省、市、县三级疾病预防控制中心新冠肺炎早期疫情防控胜任水平研究

Study on competence level of provincial, municipal and county-level CDC for COVID-19 prevention and control in early period

[目的]了解省、市、县三级疾病预防控制中心(CDC)新冠肺炎早期疫情(2020年4月底前)防控胜任水平,为有针对性地提升疫情防控能力提供借鉴,为今后系统、深入开展新冠肺炎疫情防控胜任力研究、推动疾控体系改革等提供参考。[方法]两阶段分层随机抽样548个CDC(32个省级CDC、145个地市级CDC、371个县区级CDC)开展问卷调查。[结果]调查对象新冠肺炎早期疫情防控胜任水平自评分平均(7.68±1.473)分,其中省级CDC得分(8.72±0.924)分、地市级CDC得分(8.03±1.497)分、县区级CDC得分(7.45±1.445)分,行政级别与胜任水平间呈线性关系;东部地区CDC得分[(7.98±1.488)分]高于中部地区CDC得分[(7.64±1.418)分]和西部地区CDC得分[(7.46±1.472)分],曾处置病例的CDC得分[(7.83±1.434)分]高于未处置过病例的CDC[(7.09±1.482)分],曾开展流调的CDC得分[(7.81±1.434)分]高于未开展过流调的CDC[(7.11±1.503)分],曾开展核酸检测的CDC得分[(7.90±1.463)分]高于未开展过核酸检测的CDC[(7.33±1.422)分];在县区级CDC水平上,不同经济分区、地理分区、是否曾处置病例、是否曾开展流调的调查对象间的胜任水平均有差异;多元分析显示行政级别、经济分区是影响胜任水平的重要特征因素。[结论]省、市、县三级CDC新冠肺炎早期疫情防控胜任水平总体较好,但分布不均衡;县区级CDC防控能力偏弱且不平衡情况更明显,需尽快得到提升;应将经济不发达地区的县区级CDC作为疾控体系重塑性改革重点,促进基层疾控机构全面、均衡发展。

Objective To understand the competence level of provincial, municipal and county-level CDC for COVID-19 prevention and control in early period(before the end of April 2020),so as to provide reference for targeted improvement of epidemic control and prevention competence, for systematic and in-depth research on COVID-19 control and prevention competence in the future, and for promotion of the reform in the disease control and prevention system. Methods A two-stage stratified random sampling of 548 CDC(including 32 provincial CDC,145 municipal CDC and 371 county-level CDC)was conducted for questionnaire survey. Results The average self-score of competence level for CDC for COVID-19 prevention and control in early period of respondents was(7.68±1.473)points, including provincial level score(8.72±0.924)points, municipal level score(8.03±1.497)points and county-level score(7.45±1.445)points. There was a linear relationship between administrative level and competence level, and CDC in eastern region(7.98±1.488)was higher than that in central region(7.64±1.418)and western region(7.46±1.472). The CDC score of those which had treated cases(7.83±1.434)was higher than that of untreated cases(7.09±1.482),the CDC score of those who had carried out epidemiological survey(7.81±1.434)was higher than those who had not carried out epidemiological survey(7.11±1.503),and the CDC score of those who had carried out nucleic acid testing(7.90±1.463)was higher than those who had not carried out nucleic acid testing(7.33±1.422). The competence level of county CDC,there were differences in the competence level of respondents in different economic regions, geographical regions, whether they had treated cases, and whether they had carried out epidemiological survey. Multivariate statistical analysis showed that administrative level and economic region were important characteristic factors affecting the competence level. Conclusions Competence level of provincial, municipal and county-level CDC for COVID-19 prevention and control in early period is generally good, but the distribution is uneven;Especially the competence of county-lelel CDC for disease coutrol and prevention is weak and has an obvious imbalance which needs to be promoted as soon as possible. County-level CDC in economically underdeveloped areas should be the focus of the restructuring of the disease control and prevention system, in order to promote the comprehensive and balanced development of grassroots disease control and prevention institutions.