定点医院模式实施前后结核病控制效果分析

Effect of tuberculosis control before and after implementation of designated hospital service- a case study of six model regions

目的分析实行结核病定点医院服务模式前后结核病发现和治疗效果变化情况,为保障新模式的可持续发展提供参考建议。方法 2015年11月收集山东、陕西和湖南3个省6个样本地区实行定点医院模式前后5~7年的结核病患者登记数据,分析结核患者登记率、新发涂阳患者登记率、涂阳患者治愈率和涂阴患者治疗完成率的变化。结果对于结核患者登记率,湖南浏阳由职责调整前2年的59.05/10万上升到职责调整后第3年的80.51/10万,陕西阎良由职责调整前2年的54.58/10万,在职责调整后第3年升为72.4/10万;其他4个地区均呈下降趋势,下降最明显的是山东庆云,由职责调整前2年的64.00/10万降至职责调整后第5年的13.16/10万;所有样本地区的涂阳患者登记率均呈下降趋势;绝大多数样本县(市、区)的涂阳患者治愈率和涂阴患者治疗完成率在定点医院模式实施前后差异均无统计学意义。结论实行定点医院模式后,结核患者发现登记管理的工作质量少数地区提高,大部分地区下滑,治疗效果基本能够满足国家防治规划的需要,定点医院模式下的患者登记管理工作需要进一步加强。

Objective To analyze changes in effects of tuberculosis （TB） detection and treatment before and after the implementation of government administration-designated hospital service model and to provide references for smooth development of the new service model. Methods Data on TB registration two years before and 3 -5 years after the implementation of designated hospital service in six model regions of three provinces were collected in November 2015 to analyze changes in TB registration rate, the registration rate of smear-positive TB, the cure rate of smear-positive TB and treatment completion rate of smear-negative TB. Results The TB registration rate increased from 59. 05/100 000 and 54. 58/100 000 two years before the implementation to 80. 51/100 000 and 72. 4/100 000 three years after the implementation of the new service model in Liuyang municipality of Hunan province and Yanliang district of Shaanxi province; whereas the rate declined significantly in the other four model regions, especially in Qingyun county of Shandong province （ from 64/100 000 to 13.16/100 000 during the same period）. The registration rate of smear-positive TB decreased in all model regions studied; while the completion treatment rate of both smear-positive and smear-negative TB showed no statistically significant variation. Conclusion After the implementation of designated hospital service, the quality of TB detection and registration were improved only in some model regions but declined in most model regions;while the effect of TB treatment met the requirement of national TB control planning. The study results suggest that management on TB registration should be strengthened after the implementation of designated hospital service to TB patients.