Objective: To establish the framework of a prediagnostic risk assessment system for outpatient dental care and to provide references for ensuring patient safety and improving the quality of medical services.
Methods: A total of 15 medical workers in a tertiary-care stomatology hospital in Sichuan Province were selected for qualitative interviews between October 2019 and December 2019. On the basis of the results of literature analysis and the interviews, an expert consultation form for prediagnostic risk assessment system for outpatient dental care was developed. Then, consultation of 10 experts in the field of oral health care and nursing was conducted between June 2020 and December 2020. Eventually, the framework of prediagnostic risk assessment system for outpatient dental care was formulated.
Results: Four themes emerged from the qualitative interviews. Firstly, prediagnostic risks of dental outpatients involved mainly syncope, cardiovascular emergencies, and other emergency medical risks. Secondly, medical risks came from three sources, patients, healthcare professionals, and the environment. Thirdly, medical professionals of outpatient dental care had limited awareness of the prediagnostic medical risks of patient. Fourthly, medical professionals of outpatient dental care showed inadequate response to and management of the prediagnostic medical risks of patient. The expert consultation helped finalize the Dental Outpatient Prediagnostic Risk Assessment Questionnaire, which included 3 primary indicators (namely, general information, medical history [including history of allergy], and medication assessment), 12 secondary indicators (including patient demographics, patients' status upon admission, oral hygiene habits and special lifestyle habits, sensory disorders, special periods for female patients [ie, menstruation, pregnancy, and breastfeeding], allergy history [history of oral treatment-related allergies], past/present medical history, types of medication, route of medication administration, duration of medication administration, accuracy of medication administration, and adverse drug reactions), and 39 tertiary indicators. The effective recall rate of the expert consultation form was 100%, expert positivity was 100%, and the authority coefficient was 0.83. Kendall's harmony coefficient ranged from 0.808 to 0.839, which was statistically significant (P<0.001).
Conclusion: The framework of prediagnosis risk assessment system for outpatient dental care is found to be scientific and specific, but its applicability still needs further validation in clinical practice.
目的: 构建口腔门诊诊前风险评估体系框架，为保障患者安全、改善医疗服务质量提供依据。
方法: 2019年10月–2019年12月于四川省某三级口腔专科医院采用目的抽样法抽取15名医务人员进行质性访谈。结合文献分析、访谈结果形成口腔门诊诊前风险评估体系专家咨询表，于2020年6月–2020年12月对10名口腔医疗及护理领域专家实施专家咨询，最终形成口腔门诊诊前风险评估体系框架。
结果: 质性访谈共提炼出4个主题：①口腔门诊患者诊前风险以晕厥、心血管急症等突发医疗风险为主；②医疗风险来自患者、医护及环境三方因素；③口腔门诊医护人员对患者诊前医疗风险认知局限；④口腔门诊医务人员对患者诊前医疗风险应对及管理不足。专家咨询形成终版口腔门诊诊前风险评估问卷包括一级指标3个〔一般资料、病史（含过敏史）、用药评估〕，二级指标12个〔患者人口学资料、患者入院情况、口腔卫生习惯及特殊生活习惯、感觉障碍、女性患者特殊时期；过敏史（口腔治疗相关过敏史）、既往史/现病史；药物种类、给药途径、用药时间、用药准确度、药物不良反应〕，三级指标39个。专家咨询表有效回收率100%，专家积极性100%，权威系数0.83。肯德尔和谐系数范围为0.808～0.839，具有统计学意义（P<0.001）。
结论: 口腔门诊诊前风险评估体系框架具有科学性及特异性，需于临床进一步验证其可操作性。
Keywords: Expert consultation; Outpatient dental care; Prediagnosis risk; Qualitative research; Risk assessment.
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