基于社区肿瘤早发现监测网络的建立和实践

Set-up of Early Detection Surveillance System on Tumors in Community

目的建立社区常见肿瘤早发现监测网络,并探讨其效果。方法(1)资源配置调查:对12家社区卫生服务中心防保院长进行面对面调查。(2)研发社区肿瘤早发现监测软件,并实现各社区卫生服务中心联网。(3)制定社区肿瘤早发现监测网络方案及质量控制指标:30%的户籍40岁以上人群完成健康教育,其中90%完成健康问卷;接受规范筛查检查人数占辖区内纳入初筛人群的比例大于50%;实际建卡规范管理的高危人群数占初筛高危人群的比例大于90%;胃镜、肠镜、CT等项目的复查率大于50%;质量符合率大于90%。(4)"四癌"早发现的知识态度调查:建网前后随机抽取758人做基线调查,572人做评估调查。结果组建平均由信息化负责人1名、全科临床医师2.1名、公共卫生医师2.8名、社区护士2名、乡村医师1名组成的63个团队;建立社区肿瘤早发现信息化监测网络,覆盖各社区卫生服务点;共完成健康教育126634人,覆盖40岁以上户籍人口的26.63%,健康问卷完成124351份,问卷完成率为98.20%,规范初筛40000人,初筛阳性1149人,复查475人,纳入高危人群管理3149人,确诊51例,早期4例,癌前病变9例。人群"四癌"早发现知识知晓率由55.21%提高到70.00%,差异有统计学意义(P<0.05);态度转变率由71.44%提高到83.11%,差异亦有统计学意义(P<0.05)。结论以信息管理平台支撑、人力资源配置合理、易患人群长效规范管理的社区肿瘤早发现监测网络是适合社区开展的,简明性、灵活性强,检出率、敏感性高,顺应性、接受性好且多途径、多癌种的监测体系。

Objective To establish early detection surveillance system on common tumors and investigate its effect. Methods ①Human resources investigation： To conduct face -to -face survey among the deans of 12 community health services （CHS） centers. ②To research and develop an early detection and monitoring software covering all CHS points. ③To draw up early detection monitoring programs and indicators for quality control： More than 30% of population over 40 years received health education, 90% of them filled out health questionnaire. More than 50% of the population in the communities received standardized screening. More than 90% of the primarily screened high - risk population was given card regulating management. The re - check rate of gastroscopy, colonoscopy, CT and other projects was over 50%. The consistent rate of quality was over 90%. ④ KAP survey ： Before and after establishment of network, baseline survey was conducted among 758 person randomly selected; and assessment survey among 572 people. Results Totally 63 teams were set up, with one responsible person for information, 2. 1 clinicians, 2. 8 public health physicians, two community nurses and one rural physicians in each. The information monitoring network covering all CHS points was established. The health education was conducted fro 126 634 persons, accounting for 26. 63% of the people more than 40 years. The number of retrieved health questionnaire was 124 351, with a complete rate of 98.20%. The people who received primarily screening was 40 000, of which 1 149 were positive, 475 received reexamination, 3 149 were brought into high risk population, 51 were diagnosed including 4 at the early stage and 9 as having pre - cancerous lesions. The awareness rate of early discovery of ＂ four cancers＂ increased from 55.21% to 70.00% （P 〈0. 05）. The change rate of attitude increased from 71.44% to 83.11% （ P 〈 0.05 ）. Conclusion The early detection surveillance system is supported by information management platform, with rational allocation of human resources and long - term standard management on predisposed group is suitable for community. It is concise and flexible, with higher sensibility, compliance, acceptability, and versatile for several tumors.