利用“病例存量研究”评价深圳市南山区结核病监测系统敏感性

Evaluation of the sensitivity of tuberculosis surveillance system in Nanshan district of Shenzhen city using “case stock study”

目的应用"病例存量研究"的方法调查2016年深圳市南山区各类医疗机构肺结核病漏报水平和南山区肺结核病漏登水平。方法收集深圳市南山区所有具有结核病诊疗资质(即具有进行X线胸片检查能力)医疗机构的2016年门诊、住院部、检验科、放射科、病理科、防保科的结核病诊疗信息,与传染病直报系统数据进行比对,计算漏报率;结合南山区结核病定点医疗机构《初诊患者登记本》中到位患者的诊疗信息,与结核病专报监测数据进行比对,计算漏登率。结果 2016年南山区共诊治疑似和确诊肺结核病例2 322例,漏报16例,漏报率为0.69%。各类医疗机构的漏报率分别为:定点结防机构0.79%(6/760);公立医疗机构1.72%(37/2 151);民营医疗机构38.10%(24/63)。2016年南山区医疗机构共发现确诊肺结核病例692例,其中报告并登记513例,漏登率为25.87%;漏登的首要原因是患者选择到深圳市结核病专科医院-深圳市第三人民医院进行治疗。结论南山区各类医疗机构均存在漏报现象,建议规范医疗机构报卡流程和加强医务人员培训,提高结核病报告质量;本区漏登率较高,应采取有力措施降低漏登率。

Objective To investigate the missing report rate of tuberculosis（TB）and under-registration rate of TB in Nanshan district of Shenzhen city in 2016 by inventory study. Methods Collected TB related records registered from outpatient department,inpatient department,laboratory,radiology,pathology and prevention department in all medical institutions for the qualification of TB diagnosis and treatment（that is,the ability to perform X-ray chest examination）. The missing report rate was calculated by comparing above records with data from national infectious disease reporting system;the under-registration rate was calculated by comparing diagnosis information from designated TB institutions with data from the TB surveillance system. Results 2 322 suspected and diagnosed cases of TB were treated in medical institutions of Nanshan district in 2016. 16 cases of TB were failed to report and the total missing report rate was 0.69%. The missing report rate of designated TB institutions,public medical institutions and private medical institutions was 0.79%（6/760）,1.72%（37/2 151）and 38.10%（24/63）,respectively; 692 diagnosed cases of TB were found in medical institutions of Nanshan district,of which 513 cases were reported and registered,179 cases were missed,and the under-registration rate was 25.87%.The primary reason for the under-registration is that the patients choose to go to Shenzhen Tuberculosis Hospital-The Third People＇s Hospital of Shenzhen for treatment. Conclusions All kinds of medical institutions in Nanshan district were missing reports,so the process of card reporting in medical institutions should be standardized and the training of medical staff should be strengthened to improve the quality of tuberculosis reporting. Under-registration rate was higher in this area,so effective measures should be taken to reduce leakage rate.