the english patient research paper

Movie Reviews

Tv/streaming, collections, great movies, chaz's journal, contributors, the english patient.

Now streaming on:

Backward into memory, forward into loss and desire, “The English Patient” searches for answers that will answer nothing. This poetic, evocative film version of the famous novel by Michael Ondaatje circles down through layers of mystery until all of the puzzles in the story have been solved, and only the great wound of a doomed love remains. It is the kind of movie you can see twice--first for the questions, the second time for the answers.

The film opens with a pre-war biplane flying above the desert, carrying two passengers in its open cockpits. The film will tell us who these passengers are, why they are in the plane, and what happens next. All of the rest of the story is prologue and epilogue to the reasons for this flight. It is told with the sweep and visual richness of a film by David Lean , with an attention to fragments of memory that evoke feelings even before we understand what they mean.

The “present” action takes place in Italy, during the last days of World War II. A horribly burned man, the “English patient” of the title, is part of a hospital convoy. When he grows too ill to be moved, a nurse named Hana ( Juliette Binoche ) offers to stay behind to care for him in the ruins of an old monastery. Here she sets up a makeshift hospital, and soon she is joined by two bomb-disposal experts and a mysterious visitor named Caravaggio (Willem Dafoe).

The patient's skin is so badly burned it looks like tortured leather. His face is a mask. He can remember nothing. Hana cares for him tenderly, perhaps because he reminds her of other men she has loved and lost during the war. (“I must be a curse. Anybody who loves me--who gets close to me--is killed.”) Caravaggio, who has an interest in the morphine Hana dispenses to her patient, is more cynical: “Ask your saint who he's killed. I don't think he's forgotten anything.” The nurse is attracted to one of the bomb disposal men, a handsome, cheerful Sikh officer named Kip ( Naveen Andrews ). But as she watches him risk his life to disarm land mines, she fears her curse will doom him; if they fall in love, he will die. Meanwhile, the patient's memories start to return in flashes of detail, spurred by the book that was found with his charred body--an old leather-bound volume of the histories of Herodotus, with drawings, notes and poems pasted or folded inside.

I will not disclose the crucial details of what he remembers. I will simply supply the outlines that become clear early on. He is not English, for one thing. He is a Hungarian count, named Laszlo de Almasy ( Ralph Fiennes ), who in Egypt before the war was attached to the Royal Geographic Society as a pilot who flew over the desert, making maps that could be used for their research--which was the cover story--but also used by English troops in case of war.

In the frantic social life of Cairo, where everyone is aware that war is coming, Almasy meets a newly married woman at a dance. She is Katharine Clifton ( Kristin Scott Thomas ). Her husband Geoffrey ( Colin Firth ) is a disappointment to her. Almasy follows her home one night, and she confronts him and says, “Why follow me? Escort me, by all means, but to follow me . . .” It is clear to both of them that they are in love. Eventually they find themselves in the desert, part of an expedition, and when Geoffrey is called away (for reasons which later are revealed as good ones), they draw closer together. In a stunning sequence, their camp is all but buried in a sandstorm, and their relief at surviving leads to a great romantic sequence.

These are the two people--the count and the British woman--who were in the plane in the first shot. But under what conditions that flight was taken remains a mystery until the closing scenes of the movie, as do a lot of other things, including actions by the count that Caravaggio, the strange visitor, may suspect. Actions that may have led to Caravaggio having his thumbs cut off by the Nazis.

All of this back-story (there is much more) is pieced together gradually by the dying man in the bed, while the nurse tends to him, sometimes kisses him, bathes his rotting skin, and tries to heal her own wounds from the long war. There are moments of great effect: One in which she plays hopscotch by herself. A scene involving the nurse, the Sikh, and a piano. Talks at dusk with the patient, and with Caravaggio. All at last becomes clear.

The performances are of great clarity, which is a help to us in finding our way through the story. Binoche is a woman whose heart has been so pounded by war that she seems drawn to its wounded, as a distraction from her own hurts. Fiennes, in what is essentially a dual role, plays a man who conceals as much as he can--at first because that is his nature, later because his injuries force him to. Thomas is one of those bright, energetic British women who seem perfectly groomed even in a sandstorm, and whose core is steel and courage.

Dafoe's character must remain murkier, along with his motives, but it is clear he shelters a great anger. And Andrews, as the bomb-disposal man, lives the closest to daily death and seems the most grateful for life.

Ondaatje's novel has become one of the most widely read and loved of recent years. Some of its readers may be disappointed that more is not made of the Andrews character; the love between the Sikh and the nurse could provide a balance to the doomed loves elsewhere. But the novel is so labyrinthine that it's a miracle it was filmed at all, and the writer-director, Anthony Minghella , has done a creative job of finding visual ways to show how the rich language slowly unveils layers of the past.

Producers are not always creative contributors to films, but the producer of “The English Patient,” Saul Zaentz , is in a class by himself. Working independently, he buys important literary properties (“One Flew Over the Cuckoo's Nest,” “ Amadeus ,” “ The Unbearable Lightness of Being ,” “At Play in the Fields of the Lord”) and savors their difficulties. Here he has created with Minghella a film that does what a great novel can do: Hold your attention the first time through with its story, and then force you to think back through everything you thought you'd learned, after it is revealed what the story is *really* about.

Roger Ebert

Roger Ebert was the film critic of the Chicago Sun-Times from 1967 until his death in 2013. In 1975, he won the Pulitzer Prize for distinguished criticism.

Now playing

Food, Inc. 2

Glenn kenny.

The American Society of Magical Negroes

Robert daniels.

The Feeling That the Time for Doing Something Has Passed

Mary & George

Cristina escobar.

Brian Tallerico

Film credits.

The English Patient (1996)

Rated R For Sexuality, Some Violence and Language

160 minutes

Colin Firth as Geoffrey Clifton

Ralph Fiennes as Almasy

Kristin Scott Thomas as Katharine Clifton

Juliette Binoche as Hana

Willem Dafoe as Caravaggio

Naveen Andrews as Kip

Written and Directed by

• Anthony Minghella

Based On The Novel by

• Michael Ondaatje

Latest blog posts

Home Entertainment Guide: April 2024

Max’s Award-Winning Hacks Returns with Its Best Season to Date

Death Feels Very Close: Ryûsuke Hamaguchi on Evil Does Not Exist

Speed Kills: On the 25th Anniversary of Go

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

•  We're Hiring!
•  Help Center

The English Patient

• Most Cited Papers
• Most Downloaded Papers
• Newest Papers
• Save to Library
• Michael Ondaatje Follow Following
• Angela Carter Follow Following
• J. M. Coetzee Follow Following
• Modernism (Literature) Follow Following
• The God of Small Things Follow Following
• Falling Man Don De Lillo Follow Following
• Amar Chitra Katha Follow Following
• Victorian Studies Follow Following
• Diplomatic History Follow Following
• Postmodernism Follow Following

Enter the email address you signed up with and we'll email you a reset link.

• Academia.edu Publishing
•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

The English Patient

Michael ondaatje, ask litcharts ai: the answer to your questions.

Michael Ondaatje’s The English Patient focuses on the love story between the unidentified English patient —later revealed to be László Almásy, a Hungarian desert explorer—and Katharine Clifton , the wife of Geoffrey Clifton , a British spy posing as an archaeologist in North Africa in the years just before World War II. Badly burned in a plane crash and suffering from amnesia, Almásy is brought to a makeshift hospital in an abandoned Italian villa near…

War and Nationality

As Michael Ondaatje’s The English Patient takes place during World War II, nationality is an exceedingly important theme throughout the novel. Hana is a Canadian nurse who diligently cares for the wounded soldiers of the Allied powers, and Caravaggio is an Italian immigrant to Canada who spent time in Canada before the war and fights on behalf of the Allies. Kip is an Indian sapper and bomb specialist who embraces Western culture, and the English …

British Colonialism and Racism

Kip is the only character of color in The English Patient , and Ondaatje constantly draws attention to Kip’s identity as a Punjabi Indian. According to tradition, the oldest son in an Indian family joins the army, and the second oldest, like Kip, becomes a doctor. However, when World War II begins, Kip joins the army, but his older brother adamantly refuses. Kip’s brother will not “agree to any situation where the English have power,”…

History, Words, and Storytelling

Michael Ondaatje’s The English Patient is a fictional account of historic events, and several of his characters—such as the English patient , László Almásy, a Hungarian desert explorer who guided German spies across the North African desert during World War II—are based on actual historical figures. The novel unfolds in a series of stories told by the main characters, including Almásy, his Canadian nurse, Hana , an Italian-Canadian thief named Caravaggio , and Kip …

God and Religion

God and religion do not appear be an important part of the lives of the characters in Michael Ondaatje’s The English Patient . As the characters converge at the abandoned Italian villa during the end of World War II, they each begin to heal from the traumas of war, but neither God nor organized religion seem to have a place within that recovery. None of the characters partake in formal religious practices, nor do they…

• Essay Database
• world trade center
• Greek Food and Culture
• The Future Portrayed I…
• Intercultural Communications
• In Heart of Darkness, …
• Things Fall Apart by C…
• In J.M. Coetzee's Wait…
• The Criminals Of Profe…
• Socialization of Children
• The Poet of Nature, Wi…
• Leonhard Euler
• Articles of Confederat…
• About all Sharks
• Vietnam Poetry

The English Patient

What is paper-research.

• Custom Writing Service
• Terms of Service
• Privacy Policy
• Biographies

This paper is in the following e-collection/theme issue:

Published on 29.4.2024 in Vol 8 (2024)

Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study

Authors of this article:

Original Paper

• Tzu Han Chen 1   ; 
• Shin-Da Lee 2 , PhD   ; 
• Wei-Fen Ma 3, 4 , PhD  

1 PhD Program for Health Science and Industry, China Medical University, Taichung, Taiwan

2 PhD Program in Healthcare Science, Department of Physical Therapy, China Medical University, Taichung, Taiwan

3 PhD Program in Healthcare Science, School of Nursing, China Medical University, Taichung, Taiwan

4 Department of Nursing, China Medical University Hospital, Taichung, Taiwan

Corresponding Author:

Wei-Fen Ma, PhD

PhD Program in Healthcare Science

School of Nursing

China Medical University

No 100, Sec 1, Jingmao Road

Beitun District

Taichung, 406040

Phone: 886 4 22053366 ext 7107

Fax:886 4 22053748

Email: [email protected]

Background: The adoption of mobile health (mHealth) apps among older adults (>65 years) is rapidly increasing. However, use of such apps has not been fully effective in supporting people with dementia and their caregivers in their daily lives. This is mainly attributed to the heterogeneous quality of mHealth apps, highlighting the need for improved app quality in the development of dementia-related mHealth apps.

Objective: The aims of this study were (1) to assess the quality and content of mobile apps for dementia management and (2) to investigate the relationship between app quality and download numbers.

Methods: We reviewed dementia-related mHealth apps available in the Google Play Store and Apple App Store in Taiwan. The identified mobile apps were stratified according to a random sampling approach and evaluated by five independent reviewers with sufficient training and proficiency in the field of mHealth and the related health care sector. App quality was scored according to the user version of the Mobile Application Rating Scale. A correlation analysis was then performed between the app quality score and number of app downloads.

Results: Among the 17 apps that were evaluated, only one was specifically designed to provide dementia-related education. The mean score for the overall app quality was 3.35 (SD 0.56), with the engagement (mean 3.04, SD 0.82) and information (mean 3.14, SD 0.88) sections of the scale receiving the lowest ratings. Our analyses showed clear differences between the top three– and bottom three–rated apps, particularly in the entertainment and interest subsections of the engagement category where the ratings ranged from 1.4 to 5. The top three apps had a common feature in their interface, which included memory, attention, focus, calculation, and speed-training games, whereas the apps that received lower ratings were found to be deficient in providing adequate information. Although there was a correlation between the number of downloads (5000 or more) and app quality (t 15 =4.087, P <.001), this may not be a significant determinant of the app’s perceived impact.

Conclusions: The quality of dementia-related mHealth apps is highly variable. In particular, our results show that the top three quality apps performed well in terms of engagement and information, and they all received more than 5000 downloads. The findings of this study are limited due to the small sample size and possibility of disregarding exceptional occurrences. Publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a quality mHealth app.

Introduction

The global aging population is experiencing an astonishing surge, which will inevitably result in a significant rise in the prevalence of dementia [ 1 ]. Consequently, it has become crucial to identify efficacious strategies to support people affected by dementia and enhance the well-being of their caregivers [ 2 ]. In addition, numerous studies have shown that mobile health (mHealth) apps can effectively reduce medical costs and improve quality of life for middle-aged and older adults, especially after COVID-19 [ 3 , 4 ].

The use of technology among older adults (aged >65 years) has triggered noteworthy transformations in health care provision [ 5 ]. An area where technology has proven especially valuable is in the realm of dementia management, with mHealth apps dominating the forefront of this field [ 6 ]. In addition, the UK government has shown support for the advancement of intelligent assistive technology for individuals with dementia [ 7 ]. This includes endorsing the development of mHealth apps specifically tailored to patients with early-stage dementia and their caregivers [ 8 ]. These apps are believed to have significant potential in aiding cognitive function and facilitating self-care among those living with dementia [ 9 ].

However, the constant emergence of mHealth apps has made it challenging for both patients with dementia and their caregivers to differentiate, evaluate, and use mHealth apps that promote healthy behaviors [ 10 , 11 ]. Therefore, information pertaining to dementia-related mHealth apps and their functionalities should be effectively evaluated and made publicly available.

There is significant heterogeneity in the quality of dementia-related mHealth apps [ 12 ], and most studies assessing app quality have used criteria that focused on general characteristics that could be assessed without downloading or using the app itself [ 13 , 14 ]. Therefore, there is a need for a human-centered, multidimensional measure that includes usability components and relatively more domains to identify high-quality mHealth apps [ 15 ]. Ideally, better features and functionality would drive high-quality apps; however, efforts to identify the differences between high- and low-quality apps have been hampered by scarce research.

Moreover, the factors that contribute to the popularity of specific mHealth apps remain largely unknown, although there is some evidence of a relationship between an app’s star rating and its number of downloads [ 16 ]. However, few studies have evaluated dementia-related mHealth apps to date. Therefore, the specific metrics of app quality that are likely to be associated with a higher number of downloads remain to be identified.

This study had several goals. The first goal was to analyze the content of mobile apps for people with dementia and their caregivers across different categories. The second goal was to assess the quality of individual apps using the user version of the Mobile Application Rating Scale (uMARS). The third objective was to perform a comparative analysis of the highest- and lowest-quality dementia-related mHealth apps, with the broader goal of establishing guidelines to facilitate future app development. Finally, the study aimed to explore the correlation between app quality and downloads. This was done to help identify the gaps in the currently available dementia-related mHealth apps and to provide recommendations for patients with dementia and their caregivers on how to select high-quality apps.

Search Strategy and Inclusion Criteria

Apps were identified from the Taiwan Apple App Store and Google Play Store. Between July 2022 and November 2022, the following search terms (in Mandarin and English) were used in the app stores: dementia, cognitive dysfunction, dementia caregiver, Alzheimer disease, dementia care, cognitive games, and memory games. The screening criteria and process are illustrated in Figure 1 .

Apps were included if they met all of the following inclusion criteria: (1) exists in the Google Play Store for Android mobile devices and the App Store for Apple mobile devices; (2) addresses daily-life topics related to neurocognitive disorders [ 17 ], and (3) was purposefully developed with the primary goal of supporting patients or caregivers (including health care workers) with the topic of mild cognitive impairment; (4) can be downloaded and used for free; (5) mainly uses Mandarin or the English version can be translated into Mandarin and is easy to understand; and (6) has been updated within the last 5 years.

Stratified Random Sampling of Apps by Average Download Numbers

In November 2022, searches were conducted on the two platforms to find apps that met the above criteria. Of the 407 apps found, 332 were deemed ineligible after screening ( Figure 1 ). The remaining 75 apps were thoroughly screened, resulting in 52 apps included for preliminary evaluation. Since the length of time an app has been available on a platform can affect its number of downloads, we calculated the ratio of download numbers with respect to time on the platform. Additionally, to consider uneven allocation and lack of continuity in stratification, the apps were sorted according to the ratio of downloads relative to the number of days since the release date on the platform. Thus, the average number of downloads was calculated as the total number of downloads/number of days on platform since the release date. The apps were then ranked according to the average number of downloads in ascending order, and we randomly selected 1 out of every 3 apps for a total of 17 apps that were subject to detailed quality assessment and review.

General Characteristics and Classification

Each app was used by two authors (THC and WFM) independently. According to their content subcategory, the selected apps were categorized into four different types using the guidelines provided by the National Institute for Health and Care Excellence and the National Health Service in the United Kingdom [ 18 , 19 ]. Any conflicts in app classification were adjudicated by discussion between the two reviewers regarding each domain within the extraction form to reach consensus. Details on the main characteristics and comments of the included apps are provided in Multimedia Appendix 1 .

mHealth App Quality Evaluation

The uMARS is a tool that can be used to evaluate the quality of mHealth apps, including four objective subdomains: engagement, functionality, esthetics, and information. There is also a domain for subjective quality and another for perceived impact. Stoyanov et al [ 20 ] developed the uMARS in 2016, which showed excellent internal consistency (Cronbach α=0.90). The uMARS scores are rated on a 5-point Likert scale ranging from 1 (“strongly disagree”) to 5 (“strongly agree”).

The objective quality score is calculated as the average of the scores of the four dimensions. Engagement is defined as fun, interesting, customizable, interactive, and has prompts (eg, sends alerts, messages, reminders, feedback, allows sharing). Functionality refers to overall app functioning, easy to learn, navigation, flow logic, and gestural design of the app. Esthetics refers to the graphic design, overall visual appeal, color scheme, and stylistic consistency. Finally, the information domain assesses whether the app contains high-quality information (eg, text, feedback, measures, and references from a credible source). The subjective quality score reflects the rater’s personal interest in the app. The final uMARS subscale includes 6 items designed to assess the perceived impact of the app on the user’s awareness, knowledge, attitude, intention to change, help-seeking, and likelihood to change the target health behavior.

Reviewer Recruitment and Selection

Reviewers recruited for this study were required to have a professional background in clinical treatment, the health care industry, or information engineering. Additionally, they were required to have at least 3 years of work experience in elderly health care or health technology–related fields, as well as experience using digital mobile devices. Exclusion criteria included no relevant work experience in elderly health care or health technology–related fields in the past 5 years.

Five reviewers were recruited as an interdisciplinary group of experts. The initial reviewer possessed knowledge and had experience in creating a content management system for a dementia management app. The second reviewer was a health informatics researcher with sufficient training and expertise in the relevant health care technology fields focused on dementia. The third reviewer also had extensive experience in dementia and in the mHealth industry. The fourth reviewer was a psychiatric nurse with experience in caring for older adults along with clinical experience in dementia. The final reviewer was a nurse practitioner who has been providing care for older adults and patients with dementia for over a decade.

Evaluation Process

Each of the apps was assessed by the five reviewers and the evaluation process was conducted between December 17, 2022, and January 3, 2023. All 17 apps can be found on the Android platform; hence, the apps were reviewed when running on the same Android tablet. The experts were blinded to the download numbers, year, and country of development of the apps, and they were not allowed to discuss their assessments with each other to ensure independence in their ratings. We ensured an equal distribution of app assessments in each round by applying a ratio that took into account the download-to-time axis. Furthermore, each reviewer allocated a minimum of 30 minutes and a maximum of 1 hour to thoroughly evaluate the included apps.

Ethical Considerations

The study received ethical approval from the ethics committee of China Medical Hospital, Taiwan, on November 8, 2022 (approval number: CMUH111-REC2-151) and was conducted according to the guidelines of the Declaration of Helsinki.

The experts in this study were not compelled to take part and had the freedom to determine their involvement. Additionally, they possessed the ability to discontinue their participation at any juncture, without being required to supply a justification for their decision.

This study utilized legally obtained publicly available information, and it was ensured that the use of information aligns with its intended public knowledge purpose. Furthermore, data collected from research and expert evaluations are stored on a hard drive and encrypted. The evaluation process was fully anonymous, with no face-to-face interactions among experts, and the evaluation of the app was a non-nominal, noninteractive, and noninvasive study. Relevant original data regarding this research will be preserved for at least 3 years after the execution period, securely locked in the principal investigator’s office cabinet.

The clinical trial protocol developed by the research institute stipulates that in the event of adverse reactions resulting in damages, China Medical University Hospital is responsible for providing compensation. Nonetheless, adverse reactions explicitly disclosed in the informed consent form signed by the experts are not eligible for compensation. This study was not covered by liability insurance and the per-expert evaluation cost was US $170.

Statistical Analysis

The number and proportion of information displayed in the apps, including the country of app development, download number, and app type, were summarized using descriptive statistics. The uMARS scores, along with the scores for each domain and subscale, are presented as the mean and SD. The t test was used to examine the association between downloads and each domain of the uMARS. Statistical analyses were conducted using IBM SPSS Statistics v28 (IBM Corp). We considered P <.05 to indicate statistical significance in all analyses.

App Attributes

The apps were primarily developed in the United States, and 11 out of the 17 dementia-related mobile apps were downloaded less than 5000 times. Among the 17 apps, 8 were classified as those designed to improve clinical outcomes from established treatment pathways through behavior change, and for enhancement of patient adherence and compliance with treatment; 5 were designed as standalone digital game therapeutics; 3 were classified for supporting clinical diagnosis and/or decision-making; and 1 app was primarily designed to provide disease-related education ( Table 1 ).

App Quality Assessment by Interdisciplinary Experts

There was a notable level of agreement or correlation among the reviewers in their app evaluations, as indicated by the Kendall W statistic of 0.143, which was significant at P =.05.

Overall, the mean app quality score was 3.35 (SD 0.56), which ranged from 2.25 (worst-rated app) to 4.07 (best-rated app). For engagement, the mean score was 3.04 (SD 0.81). Furthermore, functionality had the highest mean score of 3.76 (SD 0.38) and showed the smallest variation in minimum and maximum scores among the apps evaluated. In other words, these apps were considered to have relatively high levels of functionality and usability by the interdisciplinary expert reviewers. The esthetic quality of the interface received a mean score of 3.45 (SD 0.65), indicating that visual design elements such as button size, icon clarity, and content arrangement were perceived as being well organized. Additionally, the information domain received a mean score of 3.14 (SD 0.88), suggesting that the presentation and accessibility of information on the screen could be improved. Multimedia Appendix 2 provides the complete details of app quality scores.

Top Three and Bottom Three Performers in App Quality Score

The apps ranked in the top three positions according to app quality scores included Memorado Brain Games, NeuroNation-Brain Training & Brain Games, and Brain Track. The common characteristic among these apps is that their interface consists of training games focused on memory, attention, concentration, calculation, and speed. Conversely, Alz Test, American Caregiver Association, and Dementia and Me ranked in the bottom three; these three apps performed poorly on both engagement and information.

The overall scores for each item for the top three and bottom three apps are provided in Table 2 . The functionality domain received the highest average ratings, particularly for gestural design, navigation, and performance. The largest discrepancies in app quality ratings between the top three and bottom three apps were found in the areas of entertainment and interest, where the scores ranged from 1.4 (worst-rated app) to 5 (best-rated app). Similarly, in the subscale of perceived impact, there was a significant difference in attitude, with ratings ranging from 1.2 (worst-rated app) to 4.2 (best-rated app).

a N/A: not applicable.

Association Between Downloads and Quality of Mobile Apps

The Connectivity in Digital Health survey of global mHealth apps reported that 55% of the apps available on the Google Play store, Apple App Store, Windows Phone Store, Amazon Appstore, and Blackberry World had fewer than 5000 total downloads [ 21 ]. Therefore, the 17 apps included in our study were divided into two subgroups based on the total number of downloads. The first subset consisted of 6 apps with more than 5000 total downloads, representing 35.3% of all apps. The mean app quality score for this subgroup was significantly higher than that of the group of apps with less than 5000 downloads ( Table 3 ). In addition, apps with more than 5000 downloads generally had higher scores for each domain. However, neither information nor perceived impact scores were significantly correlated with the number of downloads ( Table 3 ).

a uMARS: user version of the Mobile Application Rating Scale.

Principal Findings

According to our results, there was only one included app that primarily focused on delivering dementia-related education. Furthermore, the top three quality apps were all classified as the main app type, as they all served as standalone digital game therapeutics. In general, the dementia-related mHealth apps were of moderate quality with a common characteristic of high functionality. Nonetheless, these apps exhibited poor performance in engagement and the credibility of information domain. Although we found a correlation between the number of downloads and app quality, this may not be a significant determinant of the information provided and the app’s perceived impact.

Comparison With Prior Work

mHealth apps offer a new way to support people with dementia and their caregivers [ 22 ]. However, previous studies have pointed out that the scientific literature on the design and evaluation of web- and mobile-based health apps remains scarce [ 23 , 24 ]. To address this issue, our study directly assessed the app type in a practical setting and found the lack of a dementia management app that delivers disease-related education. A randomized controlled trial indicated that mHealth apps can be of educational value to patients by providing structured disease and treatment-related education; therefore, future app developers can focus on increasing the availability of this app type with educational value [ 25 ].

A previous study suggested that research collaboration between health care and software engineering experts could help advance our knowledge of app functionality and effectiveness [ 16 ]. Therefore, we established a panel of experts to obtain accurate results on the quality of currently available dementia-related mHealth apps and further identified their subjective quality and perceived impact. The pattern of high functionality and low information quality is in accordance with the findings of other studies on mobile apps designed for older adults [ 26 ]. Additionally, the inadequacy of credibility was associated with several risks, particularly in the areas of self-diagnosis, prevention, and health promotion [ 27 ].

High-quality mHealth apps offer self-management features, relaxation, recreation, and trustworthy information [ 28 , 29 ]. The uMARS consists of elements of usability and a broader range of areas that are used in the assessment of mHealth apps with superior quality. Notably, a consensus was reached among the reviewers in both the engagement and esthetics domains. However, there was no correlation or similarity among reviewers with respect to assessments on functionality and information of the apps. This discrepancy may be due to the different backgrounds of the reviewers [ 30 ]; health care providers may perceive the app’s information as inadequate, whereas experienced developers of dementia apps may find its functionality to be lacking.

Currently, little is known about why some health apps become popular and others do not, and researchers have demonstrated that the number of downloads on app marketplaces does not correlate with clinical utility or validity for mental health apps [ 31 ]. A study from the Netherlands and Portugal identified the predictors that might influence the number of downloads for urology apps [ 32 ]. However, there is little research on the predictors of app downloads for dementia-related mHealth apps in the PubMed database. Hence, to gain a more comprehensive understanding, the apps were stratified using a random sampling approach. Due to the different themes of mHealth apps, our study found a positive relationship between app quality and number of downloads. Finally, the download number does only seem to be a limited orientation aid for the selection of an mHealth app, and future studies should consider this aspect.

Limitations

This study has several limitations. Initially, the search for mobile apps was conducted within a limited time frame and focused on apps that had been updated within the last 5 years. As such, the study fell short with respect to establishing causal relationships. In addition, rapidly expanding and ever-changing mobile app marketplaces are facing significant challenges in keeping pace with the dynamic landscape; hence, some of the apps evaluated in this study may have since changed or new alternatives may have been developed. Furthermore, the search for mobile apps was confined to app stores in Taiwan, which may not accurately represent app offerings in other countries due to regional disparities in developers’ decisions regarding app availability.

Previous research indicated that the cost associated with using mHealth apps acts as a major obstacle for older individuals when it comes to embracing mobile technologies [ 9 , 33 ]. Furthermore, a recent study discovered that 96% of mHealth apps that are accessible on the Chinese market can be downloaded without cost [ 34 ]. Consequently, one-quarter of the apps would have been overlooked if they required payment. Nonetheless, it is possible that within this group of paid apps, there may have been some high-quality apps that were unintentionally excluded from consideration.

Additionally, the stratification method represents both less popular and highly downloaded apps, mirroring real-world data [ 21 ]. However, this method resulted in a smaller sample size, which could potentially lead to some superior apps being overlooked by chance. With only 17 apps remaining for evaluation, it is possible that there may not have been sufficient statistical power to establish a significant relationship between app quality and download frequency.

Finally, to ensure a rigorous evaluation of the app content, experts from different fields were recruited to review the apps. However, the limited number of reviewers could potentially influence the results of the study, and the degree of agreement may not be strong given that the reviewers are from different disciplines and the time they allocated to evaluate each app could potentially impact the reliability of agreement.

Despite these limitations, this study helps to fill the gap in the evaluation of dementia-related mobile apps. The results can still be used to guide the selection of such apps in Taiwan and possibly other regions with similar app marketplaces, while also highlighting the need for ongoing evaluation of mobile apps for dementia care.

Conclusions

This study set out to gain a better understanding of the characteristics, quality, and downloads of dementia-related mHealth apps. In particular, the top three quality apps were all offered as standalone digital game therapeutics, which scored well on both engagement and information quality, and received more than 5000 total downloads. Nevertheless, the findings of our investigation do not offer a comprehensive solution due to the restricted scale of the sample and the potential for overlooking extraordinary instances. Consequently, annual reviews and publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a high-quality mobile app.

Acknowledgments

The authors acknowledge all staff and participants for their contributions to the study. This study was supported by the Ministry of Science and Technology (MOST 110-2314-B-039-041-MY2; NSTC112-2314-B-039-015) and China Medical University (CMU111-MF-108), Taiwan. The funders reviewed the study as part of the grant application but had no further role in study design; data collection, analysis, and interpretation; manuscript preparation; and paper publication.

Data Availability

The study data are identified participant data. The data that support the findings of this study will be available beginning 12 months and ending 36 months following the article publication from the corresponding author (WFM) upon reasonable request.

Authors' Contributions

THC and WFM designed the study and were responsible for data collection and analysis. THC, SDL, and WFM all contributed to manuscript preparation and critical revisions.

Conflicts of Interest

None declared.

Description, classification, and overall comments of reviewers after using the selected dementia-related mobile health apps.

User version of Mobile App Rating Scale scoring of the dementia-related mHealth apps.

CONSORT-EHEALTH checklist (V 1.6.1).

• GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. Feb 2022;7(2):e105-e125. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Astell AJ, Bouranis N, Hoey J, Lindauer A, Mihailidis A, Nugent C, et al. Technology and Dementia Professional Interest Area .... Technology and dementia: the future is now. Dement Geriatr Cogn Disord. 2019;47(3):131-139. [ CrossRef ] [ Medline ]
• Chiu C, Hu Y, Lin D, Chang F, Chang C, Lai C. The attitudes, impact, and learning needs of older adults using apps on touchscreen mobile devices: results from a pilot study. Comput Hum Behav. Oct 2016;63:189-197. [ CrossRef ]
• Almalki M, Giannicchi A. Health apps for combating COVID-19: descriptive review and taxonomy. JMIR Mhealth Uhealth. Mar 02, 2021;9(3):e24322. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Chiu C, Liu C. Understanding older adult's technology adoption and withdrawal for elderly care and education: mixed method analysis from national survey. J Med Internet Res. Nov 03, 2017;19(11):e374. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Ambegaonkar A, Ritchie C, de la Fuente Garcia S. The use of mobile applications as communication aids for people with dementia: opportunities and limitations. J Alzheimers Dis Rep. 2021;5(1):681-692. [ FREE Full text ] [ CrossRef ] [ Medline ]
• David MCB, Kolanko M, Del Giovane M, Lai H, True J, Beal E, et al. Remote monitoring of physiology in people living with dementia: an observational cohort study. JMIR Aging. Mar 09, 2023;6:e43777. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lee AR, Csipke E, Yates L, Moniz-Cook E, McDermott O, Taylor S, et al. A web-based self-management app for living well with dementia: user-centered development study. JMIR Hum Factors. Feb 24, 2023;10:e40785. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kruse CS, Mileski M, Moreno J. Mobile health solutions for the aging population: a systematic narrative analysis. J Telemed Telecare. May 2017;23(4):439-451. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Øksnebjerg L, Woods B, Ruth K, Lauridsen A, Kristiansen S, Holst HD, et al. A tablet app supporting self-management for people with dementia: explorative study of adoption and use patterns. JMIR Mhealth Uhealth. Jan 17, 2020;8(1):e14694. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Brown A, O'Connor S. Mobile health applications for people with dementia: a systematic review and synthesis of qualitative studies. Inform Health Soc Care. Oct 01, 2020;45(4):343-359. [ CrossRef ] [ Medline ]
• Agarwal P, Gordon D, Griffith J, Kithulegoda N, Witteman HO, Sacha Bhatia R, et al. Assessing the quality of mobile applications in chronic disease management: a scoping review. NPJ Digit Med. Mar 10, 2021;4(1):46. [ CrossRef ] [ Medline ]
• Kuo H, Chang C, Ma W. A survey of mobile apps for the care management of patients with dementia. Healthcare. Jun 23, 2022;10(7):1173. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Guessi Margarido M, Shah A, Seto E. Smartphone applications for informal caregivers of chronically ill patients: a scoping review. NPJ Digit Med. Mar 21, 2022;5(1):33. [ CrossRef ] [ Medline ]
• Azad-Khaneghah P, Neubauer N, Miguel Cruz A, Liu L. Mobile health app usability and quality rating scales: a systematic review. Disabil Rehabil Assist Technol. Oct 2021;16(7):712-721. [ CrossRef ] [ Medline ]
• Wisniewski H, Liu G, Henson P, Vaidyam A, Hajratalli NK, Onnela J, et al. Understanding the quality, effectiveness and attributes of top-rated smartphone health apps. Evid Based Ment Health. Feb 2019;22(1):4-9. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Sachdev PS, Blacker D, Blazer DG, Ganguli M, Jeste DV, Paulsen JS, et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol. Nov 30, 2014;10(11):634-642. [ CrossRef ] [ Medline ]
• Unsworth H, Dillon B, Collinson L, Powell H, Salmon M, Oladapo T, et al. The NICE Evidence Standards Framework for digital health and care technologies - Developing and maintaining an innovative evidence framework with global impact. Digit Health. Jun 24, 2021;7:20552076211018617. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Rowland SP, Fitzgerald JE, Holme T, Powell J, McGregor A. What is the clinical value of mHealth for patients? NPJ Digit Med. Jan 13, 2020;3(1):4. [ CrossRef ] [ Medline ]
• Stoyanov SR, Hides L, Kavanagh DJ, Wilson H. Development and validation of the user version of the Mobile Application Rating Scale (uMARS). JMIR Mhealth Uhealth. Jun 10, 2016;4(2):e72. [ FREE Full text ] [ CrossRef ] [ Medline ]
• mHealth Economics 2017/2018 – Connectivity in Digital Health. research2guidance. URL: https://research2guidance.com/product/connectivity-in-digital-health/ [accessed 2023-11-02]
• Krafft J, Barisch-Fritz B, Krell-Roesch J, Trautwein S, Scharpf A, Woll A. A tablet-based app to support nursing home staff in delivering an individualized cognitive and physical exercise program for individuals with dementia: mixed methods usability study. JMIR Aging. Aug 22, 2023;6:e46480. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Perakslis E, Ginsburg GS. Digital health-The need to assess benefits, risks, and value. JAMA. Jan 12, 2021;325(2):127-128. [ CrossRef ] [ Medline ]
• Lorca-Cabrera J, Grau C, Martí-Arques R, Raigal-Aran L, Falcó-Pegueroles A, Albacar-Riobóo N. Effectiveness of health web-based and mobile app-based interventions designed to improve informal caregiver's well-being and quality of life: a systematic review. Int J Med Inform. Feb 2020;134:104003. [ CrossRef ] [ Medline ]
• Timmers T, Janssen L, Pronk Y, van der Zwaard BC, Koëter S, van Oostveen D, et al. Assessing the efficacy of an educational smartphone or tablet app with subdivided and interactive content to increase patients' medical knowledge: randomized controlled trial. JMIR Mhealth Uhealth. Dec 21, 2018;6(12):e10742. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Portenhauser AA, Terhorst Y, Schultchen D, Sander LB, Denkinger MD, Stach M, et al. Mobile apps for older adults: systematic search and evaluation within online stores. JMIR Aging. Feb 19, 2021;4(1):e23313. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Li Y, Ding J, Wang Y, Tang C, Zhang P. Nutrition-related mobile apps in the China App Store: assessment of functionality and quality. JMIR Mhealth Uhealth. Jul 30, 2019;7(7):e13261. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Yousaf K, Mehmood Z, Saba T, Rehman A, Munshi A, Alharbey R, et al. Mobile-health applications for the efficient delivery of health care facility to people with dementia (PwD) and support to their carers: a survey. Biomed Res Int. 2019;2019:7151475. [ CrossRef ] [ Medline ]
• Hoogendoorn P, Versluis A, van Kampen S, McCay C, Leahy M, Bijlsma M, et al. What makes a quality health app-Developing a global research-based health app quality assessment framework for CEN-ISO/TS 82304-2: Delphi Study. JMIR Form Res. Jan 23, 2023;7:e43905. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Martin W, Sarro F, Jia Y, Zhang Y, Harman M. A survey of App Store analysis for software engineering. IEEE Trans Soft Eng. Sep 1, 2017;43(9):817-847. [ CrossRef ]
• Singh K, Drouin K, Newmark LP, Lee J, Faxvaag A, Rozenblum R, et al. Many mobile health apps target high-need, high-cost populations, but gaps remain. Health Aff. Dec 01, 2016;35(12):2310-2318. [ CrossRef ] [ Medline ]
• Pereira-Azevedo N, Osório L, Cavadas V, Fraga A, Carrasquinho E, Cardoso de Oliveira E, et al. Expert involvement predicts mHealth app downloads: multivariate regression analysis of urology apps. JMIR Mhealth Uhealth. Jul 15, 2016;4(3):e86. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Rasche P, Wille M, Bröhl C, Theis S, Schäfer K, Knobe M, et al. Prevalence of health app use among older adults in Germany: national survey. JMIR Mhealth Uhealth. Jan 23, 2018;6(1):e26. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Yang L, Wu J, Mo X, Chen Y, Huang S, Zhou L, et al. Changes in mobile health apps usage before and after the COVID-19 outbreak in China: semilongitudinal survey. JMIR Public Health Surveill. Feb 22, 2023;9:e40552. [ FREE Full text ] [ CrossRef ] [ Medline ]

Abbreviations

Edited by A Mavragani, H LaMonica; submitted 24.07.23; peer-reviewed by A Kaplin, A Ranerup; comments to author 10.10.23; revised version received 09.11.23; accepted 03.04.24; published 29.04.24.

©Tzu Han Chen, Shin-Da Lee, Wei-Fen Ma. Originally published in JMIR Formative Research (https://formative.jmir.org), 29.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.

• Open access
• Published: 25 April 2024

Risk management and empirical study of the doctor-patient relationship: based on 1790 litigation cases of medical damage liability disputes in China

• Limin Li 1 ,
• Tong Liu 1 ,
• Meiqiong Tan 2 ,
• Wanwan He 2 ,
• Yuzhu Luo 2 ,
• Xuerong Zhong 2 ,
• Liping Zhang 3 &
• Jiangjie Sun 1 , 4  

BMC Health Services Research volume  24 , Article number:  521 ( 2024 ) Cite this article

80 Accesses

Metrics details

Compensation for medical damage liability disputes (CMDLD) seriously hinders the healthy development of hospitals and undermines the harmony of the doctor-patient relationships (DPR). Risk management in the DPR has become an urgent issue of the day. The study aims to provide a comprehensive description of CMDLD in China and explore its influencing factors, and make corresponding recommendations for the management of risks in the DPR.

This study extracted data from the China Judgment Online - the official judicial search website with the most comprehensive coverage. Statistical analysis of 1,790 litigation cases of medical damage liability disputes (COMDLD) available from 2015 to 2021.

COMDLD generally tended to increase with the year and was unevenly distributed by regions; the compensation rate was 52.46%, the median compensation was 134,900 yuan and the maximum was 2,234,666 yuan; the results of the single factor analysis showed that there were statistically significant differences between the compensation for different years, regions, treatment attributes, and trial procedures ( P  < 0.05); the correlation analysis showed that types of hospitals were significantly negatively associated with regions ( R =-0.082, P  < 0.05); trial procedures were significantly negatively correlated with years ( R =-0.484, P  < 0.001); compensat- ion was significantly positively correlated with years, regions, and treatment attributes ( R  = 0.098–0.294, P  < 0.001) and negatively correlated with trial procedures ( R =-0.090, P  < 0.01); regression analysis showed that years, treatment attributes, and regions were the main factors affecting the CMDLD ( P  < 0.05).

Conclusions

Years, regions, treatment attributes, and trial procedures affect the outcome of CMDLD. This paper further puts forward relevant suggestions and countermeasures for the governance of doctor-patient risks based on the empirical results. Including rational allocation of medical resources to narrow the differences between regions; promoting the expansion and sinking of high-quality resources to improve the level of medical services in hospitals at all levels; and developing a third-party negotiation mechanism for medical disputes to reduce the cost of medical litigation.

Peer Review reports

Introduction

Against the background of COVID-19, China once again saw a harmonious situation in which “health is related to life”, and the DPR was on the rise [ 1 ]. But the short-lived peace was then shattered when Hu Shuyun, a cardiologist in Jishui County, Jiangxi Province, was attacked and injured by an assailant during a ward check on January 26, 2021, and later died after an ineffective rescue attempt. In recent years, there have been incidents of medical violence and injuries to doctors [ 2 , 3 ]. At a time when the entire population is united in the fight against the epidemic, and when the “messengers in white” are traveling thousands of miles to save the lives of the public, the occasional conflict between doctors and patients seriously interferes with the responsibility and social commitment of the medical and nursing community, seriously hinders the construction of a healthy medical environment, and the risks to doctors and patients need to be addressed.

A harmonious DPR is the basis for a successful therapeutic outcome [ 4 ]. However, the ‘disease-centric’ model of health that has been dominated by biomedical thinking since the mid-20th century is deeply entrenched and the needs of patients have been severely neglected. As a result, the symptoms of the disease are temporarily relieved while the root causes of the problems in the DPR remain [ 5 ]. In the UK, a study by a health service journal and UNISON found that 181 NHS trusts in England reported a whopping 56,435 incidents of physical assault on staff in 2016–2017 [ 6 ]. A survey of 16,327 practicing physicians in Australia found that 71% reported having experienced verbal or written assault and 32% had experienced physical assault [ 7 ]. The DPR in China is equally unpromising, with the White Paper on Doctor Practice in China showing that 62% of doctors and patients have varying degrees of medical disputes [ 8 ]. The literature shows that the current DPR is generally perceived as poor by both doctors and patients [ 9 , 10 , 11 ].

There is a large body of literature on how to improve patient satisfaction and thus ease the patient-practitioner relationship. Wang M et al. argued, at the level of the healthcare provider, that by improving hospital management, hospital litigation costs can be reduced, potential harm to patients reduced, and patient and staff satisfaction increased, thus improving the DPR [ 12 ]. In the context of COVID-19, Xu B noted that improving doctor-patient communication, medical technology, and patients’ medical knowledge may help improve the DPR [ 4 ]. In addition, as eHealth plays an increasingly important role in public health services, Wynn R noted the need to consider how eHealth can leverage and integrate aspects of the traditional DPR to improve services and engage patients [ 13 ].

Another part of the literature investigates the mechanisms for resolving medical disputes. Medical disputes are usually disputes between doctors and patients who do not agree on the consequences and causes of medical treatment, when they may seek accountability or compensation for damages from the health administration or the judiciary [ 14 ]. Litigation is the legal way to resolve medical disputes, but it has the disadvantages of consuming the time and energy of both doctors and patients, complicated trial procedures, and high costs. Research in the literature has found that many countries and regions tend to adopt an Alternative Dispute Resolution model for resolving medical disputes. Ferris LE et al. study points out that it is believed that doctor-patient disputes should be considered first and foremost to be resolved in an alternative form to save judicial resources effectively [ 15 ]. Yee F compared mediation, arbitration, and litigation in medical disputes and concluded that mediation has the advantage of being the most efficient and least damaging to the interests of both doctors and patients, and therefore should be widely promoted [ 16 ]. Moore J et al. proposed the Communication-and-Resolution Programs model after practice, which focuses on communication with patients and their families after an adverse event can bring them a better psychological feeling and facilitate the resolution of the adverse event [ 17 ].

At the same time, the improvement of medical quality has become the focus of attention from all walks of life and is of great significance in easing the DPR and preventing disputes between them. Valls Martinez MdC et al. used structural equation modeling to explore the relationship between service quality and satisfaction from the patient’s perspective, using an Iranian hospital as a study, and showed that optimizing service quality contributed to patient satisfaction and that patients cared most about hospital hygiene and humanistic care [ 18 ]. A study by Thawesaengskulthai N et al. found that the development of service quality measurement models should take into account not only specific situations such as location, but also the nationality and demographics of patients, and that patients’ perceived quality of healthcare services changed over time [ 19 ]. Furthermore, a study by Hanefeld J et al. further suggests that the complexity of quality of care requires not only improving technical quality but also patient-provider acceptability, responsiveness, and trust levels, which in turn improves understanding of all attributes of health system quality and their interrelationships and helps to expand access to essential health interventions [ 20 ].

Contemporary research has yielded good results in all aspects of the current state of DPR, risk management of DPR, mechanisms for resolving doctor-patient disputes, and improving healthcare quality. Since 2021, the risk of DPR has been gradually judicialized, but no research topic on judicial data on the risk of the DPR has been found, so this study uses authoritative datasets extracted from national-level adjudication documents to provide a comprehensive description of CMDLD in China and to explore its influencing factors, with a view intending to providing references for easing DPR, improving healthcare quality and improving the healthcare environment.

Data and methods

Study design and samples.

We conducted a comprehensive search of data from 2015 to 2021 using the China Judgment Online, a public database of court cases concluded. In the database, the full text is used as the search field, “medical damage liability dispute” is used as the search term, civil is used as the cause of the case, the civil case is used as the case type, judgment is used as the type of instrument, and years of medical damage liability dispute jurisprudence are 2015–2021. The inclusion criteria are as follows: (a) cases in which the subject matter is “dispute over liability for medical damage”; (b) cases in which the plaintiff is the patient; (c) cases in which the defendant is a medical institution. Exclusion criteria: (a) cases with a cause of action other than dispute over liability for medical damage such as dispute over victimization of a labor provider, traffic accident dispute, and accidental injury insurance contract, etc.; (b) cases whose time of closure and adjudication is not between 2015 and 2021; (c) cases in which the plaintiff is a medical institution or the defendant is a patient; and (d) cases in which the adjudication, judgment, etc. is dismissed, conciliated, or withdrawn. (e) cases in which key information such as the name of the hospital, the time of the dispute, and the amount of compensation is missing.

The following data were extracted from the included studies. Years, regions (the Eastern region, the Middle region, and the Western region), types of hospitals (township health center, county hospitals, and city/provincial hospitals), patients’ purposes for appeal (truth over claims, claims over the truth), treatment attributes (low cost-effectiveness of treatment, poor treatment effect, complications of treatment, treatment leading to disability, and treatment leading to death), procedures (the first trial, the second trial, and the retrial), the outcome of the financial compensation (yes or no), and compensat- ion amount. Four researchers were assigned to each case to extract key information, double-blindly enter the extracted information into the software, and check for errors to ensure the accuracy of the data.

Data from the sample distribution were sorted using Excel software, processed using SPSS 26.0 [ 21 , 22 , 23 ], and the distribution of compensation amounts by year was described in R language [ 24 , 25 ] in the form of median M (interquartile spacing). The Mann-Whitney U test and the Kruskal-Wallis H test were used to compare the dichotomous and multicategorical variables between groups, respectively, at the test level (α = 0.1). Correlations between the dependent and some of the independent variables were analyzed by Spearman, and finally, variables that were statistically significant in the one-way analysis ( p  < 0.1) were screened out and linear regression analysis was applied to explore the factors influencing the award of medical damage liability disputes (α = 0.05).

Overall situation of COMDLD

COMDLD included in the criteria for 2015–2021 is 1,790. The number of cases generally trended upwards overall, with a maximum of 296 cases in 2021; the number of awarded cases trended steadily upwards; and the number of unawarded cases trended upwards until 2019 and downwards after 2019. (See Fig.  1 )

Year distribution of COMDLD (2015–2021)

Of the 1,790 cases studied, a total of 22 provinces, five autonomous regions, and four municipalities directly under the central government were involved. The number of COMDLD was unevenly distributed across provinces, autonomous regions, and municipalities directly under the central government. Based on the combination of the level of economic development and geographical location, there are three main regions: the Eastern region, the Middle region, and the Western region. The Eastern region is the most economically developed, followed by the Middle region, and the Western region is less developed. The top five provinces (cities) where medical damage liability disputes occurred were Henan Province, Jiangsu Province, Shanghai, Hunan Province, and Guangdong Province, accounting for 160 (8.94%), 121 (6.76%), 111 (6.20%), 110 (6.15%) and 104 (5.81%) respectively. The provinces (cities) in this category are located in the Eastern and Middle regions, have relatively abundant medical resources, are densely populated, have a high number of attendances, and therefore have a high number of COMDLD. (See Fig.  2 )

Regional distribution of COMDLD

Distribution of CMDLD

We used the ggplot package in R studio 2022.12.0 to plot violin plots overlaid with box line plots. Violin plots are used to show the shape of the distribution of multiple sets of data. Of the 1,790 COMDLD heard by the courts, the number of medical damage liability dispute cases in which compensation was awarded totaled 939, with a case award rate of 52.46% and a median award of 134,900 yuan with a maximum value of 2,234,666 yuan. Although CMDLD fluctuated overall, the median award overall continued to trend upwards across all years. (See Fig.  3 )

Distribution of CMDLD(2015–2021)

Factors that influence CMDLD

By testing the normality of the 939 cases of CMDLD, it was found that the compensation did not follow a normal distribution, so the Mann-Whitney U test and Kruskal - Wallis H test were used to compare the compensation in different years, regions, types of hospitals, patients’ purposes for appeal, treatment attributes, and trial procedures.

Among the different year distributions, 2021 had the highest number of CMDLD, 250 cases, with a median of 191,897.83 yuan. The Kruskal-Wallis H-test found that the difference in CMDLD between the different year distributions was statistically significant (H = 38.251, p  < 0.001); among the different regional distributions, the Eastern region had more cases that generated CMDLD, with 418 cases and a median of 111,463.00 yuan. The Kruskal-Wallis H-test revealed a statistically significant difference in CMDLD between the different regional distributions (H = 9.692, p  < 0.05); Among the different hospital types, city/provincial hospitals generated more cases of CMDLD, with 698 cases, followed by county hospitals and the least by township health centers. The Kruskal-Wallis H-test found that the difference between the different types of hospitals was not statistically significant (H = 5.150, p  < 0.1); according to the purpose of the patient’s appeal, The Mann-Whitney U test showed no statistically significant difference in CMDLD by patient’s purpose of appeal (Z=-1.355b, p  > 0.1); According to the different treatment attributes, the number of cases with medical damage liability disputes arising from treatment leading to death and the amount of compensation was the highest, with a total of 399 cases and a median of 186,300.00 yuan. According to the Kruskal-Wallis H-test, the difference in CMDLD between different treatment attributes was statistically significant (H = 90.491, p  < 0.001); divided according to different trial procedures, the second trial had the highest number of cases generating compensation for medical damage liability disputes, with a total of 701 cases, while the first trial had the highest number of cases generating compensation for medical damage liability disputes The highest amount was awarded in the first trial, with a median of 183,497.90 yuan. The Kruskal-Wallis H-test showed that the difference in CMDLD between the different trial procedures was statistically significant (H = 9.660, p  < 0.01). (See Table  1 )

Correlation analysis

Before the regression analysis, a correlation analysis was conducted between the dependent variable and some of the independent variables, and the Spearman correlation matrix was calculated using SPSS 26.0 software and it was concluded; there was a high correlation between the indicators. It can be seen that the correlation between the partial independent variables and the dependent variable, to a certain extent, verifies the reasonableness of the selection of the independent variables in this paper. Moreover, none of the correlation coefficients between the independent variables exceeded the critical value that might lead to the problem of multicollinearity, and could better meet the requirements of regression analysis. (See Table  2 )

Linear regression analysis

Compensation based on COMDLD, the influencing factors that were statistically significant ( p  < 0.1) were selected as independent variables to enter the multi-factor analysis. The independent variables were years, regions, types of hospitals, treatment attributes, and trial procedures. Due to the large value of compensation, the logarithm was taken to participate in the linear regression analysis. Stepwise regression was used for the analysis, with a test level of (α = 0.05) for the introduced variables and (α = 0.1) for the excluded variables. Based on the results of the linear regression of compensation, the variables that had a significant effect on the determination of compensation, based on the magnitude of the absolute value of the standardized coefficients, were years, treatment attributes, and regions. (See Table  3 )

Years and regions distribution of COMDLD

The results of the study show that medical damage liability disputes are taken seriously by society and that COMDLD shows a general upward trend with the year, which is consistent with the findings of Zhou L and Zeng Y et al. [ 26 , 27 ]. One of the possible reasons for this is that the technical level of medical institutions needs to be improved and the awareness of service management needs to be optimized. Second, the deep-rooted expectation gap between doctors and patients may lead to misunderstandings when patients encounter unexpected medical outcomes, which may lead to medical disputes [ 28 ]. For example, in the Tao Yong case, a well-known Chinese ophthalmologist brought hope of sight to patient Cui, only to have the patient slashed and injured because he was dissatisfied with the outcome of the surgery. The third reason may be due to the introduction and improvement of relevant laws and regulations, such as the Regulations on the Treatment of Medical Accidents and its supporting documents, the Interpretation of the Supreme People’s Court on Several Issues Concerning the Application of Law in Hearing Cases of Compensation for Personal Damage, and the Regulations on the Prevention and Treatment of Medical Disputes, coupled with the publicity on media platforms, which have raised patients’ awareness of the safety of using legal weapons to defend their rights. Other possible causes are not excluded.

In terms of regional distribution, COMDLD is distributed in all regions of China, and shows an uneven distribution, with more distribution in the Eastern and Middle regions. The reasons for this may be as follows; firstly, the Eastern and Middle regions are more economically developed, the population is highly educated, legal knowledge is well publicized, and awareness of rights is higher. Therefore, when suffering from medical damages, they usually resort to legal means to defend their legal rights promptly. Secondly, the distribution of medical resources in China is extremely unbalanced, with medical resources nationwide being distributed mainly in the economically developed eastern provinces and the densely populated Middle provinces [ 29 , 30 ]. As a result, patients with difficult medical conditions from all over the country will come to medical institutions in the eastern and Middle regions from all over the world in search of better medical resources, with diversified diseases and complications, making it more difficult to cure and the higher the risk of medical accidents. In addition, it may be related to the degree of population concentration. The Eastern and Middle are densely populated, while the Western region is sparsely populated. The larger the population, the greater the number and frequency of visits, and the greater the likelihood of doctor-patient disputes.

Distribution of types of hospitals, patients’ purposes for appeal, and trial procedures in cases of CMDLD

The results of this study showed that the highest incidence of medical damage liability cases in China was found in tertiary hospitals (city/provincial hospitals), which is consistent with the findings of previous studies [ 27 ]. Possible reasons for this are as follows: firstly, the Chinese healthcare system is still flawed. At present, China’s hierarchical medical system is still in its infancy and is not yet sound [ 31 ]. The higher-ranked hospitals have a high load and the lower-ranked hospitals have not yet played a better role in diverting traffic. With the rise in economic standards, people generally want better medical resources and flock to tertiary hospitals with better medical technology for both major and minor illnesses. These are mainly city/provincial hospitals with a high volume of patient visits and more medical services provided by the hospitals and are therefore also more prone to medical dispute incidents. Secondly, the higher the level of hospital attendance in China, the higher the workload of medical staff and the lack of effective communication with patients. The short duration and low content of doctor-patient communication prevent patients from obtaining sufficient information, and language and cultural differences also act as barriers to information exchange between doctors and patients [ 32 ]. In the event of adverse outcomes or a prognosis that does not meet the patient’s expectations, the patient may consider the medical practitioner to be irresponsible and negligent, making him or her vulnerable to medical disputes. Thirdly, patients generally spend more at higher-level hospitals than at lower-level hospitals and have higher expectations of the outcome of their treatment. For example, the reimbursement rate for residents’ health insurance is 80% for first-class hospitals, 60% for second-class hospitals, and 50% for third-class hospitals. However, as most of the difficult cases are concentrated in higher level medical institutions such as city/provincial level, the treatment is difficult and the risk of treatment is high, therefore the proportion of medical incidents during the treatment is also higher compared to other medical institutions.

The results of this study show that there is a high rate of appeals in the second trial and a high rate of hospital compensation. The data of this study shows that the largest number of cases of medical damage liability dispute compensation in the second trial, 701 cases, but the largest number of cases in the first instance with a median financial compensation of 183,497.90 yuan, and a hospital compensation rate of 52.46%. The reasons for this are as follows: firstly, China’s Tort Liability Law provides that where a patient suffers damage in the course of medical treatment activities and the medical institution and its medical staff are at fault, the medical institution shall bear the liability for medical damage; secondly, the patient’s litigation expectations were too high and there was a huge contrast between its and the realized value. Patients, not being satisfied with the amount of the judgment, will in turn bring it up again to defend their rights and interests.

Different influencing factors of CMDLD

This study conducted a linear regression analysis on the factors influencing medical damage liability compensation, and the results showed that the outcome of medical damage liability disputes was associated with all three factors: years, regions, and treatment attributes.

The results of this study showed that the median amount of compensation for medical damage liability disputes had significant differences between years, with medical damage liability damages fluctuating but generally showing an upward trend. This is consistent with the findings of Zhou L et al. [ 27 ]. 2021 had the highest median amount of compensation for medical damage liability disputes at 191,897.83 yuan. Possible reasons for this are as follows: firstly, people’s increasing awareness of the legal system and their awareness of defending their legitimate rights and interests; in addition, the improvement of the overall legal system in society and the increased protection of vulnerable groups is another important reason for this status quo. Finally, in the past, China’s civil tort compensation was based on the principle of “filling in the losses”, with the tortfeasor paying as much as the right holder lost. Statistics from relevant scholars show that there can be a difference of 2.56 times in death compensation between urban and rural residents. Since the Supreme People’s Court issued the “Notice on the Authorisation of the Pilot Project on the Unification of Urban and Rural Standards for Personal Damage Compensation” in September 2019, the amount of personal damage compensation for rural residents has been greatly increased, which has also contributed to the increase in the overall level of compensation for medical damage liability disputes.

The results of this study show that the median amount of compensation for medical damage liability disputes varies greatly between regions, with the Eastern and Middle regions accounting for a larger proportion of medical damage liability disputes and a higher median amount of compensation than the Western regions. The reasons for this may be as follows: one reason is that the eastern and Middle regions have a relatively higher level of medical technology and receive more critically ill patients, which can result in more serious consequences of medical damage if not treated properly; a possible reason is that the costs of medical treatment, accommodation, transportation and per capita wage levels are higher in the eastern and Middle regions than in the Western regions, and these costs are all linked to the cost of medical damage compensation; the third possible reason is that there is a big difference in the level of medical care between the Eastern and Middle regions and the Western regions of China, and the standard of medical duty of care for medical personnel in the Eastern and Middle regions is higher than that in the Western regions, so that the amount of financial compensation incurred in the event of a medical injury is also higher.

The results of this study show that the more serious the consequences of the damage caused by the treatment, the higher the CMDLD. In the data of this study, medical treatment resulted in the highest number of cases of death, 399, and the highest compensation, with a median compensation of 186,300.00 yuan. The levels of medical malpractice are explained in China’s laws and regulations on medical malpractice. Firstly, Article 4 of the Regulations on the Treatment of Medical Accidents, which came into force in China on 1 September 2002, provides that the classification of medical accidents is based on “the degree of damage caused to the patient’s person”. This regulation classifies medical accidents into four levels and provides a reference standard for the technical identification of medical accidents. Secondly, the Health Law specifies that compensation for medical incidents should take into account the level of medical incidents, and the more serious the medical incident, the higher the amount of compensation. Third, Article 12 of the Interpretation of the Supreme People’s Court on Several Issues Concerning the Application of Law in Hearing Cases of Compensation for Personal Damage stipulates that the disability compensation shall be calculated by the degree of the victim’s loss of working capacity or the level of disability, by the standard of the per capita disposable income of urban residents in the previous year in the locality of the court under appeal, and shall be calculated based on twenty years from the date of determination of disability. Therefore, the more serious the consequences of the treatment damage, the higher the amount of compensation.

Limitations of this study

The limitation of this study is that the data comes from public databases, and in the process of data collection, it is more difficult to take effective remedial measures for the undisclosed and missing key information in the cases of medical damage liability disputes, which may have a certain impact on the results of the study. Secondly, this paper focuses on analyzing the influencing factors of compensation for medical damage liability disputes, and fails to reasonably extract and summarize the reasons for the occurrence of medical damage liability disputes in the cases, so the research needs to be in-depth. In addition, this study puts forward relevant suggestions for the main factors of compensation for medical damage liability disputes, which provides a reference for the risk management of doctor-patient relationship. However, the inclusion of only data on medical damage liability dispute cases in China may limit the generalization of the research results.

In general, with the frequent occurrence of medical damage liability disputes and the increasing amount of CMDLD, the developed Eastern and Middle regions and municipal/provincial medical institutions have become the high-incidence areas for medical damage compensation, and the compensation and appeal rates of cases remain high, leading to the deteriorating DPR and the squeezing and wasting of judicial resources, which seriously threatens the development of China’s health and the harmony and stability of society. To ease the DPR, improve the quality of medical care and build a harmonious medical environment, we make the following recommendations.

First, the unreasonable allocation of medical resources is an important factor leading to the low quality of medical services and obvious regional differences in compensation for medical damage liability disputes. The government should promote the optimization and adjustment of medical resources to achieve resource sharing on a large regional scale, improve allocation efficiency, and narrow the gap between urban and rural areas and regions. Secondly, it can promote the construction of medical consortia through the expansion and sinking of high-quality resources, and continuously improve the comprehensive capacity of county hospitals. This will enhance the accessibility of medical services in primary medical institutions, reduce the operational pressure of large hospitals, and ensure the improvement of medical services at all levels of hospitals, thus achieving the result of reducing the occurrence of medical damage incidents in high-level hospitals. Finally, the cost of medical litigation is reduced through the development of a third-party negotiation mechanism for medical disputes. At present, third-party mediation of medical disputes has received widespread attention [ 33 , 34 ]. Its high efficiency, acceptability, and low cost make up for the drawbacks of traditional settlement methods. However, there is still a need to improve the legal system related to the third-party negotiation mechanism, establish a professional talent team, and build a multi-party linkage and cooperation mechanism, so that it can improve the quality and efficiency of resolving medical damage liability disputes.

Data availability

The dataset analyzed in this study is only available when successfully registered using one’s cell phone number, and access to the dataset should be requested from the China Judgment Online ( https://wenshu.court.gov.cn/ ). The data used and/or analyzed during the current study is available from the corresponding author on reasonable request.

Abbreviations

Compensation for medical damage liability disputes

Doctor-patient relationships

Cases of medical damage liability disputes

Zhou Y, Ma Y, Yang WFZ, Wu Q, Wang Q, Wang D, et al. Doctor-patient relationship improved during COVID-19 pandemic, but weakness remains. BMC Fam Pract. 2021;22(1). https://doi.org/10.1186/s12875-021-01600-y .

Sun JJ, Zheng ZB, Jiang XL, Hu WW, Liu J, Ma NZ, et al. Research on Management of Doctor-Patient Risk and Status of the Perceived behaviors of Physician Trust in the patient in China: New Perspective of Management of Doctor-Patient risk. Math Probl Eng. 2020;2020:2145029. https://doi.org/10.1155/2020/2145029 .

Article   Google Scholar  

He AJ, Qian J. Explaining medical disputes in Chinese public hospitals: the doctor-patient relationship and its implications for health policy reforms. Health Econ Policy Law. 2016;11(4):359–78. https://doi.org/10.1017/s1744133116000128 .

Article   PubMed   Google Scholar  

Xu B. The impact of COVID-19 on the doctor-patient relationship in China. Front PUBLIC HEALTH. 2022;10. https://doi.org/10.3389/fpubh.2022.907009 .

Chamsi-Pasha H, Albar MA. Doctor-patient relationship islamic perspective. Saudi Med J. 2016;37(2):121–6. https://doi.org/10.15537/smj.2016.2.13602 .

Article   PubMed   PubMed Central   Google Scholar  

HSJ GUIDES. https://guides.hsj.co.uk/5713.guide . Accessed 4 April 2023.

Hills DJ, Joyce CM, Humphreys JS. A national study of workplace aggression in Australian clinical medical practice. Med J Aust. 2012;197(6):336–40. https://doi.org/10.5694/mja12.10444 .

Chinese Physicians Association. http://www.cmda.net/rdxw2/11526.j.html . Accessed 4 April 2023.

Hamid SA, Begum A, Azim MR, Islam MS. Doctor-patient relationship: evidence from Bangladesh. Health Sci Rep. 2021;4(4):e394–e. https://doi.org/10.1002/hsr2.394 .

Zhou P, Grady SC. Three modes of power operation: understanding doctor-patient conflicts in China’s hospital therapeutic landscapes. Health Place. 2016;42:137–47. https://doi.org/10.1016/j.healthplace.2016.09.005 .

Qiao T, Fan Y, Geater AF, Chongsuvivatwong V, McNeil EB. Factors associated with the doctor-patient relationship: doctor and patient perspectives in hospital outpatient clinics of Inner Mongolia Autonomous Region, China. Patient Prefer Adherence. 2019;13:1125–43. https://doi.org/10.2147/PPA.S189345 .

Wang M, Liu GG-E, Bloom N, Zhao H, Butt T, Gao T, et al. Medical disputes and patient satisfaction in China: how does hospital management matter? Int J Health Plann Manag. 2022;37(3):1327–39. https://doi.org/10.1002/hpm.3399 .

Wynn R. Drawing on the doctor-patient relationship in e-Health services. Stud Health Technol Inform. 2022;289:160–1. https://doi.org/10.3233/SHTI210883 .

Liu Y, Wang P, Bai Y. The influence factors of medical disputes in Shanghai and implications-from the perspective of doctor, patient and disease. BMC Health Serv Res. 2022;22(1). https://doi.org/10.1186/s12913-022-08490-5 .

Ferris LE. A challenge and an opportunity for medical regulators–considering the public’s interests in cases using ADR to resolve disputes about physicians’ practices: a Canadian analysis. Med Law. 2002;21(1):11–42.

PubMed   Google Scholar  

Yee F. Mandatory mediation: the Extra Dose needed to cure the Medical Malpractice Crisis. Cardozo J Confl Resol. 2005;7:393.

Google Scholar  

Moore J, Bismark M, Mello MM. Patients’ experiences with communication-and-Resolution Programs after Medical Injury. JAMA Intern Med. 2017;177(11):1595–603. https://doi.org/10.1001/jamainternmed.2017.4002 .

Ramirez-Orellana VMMC, Grasso A, International journal of environmental research and public health. MS. Health Investment Management and Healthcare Quality in the Public System: A Gender Perspective. 2021;18(5). https://doi.org/10.3390/ijerph18052304 .

Thawesaengskulthai N, Wongrukmit P, Dahlgaard JJ. Hospital service quality measurement models: patients from Asia, Europe, Australia and America. Total Qual Manage Bus Excellence. 2015;26(9–10):1029–41. https://doi.org/10.1080/14783363.2015.1068596 .

Hanefeld J, Powell-Jackson T, Balabanova D. Understanding and measuring quality of care: dealing with complexity. Bull World Health Organ. 2017;95(5):368–74. https://doi.org/10.2471/BLT.16.179309 .

Zhao SH, He B, Tang XT, Wang XL, Zhang MM, Zhou J, et al. Effect of disability severity on home-based care quality among families with Uygur and Kazakh disabled older adults in far western rural China: a cross-sectional study. Int J Nurs Pract. 2022;28(6). https://doi.org/10.1111/ijn.13082 .

Ai W, Zhang M, Hu J. Effects of Endothelin-1 and nitric oxide levels on myocardial ischemia-reperfusion injury. ANNALS TRANSLATIONAL Med. 2022;10(24). https://doi.org/10.21037/atm-22-4998 .

Zhu H, Tao H-H, Wei M, Liu P, Yuan L, Zhang Y-N, et al. Effects of different frequencies of Er:YAG laser on the bonding properties of zirconia ceramic. Lasers Med Sci. 2022;38(1):4. https://doi.org/10.1007/s10103-022-03660-7 .

Manathunga SS, Abeyagunawardena IA, Dharmaratne SD. A comparison of transmissibility of SARS-CoV-2 variants of concern. Virol J. 2023;20(1):59. https://doi.org/10.1186/s12985-023-02018-x .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Chan BKC. Data Analysis Using R Programming. In: Chan BKC, editor. BIOSTATISTICS FOR HUMAN GENETIC EPIDEMIOLOGY. 10822018. pp. 47–122. https://doi.org/10.1007/978-3-319-93791-5_2 .

Zhou L, Li H, Li C, Li G. Risk management and provider liabilities in infantile cerebral palsy based on malpractice litigation cases. J Forensic Leg Med. 2019;61:82–8. https://doi.org/10.1016/j.jflm.2018.11.010 .

Zeng Y, Zhang L, Yao G, Fang Y. Analysis of current situation and influencing factor of medical disputes among different levels of medical institutions based on the game theory in Xiamen of China A cross-sectional survey. Medicine. 2018;97(38). https://doi.org/10.1097/MD.0000000000012501 .

Toraldo DM, Vergari U, Toraldo M. Medical malpractice, defensive medicine and role of the media in Italy. Multidisciplinary Respiratory Med. 2015;10(1):12. https://doi.org/10.1186/s40248-015-0006-3 .

Chai K-C, Zhang Y-B, Chang K-C. Regional Disparity of Medical resources and its Effect on Mortality Rates in China. Front Public health. 2020;8. https://doi.org/10.3389/fpubh.2020.00008 .

Zhou Z, Zhao Y, Shen C, Lai S, Nawaz R, Gao J, Medicine. Evaluating the effect of hierarchical medical system on health seeking behavior: a difference-in- differences analysis in China. Social science &; 2021. p. 268. https://doi.org/10.1016/j.socscimed.2020.113372 .

Liang C, Zhao Y, Yu C, Sang P, Yang L. Hierarchical medical system and local medical performance: a quasi-natural experiment evaluation in Shanghai, China. Front Public Health. 2022;10. https://doi.org/10.3389/fpubh.2022.904384 .

Paternotte E, van Dulmen S, van der Lee N, Scherpbier AJJA, Scheele F. Factors influencing intercultural doctor-patient communication: a realist review. Patient Educ Couns. 2015;98(4):420–45. https://doi.org/10.1016/j.pec.2014.11.018 .

Poniewierza P, Poniewierza P. Mediation as an opportunity in disputes relating to compensation for adverse medical events - international experiences. Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego. 2020;48(287):375–8.

Chen W-T, Huang Y-Y, Chen W-W, Liu Y-P, Shih C-L, Shiao Y-C, et al. Fostering guardians for frontline medical disputes: a government-led medical dispute mediator training program in Taiwan. BMC Health Serv Res. 2022;22(1). https://doi.org/10.1186/s12913-022-08909-z .

Download references

Acknowledgements

Not applicable.

This work was supported in part by the Open Program of Hospital Management Institute, Anhui Medical University(2023gykj09), the National Natural Science Foundation of China (No.72374005), the NSF Center for Basic Science Project (No.72188101), the Cultivation Programme for Young and Middle-aged Excellent Teachers in Anhui Province (No.YQZD2023021), and the Natural Science Foundation for the Higher Education Institutions of Anhui Province of China (No. 2023AH050561, No.2022AH051143, and No. KJ2021A0266), and Quality Engineering for research projects of the Anhui Department of Education (No.2022sx067), Ideological and Political Project of Anhui Medical University (No.2023xszh36).

Author information

Authors and affiliations.

School of Health Care Management, Anhui Medical University, 230032, Hefei, China

Hui Li, Limin Li, Tong Liu & Jiangjie Sun

The Second Clinical Medical College, Anhui Medical University, 230032, Hefei, China

Meiqiong Tan, Wanwan He, Yuzhu Luo & Xuerong Zhong

School of Marxism, Anhui Medical University, 230032, Hefei, China

Liping Zhang

School of Management, Hefei University of Technology, 230039, Hefei, China

Jiangjie Sun

You can also search for this author in PubMed   Google Scholar

Contributions

H.L. and J.J.S. conceived and designed the study; M.Q.T., W.W.H., Y.Z.L., and X.R.Z. contributed to the acquisition of the data; H.L. and L.M.L. extracted and analyzed the data, T.L. and L.P.Z. validated the analytical methods, and all authors interpreted the data. H.L. drafted the manuscript, and all authors critically revised the manuscript and approved the final version for publication. All authors had full access to the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding authors

Correspondence to Liping Zhang or Jiangjie Sun .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Li, H., Li, L., Liu, T. et al. Risk management and empirical study of the doctor-patient relationship: based on 1790 litigation cases of medical damage liability disputes in China. BMC Health Serv Res 24 , 521 (2024). https://doi.org/10.1186/s12913-024-10952-x

Download citation

Received : 14 April 2023

Accepted : 04 April 2024

Published : 25 April 2024

DOI : https://doi.org/10.1186/s12913-024-10952-x

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Doctor-patient relationship
• Medical damage
• Liability disputes
• Risk management
• Empirical analysis
• Compensation

BMC Health Services Research

ISSN: 1472-6963

• General enquiries: [email protected]