醫療傷害流行病學:到底問題有多嚴重?【本期企劃】 試閱
Epidemiology of Medical Injury : How serious is the problem?
醫療糾紛乃指醫病之間因為病人認為受有「醫療傷害」而生責任歸屬的爭執。到底什麼是「醫療傷害」?病人本就是帶病求醫,而醫療行為本身也具有傷害性,所以最後的不良結果是病程不可逆的發展呢?是醫療行為原本就有的副作用呢?還是可歸責於提供者的醫療傷害?這是處理醫療糾紛第一個必須面臨到的認定難題。1986年美國哈佛大學的研究團隊發展出紮實的研究方法,利用病歷分析首度揭開了關於「醫療傷害」的神秘面紗。本文將詳細介紹以「病歷分析法」在全球所進行的醫療傷害實證研究,發現醫療傷害的高盛行率令人驚訝!筆者主張,針對巨量的醫療傷害,政策制定者需要有新的醫療糾紛思維。
Medical dispute is due to patients are injured when receiving medical treatment, and doctors and patients have different opinion on who should be responsible for this medical injury. What is “Medical injury”?
The Harvard Medical Practice Study (HMPS) method for identifying adverse events is based on a two stage chart review. They create a weighted sample of 31429 records of hospitalized patients from a population of 2671863 non-psychiatric patients discharged from nonfederal acute care hospitals in New York in 1984. Initially, the records were screened by trained nurses and medical records analysts. According to HMPS 3 7% hospitalized patients suffer from medical injury and 76% of it are avoidable.HMPS laid the groundwork for policy discussions on patient safety in several countries.
This article aims to analysis and discuss the using of “chart review” in other countries.
022-029