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医疗纠纷预防与处理立法文本框架构建研究

【作者】 高任

【导师】 王梅红;

【作者基本信息】 北京中医药大学, 社会医学与卫生事业管理, 2016, 硕士

【摘要】 研究目的:本研究运用德尔菲法对医疗纠纷预防与处理立法展开研究,决定条目池的选取,确定项目的权重,构建医疗纠纷预防与处理文本框架,为国家立法的开展和地方立法的完善提供建议和参考。研究意义:将德尔菲法引入立法领域研究中,通过德尔菲法将医疗纠纷预防与处理立法进行项目量化,为立法工作的开展及其完善提供新的思路。通过德尔菲法确定不同项目的权重,分析不同权重产生的原因,为国家医疗纠纷预防与处理立法提供参考,为地方立法的完善提供建议。研究内容:对医疗纠纷的预防与处理及其相关立法内容进行文献回顾,掌握全国各地医疗纠纷预防与处理地方立法的动态,确定研究方向——运用德尔菲法构建医疗纠纷预防与处理立法文本框架;对全国医疗纠纷预防与处理地方立法文件进行收集、归纳,通过汇总立法文件中对应项目的出现频率以及与专家讨论,最终确定评价项目,编制专家咨询问卷,同时根据专家修改建议,形成正式问卷;根据已经确定的专家咨询问卷邀请16名医事法领域、立法领域专家,采取微信电子问卷的方式对问卷中各项项目的权重进行打分,第二轮专家咨询的问卷中的每一个项目后均附有第一轮专家咨询后的统计结果,供专家第二次判定时参考。通过德尔菲法进行两轮背靠背问卷咨询,进一步集中专家意见,回收数据;对问卷数据结果进行统计分析,以了解医疗纠纷预防与处理立法不同项目的权重;根据专家给每项项目的打分确定权重后,针对权重较高的项目,结合专家访谈分析原因,为国家立法提供建议参考。研究方法:采用文献研究法,通过对万方数据库、中国知网进行近年文献的查阅,搜集和整理了医疗纠纷预防与处理立法的资料,初步积累了一定的文献背景资料;通过跟随北京市立法课题组实地调研获取全国45份地方立法文件,汇总立法文件中对应项目的出现频次以及与专家讨论,最终确定评价项目,编制专家咨询问卷。运用德尔菲法,选择相关研究领域专家,请专家对研究问题进行评估,通过两轮问卷调查,集中专家意见,得到专家对不同项目的打分。通过统计分析方法,借助IBM SPSS 19.0对收集的数据进行统计分析,根据分析结果得到医疗纠纷预防与处理立法项目的权重。通过专家咨询法,针对德尔菲法确定的不同项目的权重,对专家进行咨询,了解相应项目权重较高的原因。结果与讨论:医务人员的权利和义务(4.87)、患者的权利和义务(4.75)、病历的保管、查阅(4.69)、医疗纠纷人民调解(4.84)、新闻媒体的职责(4.66)评分均高于4.60分,说明专家一致认为有关医患双方的权利和义务、有关病历的保管与查阅以及有关医疗纠纷人民调解的法律规定十分重要,位于医疗纠纷预防与处理立法的突出地位,必须予以高度重视。有关概念的定义(3.82)、医疗纠纷的报告制度(3.94)、医疗责任风险金(3.95)、附则(4.08)评分均低于平均分4.43分,尤其是有关概念的定义(3.82)、医疗纠纷报告制度(3.94)、医疗责任风险金(3.95)、附则(3.82)等评分低于4分,可见专家对以上问题不是特别关注。相比之下立法目的(4.44)、医疗机构的义务(4.53)、医疗机构行为规范(4.44)、医疗纠纷解决途径(4.56)、尸体的保存、检验(4.53)、医疗纠纷的应急处置(4.50)、公安机关的处理程序(4.44)、专家咨询和医疗鉴定(4.56)、医疗责任保险(4.56)、仲裁和诉讼(4.44)和法律责任(4.44)的得分在平均值4.43与4.60之间。由此可见专家认为,医疗机构的义务、医疗机构行为规范、医疗纠纷解决途径、尸体的保存、检验、医疗纠纷的应急处置、公安机关的处理程序、专家咨询和医疗鉴定、医疗责任保险、仲裁和诉讼、法律责任方面的内容应该在医疗纠纷预防与处理立法中强调,有针对性的在法律中予以详细的规定。专家评价得到较高权重的项目是“医务人员的权利和义务”、“患者的权利和义务”、“病历的保管、查阅”、“医疗纠纷人民调解”和“新闻媒体的职责”;专家评价得到较低权重的项目是“有关概念的定义”、“医疗纠纷的报告制度”、“医疗责任风险金”、“附则”两轮咨询的专家积极系数分别为80%和100%,表明接受咨询的专家都十分关心本次研究,并且回收率也满足了本研究的基本需要。在本次研究中选择的专家全部完成两轮咨询的专家共有16名,分别来自北京、上海、浙江、黑龙江、重庆、河北、湖北、辽宁等地的专家,均为从事卫生法研究、立法研究的法律专家。他们的平均年龄46.25±8.06岁,平均工作年限21.67±7.64年,31.25%的专家具有正高级技术职称,81.25%的专家具有硕士以上学位。16位专家的熟悉系数为4.35±0.26,说明专家对各项项目的熟悉程度较好,对项目重要性的评估均为经过慎重考虑做出的选择,得出的数据准确可靠。第一轮专家的协调系数为0.23(P>0.05),第二轮专家协调系数为0.34(P<0.05),说明通过反馈第一轮咨询结果,专家的重视程度有所提升,对每一个项目也有了更加深入的理解,评分较第一轮更加的客观真实,专家们对各项目的认同逐渐趋向于统一。在两轮咨询中,工作单位性质不同、不同职称和年龄组的专家对项项目的评分均无统计学差异。这说明专家对各项项目重要性的认识在不同职称和年龄组中差别不大,说明本次研究得到的各项项目的评价权重有较好的外推性。从前后两轮16名专家对各项项目的评分的对比中我们能够看出,均数基本不变,满分比有所下降,变异系数有所下降。通过两轮的打分,每一项项目的分值都愈加趋向于平均值,打分过高或者过低的情况在第二轮中明显少于第一轮。说明通过第一轮的信息反馈,专家对各项项目的打分更加有理性,也愈加的合理,使得结果更为真实,更为可信。

【Abstract】 Objective:This study Delphi method to medical disputes prevention and treatment indicators legislation through evaluation of the decision to select indicators, to determine the weight of index of China’s medical dispute prevention and management legislation evaluate, evaluation framework.Significance:The Delphi method to introduce legislation in the field study, the Delphi method by medical disputes prevention and treatment programs to quantify legislation, to provide new ideas for legislation to carry out its Perfection. Weight to determine the weight of different projects, analyze the reasons for different weights generated for the state to provide medical disputes prevention and treatment reference legislation, provide recommendations for improving local legislation by the Delphi method.Research:Literature research method, through Wanfang database, Chinese literature in recent years carried out HowNet Now, collect and organize medical dispute prevention and treatment of information on legislation, the initial accumulation of a certain amount of background information document; followed by legislative research group Field Beijing National research gets 45 local legislative documents, summary frequency appears legislative documents corresponding to the project, and discussions with experts, to finalize the evaluation project, the preparation of expert consultation questionnaire. Using the Delphi method, select the relevant research experts in the field, experts on the research questions to assess, through two questionnaires, focus on expert opinion, experts on different projects to get scoring. Through statistical analysis, using IBM SPSS 19.0 data collected for statistical analysis, based on the analysis results of medical disputes prevention and treatment of severe rights legislation project. Through expert consultation, the right to determine the Delphi method different projects for heavy, expert consultation, project higher weights for the appropriate reasons.Methods:literature research, Delphi questionnaire, statistical methods, expert consultationResults and discussion:The rights and obligations of medical personnel (4.87), keeping the rights and obligations of patients (4.75), medical records, access to (4.69), People’s Medical Dispute Mediation (4.84), the news media’s responsibility (4.66) rates were higher than 4.60 points, Description experts agree that both doctors and patients about the rights and obligations of the relevant medical records and legal custody and consult the relevant provisions of medical disputes people’s mediation is very important, is located in medical disputes prevention and treatment prominence legislation, must be highly valued. About the definition of the concept (3.82), medical disputes reporting system (3.94), medical liability risk capital (3.95), Annex (4.08) rates were lower than the average 4.43 points, in particular the definition of the concept of (3.82), medical disputes reporting system (3.94), medical liability risk capital (3.95), Annex (3.82) score of less than 4 points, etc., visible expert on these questions not particularly concerned. In contrast legislative purpose (4.44), a compulsory medical institutions (4.53), a code of conduct medical institutions (4.44), medical disputes Solution (4.56), body preservation, inspection (4.53), emergency medical disputes (4.50), public security organs handler (4.44), expert advice and a medical identification (4.56), medical liability insurance (4.56), arbitration and litigation (4.44) and liabilities (4.44) between the average score of 4.43 and 4.60. Thus experts believe that the obligation of medical institutions, medical institutions conduct medical dispute resolution ways to preserve dead bodies, inspection and emergency medical disputes, handlers, the public security organs, expert advice and medical evaluation, medical liability insurance, arbitration and litigation, the legal responsibility of the content should be in the prevention and treatment of medical disputes legislation highlighted, targeted to be detailed in the law. Expert evaluation to give a higher weight of the project is "the rights and obligations of medical staff", "Patient rights and obligations", "medical records storage, access," "medical disputes People’s Mediation" and "media responsibility"; expert evaluation get a lower weighting of the project is "the definition of the concept", "medical disputes reporting system", "medical liability risk capital", "Annex." Experts positive coefficient of two rounds of consultation were 80% and 100%, indicating that counseling experts are very concerned about this study, and the recovery rate to meet the basic needs of the present study. Experts in this study completed two rounds of consultation selected a total of 16 experts, experts from Beijing, Shanghai, Zhejiang, Heilongjiang, Chongqing, Hebei, Hubei, Liaoning and other places, are engaged in health law research, legislation research legal experts. Their average age 46.25±8.06 years, the average length of service 21.67±7.64 years,31.25% of the experts have a positive senior technical titles,81.25% of experts with master’s degrees. Experts familiar with the coefficient 16 is 4.35 ±0.26, explain the project expert familiarity with the better assessment of the importance of the project are the choices made after careful consideration, the resulting data is accurate and reliable. Coordination coefficient of the first round of experts is 0.23 (P> 0.05), the second round of expert coordination coefficient of 0.34 (P<0.05), illustrated by the feedback of the first round results of the consultation, the degree of attention of experts has improved, for each project also have a more in-depth understanding of the true score more objective than the first round, the experts for the purpose of gradually moving to a unified identity. In the two rounds of consultation, the different nature of the workplace, experts from different age groups and titles of key projects scores were not statistically different. This shows that the experts on the importance of the project in different titles and age groups is not very different, indicating that the right to evaluate the present study was the weight of the items have a better extrapolation. We can see from the before and after comparison of two 16 experts of the project score, the mean essentially the same, out of decline than the coefficient of variation declined. Through two rounds of scoring, the score of each project are increasingly tend to average scoring too high or too low in the second round was significantly less than in the first round. Illustrated by a first round of feedback, expert scoring more rational for the project, has become even more reasonable, so that the result is more real, more believable.

  • 【网络出版投稿人】 北京中医药大学
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