【作者】 郜浩；

【导师】 连斌；

【作者基本信息】 第二军医大学 ， 社会医学与卫生事业管理， 2010， 硕士

【摘要】 国际公认“医疗风险无处不在”,它贯穿于门诊、住院、出院等环节和诊断、治疗、康复等诊疗行为的全过程中。近年来,伴随着我国卫生事业的迅速发展,医疗纠纷的发生数量呈逐年上升的趋势。作为卫生事业管理者,应当正视医疗纠纷,深入了解医疗纠纷的特点,进而采取针对性的措施控制医疗纠纷,维护医患双方的共同利益。本课题以医疗纠纷作为主要研究对象,通过对某区已发生医疗纠纷投诉案例的调查和分析,明确医疗纠纷的分布和特点,提炼引发医疗纠纷的主要原因,并给予相应的政策性建议。研究共分为四个部分进行。第一部分为某区医疗纠纷情况调查。在了解该区医疗资源整体状况的基础上,对该区2007至2009年的医疗纠纷投诉案例进行调查。使用饼图和直方图的方式,描述医疗纠纷在时间、空间和人群间的分布情况。第二部分为医疗纠纷数据的统计分析。将样本的196例医疗纠纷案例分类统计后,录入SAS软件,对不同情况下医疗纠纷的发生率进行卡方检验,以明确医疗纠纷的发生特点,并分别进行讨论。本部分得出以下一些结论：二三级医疗机构的纠纷发生率高于其他医疗机构；病房较门急诊更易发生医疗纠纷；外科医疗纠纷发生率最高,其次是妇产科和儿科；二级医疗机构的急诊和手术病人较三级医疗机构更易发生医疗纠纷。第三部分从医疗纠纷的个案着手,针对纠纷患者的投诉内容,逐一分析出引起医疗纠纷投诉的原因；汇总后,提炼出社会因素、医方因素和患方因素三方面导致医疗纠纷发生的主要因素,共九条,分别是：医疗资源的整体投入不足；社会舆论的负面影响；医务人员业务水平不足；医务人员的责任心缺乏；医务人员的服务意识淡薄；医院的管理体制疏漏；患者的维权意识增强；患者医疗知识的缺乏；患者自身素质原因。最后对这九条纠纷的主要因素分别予以讨论。第四部分是政策性建议部分,在前文总结医疗纠纷的特点和产生原因的基础上,采取文献研读和专家咨询的方式,对医疗纠纷的防范和处理给出了相应的对策。其中医疗纠纷防范策略有五条,涵盖了政策的制定、医务人员的培训、医院管理的完善和和谐医患关系的构建等方面；医疗纠纷的处理策略四条,主要集中于医事法律的完善、风险分担机制的建立、纠纷应急方案的制定实施和非诉讼纠纷解决方式的推广。本课题从已发生的医疗纠纷案例着手,研究当前医院管理的棘手问题,调查资料丰富详实、研究方法科学有效、结果真实有针对性。研究成果对医疗政策的制定者和医院的管理者都有一定的借鉴意义。更多还原

【Abstract】 ’Medical Risks exist anywhere’has been accepted all over the world. They exist in outpatient, inpatient, hospital and other sectors, and hide in the process of diagnosis treatment and rehabilitation. In recent years, with the rapid development of China’s health service, the number of medical disputes increases year by year. As a health manager, we should face the medical dispute status, understand the characteristics of medical dispute, take appropriate measures to control it and protect the common benefits of both doctors and patients.This subject take medical disputes as the main study object., and aim to figure out the distribution and characteristics of medical disputes, extract the main reason cited for the medical disputes, then give some appropriate policy recommendations through investigation and analysis one district’s medical dispute cases. This study is divided into four parts.The first part is a survey of a district’s medical disputes. Medical dispute cases of the area from 2007 to 2009 is investigated on the foundation of knowing the information of health care resources. There are pie charts and histograms to describe the distribution of medical dispute in time, space and groups.In the second part, we analyzed the data of medical disputes. Count the sample of medical disrupts after assort them, and input results into the software of SAS. We use the x2 test to clarify the specific features of medical disputes in different circumstances, then discussed them. This part has draw conclusions as follows:Incidence of medical disputes in high-level hospital is higher than others. Inpatients are more likely to have medical disputes than outpatient and emergency. Surgical department is the most vulnerable area to exist medical dispute in clinical departments. In emergency and surgery, Grade-II hospital is more likely to have medical disputes than Grade-Ⅲhospital.In the third part, we focused on the complaints of medical disputes, analyze the reasons of each case and composed them. After these steps, we extract nine main factors from society, hospital and patients. I. The overall shortage of health care resources, negative impact on public media, lack of medical skills, accountability. weak awareness of medical services among the stuffs, oversight of hospital management system, patients have more awareness of safeguard legal rights but less medical knowledge and the patient’s own reasons.The fourth part is suggestion on policy recommendations. Based on the above study, we study files and ask exporters for advice and give corresponded countermeasures to prevent and handle medical disputes. Five strategies to prevent medical disputes:policy development, training of medical staffs, hospital management, improvement and construction of physician-patient relationship and so on. Four strategies to handle medical disrupts:mainly in improve medical law, build risk-sharing mechanism, formulate the contingency plans disputes and alternative dispute resolutionThis subject targets on occurred medical disrupts, study the knotty problems of hospital management. Survey data is extensive and detailed; research methods are scientific and effective; conclusions are real and targeted. The research has certain benefits to health policy makers and hospital managers.更多还原