边疆地区儿童先天性心脏病筛查及效率分析

Screening of congenital heart disease among children in Western China and its efficiency

目的分析国内边疆地区儿童先天性心脏病的筛查效率为先心病筛查工作提供参考方法2017—2020年,以云南省阜外心血管病医院筛查队所到8个省份为调查地点。采用横断面调查,现场收集筛查区/县数、学校数、筛查儿童总人数、疑似病例数、确诊病例数、医务人员服务人次数、服务时长天数及支出费用。利用Excel建立数据库,分析8省份儿童先心病筛查结果整体情况、参与筛查医务人员工作效率、筛查所耗资源情况。结果4年间共筛查3015470名儿童,疑似病例数(疑似率)为48181(1.60%),确诊病例数(确诊率)为3805(0.13%)。医疗队平均每筛查1个县(区)配备了9.7名听诊医务人员和0.9名超声医务人员,听诊医务人员和超声医务人员配比为10∶1。每筛查1名儿童的平均成本约为1.0元,确诊1名患儿平均成本为821.9元。筛查1个学校平均所需医务人员服务0.1人次,筛查出1名先心病疑似病例和确诊病例分别需要医务人员服务约0.02人次和0.2人次。结论较少经费投入能保证持续开展边疆地区儿童先心病筛查。

Objective To analyze the efficiency in screening children with congenital heart disease(CHD)in the western areas of China,so as to provide reference for the screening of CHD.Methods From 2017 to2020,the 8 provinces visited by the screening team of the Fuwai Yunnan Cardiovascular Hospital were chosen as the survey sites.A cross-sectional survey was performed to collect on-site the number of screening districts/counties,the number of schools,the total number of children screened,the number of suspected cases,the number of confirmed cases,the number of children served by medical personnel,the number of days of service,and the expenditures.A database was created using Excel to analyze the overall results of screening for pediatric CHD in eight provinces,the efficiency of the medical staff involved in the screening,and the resources consumed for the screening.Results A total of 3015470 children were screened over the four-year period,with a suspected case count(suspected rate)of 48181(1.60%),and a confirmed case count(confirmed rate)of 3805(0.13%).The medical team had an average of 9.7 auscultatory medical staff and 0.9 ultrasound medical staff for each county(district)screened,with a 10∶1 ratio of auscultatory medical staff to ultrasound medical staff.The average cost for screening a child was about 1.0 yuan,and the average cost for confirming a pediatric patient was 821.9 yuan.Screening a school required an average of 0.1 person-time service of medical staff,and screening a suspected CHD case and a confirmed case required about 0.02 person-time and 0.2 person-time service of medical staff,respectively.Conclusions Less funding can ensure the continuous screening of children with congenital heart disease in Western China.