四川省骨质疏松症诊疗质量及考核标准调查

Investigation of Osteoporosis Diagnosis and Treatment Quality and Assessment Criteria in Sichuan Province

目的调查四川省各级医院相关科室基线时和医院行为干预后骨质疏松症诊疗质量,了解骨质疏松症诊疗现状及医院行为干预作用,制定各级医院和各类科室质量控制建议标准。方法本研究以四川大学华西医院和成都市第五人民医院、成都市龙泉驿区第一人民医院、四川电力医院作为四川省三级甲等医院、二级甲等医院和社区医院各层次医院代表,采用自行设计的骨质疏松症调查问卷和病历查阅方式,在2015—2018年间以预调查-医院干预-调查-医院干预-再调查的模式在各级医院各科室展开调查,对收集到的数据进行汇总分析。结果调查共完成了5773份问卷和病历查询,基线时各级医院骨密度筛查率多在10%左右,骨质疏松症诊断率明显高于治疗率,二级医院和社区医院的骨质疏松症患者转诊率和随访率远高于三级医院。医院行为干预后,各级医院的骨密度筛查率、骨质疏松症诊断率和治疗率均较前提升,显示出更好的骨质疏松症诊疗质量,但仍存在较为明显的诊治差距。基于此次调查结果制定各级医院和相关科室骨质疏松症诊疗质量相关指标的考核标准。结论目前骨质疏松症诊疗现状仍不理想,呈现低筛查率、低诊断率、低治疗率的现状。但骨质疏松症医疗质量可控,通过实施和贯彻骨质疏松症诊疗质控量化考核指标,可一定程度上提升骨质疏松症诊疗质量。

Objective To investigate the baseline and post-intervention osteoporosis diagnosis and treatment quality in departments across different levels of hospitals in Sichuan Province to understand the status of osteoporosis diagnosis and treatment and the effect of intervention as well as to set quality control recommended standard for various departments in hospitals at all levels.Methods West China Hospital,Sichuan University,Chengdu Fifth People s Hospital,The First People s Hospital of Longquanyi District,Sichuan Electric Power Hospital were selected to represent tertiary Grade-A,secondary Grade-A,and community hospitals,respectively.A self-designed osteoporosis questionnaire and medical records were utilized.Between 2015 and 2018,a phased approach involving pre-survey,hospital intervention,survey,hospital intervention,and re-survey was conducted across various departments in different levels of hospitals.The collected data were subjected to comprehensive analysis.Results A total of 5773 questionnaires and medical record inquiries were completed.The baseline bone mineral density screening rates in hospitals were around 10%,with osteoporosis diagnosis rates notably surpassing treatment rates.Referral and follow-up rates for osteoporosis patients were much higher in secondary hospitals and community hospitals than to tertiary hospitals.Post-hospital intervention,there were evident improvements in bone mineral density screening rates,osteoporosis diagnosis rates and treatment rates across all hospitals,reflecting enhanced osteoporosis diagnosis and treatment quality.However,the significant gap between diagnosis and treatment persisted.Based on these findings,assessment criteria for osteoporosis diagnosis and treatment quality indicators were formulated for hospitals and relevant departments.Conclusion The current status of osteoporosis diagnosis and treatment is suboptimal,characterized by low screening,diagnosis and treatment rates.However,the medical quality of osteoporosis is manageable.By implementing and adhering to quantifiable assessment indicators for osteoporosis diagnosis and treatment quality control,it is possible to improve osteoporosis diagnosis and treatment quality.