基于MEWS模型建立云南多民族地区医疗风险预警机制应用效果研究

Nowadays, “Medical risk is everywhere” has been a common consensus in the global medical filed, with the transformation of medical model and establishment of the concept of “Macro-view of Health”, the situation of medical risk in our country facing has been more and more serious. Yunnan is located in the southwest of China which consisting of many ethnic minorities. In Yunnan, the development of economics is backward, the traffic is inconvenience, also the level of health care service and health cognition of residents are low as well. Moreover, there are no specific medical risk early warning mechanism. Compare with other provinces in China, Yunnan has many characteristics as higher level of medical risk, such as insufficient capacity of risk identification, and more serious consequence of medical risk. This research based on the Modified Early Warning Score (MEWS) model of nursing risk identification. The researchers intend to investigate the characteristics of medical risk at nine different levels hospitals in Yunnan province using empirical investigation, and to analyze the background, process, regular pattern, causes and factors of medical risk. On the other hand, based on the characteristics of MEWS model, by combining multidisciplinary and using a.variety of methods to establish a long-term warning mechanism according to the characteristics of medical risk of multi-ethnic areas in Yunnan, and to determine the level of medical risk and threshold of warning system so that to achieve the standardized, systematic, efficient and scientific management of medical risk management. Moreover, through two years of empirical intervention in research setting, to evaluate the effect of early warning mechanism, to develop Information Education Communication （IEC） materials, to promote and train this warning.mechanism within different levels hospitals of Yunnan. Finally, to improve the management ability and the level of early warning system of medical risk in Yunnan.

医疗风险无处不在，已成为当前全球医疗界的共识，而且随着医学模式的转变和“大卫生概念”的确立，我国面临医疗风险形势越来越严峻。云南位于我国西南边陲，少数民族众多、经济落后、交通不便、医疗水平低下、居民健康素养低，且未建立符合当地医疗风险特点的预警机制，与全国其他地区相比：医疗风险危险度高、风险识别能力不足、产生后果严重。课题组前期进行了基于MEWS模型的护理风险识别的研究，本次研究拟通过实证调查云南省不同地区不同级别的9所医院医疗风险发生特点，分析医疗风险发生的背景、过程、规律、成因及各种影响因素，在此基础上，基于MEWS模型特点，采用多学科融合、多种方法建立符合云南多民族地区医疗风险特点的长效预警机制，确定风险等级及预警阈值，实现医疗风险管理的规范化、系统化、高效化和科学化。并通过2年的实证干预研究评估预警机制效果，开发IEC材料，在全省推广和培训，提升全省医疗风险预警管理能力与水平。

项目背景： 医疗风险无处不在，已成为当前全球医疗界和公众关注的焦点，随着医学模式的转变和“大卫生概念”的确立，我国面临医疗风险形势越来越严峻。云南位于我国西南边陲，少数民族众多、经济落后、交通不便、居民健康素养较低，在全省范围内暂未建立符合当地医疗风险预警特点的预警机制，与全国其他地区相比：医疗资源短缺，风险增加、医务人员对风险识别能力不足、产生后果更加严重、甚至导致病人死亡，在此背景下开展医疗风险预警研究；研究内容为医疗风险预警机制建立；构建医疗风险预警指标体系；确定医疗风险指标阈值；提高医务人员风险防控意识；降低医疗风险发生率；开发预警系统软件并推广到全省。研究结果：本次研究通过实证调查云南省昆明、大理地区、对6家医院医疗风险发生特点、背景、过程、规律、成因及各种影响因素进行分析，得出初步结果：云南地区患者对医疗风险意识淡薄，少数民族民风淳朴，对医生依从性较好，尤其是老年患者，难治重症患者家属不愿患者在医院死亡，同时患者及家属对慢性疾病的早期认知不足，疾病没有得到很好的控制，如高血压、糖尿病等并发症出现才送到医院看病，错过了最佳防治时期，基层医务人员早期的筛查及宣教迫切，在基层乡镇卫生院(所)人员较少，设备落后，还没有开展疾病的早期筛查，乡镇卫生院（所）医务人员培训匮乏，因此建立医疗风险预警机制；构建医疗风险预警指标体系；确定医疗风险指标阈值及建立MEWS模型预警并推广尤为重要。.关键数据：2020-2022年疫情影响，课题现场调研完成50%；目前完成大理及昆明地区三级医院、二级医院各一家，一级乡镇卫生院三家；发放问卷1200份，回收1200份，下一步计划2023年2月底前完成玉溪地区一、二、三级医院调研，发放调研问卷1300份，完成数据收集，课题组进行统计、分析，完成结题报告及后期工作，争取2023年12月结题。意义：通过到云南多地的基层调研，了解云南不同少数民族对疾病的认知，为下一步健康扶贫提供科学依据。