影响根本死因选择的因素探讨

Discussion of Factors Influencing the Selection of the Root Cause of Death

目的通过死因复核,分析影响根本死因正确选择的因素并提出切实可行的改进意见。方法随机抽取2016年丰台区二级以上医疗机构内死亡的死亡病例220份,由病案专家和临床专家分别对病案进行复核,分别填写死因链,并推导出根本死因。区疾控中心将两次复核结果结合原死因链进行综合分析,得出该死者的正确根本死因,并将三次根本死因分别与正确结果进行比对,找出错误的根本死因并对错误原因进行汇总分析。结果三次复核根本死因选择错误共计129例,错误原因分别是准确性问题31例,占24.03%,完整性问题26例,占20.16%,逻辑性问题27例,占20.93%,特异性问题14例,占10.85%,疾病ICD编码问题27例,占20.93%,根本死因选择问题4例,占3.10%。结论根本死因的正确选择有赖于临床医生对死因链的正确填写,编码人员的正确编码及根本死因的正确选择,任何一个环节的问题都会导致根本死因选择的错误。

Objective To Analyze the factors on influencingthe selection of the root cause of death so that finding the improve way.Methods To take a random sample of 220 death cases from secondary and above medical institutions in 2016,and reviewed these medical records and filled the chain of cause of death,and got the root cause of death by medical record experts and clinical experts,then the CDC combined the two results with the original root cause of death and comprehensive analyzed so that got the correct root cause of death.Then compared the three root causes of death with the correct results,and calculated the coincidence rate and analyzed the wrong reason.Results There were a total of 129 errors in three reviews,including 31 errors in accuracy（24.03%）,26 errors in completeness（20.16%）,27 logical problems（20.93%）,14 specific problems（10.85%）,27 ICD coding problems（20.93%）,and 4 errors in choice of the root cases of death（3.10%）.Conclusion The correct choice of the root cause of death depends on the clinician filling in the proper chain of cause of death,the coding of the code and the correct choice of the root cause of death.Any problem will lead to the error of the root cause of death.