• 1. 蘭州大學循證醫(yī)學中心（蘭州 730000） 2. 四川大學華西醫(yī)院中國循證醫(yī)學中心（成都 610041） 3. 吐哈油田職工醫(yī)院（哈密 839009） 4. 衛(wèi)生部醫(yī)政司（北京 100044） 5. 中國醫(yī)師協(xié)會（北京 100054）;

目的 　循證評價美國醫(yī)療風險監(jiān)測預警機制的經(jīng)驗及其對我國醫(yī)療風險監(jiān)管系統(tǒng)建立的借鑒意義。
方法 　檢索相關數(shù)據(jù)庫和網(wǎng)絡資源，全面檢索有關美國醫(yī)療風險管理、醫(yī)療差錯、病人安全、和安全教育等方面的文獻，將文獻質(zhì)量按循證科學的原理和方法進行分級并分類統(tǒng)計。
結(jié)果 　1999年美國醫(yī)學研究所（IOM）《犯錯人皆難免，構(gòu)建更安全的醫(yī)療衛(wèi)生系統(tǒng)》的報告，揭示了美國醫(yī)療差錯的嚴重性，同時指出了問題的根源和提出了解決的途徑。2000年，政府指定國家質(zhì)量協(xié)調(diào)特別工作組（QuIC）評估IOM報告并制訂了具體的整改措施。經(jīng)過5年改革，在增強公眾醫(yī)療差錯意識、建立病人安全中心、制定醫(yī)療安全執(zhí)行標準、應用信息技術、建立差錯報告系統(tǒng)等方面取得了一定的成績，建立了完善的醫(yī)療風險監(jiān)管機制。但在風險防范方面仍存在一定不足。
結(jié)論 　我國在建立醫(yī)療風險監(jiān)管體系時應結(jié)合自身的特點：① 普及和加強公眾的醫(yī)療風險、病人安全意識，支持和開展病人安全相關研究；② 建立醫(yī)院檢查審核制度和醫(yī)務人員的定期考核管理制度，重視和加強醫(yī)務人員的繼續(xù)教育及醫(yī)學生有關醫(yī)療風險知識的在校教育；③ 應用循證科學的原理和方法，制定涉及醫(yī)療保健系統(tǒng)、采購系統(tǒng)、藥物供應系統(tǒng)等各個方面相應的制度和指南，規(guī)范操作制度和管理；④ 利用計算機信息技術，促進醫(yī)院的信息化建設和規(guī)范化管理，減少人為因素的影響；⑤ 在選點示范、逐步推行的同時，應用循證科學的原理和方法后效評價，止于至善。

引用本文： 楊克虎,馬 彬,田金徽,劉雅莉,張仲男,李幼平,王 莉,段明友,王 羽,張宗久,趙明鋼,陸 君,柳琪林. 美國醫(yī)療風險監(jiān)測預警機制現(xiàn)狀及績效的循證評價. 中國循證醫(yī)學雜志, 2006, 06(6): 439-450. doi: 復制

版權信息： ?四川大學華西醫(yī)院華西期刊社《中國循證醫(yī)學雜志》版權所有，未經(jīng)授權不得轉(zhuǎn)載、改編

1. 劉同奎, 湯洪延. 美國醫(yī)療保障制度與衛(wèi)生體制改革概述. 國外醫(yī)學: 醫(yī)院管理分冊, 1998; (4): 145-147.
2. 殷大奎. 醫(yī)療風險之我見. “2005國際醫(yī)療風險管理與病人安全研討會”資料匯編; p22.
3. 李大川. 加強我國醫(yī)療風險建監(jiān)管,確保病人安全.“2005國際醫(yī)療風險管理與病人安全研討會”資料匯編 p28.
4. 衛(wèi)生部 國家中醫(yī)藥管理局關于印發(fā)《重大醫(yī)療過失行為和醫(yī)療事故報告制度的規(guī)定》的通知. Available from URL: http://www.moh.gov.cn/public/open.aspx?n_id=1570&seq=0.
5. 中國9月1日起將實行重大醫(yī)療過失事故報告制度. Available from URL:http://www.law999.net/news/doc/LAWN/2002/08/23/00003833.html.
6. 徐紅平, 胡豐涵, 崔建華. 醫(yī)患利益保護下的醫(yī)療糾紛賠償. 法律與醫(yī)學雜志, 2000; 1: 14~15.
7. The Quality Interagency Coordination Task Force (QuIC). Doing what counts for partient saferty: federal actions to reduce medical errors and their impact (report to the president). February 2000.
8. Thomas EJ, Studdert DM, Newhouse JP, et al. Costs of medical injuries in Utah and Colorado. Inquiry, 1999; (36):255-264.
9. Brennan TA, Leape LL, Laird NM. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. New Engl J Med, 1991; 324(6): 370-376.
10. Leape LL, Brennan TA, Laird N. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med, 1991; 324(6): 377-384.
11. Kohn LT, Corrigan JM, Donaldson MS, eds. The Institute of Medicine. To Error is Human: Building a Safety Health System. (Washington: National Academy Press, 1999) .
12. Allen S, Staff G. Five years later, medical errors is still a leading killer. November 9, 2004.
13. The Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. March 2001. Available from URL: http://www.iom.edu/Object.File/Master/27/184/Chasm-8pager.pdf.
14. About the Commission. Available from URL:http://www.hcqualitycommission.gov/about.html.
15. The White House Office of the Press Secretary. Establishment of QuIC Task Force . March 13, 1998. Available from: URL: http://www.quic.gov/press/press1.htm.
16. QuIC Fect Sheet. Available from URL: http://www.quic.gov/about/quicfact.htm.
17. QuIC Workgroups. Available from URL: http://www.quic.gov/workgroups/index.htm .
18. Schrappe M. Patient safety and risk management. Medizinische Klinik, 2005; 100(8): 478-485.
19. Battles JB, Lilford RJ. Organizing patient safety research to identify risks and hazards. Quality and Safety in Health Care, 2003; 12 Suppl 2: ii2-7.
20. Berte LM. Patient safety: Getting there from here - Quality management is the best patient safety program. Clinical Leadership and Management Review, 2004; 18(6): 311-315.
21. Liebman CB, Hyman CS. A mediation skills model to manage disclosure of errors and adverse events to patients. Health Affairs, 2004; 23(4): 22-32.
22. Berman A. Reducing medication errors through naming, labeling, and packaging. Journal of Medical Systems, 2004; 28(1): 9~29.
23. Dean B. Learning from prescribing errors. Quality & Safety in Health Care, 2002; 11(3): 258~260.
24. Lambert BL., Lambert BL, Chang KY, et al. Effect of orthographic and phonological similarity on false recognition of drug names. Social Science and Medicine, 2001; 52(12): 1843-1857.
25. Resident education in quality and risk management. QRC advisor, 1989; 5(10): 1-2.
26. Risk management education for the office staff. An important ingredient to successful malpractice prevention. Michigan medicine, 1994; 93(3): 20-22.
27. Grenvik A, Schaefer JJ. New aspects on critical care medicine training. Current Opinion in Critical Care, 2004; 10(4): 233-237.
28. Patient Safety Research in Progress. No. 05-P003-3 Revised, No. 05-P003-1 & 05-P003-2. AHRQ Pub. June 2005.
29. Rosenthal J, Booth M. Maximizing the Use of State Adverse Event Data to Improve Patient Safety. October 2005.
30. Healthgrade Quality Study: Second Annual Patient Safety in American Hospital Report by Health Grades Inc. May 2005.
31. The Kaiser Family Foundation, Agency for Healthcare Research and Quality and the Harvard School of Public Health. November 2004.
32. Woodcock J, Overview of drug Safty in the US. Committee on the Assessment of the US Drug Safety System, June 8, 2005.
33. FDA . Medication errors: An FDA perspective. January 6, 2005 Available from URL: http://www.iom.edu/CMS/3809/22526/24262/24536.aspx .
34. Zhan, C., E. Kelley, et al. Assessing patient safety in the United States: Challenges and opportunities. Medical Care, 2005; 43(3 SUPPL).
35. MedPAC. Quality of care for Medicare beneficiaries. Report to the Congress: Medicare Payment Policy. March 2005.
36. Advances in Patient Safety：From Research to Implementation. Brent C. James. Prologue: Five years later—Are we any safety?.
37. Berwick DM. Invisible injuries. (Op-ed column) The Washington Post 2003 July 29; p.A17.
38. Morrissey J. Patient safety proves elusive. Mod Healthc, 2004; 6-7, 24-5, 30, 32.
39. Liu TK, Tang HY, Zhu YJ. Overview of American Health Insurance and Health System Reform. Foreign Medicine: Hospital Administration, 1998; (4): 145-147.
40. Available from URL: http://new.cms.hhs.gov/History/.
41. Fostering Rapid Advances in Health Care: Learning from System Demonstrations. Available from URL: http://www.iom.edu/CMS/3809/4639/4294.aspx .
42. Priority Areas for National Action: Transforming Health Care Quality. Jan 7, 2003. Available from URL: http://www4.nationalacademies.org/news.nsf/isbn/0309085438?OpenDocument.
43. Patient Safety: Achieving a New Standard for Care. Available from URL: http://www.iom.edu/CMS/3809/4629/16663/27174.aspx.
44. 1st Annual Crossing the Quality Chasm Summit: A Focus on Communities. September14, 2004. Available from URL:http://www.iom.edu/CMS/3809/9868/22344.aspx.
45. Yin DK. Dr Yin assess the medical risk. 2005 International Symposium on Healthcare Risk Management and Patient safety. BeiJing. China, 2005. p22.
46. Li DC. Ensuring the patient safety by strengthening medical risk management in China. 2005 International Symposium on Healthcare Risk Management and Patient safety. BeiJing. China, 2005 p28.
47. Bagian JP, Gosbee JW. Developing a culture of patient safety at the VA. Ambul Outreach 2000 Spring; 25-29.
48. Lester H, Tritter JQ. Medical error: a discussion of the medical construction of error and suggestions for reforms of medical education to decrease error. Med Educ, 2001; 35(9): 855-861.
49. Department of Health. The notice that drug administration published ,《Report System of the great medical error and incident》.Available from URL: http://www.moh.gov.cn/public/open.aspx?n_id=1570&seq=0.
50. China will perform report system of great medical error and incident from 1 September, 2002.Available from URL:http://www.law999.net/news/doc/LAWN/2002/08/23/00003833.html.
51. Xu HP, Hu fh, Cui JH. The compensation medical dispute under the protection of the doctor-patient interests. Law and Medicine, 2000, 1: 14-15.
  1. 1. 劉同奎, 湯洪延. 美國醫(yī)療保障制度與衛(wèi)生體制改革概述. 國外醫(yī)學: 醫(yī)院管理分冊, 1998; (4): 145-147.
  2. 2. 殷大奎. 醫(yī)療風險之我見. “2005國際醫(yī)療風險管理與病人安全研討會”資料匯編; p22.
  3. 3. 李大川. 加強我國醫(yī)療風險建監(jiān)管,確保病人安全.“2005國際醫(yī)療風險管理與病人安全研討會”資料匯編 p28.
  4. 4. 衛(wèi)生部 國家中醫(yī)藥管理局關于印發(fā)《重大醫(yī)療過失行為和醫(yī)療事故報告制度的規(guī)定》的通知. Available from URL: http://www.moh.gov.cn/public/open.aspx?n_id=1570&seq=0.
  5. 5. 中國9月1日起將實行重大醫(yī)療過失事故報告制度. Available from URL:http://www.law999.net/news/doc/LAWN/2002/08/23/00003833.html.
  6. 6. 徐紅平, 胡豐涵, 崔建華. 醫(yī)患利益保護下的醫(yī)療糾紛賠償. 法律與醫(yī)學雜志, 2000; 1: 14~15.
  7. 7. The Quality Interagency Coordination Task Force (QuIC). Doing what counts for partient saferty: federal actions to reduce medical errors and their impact (report to the president). February 2000.
  8. 8. Thomas EJ, Studdert DM, Newhouse JP, et al. Costs of medical injuries in Utah and Colorado. Inquiry, 1999; (36):255-264.
  9. 9. Brennan TA, Leape LL, Laird NM. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. New Engl J Med, 1991; 324(6): 370-376.
  10. 10. Leape LL, Brennan TA, Laird N. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med, 1991; 324(6): 377-384.
  11. 11. Kohn LT, Corrigan JM, Donaldson MS, eds. The Institute of Medicine. To Error is Human: Building a Safety Health System. (Washington: National Academy Press, 1999) .
  12. 12. Allen S, Staff G. Five years later, medical errors is still a leading killer. November 9, 2004.
  13. 13. The Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. March 2001. Available from URL: http://www.iom.edu/Object.File/Master/27/184/Chasm-8pager.pdf.
  14. 14. About the Commission. Available from URL:http://www.hcqualitycommission.gov/about.html.
  15. 15. The White House Office of the Press Secretary. Establishment of QuIC Task Force . March 13, 1998. Available from: URL: http://www.quic.gov/press/press1.htm.
  16. 16. QuIC Fect Sheet. Available from URL: http://www.quic.gov/about/quicfact.htm.
  17. 17. QuIC Workgroups. Available from URL: http://www.quic.gov/workgroups/index.htm .
  18. 18. Schrappe M. Patient safety and risk management. Medizinische Klinik, 2005; 100(8): 478-485.
  19. 19. Battles JB, Lilford RJ. Organizing patient safety research to identify risks and hazards. Quality and Safety in Health Care, 2003; 12 Suppl 2: ii2-7.
  20. 20. Berte LM. Patient safety: Getting there from here - Quality management is the best patient safety program. Clinical Leadership and Management Review, 2004; 18(6): 311-315.
  21. 21. Liebman CB, Hyman CS. A mediation skills model to manage disclosure of errors and adverse events to patients. Health Affairs, 2004; 23(4): 22-32.
  22. 22. Berman A. Reducing medication errors through naming, labeling, and packaging. Journal of Medical Systems, 2004; 28(1): 9~29.
  23. 23. Dean B. Learning from prescribing errors. Quality & Safety in Health Care, 2002; 11(3): 258~260.
  24. 24. Lambert BL., Lambert BL, Chang KY, et al. Effect of orthographic and phonological similarity on false recognition of drug names. Social Science and Medicine, 2001; 52(12): 1843-1857.
  25. 25. Resident education in quality and risk management. QRC advisor, 1989; 5(10): 1-2.
  26. 26. Risk management education for the office staff. An important ingredient to successful malpractice prevention. Michigan medicine, 1994; 93(3): 20-22.
  27. 27. Grenvik A, Schaefer JJ. New aspects on critical care medicine training. Current Opinion in Critical Care, 2004; 10(4): 233-237.
  28. 28. Patient Safety Research in Progress. No. 05-P003-3 Revised, No. 05-P003-1 & 05-P003-2. AHRQ Pub. June 2005.
  29. 29. Rosenthal J, Booth M. Maximizing the Use of State Adverse Event Data to Improve Patient Safety. October 2005.
  30. 30. Healthgrade Quality Study: Second Annual Patient Safety in American Hospital Report by Health Grades Inc. May 2005.
  31. 31. The Kaiser Family Foundation, Agency for Healthcare Research and Quality and the Harvard School of Public Health. November 2004.
  32. 32. Woodcock J, Overview of drug Safty in the US. Committee on the Assessment of the US Drug Safety System, June 8, 2005.
  33. 33. FDA . Medication errors: An FDA perspective. January 6, 2005 Available from URL: http://www.iom.edu/CMS/3809/22526/24262/24536.aspx .
  34. 34. Zhan, C., E. Kelley, et al. Assessing patient safety in the United States: Challenges and opportunities. Medical Care, 2005; 43(3 SUPPL).
  35. 35. MedPAC. Quality of care for Medicare beneficiaries. Report to the Congress: Medicare Payment Policy. March 2005.
  36. 36. Advances in Patient Safety：From Research to Implementation. Brent C. James. Prologue: Five years later—Are we any safety?.
  37. 37. Berwick DM. Invisible injuries. (Op-ed column) The Washington Post 2003 July 29; p.A17.
  38. 38. Morrissey J. Patient safety proves elusive. Mod Healthc, 2004; 6-7, 24-5, 30, 32.
  39. 39. Liu TK, Tang HY, Zhu YJ. Overview of American Health Insurance and Health System Reform. Foreign Medicine: Hospital Administration, 1998; (4): 145-147.
  40. 40. Available from URL: http://new.cms.hhs.gov/History/.
  41. 41. Fostering Rapid Advances in Health Care: Learning from System Demonstrations. Available from URL: http://www.iom.edu/CMS/3809/4639/4294.aspx .
  42. 42. Priority Areas for National Action: Transforming Health Care Quality. Jan 7, 2003. Available from URL: http://www4.nationalacademies.org/news.nsf/isbn/0309085438?OpenDocument.
  43. 43. Patient Safety: Achieving a New Standard for Care. Available from URL: http://www.iom.edu/CMS/3809/4629/16663/27174.aspx.
  44. 44. 1st Annual Crossing the Quality Chasm Summit: A Focus on Communities. September14, 2004. Available from URL:http://www.iom.edu/CMS/3809/9868/22344.aspx.
  45. 45. Yin DK. Dr Yin assess the medical risk. 2005 International Symposium on Healthcare Risk Management and Patient safety. BeiJing. China, 2005. p22.
  46. 46. Li DC. Ensuring the patient safety by strengthening medical risk management in China. 2005 International Symposium on Healthcare Risk Management and Patient safety. BeiJing. China, 2005 p28.
  47. 47. Bagian JP, Gosbee JW. Developing a culture of patient safety at the VA. Ambul Outreach 2000 Spring; 25-29.
  48. 48. Lester H, Tritter JQ. Medical error: a discussion of the medical construction of error and suggestions for reforms of medical education to decrease error. Med Educ, 2001; 35(9): 855-861.
  49. 49. Department of Health. The notice that drug administration published ,《Report System of the great medical error and incident》.Available from URL: http://www.moh.gov.cn/public/open.aspx?n_id=1570&seq=0.
  50. 50. China will perform report system of great medical error and incident from 1 September, 2002.Available from URL:http://www.law999.net/news/doc/LAWN/2002/08/23/00003833.html.
  51. 51. Xu HP, Hu fh, Cui JH. The compensation medical dispute under the protection of the doctor-patient interests. Law and Medicine, 2000, 1: 14-15.