上海市医疗机构依法执业风险分析研究

Risk Analysis of Medical Institutions Practicing According to Law in Shanghai

目的了解上海市医疗机构依法执业行为情况,明确医疗机构依法执业风险,为制定监管策略提供依据。方法对2019—2020年上海市医疗机构不良执业行为出现情况进行统计分析,内容涵盖医疗机构所有制形式、机构类别、机构级别、服务对象等医疗机构基本信息,以及监督检查后的结果和不良执业行为记分,采用卡方检验对不同组间率进行比较,应用logistic回归模型进行相关因素分析。结果2019—2020年医疗机构不良执业行为出现率为4%(129/3366),不同所有制形式、经营性质、机构类别、机构级别、机构类型的医疗机构出现不良执业行为的情况不同(P<0.05)。其中,私人所有和股份制医疗机构、有定级的医疗机构、营利性医疗机构、民营医疗机构较易出现不良执业行为。结论2019—2020年,上海市医疗机构中,私人所有的医疗机构、营利性医疗机构、医院、门诊部和诊所等类型较易出现不良执业行为,应针对不同医疗机构有针对性开展法制宣传教育,提升其自治水平,并通过信用评级管理动态防控风险。

Objective To understand the legal practice of medical institutions in Shanghai,clarify the legal practice risks of medical institutions,and provide a basis for formulating regulatory strategies.Methods A statistical analysis was conducted among all the medical institutions with bad practice behavior in Shanghai during 2019 to 2020,covering the form of ownership,institutional categories,institutional level,the service object,as well as the supervision and inspection and the result of the bad practice.Chi-square test was used to compare the proportions of bad practice-related among different groups.Logistic regression model was used to analyze the related factors.Results From 2019 to 2020,the occurrence rate of bad practice behavior in medical institutions was 4%(129/3366),and the occurrence rate of bad practice behavior was different among medical institutions with different ownership forms,operation nature,types of institutions,levels of institutions and types of institutions(P<0.05).Among them,private and joint-stock institutions,grading institutions,nursing homes and clinical testing centers,for-profit and private medical institutions had a higher incidence of bad practicing behaviors.Conclusion From 2019 to 2020,private medical institutions,for-profit medical institutions,hospitals,outpatient departments and clinics in Shanghai were more likely to have bad practice behaviors.Legal publicity and education should be carried out for different medical institutions to improve their autonomy level,and dynamic risk prevention and control through credit rating management.