Abstract:Objective：To retrospectively analyze the difficult medical records of a certain hospital from 2019 to 2022，identify the influencing factors that lead to its defects，and provide reference for internal quality control management of the hospital and relevant departments’ supervision of medical quality. Method：Randomly select difficult medical records from a certain hospital from 2019 to 2022，evaluate the medical records according to the medical record evaluation standards，and divide them into defect group and no defect group. Screening the influencing factors of difficult medical record defects through binary logistic regression analysis. Result：A total of 1，700 difficult medical records were selected，with an average hospital stay of 20.51 days. After evaluation，228 medical records were in the defect group and 1，472 medical records were in the none defect group. Using clinical features of each medical record as research variables. Logistic regression analysis showed that the main diagnosis was “tumor”，“injury poisoning”，the discharge department was “surgery”，“ICU”，and the treatment outcome was “death”，which were risk factors leading to difficult medical record defects（P < 0.05）. Whether the medical record is critical is a protective factor. Conclusion：Difficult and defective medical records should be a key regulatory object for medical record quality control，and hospitals and health departments should carry out targeted supervision work to further improve the quality level of medical records.