Study of the factors causing medical disputes in a Third‐Level Grade A Hospital in Shanghai

Liu, Yu; Bai, Yonghai; Wang, Pei; Xu, Zhongliang

doi:10.1002/hpm.2599

Cited by 7 publications

(11 citation statements)

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“…In a context of high incidence of medical disputes [ 30 , 31 ], the use of defensive medicine has generated an increasing number of tests performed per patient, usually generated through predetermined panels of tests, that are easily ordered [ 32 ]. Utilization and decisions based on routine tests, given the widespread nature of their use, the ease of measurement and low cost, are not always appropriate, leading to undesirable consequences for the patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital

et al. 2020

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Background Computerized Clinical Decision Support Systems (CCDSS) have become increasingly important in ensuring patient safety and supporting all phases of clinical decision making. The aim of this study is to evaluate, through a CCDSS, the rate of the laboratory tests overuse and to estimate the cost of the inappropriate requests in a large university hospital. Method In this observational study, hospital physicians submitted the examination requests for the inpatients through a Computerized Physician Order Entry. Violations of the rules in tests requests were intercepted and counted by a CCDSS, over a period of 20 months. Descriptive and inferential statistics (Student’s t -test and ANOVA) were made. Finally, the monthly comprehensive cost of the laboratory tests was calculated. Results During the observation period a total of 5,716,370 requests were analyzed and 809,245 violations were counted. The global rate of overuse was 14.2% ± 3.0%. The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis Nucleic Acid Amplification (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). The monthly cost of over-utilization was 56,534€ for basic panel, 14,421€ for coagulation, 4,758€ for microbiology, 432€ for immunology exams. All the exams, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital. Conclusions The study confirms the wide variability in over-utilization rates of laboratory tests. For these reasons, the real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exams that is useful not only to reduce costs, but also to ensure standardization and high-quality care.

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Section: Discussionmentioning

confidence: 99%

Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital

et al. 2020

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“…Medical disputes are classi ed into four levels: level-4 medical disputes with compensation below 100,000 RMB, level-3 medical disputes with compensation between 100,000 and 500,000 RMB, level-2 medical disputes with compensation between 500,000 and one million RMB, and level-1 medical disputes with compensation above one million RMB [18] . Among the 520 cases of medical disputes sampled by multistage sampling, 406 cases belonged to level-4 medical disputes, which were 78%; 95 cases were level-3 medical disputes and took up 18%; 19 cases were level-2 medical disputes and accounted for 4%.…”

Section: Medical Dispute Levelmentioning

confidence: 99%

“…Domestic scholars mainly study doctor-patient relationship in four aspects, namely doctor-patient relationship research from the perspective of different disciplines, research on the nature of doctor-patient relationship, investigation of doctor-patient relationship, research on in uence factors of doctor-patient relationship, and research on countermeasures for building harmonious doctor-patient relationship. Foreign scholars, on the other hand, concentrate on discussing the modes of doctor-patient relationship [15] . Innovation of this paper is that taking hospital management as the cut-in point and based on the perspectives of doctors, patients and diseases, 561 cases of medical disputes occurred in Shanghai in recent three years were extracted by multistage sampling.…”

Section: Introductionmentioning

confidence: 99%

The Influence Factors of Medical Disputes in Shanghai and Implications - From the Perspective of Doctor, Patient and Disease (Observational Study)

Liu

Zhao³

et al. 2021

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Objective Based on the cases collected in eight hospitals in Shanghai in recent three years, causes of medical disputes in Shanghai and influence factors of medical dispute levels were discussed, and targeted suggestions were put forward. Methods Multistage sampling were used to collect 561 cases of medical disputes occurred in two Class A Tertiary hospitals, two Class A Secondary hospitals and four community hospitals in Shanghai in recent three years. On the basis of questionnaire, the causes of medical disputes were analyzed by descriptive statistics and the factors affecting the level of medical dispute were analyzed by means of one-way ANOVA and Logistic regression analysis.Results Factors of doctor and patient are involved in the causes of medical disputes, with 87.1% disputes related to doctors and 13.9% related to patients. The doctor’s factors include lack of communication (28.82%), low technical level (16.91%), lack of sense of responsibility (8.86%), defective case records (6.92%), imperfect operation (6.44%), inadequate experience (6.44%), inadequate condition evaluation (5.8%), irregular management process (4.03%), violation of diagnosis and treatment regulation (4.03%), misdiagnosis and mistreatment (3.54%), belated diagnosis and treatment (2.58%), postoperative complications (2.42%), equipment problems (1.13%), missed diagnosis (0.81%), poor condition monitoring (0.48%), unreasonable charge (0.48%) and poor service attitude (0.32%). The patient's factors include misunderstanding of medical behavior (43.48%), high expectation of prognosis (25%), bad attitude (13.04%), inadequate medical knowledge (7.61%), disturbance (6.52%), poor compliance (3.62%) and mistrust (1.09%). Among all medical disputes, there are 406 cases of level-4 medical disputes (78%), 95 cases of level-3 medical disputes (18%), 19 cases of level-2 medical disputes (4%), and no level-1 medical dispute. Meanwhile, the classification of diseases, treatment effect, doctors' violation of diagnosis and treatment regulation, and low technical level are the reasons for the level differences in medical disputes.Conclusion Factors of doctor in medical disputes in Shanghai mainly include inadequate communication and low technical level while the patient’s factors mainly contain misunderstanding of medical behavior and high expectation of the prognosis. Level-3 and 4 medical disputes take up the major part in all medical disputes. The classification of diseases, treatment effect, doctors' violation of diagnosis and treatment regulation, and doctor’s deficient technical level are high-risk factors requiring critical attention in medical disputes.

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“…Medical disputes are classi ed into four levels: level-4 medical disputes with compensation below 100,000 RMB, level-3 medical disputes with compensation between 100,000 and 500,000 RMB, level-2 medical disputes with compensation between 500,000 and one million RMB, and level-1 medical disputes with compensation above one million RMB [17]. Among the 520 cases of medical disputes sampled by multistage sampling, 406 cases belonged to level-4 medical disputes, which were 78%; 95 cases were level-3 medical disputes and took up 18%; 19 cases were level-2 medical disputes and accounted for 4%.…”

Section: Medical Dispute Levelmentioning

confidence: 99%

The Influence Factors of Medical Disputes in Shanghai and Implications - From The Perspective of Doctor, Patient and Disease

Liu

Bai

Wang

2021

Preprint

Self Cite

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Background Based on the cases collected in eight hospitals in Shanghai in recent three years, causes of medical disputes in Shanghai and influence factors of medical dispute levels were explored, and targeted suggestions were put forward. Methods Multistage sampling were used to collect 561 cases of medical disputes occurred in two Tertiary hospitals, two Secondary hospitals and four primary hospitals. The causes of medical disputes were analyzed by descriptive statistics and the factors affecting medical dispute were analyzed by means of one-way ANOVA and Logistic regression analysis. Results Factors of doctor and patient are involved in the causes of medical disputes, with 87.1% disputes related to doctors and 13.9% related to patients. The doctor’s factors include lack of communication (28.82%), low technical level (16.91%), lack of sense of responsibility (8.86%), defective case records (6.92%), imperfect operation (6.44%), inadequate experience (6.44%), inadequate condition evaluation (5.8%), irregular management process (4.03%), violation of diagnosis and treatment regulation (4.03%), misdiagnosis and mistreatment (3.54%), belated diagnosis and treatment (2.58%), postoperative complications (2.42%), equipment problems (1.13%), missed diagnosis (0.81%), poor condition monitoring (0.48%), unreasonable charge (0.48%) and poor service attitude (0.32%). The patient's factors include misunderstanding of medical behavior (43.48%), high expectation of prognosis (25%), bad attitude (13.04%), inadequate medical knowledge (7.61%), disturbance (6.52%), poor compliance (3.62%) and mistrust (1.09%). Among all medical disputes, there are 406 cases of level-4 medical disputes (78%), 95 cases of level-3 medical disputes (18%), 19 cases of level-2 medical disputes (4%), and no level-1 medical dispute. Meanwhile, the classification of diseases, treatment effect, doctors' violation of diagnosis and treatment regulation, and low technical level are the reasons for the level differences in medical disputes. Conclusions Factors of doctor in medical disputes in Shanghai mainly include inadequate communication and low technical level while the patient’s factors mainly contain misunderstanding of medical behavior and high expectation of the prognosis. Level-3 and 4 medical disputes take up the major part in all medical disputes. The classification of diseases, treatment effect, doctors' violation of diagnosis and treatment regulation, and doctor’s deficient technical level are high-risk factors requiring critical attention in medical disputes.

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Study of the factors causing medical disputes in a Third‐Level Grade A Hospital in Shanghai

Abstract: Medical disputes in the hospital would be substantially reduced by taking such measures as strengthening trainings on how to deal with unexpected incidents for medical staff, standardizing procedures for clinical practices, and improving the therapeutic effects of various diseases.

Cited by 7 publications

References 0 publications

Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital

Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital

The Influence Factors of Medical Disputes in Shanghai and Implications - From the Perspective of Doctor, Patient and Disease (Observational Study)

The Influence Factors of Medical Disputes in Shanghai and Implications - From The Perspective of Doctor, Patient and Disease

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