基于人群的住院急性呼吸道感染和侵袭性肺炎球菌病监测质量评估

发布时间：2018-06-27 08:24

  本文选题：严重急性呼吸道感染(SARI) + 侵袭性肺炎球菌病(IPD)　； 参考：《中国疾病预防控制中心》2013年硕士论文

【摘要】：目的：旨在评价湖北省荆州市“基于人群的住院急性呼吸道感染(Severe Acute Respiratory Infection, SARI,以下同)和侵袭性肺炎球菌病(Invasive Pneumococcal Disease, IPD,以下同)监测”系统的特征(准确性、完整性及一致性),发现监测活动中的薄弱环节和与监测目标的差距,以期不断提高监测质量,进一步完善监测提供依据。 方法：参照世界卫生组织(WHO)和美国疾病预防控制中心(US CDC)疾病监测系统评估方法,依据本监测方案的要求,结合当地操作情况,采用现场督导与评估的方法,收集定量资料,得到监测系统的特征值,再与理想的评价值进行比较。辅助以过程评估方法,建立逻辑框架,选取投入指标(人力资源及资金保障)、过程指标(项目活动,即培训、督导)及产出指标(培训医务人员的数量及实施评价的次数)进行评价。收集荆州市四家监测医院2010年7月-2012年6月的监测数据,使用EPI DATA3.0和SPSS19.0统计软件进行分析。 结果：投入指标为：监测项目自2010年1月正式运行起,从建立到维持监测系统运行,共计花费九百万人民币(包括人员费用、实验室设备、试剂、培训、会议、差旅等)。前后共计十二家单位和部门,459人参与监测活动；制定SARIIPD监测方案1份：项目执行手册1份；数据录入与管理规定1份；呼吸道标本操作流程1份；呼吸道标本流感病毒实验室检测标准操作规范1份；临床标本的采集、运输、处理与分装、流感病毒的保存及管理和流感病毒的快速检测方法的标准操作程序1份；实验室耗材管理方案1份；项目督导评估方案1份。过程指标：国家级、省级现场考察、调研、协调会共计25次；SARIIPD监测方案修订版1份；产出指标：培训、督导类活动共计35次。培训医务人员共计690人次。SARIIPD工作简报24份；省级地市级定期工作总结20份；截至2012年9月30日,四家监测医院,共登记了25,438例病例,其中SARI病例25,319例、脑膜炎病例119例。总计检测24,340份鼻咽拭子,完成4,259份血培养,其中26份(0.6%)肺炎链球菌阳性。共开展尿抗原检测2,049份,其中88份(4.3%)肺炎链球菌阳性。通过不同时间对各监测医院的督导和评估,发现除儿童血标本采集率(11.97%)和尿标本采集率(64.62%)没有达到预先设定的监测方案评价标准外,其余指标均达到评价标准。在各监测医院之间各监测指标存在较大差异：①病例纳入准确率：最高的是妇幼保健院,准确率为99%,最低是第二人民医院,准确率为86%；②病例纳入的漏报率：最高的是中心医院,漏报率为19.86%,最低是妇幼保健院,漏报率为11.03%；③尿采集率：最高的是第一人民医院,采集率为87.86%,最低的是第二人民医院,采集率为72.94%；通过四次不同时间核心指标评价,结果显示：病例纳入的准确率由第一次的79.86%上升至第四次的100%；漏报率由第一次的23.33%下降至16.84%；鼻咽拭子标本采集率由第一次的95.99%上升至98.79%；成人血标本采集率由第一次的77.47%上升至第四次的94.57%；尿标本采集率由第一次的64.62%上升至83.17%。 结论：①本研究发现,通过所选取的评价指标可以密切关注监测活动的进展及变化。如实反应监测系统特征的完整性、一致性和准确性。②通过四次不同时间的评价,选定的七项核心中,病例纳入的准确性、鼻咽拭子、成人血标本和尿标本的采集率不断提升,监测质量得到明显的改善,但由于基于人群监测系统组织实施的复杂性,评价指标如病例的漏报率,并不稳定,且有一定的波动,监测质量还有待进一步提高。③评价工作可有助于明确差距及潜在项目运行的障碍,为相关利益者下一步计划提供依据。
[Abstract]:Objective : To evaluate the characteristics ( accuracy , completeness and consistency ) of monitoring system in Jingzhou city of Hubei Province based on population - based hospitalized acute respiratory tract infection ( SARS ) , and to find out the weak links in monitoring activities and the gap with monitoring target , with a view to continuously improving the monitoring quality and further improving the basis for monitoring .

Methods : According to the requirements of the World Health Organization ( WHO ) and the United States Centers for Disease Control and Prevention ( CDC ) disease surveillance system , according to the requirements of the monitoring plan , the method of site supervision and evaluation was adopted to collect quantitative data to obtain the characteristic values of the monitoring system , and then compared with the ideal evaluation value .

Results : The input indicators were : the monitoring items were formally run from January 2010 and were run from the establishment of the maintenance monitoring system to a total cost of 9 million RMB ( including personnel costs , laboratory equipment , reagents , training , meetings , travel , etc . ) . A total of 12 units and departments and 459 persons were involved in the monitoring activities .
Development of 1 part of the SARIAT monitoring programme : 1 copy of the project implementation manual ;
1 part of data entry and management ;
1 part of respiratory specimen operation flow ;
Standard operation specification for influenza virus laboratory in respiratory tract : 1 part ;
1 part of the standard operating procedures for the collection , transportation , treatment and packaging of clinical specimens , the preservation and management of influenza virus and the rapid detection method of influenza virus ;
1 part of laboratory consumable management scheme ;
1 . Project supervision evaluation scheme : 1 . Process indicators : national , provincial , field investigation , investigation and coordination for 25 times ;
Rev . 1 of the SARIAT Monitoring Protocol ;
Output indicators : 35 training and supervision activities , 690 person - times for training medical personnel .
The provincial prefecture - level regular work is summarized in 20 parts ;
As of September 30 , 2012 , there were 25,438 cases in four monitoring hospitals , including 25 , 319 cases of SARI and 119 cases of meningitis .
( 2 ) The incidence rate of the cases included : the highest is the central hospital , the leakage rate is 19.86 % , the lowest is the maternal and child health care center , the leakage rate is 11.03 % ;
( 3 ) urine collection rate : the highest is the first people ' s hospital , the collection rate is 87.86 % , the lowest is the second people ' s hospital , the collection rate is 72.94 % ;
The results showed that the accuracy of cases was increased from 79.86 % for the first time to the fourth 100 % .
The leakage rate decreased from 23.33 % to 16.84 % in the first time .
The collection rate of nasopharyngeal swab specimens increased from 95.99 % to 98.79 % for the first time .
The collection rate of adult blood samples increased from 77.47 % for the first time to 94.57 % in the fourth time .
The rate of urine collection increased from 64.62 % to 83.17 % for the first time .

Conclusion : 鈶，

本文编号：2073298