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目的分析江苏省定点医院在结核病防治新体系中的实施效果,为制定结核病防控策略提供科学依据。方法选择江苏省采用定点医院模式和CDC模式的县(市、区)各10个,收集这20个地区2012年1月至2012年12月期间发现登记的10 578例肺结核患者的诊断延迟、转诊追踪、系统管理、治疗结局、资料质量等数据,采用SPSS 17.0软件进行分析,探讨两种模式的运行效果。结果定点医院模式和CDC模式下的肺结核登记率[分别为55.60/10万(4768/8 575 823)和55.93/10万(5810/10 388 634),χ2=0.091,P=0.763]、转诊追踪总体到位率[分别为99.1%(4939/4985)和99.2%(6064/6111),χ2=0.780,P=0.3771]、从诊断至报告的时间[分别为(0.021±0.009)d和(0.025±0.010)d,t=0.419,P>0.05]、系统管理率[分别为99.0%(5048/5097)和98.7%(5645/5719),χ2=2.65,P=0.103]、涂阴患者完成疗程率[分别为96.6%(3182/3295)和97.4%(3661/3760),χ2=3.82,P>0.05]的差异均无统计学意义。定点医院模式下的肺结核患者从发病到诊断的平均时间为(11.117±6.109)d,显著低于CDC模式的(15.399±6.866)d(t=12.42,P<0.001),而且因症就诊比率定点医院模式与CDC模式[分别为52.0%(2479/4768)和33.8%(1966/5810),χ2=352.468,P<0.0001)、转诊率[分别为99.1%(4941/4985)和98.5%(6017/6111),χ2=9.606,P=0.0019]、追踪到位率[分别为99.6%(1320/1325)和97.9%(1559/1593),χ2=16.993,P=0.000 04]比较前者高于后者,差异有统计学意义。而定点医院模式与CDC模式比较,新涂阳治愈率[分别为89.8%(1172/1305)和94.7%(1293/1366),χ2=22.03,P<0.0001]、复治涂阳治愈率(分别为80.8%(274/339)和88.9%(335/377),χ2=9.06,P<0.01)、信息录入及时率[分别为98.9%(23 571/23 840)和99.0%(28 773/29 050),χ2=4.088,P=0.043]和完整率[分别为98.8%(28 272/28 608)和99.4%(34 646/34 860),χ2=60.113,P<0.0001]均低于CDC模式,但均能够满足相关工作要求。结论江苏省县(区)级定点医院模式的实施效果较好,定点医院模式是符合我国医疗机构改革大方向的必然趋势,能适应不断发展的结核病防治工作需求,可以因地制宜地稳步推行。
Objective To analyze the implementation effect of fixed-point hospitals in the new system of tuberculosis prevention and control in Jiangsu Province, and to provide a scientific basis for the development of tuberculosis prevention and control strategies. Methods Ten counties (cities, districts) in Jiangsu Province using fixed-point hospital model and CDC model were selected and 10 578 cases of pulmonary TB patients registered between January 2012 and December 2012 in the 20 districts were collected. The diagnosis was delayed and transferred Diagnosis and follow-up, system management, treatment outcome, data quality and other data, using SPSS 17.0 software analysis to explore the operation of the two modes. Results The registration rates of tuberculosis in fixed hospital and CDC models were 55.60 / 100,000 (4768/8 575 823) and 55.93 / 100 000 (5810/10 388 634, respectively, χ2 = 0.091, P = 0.763] The overall odds ratio [99.1% (4939/4985) and 99.2% (6064/6111), χ2 = 0.780, P = 0.3771] were tracked and the time from diagnosis to presentation [(0.021 ± 0.009) d and (P = 0.019), ± 0.010) d, t = 0.419, P> 0.05]. The rate of systemic management was 99.0% (5048/5097) and 98.7% (5645/5719, respectively, χ2 = Rate [96.6% (3182/3295) and 97.4% (3661/3760, respectively, χ2 = 3.82, P> 0.05] showed no significant difference. The average time from onset to diagnosis of TB patients in fixed-point hospital was (11.117 ± 6.109) d, which was significantly lower than that in CDC (15.399 ± 6.866) d (t = 12.42, P <0.001) The hospital and CDC patterns were 52.0% (2479/4768) and 33.8% (1966/5810, respectively, χ2 = 352.468, P <0.0001), with a referral rate of 99.1% (4941/4985) and 98.5% (99.6% (1320/1325) and 97.9% (1559/1593, respectively), χ2 = 16.993, P = 0.000 04] compared with the former (6017/6111), χ2 = 9.606, P = 0.0019] The difference was statistically significant. The fixed-point hospital model and CDC model, the new cure rate of smear [89.8% (1172/1305) and 94.7% (1293/1366, respectively, χ2 = 22.03, P <0.0001] , The rate of information entry was 98.9% (23 571/23 840) and 99.0% (28 773/29), respectively (P = 0.01) 050), χ2 = 4.088, P = 0.043] and complete rate [98.8% (28 272/28 608) and 99.4% (34 646/34 860, respectively, χ2 = 60.113, P <0.0001] , But are able to meet the relevant job requirements. Conclusion The implementation of fixed-point hospitals at county (district) level in Jiangsu Province is effective. The fixed-point hospital mode is an inevitable trend that meets the general direction of the reform of medical institutions in our country. It can adapt to the demand of TB prevention and control work that is constantly developing and can be steadily implemented according to local conditions.