Abstract

Introduction

Healthcare complaints are underutilized for quality improvement in general practice. Systematic analysis of complaints has identified hot spots (areas across the care pathway where issues occur frequently) and blind spots (areas across the care pathway that cannot be observed by staff) in secondary care. The Healthcare Complaints Analysis Tool (HCAT) has been adapted to the HCAT(GP).

Aims

This study aimed to: (i) assess whether the HCAT(GP) can systematically analyze complaints about general practice; and (ii) identify hot spots and blind spots in general practice.

Methods

GP complaints were sampled. Complaints were coded with the HCAT(GP), classified by HCAT(GP) category (e.g. Safety, Environment, Listening), stage of care (e.g. accessing care, referral/follow-up), severity (e.g. low, medium, high), and harm (e.g. none, major). Descriptive statistics were run to identify discrete issues. A chi-square test of independence identified hot spots, and logistic regression was used for blind spots.

Results

A total of 230 complaints, encompassing 432 issues (i.e. unique problems within complaints), were categorized. Relationship issues (e.g. problems with listening, communication, and patient rights) emerged most frequently (n = 174, 40%). Hot spots were identified in the consultation and the referral/follow-up stages (χ ²(5, n = 432) = 17.931, P < 0.05). A blind spot for multiple issues was identified, with the likelihood of harm increasing with number of issues (odds ratio = 2.02, confidence interval = 1.27–3.23, P < 0.05).

Conclusions

Complaints are valuable data for improving general practice. This study demonstrated that the HCAT(GP) can support the systematic analysis of general practice complaints, and identify hot spots and blind spots in care.

中文翻译：

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从患者对一般实践的投诉中识别整个护理路径中的伤害热点和盲点

摘要

介绍

在一般实践中，医疗投诉未充分用于质量改进。对投诉的系统分析确定了二级保健中的热点（整个护理路径中问题频繁发生的区域）和盲点（整个护理路径中工作人员无法观察到的区域）。医疗保健投诉分析工具 (HCAT) 已适应 HCAT(GP)。

目标

本研究旨在： (i) 评估 HCAT(GP) 是否可以系统地分析对一般实践的投诉；(ii) 在一般实践中识别热点和盲点。

方法

对全科医生的投诉进行了抽样调查。投诉使用 HCAT(GP) 编码，按 HCAT(GP) 类别（例如安全、环境、听力）、护理阶段（例如获得护理、转诊/随访）、严重程度（例如低、中、高）分类和伤害（例如无，主要）。运行描述性统计以识别离散问题。独立性卡方检验识别热点，逻辑回归用于盲点。

结果

共分类230件投诉，包括432个问题（即投诉中的独特问题）。关系问题（例如倾听、沟通和患者权利问题）最常出现（n = 174, 40%）。在咨询和转诊/随访阶段确定了热点（χ  ²（5，n = 432）= 17.931，P <0.05）。确定了多个问题的盲点，伤害的可能性随着问题的数量而增加（优势比 = 2.02，置信区间 = 1.27–3.23，P < 0.05）。

结论

投诉是改善一般实践的宝贵数据。本研究表明，HCAT(GP) 可以支持对全科医疗投诉的系统分析，并识别护理中的热点和盲点。