合肥市某军队三甲医院医疗风险预警预控研究

发布时间：2018-01-27 07:04

本文关键词： 三甲医院医疗风险风险预警　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过研究合肥市某军队三甲医院实际发生的医疗风险案例,总结归纳医疗风险的主要影响因素,构建医疗风险预警指标体系,进一步筛选出可量化的医疗风险高危因素,建立医疗风险预警信息系统,从而实时监测医疗风险预警指标及其阈值的变化,以便医院及早采取有效干预措施,预防和减少医疗风险的发生。方法:首先采用德尔菲法征询专家意见、筛选指标,并用层次分析法计算指标权重,构建医疗风险预警指标体系;其次采用单因素分析和logistic回归分析进一步筛选并确定医疗风险高危因素;最后将最终筛选出的医疗风险指标及其阈值嵌入医院信息系统,制成信息软件,实时监测。结果:(1)医疗风险预警指标体系结果通过德尔菲法和层次分析法建立了医疗风险预警指标体系。包含患者因素、住院因素和出院因素3个一级指标,以及患者年龄、受教育水平、经济水平、休克、药物不良反应、出院病情、出院方式和死亡等22个二级指标。两轮调查专家权威系数均0.8,且专家意见较为集中,协调性较好。(2)单因素分析结果单因素分析结果显示:患者入院方式、住院天数、并发症、伤口愈合不良、感染、休克、出院病情和出院方式等16个指标有统计学意义,而年龄、固定职业、医保状况、手术分级、药物不良反应等5个指标无统计学意义。(3)多因素分析结果经过多因素logistic回归分析,最终纳入X5(住院天数)、X8(四周内手术次数)、X10(术中出血量)、X12(病情危重)、X15(并发症)、X20(出院病情)等6个指标。(4)医疗风险预警信息系统将最终筛选出的6个医疗风险指标及其阈值制成信息软件,建立医疗风险预警信息系统,实时监测医疗风险高危因素,随时掌握医疗风险指标及其阈值的变化情况,从而第一时间发现风险苗头,提前防范。结论:本研究通过文献查阅、专家咨询等方法,建立了一套合理、实用的医疗风险预警指标体系,并选取合肥地区一家省级军队三甲医院进行实证研究,筛选该院医疗风险高危因素,将其制成信息软件应用于医院实际管理,使医院风险管理方法更加科学、手段更加多样,对医院防范医疗风险具有一定的参考价值。
[Abstract]:Objective: to study the actual cases of medical risk in a military third Class A hospital in Hefei, summarize the main influencing factors of medical risk, and construct the early warning index system of medical risk. Furthermore, the quantifiable high risk factors of medical risk were screened out, and the early warning information system of medical risk was established, so as to monitor the change of medical risk warning index and its threshold in real time, so that the hospital could take effective intervention measures as early as possible. Methods: firstly, Delphi method was used to consult experts, select indicators, calculate index weight by AHP, and construct early warning index system of medical risk. Secondly, univariate analysis and logistic regression analysis were used to further screen and determine the high risk factors of medical risk. Finally, the selected medical risk index and its threshold are embedded into the hospital information system, and the information software is made. Results: 1) the index system of early warning of medical risk was established by Delphi method and Analytic hierarchy process (AHP). Hospitalization and discharge factors, as well as the patient's age, education level, economic level, shock, adverse drug reactions, discharge condition. There were 22 secondary indexes, such as discharge mode and death. The authority coefficient of experts in two rounds of investigation was 0.8, and the opinions of experts were concentrated. The results of univariate analysis showed that: admission, length of stay, complications, poor wound healing, infection, shock. There were statistical significance in 16 indexes, such as discharge condition and discharge mode, but age, fixed occupation, medical insurance status, surgical grading. The results of multivariate analysis were analyzed by multivariate logistic regression analysis and finally included in X5 (length of stay). X8 (the number of operations within four weeks was less than X 10) (intraoperative bleeding volume was less than X 12). X20 (discharge condition) etc.) the medical risk early warning information system makes the 6 medical risk indexes and their threshold selected finally into information software, and establishes the medical risk early warning information system. Real-time monitoring of high risk factors of medical risk, at any time to grasp the changes of medical risk indicators and thresholds, so that the first time to find the risk of early prevention. Conclusion: this study through literature review. Expert consultation and other methods, established a reasonable, practical early warning index system of medical risk, and selected a provincial military third-class first class hospital in Hefei for empirical study, screening the high risk factors of medical treatment in this hospital. It is made into information software to be used in actual hospital management, which makes the method of hospital risk management more scientific and the means more diverse. It has certain reference value for the hospital to prevent the medical risk.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R82

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