[1]王州 林海涛 周瑾 唐琴 沈乐冲 王志刚 谢印库.基于不良事件管理的医疗纠纷列线图预测模型构建及评价[J].中国卫生质量管理,2025,32(04):074-78.[doi:10.13912/j.cnki.chqm.2025.32.4.17]
　WANG Tongzhou,LIN Haitao,ZHOU Jin.Construction and Evaluation of a Nomogram Prediction Model for Medical Disputes Based on Adverse Events Management[J].Chinese Health Quality Management,2025,32(04):074-78.[doi:10.13912/j.cnki.chqm.2025.32.4.17]
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基于不良事件管理的医疗纠纷列线图预测模型构建及评价()
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《中国卫生质量管理》[ISSN:1006-7515/CN:CN 61-1283/R]

卷:
第32卷
期数:
2025年04期
页码:
074-78
栏目:
患者安全
出版日期:
2025-04-15

文章信息/Info

Title:
Construction and Evaluation of a Nomogram Prediction Model for Medical Disputes Based on Adverse Events Management
作者:
王州 林海涛 周瑾 唐琴 沈乐冲 王志刚 谢印库
江苏省肿瘤医院(南京医科大学附属肿瘤医院/江苏省癌症中心)
Author(s):
WANG Tongzhou;  LIN Haitao;  ZHOU Jin
Jiangsu Cancer Hospital (Jiangsu Province Hospital Affiliated to Nanjing Medical University/Jiangsu Cancer Center)
关键词:
医疗纠纷; 不良事件; 列线图; 预测模型
Keywords:
Medical Disputes; Adverse Events; Nomogram; Prediction Model
分类号:
R197.323
DOI:
10.13912/j.cnki.chqm.2025.32.4.17
文献标志码:
A
摘要:
目的基于医疗质量安全不良事件分析医院医疗纠纷的影响因素，构建医疗纠纷风险列线图预测模型并进行评价。方法选取2020年1月—2023年12月江苏省某三甲医院503例不良事件作为研究对象，采用单因素和多因素logistic回归分析医疗纠纷发生的影响因素，并建立医疗纠纷风险的列线图预测模型，采用受试者工作特征曲线和校准曲线评价列线图模型的诊断效能和校准度，采用决策曲线评估其收益性。结果医务人员性别男性、患者年龄段≤40岁、患者职业为农民、患病程度非危重、一~三级不良事件是医疗纠纷的独立危险因素（P均＜0.05），列线图预测模型的受试者工作特征曲线下面积为0.888，H-L检验P=0.059，校准曲线内部验证的C-Index=0.897，平均绝对误差为0.021。决策曲线的阈值概率为0.02~0.80时净收益较高。结论基于医疗不良事件管理构建的医疗纠纷风险列线图预测模型具有较好的预测效能和临床适用性，可为医疗质量安全管理提供思路
Abstract:
ObjectiveTo analyze the influencing factors of medical disputes in hospitals based on medical quality and safety adverse events, construct a nomogram prediction model for medical disputes risk, and evaluate its performance. MethodsA total of 503 adverse events from a tertiary hospital in Jiangsu Province between January 2020 and December 2023 were selected as the study subjects. Univariate and multivariate logistic regression analyses were used to identify the influencing factors of medical disputes. A nomogram prediction model for medical disputes risk was established.The diagnostic performance and calibration of the nomogram model were evaluated using receiver operating characteristic (ROC) curve and calibration curve, while decision curve analysis was employed to assess its utility.ResultsMale healthcare workers, patient age ≤40 years, patient occupation as farmer, non-critical illness severity, and adverse events of levels one to three were independent risk factors for medical disputes (all P<0.05). The area under the ROC curve for the nomogram prediction model was 0.888, with an H-L test P-value of 0.059. The C-Index for internal validation of the calibration curve was 0.897, and the mean absolute error was 0.021. The net benefit of the decision curve was high when the threshold probability ranged from 0.02 to 0.80.Conclusion The nomogram prediction model for medical disputes risk constructed based on medical adverse events management demonstrates good predictive performance and clinical applicability, providing insights for medical quality and safety management.

参考文献/References:

［1］.国家卫生健康委办公厅.关于印发2024年国家医疗质量安全改进目标的通知：国卫办医政函〔2024〕40号［EB/OL］.（2024-02-01）［2024-07-26］.http://www.nhc.gov.cn/yzygj/s7657/202402/6aea 7c6510da48a6b50e84417b4f30a3.shtml.［2］王晓刚,谢 雪,何 睿,等.成都市某两家医院医疗纠纷预测模型构建及评价研究［J］.医学与社会,2022,35(7):68-73，80.［3］刘长英,王晓刚,王 璋,等.从不良事件角度探析医疗纠纷的影响因素及防控策略［J］.中国卫生质量管理,2023,30(10):46-50.［4］曾江忠,吴秀秀,林 丽.顺产初产妇发生产后性功能障碍的危险因素分析及风险预测列线图模型构建［J］.中国妇幼保健,2024,39(1):96-100.［5］庹 琳,李 萌,王旖旆,等.基于DRGs死亡风险分级的医疗纠纷分析［J］.中华医院管理杂志,2018,34 (8):648-651.［6］程静.患者信任的多层内涵与影响机制探析［J］.医学与哲学, 2024, 45 (17): 44-47. ［7］郭 邈,李 栋,郭颖婕.生命哲学视域下和谐医患关系构建的伦理思考［J］.现代医院, 2024, 24 (8): 1171-1174.［8］YU L, YONGHAI B, PEI W, et al. Study of the factors causing medical disputes in a third-level grade a hospital in Shanghai［J］. The International Journal of Health Planning and Management, 2018, 33 (4): e1137-e1146. ［9］SCHAFER D.What is death? Definitions and diagnoses from 2500 years of natural philosophy and medicine［J］.Deutsche Medizinische Wochenschrift,2013,138 (51-52) : 2671-2677．［10］罗莉娅,罗 旭,吴 昊.医患双方对医患关系认知评价的调查研究［J］.中国卫生质量管理, 2020, 27 (1): 70-73,98. ［11］杨艳杰,褚海云,杨秀贤,等.共情能力在医生压力与医患关系间的中介效应［J］.中国公共卫生,2021,37(1):153-156.［12］蔡梓薇,辛 怡,马蔚姝,等.外科医疗损害事件影响因素研究［J］.中国卫生质量管理, 2019, 26 (6): 111-114. ［13］YU L, PEI W, YONGHAI B. The influence factors of medical disputes in Shanghai and implications - from the perspective of doctor, patient and disease ［J］. BMC Health Services Research, 2022, 22 (1): 1128-1128. ［14］殷 璐,曾日红,高 熹,等.三甲医院医疗纠纷发生现状及影响因素分析：基于医、患、家属三方视角［J］.卫生经济研究,2019,36(12):67-70,74.［15］王立先,王星星,王 斌,等. 2015年-2020年甘肃省级医院医疗纠纷影响因素变化趋势研究［J］.江苏卫生事业管理, 2023, 34 (8): 1055-1059. ［16］卑其欢,徐 勇.某市人民医院医疗纠纷现状分析与对策研究［D］.苏州:苏州大学,2017.［17］段双妮,邓 超,文晴,等.基于患者视角的医学人文关怀管理与患者就医满意度现况调查及研究［J］. 湘南学院学报(医学版), 2024, 26 (3): 51-54.［18］王晓刚,谢 雪,何 睿,等.基于聚类分析的不良事件类型对医疗纠纷的预测效能研究［J］.中国社会医学杂志,2023,40(2):220-224.

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更新日期/Last Update: 2025-04-15