滨州市法定传染病网络直报质量评价及影响因素研究

发布时间：2018-04-03 03:32

本文选题：法定传染病　切入点：报告质量　出处：《山东大学》2011年硕士论文

【摘要】：研究背景传染病早期报告和发现是及时、高效控制传染病暴发流行的关键。我国于上世纪50年代初建立了全国传染病疫情报告系统,最初报告传染病病种18种,报告系统以旬报告手工统计为运转管理模式。山东省滨州市1956年开始正式有法定传染病疫情资料登记,以辖区各医疗机构填报传染病报告卡至基层防保机构逐级审核上报为运转模式,至1996年滨州市实现与省、县两级电子邮件计算机联网,并先后经历DOS版、WINDOWS95版更迭,但医疗机构管理方式未见改变。 2003年"SARS"暴发,原有的疫情报告系统暴露出信息严重滞后、准确性差等缺点,不能反映出真正的疾病发生状况,已不能满足传染病防控快速反应积极应对的需要。2003年国家卫生部开始试行传染病网络直报,2004年1月1日国家法定传染病疫情报告系统《疾病监测信息报告管理系统》建成并正式启动,标志着我国对法定传染病疫情监测工作进入一个新的时期,迄今已运转七年,传染病疫情报告管理工作发生了质的飞跃,传染病发现-报告时间缩短,为迅速、高效处置传染病暴发流行打下坚实基础。网络直报系统的建立解决了传染病报告的硬件问题,但传染病报告的质量高低影响传染病直报系统的有效性。掌握和了解传染病报告的质量,可以发现传染病报告中存在的问题,明确质量管理的方向,分析探讨影响报告质量的因素,为网络直报系统高质高效的运转提供保证。研究目的 1.对2004-2009年滨州市法定传染病疫情报告质量进行评价,掌握全市传染病报告运行状况,进一步清晰今后质量管理的重点。 2.对可能影响报告质量的因素进行分析,探询其质量管理的薄弱环节,为采取有效措施提供依据。研究对象与方法 1.由《疾病监测信息报告系统》导出2004-2009年滨州市各级医疗机构报告的所有法定传染病个案报告卡片,剔除已删除卡、病原携带者卡片、诊断日期与录入日期有逻辑错误卡片。 2.数据的统计分析处理用Excel、SPSS 17.0进行。研究结果 1.网络直报系统运转情况： 2004年启动网络直报系统,当年滨州市网络直报覆盖率仅为85.26%(133/156),随着工作不断深入,覆盖率逐年上升至2006年达到100%(156/156)。2004-2009年网络直报单位类型以综合医院为主要报告单位,7年所占比例变化不大(62.53%-70.27%),但乡镇卫生院报告比例上升明显,由5.17%上升至9.24%；CDC也由0.50%上升至3.63%。2004年43家县及县以上医疗机构仅31家有传染病报告,113家乡镇卫生院仅有40家有报告；至2009年43家县及县以上、95家乡镇级网络直报单位均有传染病报告,且达到无零缺报标准；(即每月均有传染病报告),8家缺报(低于每月一张报告卡),2家零报。网络直报率由2004年45.51%上升至2009年92.62%。传染病报告已由最初直报系统建设阶段、维持系统运转阶段发展到系统高质量运转阶段。 2.传染病报告质量评价： 2004-2009年滨州市共报告法定传染病卡片38358张,未及时报告卡片7208张；未及时审核卡片439张,累计重卡238张,累计零缺报县区0个；未及时报告率为18.79%,未及时审核率为1.14%,传染病卡重复报告率为0.05%,县区零缺报率为0；综合指数率为4.98%。诊断---报告、报告---审核、诊断---审核三个时间间隔均值分别为0.21d(天,下同)、0.04d和0.25d,由此可见诊断—报告阶段为影响传染病报告过程主要阶段,该阶段是否及时决定了报告及时性的高低。 3.报告及时性影响因素：滨州市不同地区、不同级别报告单位、不同病种存在不平衡现象。无棣县、邹平县报告及时性较好,省级、地级医疗机构报告优于县乡级医疗机构,丙类传染病报告优于乙类传染病报告。疾控机构对医疗机构督导行为方式的改变通过态度-知识-行为方式影响报告及时性。研究结论及建议 1.滨州市网络直报运转质量逐年提高,但仍需加强使用率管理,发挥所有直报单位的监测职能。网络直报系统建立应发挥其最大的监测作用,应继续稳定网络直报单位人员队伍,加大培训力度,完善对直报单位的督导,形成医防衔接的工作模式,健全医疗机构传染病报告规章制度,保障其灵敏高效运转。 2.传染病报告质量关键取决于报告及时率,滨州市传染病报告存在不平衡现象。应对报告较差的县区及医疗机构重点督导,加大管理力度。按照《山东省疾控机构对医疗机构管理规范》要求,逐步规范医疗机构内部报告管理机制,杜绝不及时报告。
[Abstract]:Background of the study

The early report and discovery of infectious diseases is the key to timely and efficient control of the outbreak of infectious diseases . In China , 18 species of infectious diseases were first reported in China in the early 1950s .

In 2003 , the SARS outbreak , the original epidemic report system exposed the shortcomings of serious information lag , poor accuracy and so on , can not reflect the real disease occurrence condition , has not met the need of the epidemic prevention and control rapid response active response . In 2003 , the State Department of Health began trial implementation of the epidemic prevention and control rapid response . In 2003 , the State Department of Health started trial implementation of the infectious disease epidemic situation monitoring work into a new period , marked the country ' s disease epidemic situation monitoring work to enter a new period , the infectious disease discovery - reporting time shortened , and laid a solid foundation for the rapid and efficient disposal of infectious diseases outbreak .

The establishment of the network direct reporting system solves the hardware problem of infectious diseases report , but the quality of infectious disease report affects the effectiveness of the reporting system of infectious diseases . The quality of infectious diseases report can be grasped and understood , the problems existing in the report of infectious diseases can be found , the direction of quality management is clarified , the factors influencing the quality of report are analyzed , and the guarantee of high quality and efficient operation of the network direct reporting system is provided .

Purpose of study

1 . To evaluate the quality of notifiable infectious diseases reported in Binzhou from 2004 to 2009 , and to master the health situation of infectious disease report in the city , and to further clarify the emphasis of quality management in the future .

2 . Analyze the factors that may affect the quality of the report , inquire about the weak link of its quality management , and provide the basis for effective measures .

Research objects and methods

1 . The report card of all statutory infectious diseases reported by the medical institutions at all levels in Binzhou City from 2004 to 2009 shall be derived from the Reporting System for Disease Monitoring and Information Reporting System , and the card of deleted card , pathogen carrier card , date of diagnosis and date of entry shall be logically incorrect .

2 . Statistical analysis of data was performed with Excel and SPSS 17.0 .

Results of the study

1 . Operation of network direct reporting system :

In 2004 - 2009 , the coverage rate of network direct reporting was only 85.26 % ( 133 / 156 ) , and the coverage rate increased year by year to 100 % ( 156 / 156 ) .
The CDC also increased from 0.50 % to 3.63 % . Only 31 infectious diseases were reported in 43 hospitals in 43 counties and above counties in 2004 , and only 40 of 113 township hospitals had reports ;
From 43 counties and counties in 2009 , 95 township - level network direct reporting units have reported infectious diseases , and the standard of non - zero reporting is achieved ;
( i . e . infectious disease reports on a monthly basis ) , 8 missing reports ( less than a monthly report card ) and 2 zero reports . The rate of network reporting increased from 45.51 per cent in 2004 to 92.62 per cent in 2009 . The infectious disease report has been developed into a high - quality operating phase of the system from the initial direct reporting system construction phase .

2 . Quality evaluation of infectious disease report :

In 2004 - 2009 , 38358 legal infectious diseases cards were reported in Binzhou City , and 7208 cards were not reported in time ;
The card 439 has not been audited in a timely manner , the cumulative weight is 238 sheets , and the accumulated zero is reported to be 0 in the county area ;
The non - timely reporting rate was 18.79 % , the rate of non - timely review was 1.14 % , the rate of repeat reporting of infectious disease card was 0.05 % , and the rate of zero defect in county area was 0 ;
The comprehensive index rate was 4.98 % . The diagnosis - - report , report - - review , diagnosis - - the three time - interval mean values were 0.21 days ( days , below ) , 0.04 d , and 0.25 d , respectively , so that the diagnosis - reporting period was the main stage of the reporting process affecting the infectious disease , and whether the phase of the report was timely and timely determined the timeliness of the report .

3 . Factors affecting the timeliness of the report :

In different parts of Binzhou , there is imbalance in different levels of reporting units and different diseases . In Wudi County , Zhouping County reported good timeliness , provincial and prefecture - level medical institutions reported better than the county - level medical institutions , and the reports of Class C infectious diseases were better than those reported in Class B infectious diseases . The change of supervision behavior of medical institutions through attitude - knowledge - behavior mode influence the timeliness of reporting .

Study conclusions and recommendations

1 . The running quality of the network direct reporting system in Binzhou City is increased year by year , but it is still necessary to strengthen the usage management and play the monitoring function of all direct reporting units . The establishment of the network direct reporting system should give full play to the monitoring function of all direct reporting units . The network direct reporting system should continue to stabilize the network direct reporting unit personnel team , increase the training intensity , improve the supervision of the direct reporting unit , establish a medical anti - connection working mode , and improve the rules and regulations of the infectious diseases reporting of the medical institutions and ensure its sensitive and efficient operation .

2 . The key to the quality of infectious diseases report depends on the timely rate of the report , and there is an imbalance in the reporting of infectious diseases in Binzhou City . The county and the medical institutions with poor reporting should focus on supervision and management . In accordance with the requirements of the disease control institution in Shandong Province to regulate the management of medical institutions , the management mechanism of internal reporting of medical institutions shall be gradually regulated , and no timely report shall be reported .

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R181.81

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