关键词: 结核,肺, 卫生服务使用研究, 卫生保健质量, 获取和评价, 对比研究, 数据说明,统计

Abstract:

Objective To provide reference for improving the construction of new type of tuberculosis (TB) control and prevention service system by comparing the working quality before and after reformation in Hunan Province. Methods A total of 131 counties/districts in 14 cities/states of Hu’nan Province before and after reformation were selected, 15 indexes such as the registration rate of tuberculosis, clinic visit rate due to symptoms and so on were collected from “China Information System for Disease Control and Prevention” to describe and compare case detection, referral and diagnosis, laboratory examination, treatment and management of TB patients in Hunan Province before (2014-2016), during (2017-2018) and after (2019) reformation. Chi-square test was used to analyze the differences before and after reformation by SPSS 17.0, P<0.05 was considered statistically significant. Results Before reformation, the rate of smear-positive PTB patients in active PTB patients, clinic visit rate due to symptoms, pathogenic positive rate, the drug resistance screening rate in high-risk population, exclusion rate of suspected patients after confirming, treatment enrolled rate of rifampicin-resistant patients were 38.47% (62759/163147), 38.44% (62782/163330), 39.00% (62759/160938), 40.95% (3919/9570), 54.47% (97246/178526) and 55.96% (906/1619), respectively. And those indexes were 45.33% (24680/54449), 22.21% (12114/54543), 46.44% (24680/53144), 78.45% (2341/2984), 44.63% (31161/69813), 64.55% (477/739), respectively after reformation. The work quality of those indexes were significantly improved after reformation (χ²=524.584, P=0.000; χ²=3395.102, P=0.000; χ²=604.545, P=0.000; χ²=897.304, P=0.000; χ²=1123.304, P=0.000; χ²=9.739, P=0.002). Before reformation, the registration rate of tuberculosis,rate of sputum test in initial patients, rate of non-sputum test in active PTB patients at the end of 2 or 3 months, cure rate of new smear-positive TB patients, sputum negative conversion rate after 2- or 3-month treatment in smear-positive PTB patients were 80.84/100000 (163330/202032200), 94.74% (536808/566601), 1.64% (1033/62805), 92.35% (58511/63357) and 98.11% (61620/62805), respectively; and those indexes were 79.06/100000 (54543/68987700), 92.60%(161429/174329), 4.36% (863/19776), 87.17% (15519/17803) and 95.16% (18819/19776), respectively after reformation. The working quality of those indexes were significantly declined after reformation (χ²=7.718, P=0.005; χ²=75.790, P=0.000; χ²=26.658, P=0.000; χ²=287.790, P=0.000; χ²=59.985, P=0.000). Conclusion Part of the working quality has been steadily improved after reformation, however, we should pay attention to those declined indexes, such as the registration rate of tuberculosis, the rate of sputum examination in initial patients and so on.

Key words: Tuberculosis,pulmonary, Marketing of health services, Health care quality, Access and evaluation, Comparative study, Data interpretation,statistical