2008—2020年我国三级甲等医院医疗诉讼案例患者损害研究  

Prevalence Study of the Damage on Patients in Medical Litigation in Grade A Tertiary Hospitals in China from 2008 to 2020

作　　者：宋可玉 董圣洁 施贞夙 李国红[1,2] Song Keyu;Dong Shengjie;Shi Chensu;Li Guohong(School of Public Health,Shanghai Jiaotong University,Shanghai,200025,China;不详)

机构地区：[1]上海交通大学公共卫生学院,上海200025 [2]上海交通大学中国医院发展研究院,上海200025

出　　处：《中国医院管理》2023年第7期46-52,共7页Chinese Hospital Management

基　　金：国家自然科学基金项目(72074147)。

摘　　要：目的 回顾2008—2020年三级甲等医院医疗诉讼案例涉诉患者损害结局,进而分析影响患者损害的重要因素。方法 使用R语言对我国三级甲等医院医疗诉讼案例涉及患者结局情况进行描述性统计分析并构建多分类logistic回归模型。结果 2008—2020年三级甲等医院医疗诉讼案例数为9 609例,2019年医疗诉讼数量达到峰值2 172例,2020年受新冠疫情影响降至827例;医疗行为相关患者损害率达78.3%。入院共病多、老龄者诉讼发生率高;内科、急诊死亡率高,外科、妇产科伤残率高。诊疗要素(ICU、手术经历、医源性感染)是患者伤残或死亡结局的影响因素。治疗技术过失和医疗管理过失发生率最高,且严重损害结局发生率与未发生者相比均高。结论 医疗诉讼的发生通常意味着患者遭受了严重的健康损害,损害的发生既受患方自身健康基础的影响,也由各诊疗环节不规范医疗行为导致,需从整体出发构建全流程患者损害风险预警机制,以提升医疗质量,保障患者安全。Objective To review the damaged results and its interfering factors involved in medical litigation among Grade Ⅲ tertiary hospitals from 2008 to 2020.Methods R was used to make descriptive statistics and establish a disordered multi-classification logistic regression models on health outcome involved in medical litigation of Grade Ⅲ A hospitals in China.Results From 2008 to 2020,there were 9 609 cases of listed hospitals.The case number reached a peak of 2 172 in 2019 while in 2020 it dropped to 827 because of the COVID-2019 epidemic.The incidence of medical-behavior-related-damage was 78.3%.Patients with more comorbidities or elderly patients are litigation prone patients.The experience of ICU,surgery and iatrogenic infection during hospital are influencing factors of patient harm.The highest rates of technical negligence in treatment and negligent medical management were found,and the rates of serious damage outcomes were higher in both cases compared to those that did not occur.Conclusion The occurrence of medical litigation usually means that patients have suffered serious health damage.Damage is not only affected by the patient's own health foundation,but also resulted from non-standard medical behavior during diagnosis and treatment.It is necessary to build a whole process patient safety risk early warning mechanism to improve medical quality and ensure patient safety.

关 键 词：医疗诉讼 患者安全 损害结局 医疗过失 

分 类 号：R197.323.4[医药卫生—卫生事业管理]