Analysis On The Influencing Factors And Study On The Preventive Countermeasures Of Medical Disputes-Data Based On One Three-level Hospital In The Military

ObjectivesThis subject is based on the retrospective analysis of medical dispute cases in one three-level hospital in the army,and combined with the investigation on influencing factors of medical disputes such as medical staff’s cognition of disputes and the quality of diagnosis and treatment.It adheres to the research ideas from phenomena to essence,from data to facts,and explores the main influencing factors of medical disputes in the military’s large-scale comprehensive three-level hospital.It aims to propose targeted countermeasures in improving medical technology,optimizing medical procedures,improving service quality,and strengthening medical management,which can provide reference for effectively preventing and dealing with disputes in other military hospitals and for relieving the doctor-patient relationship.Methods1.Descriptive research.From the medical complaint reception center,information department,quality management department and infection control department of the hospital,we collected related data from 2013 to 2016,including 78 disputes of outpatient and emergency patients and 243 disputes of inpatient,using Excel 2010 software to establish a database and SPSS19.0 software to descriptively analyze the distribution of the disputes related to the rate of complaints,the complaints section,the characteristics of the complainant and the reasons for the complaint.2.Research on the influence factors of medical staff’s cognition on medical disputes.The methods of literature analysis and expert consultation were used to determine the research targets such as the classification of questionnaires.Combining semi-structured interviews,to design questionnaires and evaluate its reliability and validity.The questionnaire was distributed to the medical staff of the first line of the hospital.The content of the questionnaire includes 64 questions in 9 aspects,including basic information,medical dispute recognition,communication and attitude.Univariate analysis and logistic regression analysis were carried out according to the results of questionnaire recovery.Among which,the occurrence of medical disputes in the past five years was set as the dependent variable,and the influencing factors such as gender,title level,and cognition level of medical personnel were set as independent variables.3.Research on the quality of diagnosis and other influencing factors.Based on the data of 243 inpatients’ medical disputes,729 non-dispute cases were compared according to the ratio of 1:3 as controls,totaling 972 cases.The method of expert consultation was used to determine the research indicators,and six aspects of specific information in the first page of the medical record,including the medical side,patient side,diagnosis,surgery,treatment,and expenses was analyzed by univariate analysis and logistic regression analysis.Among which,regression analysis takes disputes as dependent variables,diagnosis,treatment information and other factors as independent variables.Results1.Descriptive research results.The average complaint rate of outpatient and emergency patients was 0.524/100000.The average complaint rate of inpatient was 1.634/100000,about 3.1 times of the outpatient and emergency dispute.In all disputes,department of surgery,internal,and specialties were complained the most;number of complaints from middle-aged patients was the highest;the dispute of outpatient and emergency patients were mainly for referral patients;the dispute of inpatient were mainly newly diagnosed patients,completely opposite to the outpatient and emergency patients;patients accounted for 84.74% of all complaints because of problems in diagnosis and treatment,death of patients,and failure of surgery.2.Results of research on the influence factors of medical staff’s cognition on medical disputes.Among medical personnel who had medical disputes,the proportion of men,ages≥41 years old,doctors,doctoral degrees,senior titles,working 6-10 years,and medical personnel of military status were significantly higher than medical personnel without medical disputes.The proportion of medical disputes in surgery is obviously higher than that of other departments.Among medical personnel who had medical disputes,the proportion of high scores in cognition,low scores in attitudes,low scores in medical,low scores in patients,and low scores in social factors were significantly higher than those medical personnel without medical disputes.There were significant differences in the composition of medical disputes and non-medical disputes(P<0.05),including factors of medical staff gender,age,occupation,education,professional title,work years,identity category,department category,medical dispute cognition,attitudes,medical treatment,patients,etc.There were no significant differences in the composition of medical disputes and non-medical disputes(P>0.05),including factors of communication,hospital management and risk prevention.3.Results of research on the quality of diagnosis and other influencing factors.Among patients with medical disputes,urgent and critical patients,children,emergency admission patients,hospitalization days≥21 days patients,cost>30000 patients,rescued patients,transfusion patients,special cared patients,primary cared patients,entered the ICU patients,number of diseases>2 patients,patients whose admission and discharge diagnosis do not correspond,ineffective treatment or deceased patients,surgical patients,patients with unplanned secondary surgery,patients with complications,infected patients,nosocomial infection patients,and consulted patients,the proportion was significantly higher than non-disputed patients.There were significant differences in the composition of medical disputes and non-medical disputes(P<0.05),including factors of admission conditions,admission mode,days of hospitalization,total cost,whether to rescue,whether blood transfused,whether special or primary cared,whether entered the ICU,the number of diseases,diagnosis of admission and discharge,prognosis of disease,whether operated,whether planned secondary operations,whether with complications,whether infected,whether nosocomial infected,whether with consultation,etc.There were no significant differences in the composition of medical disputes and non-medical disputes(P>0.05),including factors of marital status,patient identity category,patient expense status,patient household type,patient gender,patient age,history of allergies,whether second level nursed,doctor gender,professional title,doctor education,doctor status category,department classification,coincidence of outpatient and discharge diagnosis,diagnosis of clinical and pathological,confirmed status in 3rd,and total number of hospitalizations,etc.Conclusions1.The average incidence of hospitalized patients’ disputes was significantly higher than that of outpatient and emergency patients,which was about 3.1 times.The medical disputes in the departments of surgery,internal medicine,specialties,have significant differences,with a focus on surgery;middle-aged patients were the main population of medical disputes.Disputes of outpatient and emergency were mainly referral patients,and inpatient disputes were mainly first diagnosed patients,diametrically the opposite.The causes of disputes are mainly due to the problems of diagnosis and treatment,patient death,and surgical failure.2.Aspects of medical staff’s cognition of medical disputes and other influencing factors,medical personnel’s gender,occupation,professional title,working years,department classification,cognitive level of medical disputes,and medical treatment were the most important factors of medical disputes.Among which,in terms of gender,male medical personnel are more prone to medical disputes than female medical personnel;in career,doctors are more prone to medical disputes than nurses,medical technicians and other personnel;in the aspect of professional titles,the sub-high level is more prone to medical disputes than primary and other titles.In terms of working years,6-10 years of work is more prone to medical disputes than ≤5 years;in terms of department classification,department of surgery is more prone to medical disputes than department of internal,specialists and medical technology;in the aspect of medical treatment,the lower scores is more prone to medical disputes than those with middle and high scores.3.Aspects of the quality of medical treatment and other influencing factors,patient days of hospitalization,age of the patient,the number of diagnosed diseases,the prognosis of disease,whether operated,whether had complications,and whether with complications were the most important factors of medical disputes.Among which,in terms of hospitalization days,patients with >20 days more prone to medical disputes than those ≤10 days;in terms of patient age,children were more prone to medical disputes than middle-aged and elderly patients;in terms of the number of disease diagnoses,patients with more than 2 kinds of diseases were more likely to have medical disputes;in terms of disease prognosis,patient deaths and treatment of failure were more prone to medical disputes than other disease prognosis;patients of surgical operation,patients with complications and patients with consultations were more likely to cause medical disputes than non-operative patients,uncomplicated patients,and unconsulting patients.