天津市医疗损害事件医方原因力判定影响因素分析  

Analysis of Factors Influencing the Determination of Medical Causal Force for Medical Injury Incidents in Tianjin

作　　者：周金满 褚建欣 李玉[3] 刘丹 张艺馨[1] 杜汋[1,4] Zhou Jinman;Chu Jianxin;Li Yu(School of Public Health,Tianjin Medical University,Tianjin,300070,China;不详)

机构地区：[1]天津医科大学公共卫生学院,天津300070 [2]天津市医药学(协)会,天津300022 [3]天津医科大学总医院,天津300052 [4]天津医科大学突发公共卫生事件应急研究中心,天津300070

出　　处：《中国医院管理》2025年第3期93-96,共4页Chinese Hospital Management

基　　金：天津市哲学社会科学规划项目(TJZDDY20-21);天津医科大学医院管理创新研究项目(2024YG01)。

摘　　要：目的回顾医疗损害事件中患者的损害结局,分析天津市医疗损害事件医方原因力判定的影响因素,以期通过规避危险因素规范医务人员诊疗活动,减少医疗损害事件的发生。方法选取天津市医学会医疗损害鉴定办公室2017—2023年处理的316例医疗损害事件作为研究对象,利用描述性分析总结医疗损害事件基本情况,通过单因素分析、构建多因素logistic回归模型探索影响医疗损害事件医方原因力大小的医疗过错因素。结果诊疗行为过错(OR=3.140)和术前评估不全(OR=6.008)是医疗损害事件医方原因力判定的影响因素(P<0.05),且三者回归系数均大于0,即三者与医方原因力被判定为大于等于同等原因的概率呈正相关。结论天津市医疗损害事件数量呈波动下降趋势,三级公立综合医院医疗损害事件数量最多。因此,医疗机构应建立健全多学科诊疗模式,提升诊疗水平;加强术前评估,避免手术风险。Objective To review the damage outcomes of patients in medical damage events and to analyze the influencing factors of medical causality determination in medical damage events in Tianjin city,with a view to reducing the occurrence of medical damage events by avoiding risk factors and standardizing the diagnostic and therapeutic activities of medical personnel.Methods 316 cases of medical damage events handled by the Medical Damage Identification Office of Tianjin Medical Association from 2017 to 2023 were selected as the research object,and descriptive analysis was used to summarize the basic situation of medical damage events,and the medical fault factors affecting the magnitude of the cause force of the medical side of medical damage events were explored through single-factor analysis and the construction of multiomal logistic regression models.Results Medical malpractice(OR=3.140)and incomplete preoperative assessment(OR=6.008)are factors that influence the determination of the liability of the medical institution in medical malpractice events(P<0.05),and all three regression coefficients were greater than 0,all three were positively correlated with the probability that the medical cause power was judged to be greater than or equal to the equivalent cause.Conclusion The number of medical damage incidents in Tianjin shows a fluctuating downward trend.In Tianjin,the number of medical injury incidents showed a fluctuating downward trend,and the number of medical injury incidents in tertiary public general hospitals was the largest.Therefore,medical institutions should establish and improve multidisciplinary diagnosis and treatment mode to improve the level of diagnosis and treatment.Strengthen preoperative evaluation to avoid surgical risk.

关 键 词：医疗损害 原因力 影响因素 医疗鉴定 

分 类 号：R951[医药卫生—药学]