摘要目的：通过对低风险死亡病例的分析,探索快速准确发现医疗质量管理薄弱环节的方法,持续改进医疗质量。方法对北京市属医院2012年的114例低风险死亡病例的数据质量与诊疗过程进行2轮分析,发现存在的问题,并通过与其他信息的交互,验证该方法的可行性与精准性。结果21家医院2012年出院病例585760例,其中151193例为低风险病例。其中,低风险死亡病例共计114例,占总出院病例的0.019%,占低风险病例的0.075%。通过分析上述病例发现,主要诊断有问题的病例50份(43.86%)；诊疗过程可能存在不足的病例45份(39.47%)。39例次(34.21%)主要诊断缺失,28例(24.56%)手术项目缺失,这其中部分病例有多个问题重合。诊疗过程可能存在不足及诊断有问题的病例中,有10份病例发生了纠纷并进行了赔偿。结论通过对低风险死亡病例进行分析,可以从海量数据中快速聚焦问题病例,找出诊疗过程中的常见问题,有利于持续改进医疗质量与医院精细化管理工作。

abstractsObjective To explore methods of quickly identifying loopholes in medical quality management and to improve medical quality by means of analyzing low-risk death cases.Methods Two rounds of analysis of 1 14 low-risk death cases of hospitals in Beijing in 2012 in terms of data quality and medical procedures,in an effort to identify problems and to verify the feasibility and accuracy of the method through interaction with other data.Results Totally 585 760 inpatients were discharged in 2012 from 21 hospitals,of whom 1 5 1 1 93 being low-risk cases.Such cases included 1 14 low-risk death cases, accounting for 0.01 9% of the total discharged,and 0.075% of low-risk discharged cases.Analysis of these medical records found 50 cases of problematic diagnosis (43.86%),45 cases of possible defects in diagnosis and treatment (39.47%),39 cases of missing items of secondary diagnosis (34.21%),and 28 cases of missing items of surgery/operation (24.56%). Some of the abovementioned cases had overlapping mistakes.Conclusion Analysis of low-risk death cases can help focus among massive data of medical records,problems of diagnostic and therapeutic insufficiency,pinpointing common problems in medical service and improving medical quality and fine management of hospitals.