两种不同管理模式对县级医院肺结核发现的影响

Impact of Two Different Management Modes on Case Finding of Pulmonary Tuberculosis in County Hospitals

目的探讨以培训为主的管理模式及医防合作管理模式对县级医院发现肺结核患者的影响。方法选取北京市同级别和同规模的两家基层县级医院为研究对象。北京市密云县医院为观察组，北京市昌平县医院为对照组，观察组采取以培训为主的管理模式；对照组采取医防合作的管理模式。比较两种不同管理模式对肺结核报告菌阳率和报告痰检率有无差异。结果两组管理后报告菌阳率比较，差异无统计学意义（P〉0．05）。两组各自管理前后报告菌阳率比较，差异均无统计学意义（P〉0．05）。两组管理前报告痰检率比较，差异无统计学意义（P〉0．05）；而管理后两组报告痰检率比较，差异均有统计学意义（P〈0．01）。结论医防合作管理模式比培训为主的管理模式对肺结核发现工作在基层县级医院更持续有效，该县的经验在北京地区值得借鉴。

Objective To investigate the different effects of training management mode and hospital-prevention and control institution cooperation mode in case finding of pulmonary tuberculosis in two county hospitals. Methods We selected two county hospitals of the same class： Miyun county hospital as the control subject and Changping county hospital as the study subject. Management modes through training the staff or through cooperation between the prevention and control research institutions and general hospitals were tried on the study subject and the control subject respectively.We adopted prospective methods and compared the effects of these modes on case finding of pulmonary tuberculosis.Results Sputum positive rates showed no statistical differences between the two groups after management （P〉0.05）; sputum positive rates of each hospital were similar before and after management （P〉0.05）. Sputum examination rates were not statistically different between the two hospitals before managemet （P〉0.05）; while became significantly different after treatment （P〈0.01）. Conclusion Effects of the cooperation mode of prevention and control research institutions and general hospitals is more lasting and effective than the training-based mode in finding pulmonary tuberculosis cases.This experience is worth popularizing in Beijing.