调查分析医疗风险告知对医疗纠纷的作用和效果。

回顾性分析2012年1月至2022年6月，某三甲医院外科患者的诊疗数据。依据风险告知改进情况，分为对照组（改进前，2012-01至2016-12）与试验组（改进后，2017-01至2022-06）。对比分析改进前后医疗纠纷发生情况。依过错比例判定过错等级，分为A（60%~100%）、B（20%~60%）、C（0%~20%）三个等级，分析医疗纠纷过错责任鉴定结果的变化，探讨改进对纠纷发生率及其鉴定结果的影响。

（1）纠纷发生率。①总纠纷发生率：2012至2022年上半年，呈下降趋势。但试验组与对照组比较，无明显降低。②告知不充分纠纷发生率：2012至2022年上半年总体呈下降趋势，在2017年出现明显降低，试验组较对照组有明显降低。（2）告知不充分纠纷占总医疗纠纷的比例。对照组各年度无明显升降趋势，试验组呈下降趋势，且2组平均占比比较，试验组低于对照组，差异有统计学意义（P<0.05）。（3）过错责任等级变化。①对照组各年度医疗纠纷过错责任各级占比均无明显升降趋势。试验组A级占比明显下降，且呈下降趋势；C级占比明显上升，且呈上升趋势；B级无明显变化。②2组各级平均占比：A级试验组<对照组，C级试验组>对照组，差异均有统计学意义（P<0.05），B级2组比较差异无统计学意义（P>0.05）。③2组责任等级各级占比总体分布比较，差异有统计学意义（P<0.05）。

完善医疗风险告知在现阶段诊疗活动中有着积极作用，有助于医疗机构和医护人员在医疗纠纷中降低或规避法律风险。但完善风险告知只是降低医疗纠纷发生率手段之一，要彻底降低纠纷的产生还需要同时对诊疗行为中的其他环节进行改进。

Investigate and analyze the role and effectiveness of medical risk disclosure in medical disputes.

A retrospective analysis was conducted on the diagnosis and treatment data of surgical patients in a tertiary hospital from January 2012 to June 2022. According to the improvement situation of risk notification, it is divided into a control group (before improvement, from January 2012 to December 2016) and an experimental group (after improvement, from January 2017 to June 2022). Compare and analyze the occurrence of medical disputes before and after improvement. According to the proportion of fault, the fault level is divided into three levels: A(60%-100%), B(20%-60%) and C(0-20%). The changes in the identification results of fault liability in medical disputes were analyzed, and the influence of improvement on the incidence of disputes and their identification results was discussed.

(1) Incidence of disputes. ①The total incidence of disputes: from 2012 to the first half of 2022, it showed a downward trend. However, there was no significant decrease in the experimental group compared with the control group. ②The incidence of insufficient notification disputes: from 2012 to the first half of 2022, the overall trend showed a downward trend, and it decreased significantly in 2017, and the experimental group was significantly lower than the control group. (2) The proportion of inadequately informed disputes in total medical disputes; There was no significant upward and downward trend in the control group each year, while the experimental group showed a downward trend, and the average proportion of the two groups was compared, the experimental group was lower than the control group, and the difference was statistically significant (P<0.05). (3) The change in fault liability level. ①In the control group, there was no significant upward or downward trend in the proportion of fault liability for medical disputes at all levels. The proportion of grade A in the experimental group decreased significantly, and showed a downward trend. The proportion of grade C increased significantly and showed a upward trend. There was no significant change in grade B. ②The average proportion of the two groups at all levels: the grade A experimental group was smaller than the control group, the grade C experimental group was larger than the control group, and the differences were statistically significant (P<0.05), and there was no statistically significant difference between the grade B two groups (P>0.05). ③There was a statistically significant difference in the overall distribution of responsibility grades between the two groups (P<0.05).

Improving medical risk disclosure plays a positive role in current diagnosis and treatment activities, which helps medical institutions and staff reduce or avoid legal risks in medical disputes. However, improving risk disclosure is only one of the means to reduce the incidence of medical disputes. To completely reduce the occurrence of disputes, it is necessary to also improve other aspects of diagnosis and treatment behavior.