Relationship between complaints and quality of care in New Zealand: a descriptive analysis of complainants and non-complainants following adverse events
Relationship between complaints and quality of care in New Zealand: a descriptive analysis of complainants and non-complainants following adverse events
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DOI：
10.1136/qshc.2005.015743
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发表时间：
2006-02-01
影响因子：
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通讯作者：
Studdert, DM
中科院分区：
文献类型：
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作者：
Bismark, MM;Brennan, TA;Studdert, DM
目的：估计受伤的病人在新西兰公立医院的医疗保健谁投诉到一个独立的卫生监察员，健康和残疾专员（“专员”）的比例和特点：受伤的病人谁提出投诉的百分比估计通过链接专员的投诉数据库，在新西兰的医疗质量研究（NZQHS）审查的记录。双变量和多变量分析调查投诉者和非投诉者之间的社会人口和社会经济差异。设置：新西兰公立医院和专员办公室于1998年。人口：向专员提出索赔的患者（n=398）和NZQHS确定发生不良事件但未向专员提出投诉的患者（n=847）主要结果测量：不良事件，可预防的不良事件，并向专员提出投诉。结果：在NZQHS确定的不良事件中，0.4%（3/850）导致投诉;在严重的，可预防的不良事件中，4%（2/48）导致投诉。受伤患者抱怨的倾向随着损伤的严重程度而急剧增加：严重永久性损伤后的抱怨几率比暂时性损伤高11倍，死亡后高18倍。老年患者抱怨的几率明显较低（比值比（OR）0.2，95%置信区间（CI）0.1 - 0.4），太平洋族裔（OR 0.3，95% CI 0.1 - 0.9），或生活在最贫困地区结论：大多数医疗伤害从未引发向专员投诉。在投诉中，严重和可预防的伤害是常见的，提供了一个潜在的有价值的“窗口”的严重威胁病人的安全。老年、社会经济贫困或太平洋族裔患者投诉倾向相对较低，这表明在投诉程序的获取和利用方面存在令人不安的差异。
Objectives: To estimate the proportion and characteristics of patients injured by medical care in New Zealand public hospitals who complain to an independent health ombudsman, the Health and Disability Commissioner ("the Commissioner'').Design: The percentage of injured patients who lodge complaints was estimated by linking the Commissioner's complaints database to records reviewed in the New Zealand Quality of Healthcare Study (NZQHS). Bivariate and multivariate analyses investigated sociodemographic and socioeconomic differences between complainants and non-complainants.Setting: New Zealand public hospitals and the Office of the Commissioner in 1998.Population: Patients who lodged claims with the Commissioner (n=398) and patients identified by the NZQHS as having suffered an adverse event who did not lodge a complaint with the Commissioner (n=847).Main outcome measures: Adverse events, preventable adverse events, and complaints lodged with the Commissioner.Results: Among adverse events identified by the NZQHS, 0.4% (3/850) resulted in complaints; among serious, preventable adverse events 4% (2/48) resulted in complaints. The propensity of injured patients to complain increased steeply with the severity of the injury: odds of complaint were 11 times greater after serious permanent injuries than after temporary injuries, and 18 times greater after deaths. Odds of complaining were significantly lower for patients who were elderly (odds ratio (OR) 0.2, 95% confidence interval (CI) 0.1 to 0.4), of Pacific ethnicity (OR 0.3, 95% CI 0.1 to 0.9), or lived in the most deprived areas (OR 0.3, 95% CI 0.2 to 0.6).Conclusion: Most medical injuries never trigger a complaint to the Commissioner. Among complaints that are brought, severe and preventable injuries are common, offering a potentially valuable "window'' on serious threats to patient safety. The relatively low propensity to complain among patients who are elderly, socioeconomically deprived, or of Pacific ethnicity suggests troubling disparities in access to and utilisation of complaints processes.