医疗机构视角下死因监测信息质量评价及优化对策分析

Analysis of the quality assessment and optimization measures of death surveillance:information from the perspective of healthcare institutions

死因监测信息是反映人群死亡水平和死因分布的重要流行病学资料,医疗机构作为主要报送单位,其工作开展情况对死因监测信息质量具有重要影响。当前死因监测评价和优化对策研究着眼于区域整体死因信息总体质量或单一类别问题评价,并基于经验或局部流程提出对策建议,缺乏对质量问题成因的系统化分析,导致其实践指导力度不足。研究对北京市某三级甲等综合医院2018年9月—2022年9月死亡个案信息进行质量评价,系统性回顾机构内管理流程;基于统计学方法和根因分析法,运用亲和图、鱼骨图和帕累托图等工具,发现死因监测信息质量在患者入院途径、疾病诊疗专业类型间存在差异,医疗机构死因监测信息质量主要受个体因素、监管因素、资源因素和技术因素影响。因此,建议加强死因信息质量管理培训、完善医疗机构内部死因信息管理机制、推进死因监测信息化建设和数据共享。

Death surveillance is a kind of important epidemiology data which shows the mortality levels and the distribu⁃tion of cause-of-death.The performance of healthcare institutions,as major reporting units,have a significant impact on the information quality death surveillance.Current study of the quality assessment of death surveillance measures focus on the overall assessment for the region as a whole from the perspectives of administration department,or on a single cate⁃gory of quality issues while giving suggestions based on management experience or partial process.The absence of sys⁃tematic analysis on the causes of quality problem leads to the lack of realistic guidance strength on quality optimization of death surveillance information.This study evaluates the quality of information on death cases from September 2018 to September 2022 in a tertiary care hospital in Beijing,reviewing systematically on the management processes within the institution.Based on the statistical methods and root cause analysis,using tools such as flow charts,affinity diagrams,fish-bone diagrams and Pareto diagrams,differences in the quality of information on cause of death surveillance were found between patient admission routes and types of disease treatment specialties,and quality of information on cause-ofdeath surveillance in healthcare institutions can be influenced by individuals,regulations,resources and technical fac⁃tors.Therefore,it is recommended that training on quality management of death surveillance information be strength⁃ened,the internal cause-of-death information management mechanism of healthcare institutions be improved,and the construction of information technology for death surveillance and data sharing be promoted.