Study On The Influence Factors Of Medical Disputes Of A Third-grade Class-A Hospital In Bengbu City

Objectives Medical disputes are growing dramatically in the recent years in China. It is an indisputable fact that medical practice environment is deteriorating and the doctor-patient relationship is worsening. Thus how to reduce unreasonable medical disputes and how to relieve the contradiction and to build a harmonious relationship between doctors and patients has become an urgent problem. The objective of the study is to analyze the distribution of the medical dispute cases occurred in Affiliated Hospital of Bengbu Medical College, to explore the influence factors of medical disputes, and to provide reference for developing corresponding strategies and countermeasures.Methods research data was collected through internet and academic database such as Medine、Proquest、CNKI、CQVIP, etc. and from the Affiliated Hospital of Bengbu Medical College. Sampling and data collect methods were as following:(1) Randomly selecting40medical dispute cases occurring from January2007to June2011as the case group by using systematic sampling method; then randomly selecting the medical cases, which didn’t occurred disputes, with the same period, same department, same disease, but different doctor in charge, as the control group, by the ratio1:2pairing according to sample size of the case group. The information of the doctor and patient of the case group and control group was collected through the hospital’s medical dispute cases archives and HIS database.(2) Conducting questionnaire survey on the doctors of the case group and control group, which including four aspects—job satisfaction, knowledge, attitude and behavior related to medical dispute.(3) Interviewing to the responsible persons in the hospital’s medical administration section to collect additional data and information. Research methods were as following:(1) Using descriptive statistic methods to demonstrate the distribution of the medical dispute cases, including distributions among different departments, and between outpatient and inpatient service.(2) Using CMH χ2test, two-independent sample t-test and paired t-test to conduct univariate analysis on the influence factors of medical dispute of the case group and control group.(3) Using Cox proportional hazards model to conduct multivariate analysis on the doctor-side factors on the basis of the univiriate analysis above.Results (1) Medical disputes mainly occurred in inpatient services (95.0%), especially department of surgery (47.5%), and also common in department of internal medicine (10.0%), pediatrics (10.0%), obstetrics (7.5%), orthopedic (7.5%), etc., which is consistent with existing literature.(2) Univiriate analysis on the case group and control group showed that the influence of operation on medical disputes was not statistically significant, while the medical expense was statistically significant, which is consistent with the existing literature. Among the patient-side factors, the influence of patient’s demographic characteristics such as gender, household register classification, age on medical dispute was not statistically significant, while the influence of educational level, occupation on medical dispute was statistically significant. The influence of other subjective factors such as the patient’s feelings about treatment outcomes and medical costs, expectations of the treatment outcome, rights awareness on medical dispute need to be further studied. Among the doctor-side factors, the influence of doctor’s sex, age and work experience, education, job title, job satisfaction and medical disputed related knowledge on the medical dispute was not statistically significant, which is inconsistent with existing literature, probably due to mall sample size, or the research perspective of this study, or the generally low satisfaction and lack of knowledge of medical disputes in current social environment. However, the influence of doctor’s attitudes and behavior on medical disputes was statistically significant, as reported in the existing literature.(3) The result of multivariate analysis on the case group and control group shows that the Cox proportional hazards model h (t, X)=h0(t) exp (0.048X满意度+0.108X知识-0.301X态度-0.231X行为+0.965X年龄+0.149X工作年限+0.514X学历+1.201X职称+1.166X性别) was statistically significant. Among the variables of this model, the variable of preventive behavior of medical dispute was statistically significant, while other variables not.Conclusions (1) Medical dispute occurs mainly in the inpatient service, and it is commonly distributed in department of surgery, internal medicine, pediatrics, obstetrics and gynecology, orthopedics of the majority, especially in department of surgery.(2) Medical cost is an influence factor of medical dispute, the higher the cost, the greater likelihood of medical dispute.(3) Patient’s education degree, occupation and type of health insurance are the influence factors of medical dispute. The lower the level of education, the higher risk of medical disputes; the risk of patients with no formal job is higher than patients with formal jobs; the lower the benefit level of health insurance, the higher risk of medical disputes. No evidence found in this study that the patient’s sex, household register classification, age are the influence factors of medical dispute.(4) Doctor’s medical dispute related attitude and behavior are influence factors of medical dispute, and the influence of preventive behavior against medical disputes is even more significant.