title: Preventing surgical disputes through early detection and intervention: a case control study in China.
abstract: BACKGROUND
  Medical disputes have become a serious issue in China. A crisis cannot usually be predicted and managed through a cost-benefit strategy; therefore, researchers believe that prevention is better than containment and post-crisis resolution. This study aimed to identify solutions to prevent medical disputes in surgical cases through early warning and intervention of potential cases.
  
  
  METHODS
  A case-control study was conducted to identify early detection indicators of medical disputes in the surgical treatment of liver cancer through Delphi consultation and logistic regression on the basis of which interventions were undertaken to prevent potential cases.
  
  
  RESULTS
  The dispute detection model was composed of patient age (P = 0.08), frequency of hospitalization (P = 0.003), length of hospital stay (P < 0.001), terminal condition (P = 0.004), unplanned reoperation (P = 0.048), blood transfusion volume (P = 0.006), and arrearage (P < 0.001). Risk management interventions through quality improvement and enhanced communication in cases with an abnormal performance indicator proved effective in practice.
  
  
  CONCLUSIONS
  This study explored the use of an evidence-based medical risk management strategy for medical disputes that involved early detection and intervention and could potentially be adopted by hospitals to prevent medical disputes.
authors.affiliation: Department of Health Service Management, Second Military Medical University, 800 Xiangyin Road, 200433, Shanghai, China. xupingsh@126.com.
authors.forename: Ping
authors.initials: P
authors.lastname: Xu
authors.affiliation: Department of Medical Education, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. fanzlch@163.com.
authors.forename: Zhenlin
authors.initials: Z
authors.lastname: Fan
authors.affiliation: Department of Health Service Management, Second Military Medical University, 800 Xiangyin Road, 200433, Shanghai, China. origin.li@gmail.com.
authors.forename: Ting
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Health Service Management, Second Military Medical University, 800 Xiangyin Road, 200433, Shanghai, China. janew1011@aliyun.com.
authors.forename: Lijie
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Mathematics, Second Military Medical University, Shanghai, China. stevensun1968@126.com.
authors.forename: Qingwen
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Department of Health Service Management, Second Military Medical University, 800 Xiangyin Road, 200433, Shanghai, China. duxia1024@163.com.
authors.forename: Xia
authors.initials: X
authors.lastname: Du
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, 225 Changhai Road, 200433, Shanghai, China. lb801@163.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Lian
authors.affiliation: Department of Health Service Management, Second Military Medical University, 800 Xiangyin Road, 200433, Shanghai, China. llzhangsh@163.com.
authors.forename: Lulu
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002681:China; D034462:Dissent and Disputes; D042241:Early Diagnosis; D055317:Evidence-Based Practice / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008113:Liver Neoplasms / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D012308:Risk Management / Q000379:methods*