1] 冉隆耀 李杨 何亚薇[1] 张家伟[1] WANG Xiaogang(The Second People's Hospital of Chengdu City,Chengdu,Sichuan,610017,China)

机构地区：[1]成都市第二人民医院,四川成都610017 [2]四川大学华西医院,四川成都610041

出　　处：《医学与社会》2022年第7期68-73,80,共7页Medicine and Society

基　　金：四川医事卫生法治研究中心立项资助“医疗投诉管理研究”项目,编号为YF18-Q06。

摘　　要：目的:构建医院医疗纠纷预测模型,并对模型进行评价,为医疗安全管理实践提供参考依据。方法:对成都市某两家综合性三甲公立医院近3年不良事件进行梳理,采用χ^(2)检验、logistic回归、ROC曲线和Z检验分析不良事件数据。结果:459例不良事件中,有73例发生纠纷,有386例未发生纠纷。科室、岗位、疾病程度、心理状态、事件分级和成因是医疗纠纷发生的影响因素(P<0.05)。非外科科室和非技术原因引起的不良事件发生纠纷的风险更低(P<0.05)。非一线医务人员、轻度疾病患者、有心理异常倾向的患者或家属和一二级不良事件发生纠纷的风险更高(P<0.05)。联合因素预测模型的L值大于-0.156时可预测纠纷发生,准确预测率为91.3%,敏感度为0.877,特异性为0.821。结论:加强重点领域和关键环节管控是医疗纠纷防范的重要措施。联合因素预测模型的性能优于其他模型,对医疗安全管理实践具有较强的应用价值。Objective:To construct the medical dispute prediction model and evaluate the model,so as to provide references for medical safety management practice.Methods:The adverse events in the past three years in two grade-A tertiary comprehensive public hospitals in Chengdu were reviewed.The chi-square test,logistic regression,ROC curve and Z test were used to analyze the adverse event data.Results:Among the 459 adverse events,73 cases were disputable,and 386 cases were not disputable.Department,post,disease degree,psychological state,event classification and cause of medical disputes were influencing factors(P<0.05).Non-surgical and non-technical causes of adverse events had a lower risk of dispute(P<0.05).Non-first-line medical staff,patients with mild diseases,patients or their family members with psychological disorder tendency and first to second level adverse events were at higher risk of disputes(P<0.05).When the L value of the combined factor prediction model was greater than-0.156,disputes were about to be predicted.The accuracy prediction rate was 91.3%,sensitivity was 0.877 and specificity was 0.821.Conclusion:Strengthening the control of key areas and key links is an important measure to prevent medical disputes.The performance of the combined factor prediction model is better than that of other models,and it has a strong application value to the practice of medical safety management.

关 键 词：医疗纠纷 预测模型 不良事件 模型评价 

分 类 号：R197.3[医药卫生—卫生事业管理]