山东省三级甲等医院医生消极防御性医疗行为预测模型构建研究  

Construction of a Predictive Model for Negative Defensive Medical Behaviors of Doctors in Tertiary Grade A Hospitals in Shandong Province

作　　者：刘霞[1] 杨芦思 高玉强[1] Liu Xia;Yang Lusi;Gao Yuqiang(Qingdao Municipal Hospital,Qingdao,Shandong Province,156001,China;不详)

机构地区：[1]青岛市市立医院,山东青岛156001

出　　处：《中国医院管理》2024年第12期86-89,共4页Chinese Hospital Management

基　　金：山东省卫生健康委员会2023年深化医改研究课题(YGY2023091)。

摘　　要：目的 探讨三级甲等医院医生消极防御性医疗行为现状以及影响因素,构建消极防御性医疗行为预测模型。方法 采用整群抽样方法,选取山东省4家三级甲等医院的946名临床医生,采用自填式问卷调查医生人口学特征、职业特征、医患关系状况、消极防御性医疗行为等。采用logistic回归分析筛选消极防御性医疗行为的影响因素,同时构建预测模型和分析模型效能。结果 72.1%的医生最近一年内采取过消极防御性医疗,最常见的为减少接触患者的数量671人,占比70.9%。二元logistic回归分析结果显示,男性、高年资、高职称、外科、负性医患关系、医疗纠纷经历、高风险感知是消极防御性医疗行为的独立影响因素(P<0.05)。纳入上述6个变量构建的预测模型AUC为0.846,校准良好,对验证样本的预测准确率为88.6%。结论 消极防御性医疗在三甲医院医生中普遍存在,应聚焦重点人群,采取针对性干预。所构建的预测模型可嵌入医院管理系统,实现智能预警。Objective To investigate the current situation and influencing factors of negative defensive medical practices among doctors in tertiary hospitals,construct a predictive model for negative defensive medicine.Methods Using cluster sampling,946 clinical doctors from 4 tertiary hospitals in Shandong Province were selected.A self-administered questionnaire was used to survey doctors'demographic characteristics,occupational characteristics,doctor-patient relationship status,and negative defensive medical behaviors.Logistic regression was used to screen the influencing factors of negative defensive medical behavior,while constructing a predictive model and analyzing the performance of the model.Results 72.1%of doctors engaged in negative defensive medical practices,with the most common being reducing the number of patient contacts(671 people,70.9%).Logistic regression results showed that male gender,high seniority,high professional title,surgical specialty,negative doctor-patient relationship,experience of medical disputes,and high-risk perception were independent influencing factors for negative defensive medical behaviors(P<0.05).The logistic regression model incorporating the above 6 variables had an AUC of 0.846,good calibration,and a prediction accuracy of 88.6%on the validation sample.Conclusion Negative defensive behavior is prevalent among doctors in tertiary hospitals.Interventions should focus on key populations and adopt targeted measures.The predictive model constructed in this study can be embedded into hospital management systems to achieve intelligent early warning.

关 键 词：消极防御性医疗 影响因素 预测模型 三级甲等医院 医生 

分 类 号：R197.1[医药卫生—卫生事业管理]