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Liu P, Cheng J, Yang Y, Zhu H. Medical errors, affected sites, and adverse consequences among patients in the orthopaedic department: Does age matter? Front Public Health 2024; 12:1306215. [PMID: 38450134 PMCID: PMC10914940 DOI: 10.3389/fpubh.2024.1306215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/26/2024] [Indexed: 03/08/2024] Open
Abstract
Background Orthopaedics have become the focus of research on patient safety due to the high incidence of medical errors. Previous studies were based on all orthopaedic patients and rarely conducted empirical analyses from the perspective of age. This study aimed to fill the academic gap in the age variable by comparing medical errors, affected sites, and adverse consequences in orthopaedic patients. Methods This retrospective study included 329 litigation claims against orthopaedists using data from China Judgments Online. First, we performed computer crawling and screened 5,237 litigation documents using keywords, including medical errors. Second, 2,536 samples were retained through systematic random sampling, and 549 irrelevant cases were deleted after manual reading. Finally, three clinicians from different medical departments selected 329 incidents related to orthopaedics for further analysis, according to the description of the lawsuits. Three other professional orthopaedists evaluated the patients' ages, affected sites of medical errors, and adverse consequences. Results The greatest number of medical errors was observed in the joints (30.43%) for all orthopaedic patients. However, adult patients (aged 18-60 years) were most susceptible to errors in the extremities (30.42%). A higher rate of complications was associated with a higher rate of morbidity/mortality for the corresponding patients. Medical errors correlated with complications occurred in the following sites: joints (15.38%), extremities (12.50%), spine (16.95%), multiple sites (15.38%), and hands and feet (14.81%). In addition to surgical errors, over 10% of all orthopaedic patients experienced missed diagnoses. The incidence of insufficient adherence to informed consent obligations was 13.5% among adult patients and was much higher in paediatric and older adults patients. When orthopaedic patients suffered from medical technical errors, iatrogenic mortality/morbidity would decrease by 0.3% for one unit increase in age. Conclusion Dividing patients into different ages demonstrated diverse results in terms of medical errors and affected sites. Negligence in diagnosis and examination can be fatal factors that endanger safety, and complications may cause morbidity/mortality. When patients suffered from technical errors, age is inversely proportional to mortality/morbidity. Special attention needs to be paid to technical errors in the younger older adults population (60-64 years old), which has inspired implications in promoting aging and public health.
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Affiliation(s)
- Paicheng Liu
- Department of Orthopaedics, Guangdong Women and Children Hospital, Guangzhou, China
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Jianxin Cheng
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, China
| | - Yuxuan Yang
- School of Government, Sun Yat-sen University, Guangzhou, China
| | - Haipeng Zhu
- Department of Orthopaedics, Guangdong Women and Children Hospital, Guangzhou, China
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Yue L, Sun MS, Mu GZ, Shang MX, Zhang YZ, Sun HL, Li CD. Spine-Related Malpractice Claims in China: A 2-year National Analysis. Global Spine J 2023; 13:1566-1575. [PMID: 34519250 PMCID: PMC10448087 DOI: 10.1177/21925682211041048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE To investigate the prevalence, characteristics, and risk factors of spine-related malpractice claims in China in a 2-year period. METHODS The arbitration files of the Chinese Medical Association (CMA) were reviewed for spine-related malpractice claims. Descriptive statistics and correlation analysis were conducted on claim characteristics, clinical data, plaintiff's main allegations, and arbitration outcomes. RESULTS A total of 288 cases of spinal claims filed in the CMA between January 2016 and December 2017 were included. Most claims were found in lumbar degenerative disorders (59.4%), lumbar trauma (13.2%), and cervical degenerative disorders (11.8%). The most common adverse events (AEs) leading to claims were new neurologic deficit (NND) (47.6%), infection (11.5%), and insufficient symptom relief (10.4%). The most common patient allegation was surgical error (66.0%), although the main arbitrated cause of AEs was disease/treatment itself (49.0%), while providers were judged as mainly responsible in only 47.3% cases. In multivariate regression analysis, cervical spine, misdiagnosis/mistreatment, and unpredictable emergency correlated with more severe damage to patients; minimally invasive surgery was predictive of judgment in plaintiff's favor, while claims in the eastern region and unpredictable emergencies were predictive of defendant's favor; only NND was associated with being arbitrated as surgical error in surgical cases where surgeons accepted major liability. CONCLUSION The current study provided a descriptive overview and risk factor analysis of spine-related malpractice claims in China. Gaining improved understanding of the facts and causes of malpractice claims may help providers reduce the risk of claims and subsequent litigation.
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Affiliation(s)
- Lei Yue
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Ming-Shuai Sun
- General Surgery Department, Peking University First Hospital, Beijing, China
| | - Guan-Zhang Mu
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Mei-Xia Shang
- Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Ying-Ze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hao-Lin Sun
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Chun-De Li
- Department of Orthopedics, Peking University First Hospital, Beijing, China
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Tsuji M, Fukahori H, Sugiyama D, Doorenbos A, Nasu K, Mashida Y, Ogawara H. Factors related to liability for damages for adverse events occurring in long-term care facilities. PLoS One 2023; 18:e0283332. [PMID: 37205652 DOI: 10.1371/journal.pone.0283332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/07/2023] [Indexed: 05/21/2023] Open
Abstract
Globally, residents of long-term care facilities (LTCFs) often experience adverse events (AEs) and corresponding lawsuits that result in suffering among the residents, their families, and the facilities. Hence, we conducted a study to clarify the factors related to the facilities' liabilities for damages for the AEs that occur at LTCFs in Japan. We analyzed 1,495 AE reports from LTCFs in one Japanese city. A binomial logistic regression analysis was conducted to identify factors associated with liability for damages. The independent variables were classified as: residents, organizations, and social factors. In total, 14% of AEs resulted in the facility being liable for damages. The predictors of liability for damages were as follows: for the resident factors, the increased need for care had an adjusted odds ratio (AOR) of 2.00 and care levels of 2-3; and AOR of 2.48 and care levels of 4-5. The types of injuries, such as bruises, wounds, and fractures, had AORs of 3.16, 2.62, and 2.50, respectively. Regarding the organization factors, the AE time, such as noon or evening, had an AOR of 1.85. If the AE occurred indoors, the AOR was 2.78, and if it occurred during staff care, the AOR was 2.11. For any follow-ups requiring consultation with a doctor, the AOR was 4.70, and for hospitalization, the AOR was 1.76. Regarding the type of LTCF providing medical care in addition to residential care, the AOR was 4.39. Regarding the social factors, the reports filed before 2017 had an AOR of 0.58. The results of the organization factors suggest that liability tends to arise in situations where the residents and their family expect high quality care. Therefore, it is imperative to strengthen organizational factors in such situations to avoid AEs and the resulting liability for damages.
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Affiliation(s)
- Mayumi Tsuji
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki-shi, Nagasaki, Japan
- Graduate School of Health Management, Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Hiroki Fukahori
- Graduate School of Health Management, Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
- Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Daisuke Sugiyama
- Graduate School of Health Management, Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
- Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Ardith Doorenbos
- Department of Bio-behavioral Health Science, College of Nursing, University of Illinois, Illinois, Chicago, United States of America
| | - Katsumi Nasu
- Faculty of Nursing, Yasuda Women's University, Hiroshima-shi, Hiroshima, Japan
| | - Yuriko Mashida
- Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Hirofumi Ogawara
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Liu P, Yang Y, Cheng J. Gender differences in medical errors among older patients and inequalities in medical compensation compared with younger adults. Front Public Health 2022; 10:883822. [PMID: 36211673 PMCID: PMC9540365 DOI: 10.3389/fpubh.2022.883822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/25/2022] [Indexed: 01/21/2023] Open
Abstract
Background Despite growing evidence focusing on health inequalities in older adults, inequalities in medical compensation compared with younger adults and gender disparities of medical errors among older patients have received little attention. This study aimed to disclose the aforementioned inequalities and examine the disparities in medical errors among older patients. Methods First, available litigation documents were searched on "China Judgment Online" using keywords including medical errors. Second, we compiled a database with 5,072 disputes. After using systematic random sampling to retain half of the data, we removed 549 unrelated cases. According to the age, we identified 424 and 1,563 cases related to older and younger patients, respectively. Then, we hired two frontline physicians to review the documents and independently judge the medical errors and specialties involved. A third physician further considered the divergent results. Finally, we compared the medical compensation between older and younger groups and medical errors and specialties among older patients. Results Older patients experienced different medical errors in divergent specialties. The medical error rate of male older patients was over 4% higher than that of females in the departments of general surgery and emergency. Female older patients were prone to adverse events in respiratory medicine departments and primary care institutes. The incidence of insufficient implementation of consent obligation among male older patients was 5.18% higher than that of females. However, females were more likely to suffer adverse events at the stages of diagnosis, therapy, and surgical operation. The total amount of medical compensation obtained by younger patients was 41.47% higher than that of older patients. Conclusions Except for the common medical errors and departments involved, additional attention should be paid to older patients of different genders according to the incidence of medical errors. Setting up the department of geriatrics or specialist hospitals is also an important alternative to improve patient safety for older people. Furthermore, there may be inequality in medical compensation in older patients due to the tort liability law of China.
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Affiliation(s)
- Paicheng Liu
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Yuxuan Yang
- School of Government, Sun Yat-sen University, Guangzhou, China,*Correspondence: Yuxuan Yang
| | - Jianxin Cheng
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, China,Jianxin Cheng
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Wang F, Qiao W, Wang F, Meng L. Analysis of Online Consultations and Emergent Treatments of Operative Dentistry and Endodontics during the COVID-19 Epidemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041931. [PMID: 35206119 PMCID: PMC8871628 DOI: 10.3390/ijerph19041931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of the present study is to evaluate the characteristics of online consultations and emergent dental treatments and analyze the status of diseases related to operative dentistry and endodontics (ODE) during the COVID-19 epidemic. METHODS Online consultations were collected from 3 February to 21 April 2020. The electronic medical record system was accessed to collect clinical diagnoses and emergent dental treatments from 9 January to 21 April 2020. RESULTS A total of 2419 patients visited us and received treatments 2 weeks before the lockdown. The number of patients decreased to 537 during the 76 days of the lockdown. Among them, dental examinations accounted for the majority of visits (88.83%). After 7 April, the outpatient number increased to 36.79 ± 6.63 per day, but the proportion of dental examinations and treatments did not change significantly. A total of 1218 online consultations were completed before the lockdown. The most common dental problem was pulpitis (48.1%). After 7 April, consultations surged from 23.15 ± 8.54 to 44.43 ± 12.63 per day. Consultations related to pulpitis, apical periodontitis, or dental caries remained stable. CONCLUSIONS Correct understanding, active treatments, and appropriate psychological interventions for the ODE staff during the COVID-19 epidemic are necessary. Our results may provide references to arrange staff and treat patients more efficiently for future epidemics.
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Affiliation(s)
- Fushi Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (F.W.); (W.Q.); (F.W.)
- Department of Cariology and Endodontics, Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Weiwei Qiao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (F.W.); (W.Q.); (F.W.)
- Department of Cariology and Endodontics, Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Fei Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (F.W.); (W.Q.); (F.W.)
| | - Liuyan Meng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (F.W.); (W.Q.); (F.W.)
- Department of Cariology and Endodontics, Hospital of Stomatology, Wuhan University, Wuhan 430079, China
- Correspondence:
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Wang M, Liu GGE, Bloom N, Zhao H, Butt T, Gao T, Xu J, Jin X. Medical disputes and patient satisfaction in China: How does hospital management matter? Int J Health Plann Manage 2021; 37:1327-1339. [PMID: 34888948 DOI: 10.1002/hpm.3399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/31/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Satisfaction with healthcare may be captured by surveys of patients and staff, or in extreme cases, the number and severity of medical disputes. This study tries to investigate the relationship between satisfaction and hospital management as well as the role of good management in preventing medical disputes ex ante. METHOD We investigate this relationship using information on management practices collected from 510 hospitals in mainland China using the World Management Survey questionnaire and combined with medical malpractice litigation data and patient/staff satisfaction surveys. Multiple regression models were used to analyse the relationship between hospital management scores and medical litigation outcomes as well as patient and staff satisfaction during 2014-2016. RESULTS An increase of one standard deviation in the management score was related to 13.1% (p < 0.10) lower incidence of medical disputes, 12.4% (p < 0.05) fewer medical litigations, and 51.3% (p < 0.10) less compensation. Better management quality of hospitals was associated with higher inpatient satisfaction (p < 0.05) and staff well-being (p < 0.01). CONCLUSION Improving hospital management could reduce hospital costs generated by lawsuits, reduce potential harm to patients, and improve patient and staff satisfaction, thus leading to a better patient-physician relationship.
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Affiliation(s)
- Mengxiao Wang
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | | | - Nicholas Bloom
- Department of Economics, Stanford University, Stanford, California, USA
| | - Hanqing Zhao
- Institute of Health Policy and Hospital Management, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Thomas Butt
- National School of Development, Peking University, Beijing, China
| | - Tianhao Gao
- Guanghua School of Management, Peking University, Beijing, China
| | - Jiaqi Xu
- Fanhai International School of Finance, Fudan University, Shanghai, China
| | - Xia Jin
- Research Institute of Hsmap, Hsmap Inc., Zhejiang, China
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Wang Y, Lu J, Ye Q, Ji L, Lu Z, Li J, Xu H. Analysis of influencing factors of nurse-patient disputes based on patient characteristics: A cross-sectional study. Nurs Open 2021; 9:245-255. [PMID: 34547181 PMCID: PMC8685786 DOI: 10.1002/nop2.1058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/22/2021] [Accepted: 09/02/2021] [Indexed: 11/08/2022] Open
Abstract
Aim To explore the prevalence of nurse‐patient disputes and the influencing factors based on an analysis of patient characteristics. Design A cross‐sectional study. Methods This study used the convenience sampling method. Three self‐designed questionnaires based on clinical experience and literature review were used to collect the current status of nurse‐patient disputes and to assess patients’ humanistic qualities and patients’ recognition of nursing work. The Big Five personality questionnaire was used to assess the five personality traits of patients. Results Of the patients, 9.6% reported having a dispute with nurses. The results of binary logistic regression analysis indicated that patients’ humanistic quality, recognition of nursing work and agreeableness in personality traits had a negative predictive effect on nurse‐patient disputes, while family monthly income and neuroticism in personality traits positively predicted disputes.
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Affiliation(s)
- Yawen Wang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Jinjin Lu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Qian Ye
- The Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Li Ji
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Zhongqiu Lu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Hongbo Xu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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Liu J, Liu P, Gong X, Liang F. Relating Medical Errors to Medical Specialties: A Mixed Analysis Based on Litigation Documents and Qualitative Data. Risk Manag Healthc Policy 2020; 13:335-345. [PMID: 32368164 PMCID: PMC7182706 DOI: 10.2147/rmhp.s246452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background We know a great deal about types, causes, and prevention of medical errors, as well as the risks of each medical specialties. Although we know something about medical errors, much remains to be done in this area particularly around effective prevention. However, little is known about whether medical errors are related to medical specialties. Our objective was to categorize and map the distribution of medical errors and analyze their relationships with medical specialties. Methods First, public cases of medical disputes were searched on “China Judgment Online” according to the key words including medical errors. Second, we set up a database with 5237 medical litigations. After removing unrelated judgment documents, we used systematic random sampling to extract half of these. Then, we hired two frontline physicians with M.D. to review the litigation documents and independently determine the medical errors and the departments in which they took place. A third physician further reviewed the divergent results. After the descriptive statistical analysis and mind map analysis, semi-structured interviews were further conducted with 63 doctors to reveal the relationships mentioned above. Results More than 97.8% of medical errors occurred in clinical departments. The insufficient implementation of informed consent obligations is the top medical error in all medical departments [internal medical departments (12.86%, N=36), surgical departments (14.57%, N=106), specialist departments (13.16%, N=86)]. The types of medical errors in diverse medical departments might be associated with therapeutic means used by physicians. Errors related to surgical operations were common in surgical departments, errors related to diagnoses were common in internal medicine departments, and errors related to therapy were common in specialist departments. A lack of clinical experience and undesirable work system design have contributed to the occurrence of medical errors. Inadequate human resources and unreasonable shift systems have increased the workload of staff members and this has in turn increased the incidence rate of medical errors. Conclusion Medical departments are facing medical errors both in humanity and technology. Medical institutions should be alert to the harm caused by medical humanity (mainly including insufficient communication between physicians and patients, insufficient implementation of infringement of informed consent, infringement of patient’s privacy and overtreatment). Improving the clinical skill and vigilance of medical staff is a top priority. Medical institutions should also improve undesirable system designs.
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Affiliation(s)
- Junqiang Liu
- School of Government, Sun Yat-sen University, Guangzhou, People's Republic of China.,Center for Chinese Public Administration Research, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Paicheng Liu
- School of Government, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xue Gong
- School of Government, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Fengbo Liang
- School of Government, Sun Yat-sen University, Guangzhou, People's Republic of China
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Tang C, Tian B, Zhang X, Zhang K, Xiao X, Simoni JM, Wang H. The influence of cultural competence of nurses on patient satisfaction and the mediating effect of patient trust. J Adv Nurs 2018; 75:749-759. [DOI: 10.1111/jan.13854] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/22/2018] [Accepted: 08/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Chulei Tang
- Xiangya School of Nursing Central South University ChangshaChina
| | | | - Xiaoxia Zhang
- Xiangya School of Nursing Central South University ChangshaChina
- Nursing Faculty Henan Medical College ZhengzhouChina
| | - Kaili Zhang
- Xiangya School of Nursing Central South University ChangshaChina
| | - Xueling Xiao
- Xiangya School of Nursing Central South University ChangshaChina
| | - Jane M. Simoni
- Department of Psychology University of Washington Seattle Washington
| | - Honghong Wang
- Xiangya School of Nursing Central South University ChangshaChina
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Zeng Y, Zhang L, Yao G, Fang Y. Analysis of current situation and influencing factor of medical disputes among different levels of medical institutions based on the game theory in Xiamen of China: A cross-sectional survey. Medicine (Baltimore) 2018; 97:e12501. [PMID: 30235759 PMCID: PMC6160241 DOI: 10.1097/md.0000000000012501] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With continuous development of the Chinese health care system, the doctor-patient relationship is increasingly tense in recent years. China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. This study aimed to help to theorize the doctor-patient relationship based on the game theory, and analyze the current situation and influencing factors for medical disputes among different hospitalsA total of 17 hospitals were randomly selected in Xiamen city, including 8 tertiary hospitals and 9 secondary hospitals. All medical dispute cases, between 2012 and 2014, were collected through questionnaires. Multiple logistic regression analyses were used to identify risk factors associated with medical disputes.In total, 896 medical dispute cases happened in 2012 to 2014, 733 (81.8%) of which occurred in tertiary hospitals. Medical disputes mainly were reported in the departments of obstetrics and gynecology (24.9%). The main causation of medical disputes was improper communication (24.0%) in tertiary hospitals and lower therapeutic skills (43.7%) in secondary hospitals, respectively. The negotiated rate (91.4%) in secondary hospitals was significantly higher than the tertiary hospitals (54.8%). The patients' age, occupation and the doctor's medical location, professional title were the main risk factors for the occurrence of medical violence.Relationships between doctors and patients have become worse increasingly, whereas doctor-patient disputes or conflicts and their compensation have aggrandized year by year. The game relationship of doctor-patient is noncooperation, dynamic, and incomplete information game, and the advantages of cooperation are far greater than the competition between doctors and patients. Therefore, we need to take targeted measures to prevent and control the medical disputes by establishing a harmonious doctor-patient relationship in different levels of medical institutions.
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Affiliation(s)
- Yanbing Zeng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University
| | - Liangwen Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University
| | - Guanhua Yao
- Health and Family Planning Commission of Xiamen, Xiamen, Fujian, PR China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University
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Chen LC, Wang LH, Redley B, Hsieh YH, Chu TL, Han CY. A Study on the Reporting Intention of Medical Incidents: A Nursing Perspective. Clin Nurs Res 2017; 27:560-578. [DOI: 10.1177/1054773817692179] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medical incidents threaten patients’ lives and health, increase medical costs, and can lead to medical disputes. A high proportion of medical incidents are not reported. The aim of this study was to explore the factors influencing nurses’ reporting of medical incidents. The cross-sectional survey design used a self-administered 47-item questionnaire to survey 835 nurses in three hospitals in Taiwan between January and December 2014. The intention among nurses to report medical incidents was high (3.86/5); nurses’ intention to report medical incidents was positively correlated ( r = .34, p < .0001) with their attitude about reporting, awareness of reporting ( r = .37, p < .0001), and support from interested parties ( r = .12, p = .001), and was negatively correlated with positive incentives ( r = -.14, p < .0001) and negative incentives ( r = .29, p < .0001). Nurses’ awareness and a supportive work environment affect nurses’ willingness to voluntarily report medical incidents; hence, they are critical considerations as Taiwan moves toward systems of mandatory reporting.
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Affiliation(s)
- Li-Chin Chen
- Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Li-Hsiang Wang
- Chang Gung University of Science and Technology, Taoyuan City, Taiwan
- Chang Gung University, Taoyuan City, Taiwan
| | | | | | - Tsung-Lan Chu
- Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Chin-Yen Han
- Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Chang Gung University of Science and Technology, Taoyuan City, Taiwan
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Explaining medical disputes in Chinese public hospitals: the doctor-patient relationship and its implications for health policy reforms. HEALTH ECONOMICS POLICY AND LAW 2016; 11:359-78. [PMID: 27018911 DOI: 10.1017/s1744133116000128] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In recent years China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. This is the result of a confluence of inappropriate incentives in the health system, the consequent distorted behaviors of physicians, mounting social distrust of the medical profession, and institutional failures of the legal framework. The detrimental effects of the damaged doctor-patient relationship have begun to emerge, calling for rigorous study and serious policy intervention. Using a sequential exploratory design, this article seeks to explain medical disputes in Chinese public hospitals with primary data collected from Shenzhen City. The analysis finds that medical disputes of various forms are disturbingly widespread and reveals that inappropriate internal incentives in hospitals and the heavy workload of physicians undermine the quality of clinical encounters, which easily triggers disputes. Empirically, a heavy workload is associated with a larger number of disputes. A greater number of disputes are associated with higher-level hospitals, which can afford larger financial settlements. The resolution of disputes via the legal channel appears to be unpopular. This article argues that restoring a healthy doctor-patient relationship is no less important than other institutional aspects of health care reform.
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Wang WL, Feng JY, Wang CJ, Chen JH. The Chinese family-centered care survey for adult intensive care unit: A psychometric study. Appl Nurs Res 2015; 29:125-30. [PMID: 26856502 DOI: 10.1016/j.apnr.2015.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 04/08/2015] [Accepted: 04/12/2015] [Indexed: 10/23/2022]
Abstract
AIMS This study aimed to develop a family-centered care survey for Chinese adult intensive care units and to establish the survey's psychometric properties. BACKGROUND Family-centered care (FCC) is widely recognized as an ideal model of care. Few studies have explored FCC perceptions among family members of adult critical care patients in Asian countries, and no Chinese FCC measurement has been developed. METHODS An English version of the 3-factor family-centered care survey for adult intensive care units (FCCS-AICU) was translated into Chinese using a modified back translation procedure. Based on the literature review, two additional concepts, information and empowerment, were added to the Chinese FCCS-AICU. The psychometric properties of the Chinese FCCS-AICU were determined with 249 family members from a medical center in Taiwan and were tested for construct and convergent validity, and internal consistency. RESULTS Both the monolingual and bilingual equivalence tests of the English and Chinese versions of the 3-factor FCCS-AICU were supported. Exploratory factor analysis supported the 5-factor structure of the Chinese FCCS-AICU with a total explained variance of 58.34%. The Chinese FCCS-AICU was correlated with the Chinese Critical Care Family Needs Inventory. Internal consistency, determined by Cronbach's α, for the overall scale was .94. CONCLUSIONS The Chinese FCCS-AICU is a valid and reliable tool for measuring perceptions of FCC by family members of adult intensive care patients within Chinese-speaking communities.
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Affiliation(s)
- Wen-Ling Wang
- Department of Nursing, College of Medicine, National Cheng Kung University
| | - Jui-Ying Feng
- Department of Nursing, College of Medicine, National Cheng-Kung University/Hospital
| | - Chi-Jen Wang
- Department of Nursing, College of Medicine, National Cheng Kung University
| | - Jing-Huei Chen
- Department of Nursing, Tri-Service General Hospital Penghu Branch.
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Preventing surgical disputes through early detection and intervention: a case control study in China. BMC Health Serv Res 2015; 15:5. [PMID: 25608604 PMCID: PMC4312442 DOI: 10.1186/s12913-014-0671-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 12/17/2014] [Indexed: 11/10/2022] Open
Abstract
Background Medical disputes have become a serious issue in China. A crisis cannot usually be predicted and managed through a cost–benefit strategy; therefore, researchers believe that prevention is better than containment and post-crisis resolution. This study aimed to identify solutions to prevent medical disputes in surgical cases through early warning and intervention of potential cases. Methods A case–control study was conducted to identify early detection indicators of medical disputes in the surgical treatment of liver cancer through Delphi consultation and logistic regression on the basis of which interventions were undertaken to prevent potential cases. Results The dispute detection model was composed of patient age (P = 0.08), frequency of hospitalization (P = 0.003), length of hospital stay (P < 0.001), terminal condition (P = 0.004), unplanned reoperation (P = 0.048), blood transfusion volume (P = 0.006), and arrearage (P < 0.001). Risk management interventions through quality improvement and enhanced communication in cases with an abnormal performance indicator proved effective in practice. Conclusions This study explored the use of an evidence-based medical risk management strategy for medical disputes that involved early detection and intervention and could potentially be adopted by hospitals to prevent medical disputes. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0671-5) contains supplementary material, which is available to authorized users.
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Kim YH, Hwang CJ. Patterns of medical accidents and disputes in the orthodontic field in Korea. Korean J Orthod 2014; 44:5-12. [PMID: 24511510 PMCID: PMC3915177 DOI: 10.4041/kjod.2014.44.1.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/10/2013] [Accepted: 12/17/2013] [Indexed: 11/10/2022] Open
Abstract
The committee of admitted doctors developed a questionnaire regarding medical dispute and distributed it to 1,600 members of Korean Academy of Orthodontics. The questionnaire consisted of three categories and 56 items covering basic information about the doctors and patients who had experienced medical disputes, the cause and workaround of medical accidents, and methods for taking precautions. The present survey showed a similar proportion of responders who had experienced a medical accident compared to the study in 1997. The primary reason for medical disputes was dissatisfaction with appearance. Many doctors felt that they would likely experience a medical dispute at some point. Most disputes were settled by doctors themselves, usually for an amount of less than 5 million Korean won. For some doctors, medical accidents lead to ongoing psychological problems. Responders felt that continuing education for medical dispute is very necessary. These results reveal a need for the association of orthodontists to lead advancements in education and countermeasures for preventing and managing medical accidents and disputes.
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Affiliation(s)
- Young Hoon Kim
- Department of Orthodontics, College of Dentisrty, Yonsei University, Seoul, Korea
| | - Chung Ju Hwang
- Department of Orthodontics, College of Dentisrty, Yonsei University, Seoul, Korea
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Mittmann N, Koo M, Daneman N, McDonald A, Baker M, Matlow A, Krahn M, Shojania KG, Etchells E. The economic burden of patient safety targets in acute care: a systematic review. Drug Healthc Patient Saf 2012; 4:141-65. [PMID: 23097615 PMCID: PMC3476359 DOI: 10.2147/dhps.s33288] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Our objective was to determine the quality of literature in costing of the economic burden of patient safety. METHODS We selected 15 types of patient safety targets for our systematic review. We searched the literature published between 2000 and 2010 using the following terms: "costs and cost analysis," "cost-effectiveness," "cost," and "financial management, hospital." We appraised the methodologic quality of potentially relevant studies using standard economic methods. We recorded results in the original currency, adjusted for inflation, and then converted to 2010 US dollars for comparative purposes (2010 US$1.00 = 2010 €0.76). The quality of each costing study per patient safety target was also evaluated. RESULTS We screened 1948 abstracts, and identified 158 potentially eligible studies, of which only 61 (39%) reported any costing methodology. In these 61 studies, we found wide estimates of the attributable costs of patient safety events ranging from $2830 to $10,074. In general hospital populations, the cost per case of hospital-acquired infection ranged from $2132 to $15,018. Nosocomial bloodstream infection was associated with costs ranging from $2604 to $22,414. CONCLUSION There are wide variations in the estimates of economic burden due to differences in study methods and methodologic quality. Greater attention to methodologic standards for economic evaluations in patient safety is needed.
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Affiliation(s)
- Nicole Mittmann
- Health Outcomes and Pharmaco Economics (HOPE) Research Centre, Division of Clinical Pharmacology, Toronto, ON, Canada
| | - Marika Koo
- Health Outcomes and Pharmaco Economics (HOPE) Research Centre, Division of Clinical Pharmacology, Toronto, ON, Canada
| | - Nick Daneman
- Division of Infectious Diseases, Toronto, ON, Canada
| | - Andrew McDonald
- Quality and Patient Safety, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michael Baker
- Patient Safety in Ontario, University Health Network, Toronto, ON, Canada
| | - Anne Matlow
- Infection Prevention and Control and Patient Safety, Hospital for Sick Children, Toronto, ON, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada
| | - Kaveh G Shojania
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Edward Etchells
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Zhu S, Li L, Li Y. China’s criminal penalty for medical malpractice: Too lenient or not? Leg Med (Tokyo) 2011; 13:116-9. [DOI: 10.1016/j.legalmed.2010.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 11/23/2010] [Accepted: 12/16/2010] [Indexed: 11/16/2022]
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