广东省职业健康检查机构现状与发展风险分析

Analysis of current status and risk of development in occupational medical examination institutions in Guangdong Province

目的分析广东省职业健康检查(OME)机构现状,分析影响其未来发展的关键控制点。方法以广东省211家OME机构为研究对象,对其进行现况调查,并基于危害分析与关键控制点理论对其未来发展进行风险评估。结果OME机构主要集中在珠江三角洲地区,共占72.0%;公立、民营医疗卫生机构分别占70.6%和29.4%;不同OME类别备案率由高到低依次为物理因素类>化学因素类>粉尘类>其他类>放射因素类>生物因素类(P<0.01),备案率依次为89.6%、88.6%、84.8%、63.0%、7.1%和1.0%。现场考核优秀率由高到低依次为听力图谱分析人员>肺功能检查操作人员>胸片阅片人员>主检医师>技术负责人>质量负责人(P<0.01),优秀率依次为49.4%、26.2%、20.6%、10.8%、8.2%和4.6%。37家机构未报送OME信息,其中23家机构备案后未开展OME工作。2020年疑似职业病要求诊断率和确诊率分别为34.3%和55.3%;2021年疑似职业病检出率仅为1.1‰。备案生物监测项目的机构中,64.1%未参加实验室室间比对;38家参加比对的机构不合格率为55.3%。风险评估结果显示,OME机构未来的发展需重点关注民营机构、未报送OME信息机构、疑似职业病漏诊与漏报机构、未参加实验室室间比对机构和质量负责人、技术负责人、主检医师等核心人员。结论广东省OME机构呈现备案类别集中、备案地区集中和备案机构性质集中的特点。结合OME机构能力建设的潜在风险,需实行分类管理,加强信息化建设和监督管理,落实岗位职责,促进OME机构高质量发展。

Objective To analyze the status of occupational medical examination(OME) institutions in Guangdong Province and the critical control points affecting their future development.Methods A total of 211 OME institutions registered in Guangdong Province were selected as the research subjects.Their current statue was investigated,and the risk assessment of their future development was carried out based on hazard analysis and critical control point theory.Results The OME institutions were mainly concentrated in the Pearl River Delta,accounting for 72.0%.The public and private medical and health institutions accounted for 70.6% and 29.4% respectively.The filing rates of different OME categories from high to low in the order were physical factors,chemical factors,dust,other,radiation factors,biological factors(P<0.01),and the filing rates were 89.6%,88.6%,84.8%,63.0%,7.1% and 1.0%,respectively.The rates of excellence in the field assessment from high to low in the order were hearing atlas analysis personnel,lung function examination operators,chest film reading personnel,chief examination physician,technical director,quality director(P<0.01),and the rates of excellence were 49.4%,26.2%,20.6%,10.8%,8.2% and 4.6%,respectively.A total of 37 institutions did not submit OME information,of which 23 institutions did not carry out OME work after filing.The required diagnosis rate and confirmed diagnosis rate of suspected occupational diseases in 2020 were 34.3% and 55.3%,respectively.In 2021,the detection rate of suspected occupational diseases was only 1.1‰.Among the institutions with biological monitoring records,64.1% did not participate in external quality assessment program in laboratory,and the unqualified rate of 38 participating institutions was 55.3%.The risk assessment results show that the future development of OME institutions needs to focus on private institutions,institutions that have not reported OME information,institutions that have missed diagnosis and missed reporting of suspected occupational diseases,institutions that have not participated in external quality assessment program in laboratory and core personnel such as quality managers,technical leaders,and main inspection physicians.Conclusion OME institutions in Guangdong Province show the characteristics of centralized filing category,centralized filing region and centralized filing institution nature.Combined with the potential risks of OME institutional capacity building,it is necessary to implement classified management,strengthen information construction,supervision and management,implement post responsibilities,and promote the high-quality development of OME institutions.