北京市公立医院骨科医疗纠纷处理现状及影响因素分析

Analysis on the status quo and influencing factors of orthopedic medical disputes in public hospitals in Beijing

目的:了解北京市公立医院骨科医疗纠纷调解现状,并探讨影响医患纠纷调解结果的影响因素,为更有针对性地改善医疗服务提出建议。方法:对2007-2017年于北京市医疗纠纷调解委员会登记平台登记的1251例骨科医疗纠纷结果进行调查分析,对患者及诊疗医生的基本资料、纠纷原因、损伤后果、就医方式以及结案时间等与是否达成协议结案进行差异性检验。结果:1251例中无协议结案509例;医疗纠纷原因以手术、操作、围手术期处理方面所占比例较大,占70.8%;患者知情同意告知不全面占6.5%;医疗无过错产生的医疗纠纷占19.2%;医院管理不到位产生的医疗纠纷占3.5%;在损伤后果方面,增加患者痛苦和支出的案例占62.4%;患者无损伤案例占24.0%;死亡及致残案例占13.6%。单因素分析中,户口类型、有无职业、付费方式、年龄、纠纷原因、损伤后果、就医方式以及结案时间与是否协议结案有关联(P<0.1)。多因素Logistic回归结果显示,城镇户口的患者、有工作、年龄、纠纷原因及损伤后果为是否能协议结案的独立影响因素(P<0.05)。结论:关注影响医疗纠纷处理的相关因素,建立完善的医疗纠纷处理机制,提高医疗纠纷的处理效率。

Objective:To understand the current situation of mediation of orthopedic medical disputes in public hospitals in Beijing,and to explore the influencing factors affecting the mediation results of doctor-patient disputes,and to provide suggestions for more targeted improvement of medical services.Methods:This study investigated and analyzed the results of 1251 medical disputes registered with the registration platform of the Beijing Medical Disputes Mediation Committee from 2007 to 2017.Use SPSS22.0 software to conduct a differential test on the basic information of the patient and the doctor,the cause of the dispute,the consequences of the injury,the method of medical treatment,and the time of closing the case.Binary logistic regression analysis was performed on the factors affecting the outcome of medical disputes.P<0.05 was statistically significant.Results:A total of 1251 medical disputes were investigated in this study.Among them,509 cases were closed without an agreement,accounting for 40.7%;the proportion of medical disputes was large in surgery,operation,and perioperative treatment,accounting for 70.8%.The medical dispute caused by the patient's informed consent was 6.5%.Medical disputes resulting from medical malpractice accounted for 19.2%.Medical disputes arising from inadequate hospital management accounted for 3.5%;in terms of the consequences of injuries,cases of increased patient suffering and expenditure accounted for 62.4%.The patient's non-injury case accounted for 24.0%.Death and disability cases accounted for 13.6%.In the univariate analysis,the type of household registration,occupation,payment method,age,cause of dispute,consequences of injury,medical treatment,and time of settlement were related to whether the agreement was closed(P<0.1).Multivariate logistic regression results showed that the patient,work,age,cause of dispute,and the consequences of injury in urban hukou were independent factors influencing the settlement(P<0.05).Conclusion Pay attention to the relevant factors affecting the treatment of medical disputes,establish a sound medical dispute handling mechanism and improve the efficiency of medical disputes.