河南省农村法定传染病报告社会干预试验效果评价

发布时间：2018-05-20 04:04

本文选题：法定传染病报告 + 效果评价　；参考：《郑州大学》2008年硕士论文

【摘要】：人类与传染病的斗争是一个永恒的课题。疾病谱由传染病转为心、脑血管疾病和恶性肿瘤,人们思想上开始忽略了传染病防治的重要性。近年来,由于全球化的加剧、交通和旅游业的发达、流动人口的增多、抗生素的滥用以及环境因素等方面的影响,病毒变异和传播的速度日益加快,导致已控制的传染病卷土重来,新发传染病不断出现。传染病加重了人们疾病的负担,在占世界人口约85%的发展中国家,传染病是一个严重的公共卫生问题。传染病疫情报告是传染病管理工作的重要内容,全面、及时、准确的疫情报告是防止疫情蔓延的信息来源,而信息对于传染病的预防和控制起着非常重要的作用。国外大多采用国家电子疾病监测报告系统,提高疫情报告的质量。在我国,SARS疫情暴露了我国疫情报告系统“不完整、不准确、不及时”的严重缺陷。2003年我国政府投入30亿元加强法定传染病信息系统建设,2004年4月,全国建立起了法定传染病网络直报系统。该系统的启用,使得我国传染病疫情报告工作发生了质的飞跃,传染病疫情报告质量有所提高,报告及时率得到很大改善。目前,我国采用的网络直报信息系统,虽然提高了信息的传递速度,但是仍然解决不了信息源头数据质量低下的问题。网络直报在农村已经逐渐延伸到乡级,村级仍沿用传统媒介传递疫情。我国是个农业大国,农村人口占全国总人口的70%,农村居民66%的门诊在村卫生室,16%门诊在乡镇卫生院。农村卫生条件差,容易滋生和传播传染病,从2005年11月16日至2006年7月,我国共报告人感染高致病性禽流感19例,除2例为城镇居民外,其余病例均为农民或在农村生活的儿童。因此,提高农村法定传染病报告质量并利用科学、准确的方法对法定传染病报告的信息质量进行评价,成为当务之急。目的本研究为河南省世行贷款/国外赠款中国传染性非典型性肺炎及其它传染病应对项目的子课题(河南省农村法定传染病报告信息传递机制研究)内容之一,旨在明确河南省农村基层法定传染病报告社会试验的干预措施以及效果,做好课题的进一步推广,并为政府决策者制定比较完善的方针政策提供科学依据,完善河南省农村法定传染病报告的信息传递机制。方法 1.研究对象:河南省的嵩县和宜阳为本研究的2个样本县,研究对象包括其中的4个试验乡镇和4个对照乡镇共8个乡镇的所有疫情责任报告人,即乡村医生和乡镇卫生院的医务人员,共305人。试验组和对照组在2005年11月1日至2006年3月31日期间的法定传染病报告情况,包括:医生填写报告卡片的完整性与准确性、网络直报系统中的传染病重卡情况以及传染病疫情的报告率与报告及时性等。 2.研究方法:采用多阶段分层整群抽样和单纯随机抽样的方法确定样本乡镇,然后按随机、均衡的原则把样本乡镇分到试验组和对照组;运用定性研究和定量研究相结合的方法对干预试验的效果进行评价。 3.调查内容:人员调查包括:调查对象的一般情况,法定传染病诊断和法定传染病报告的基本知识,法定传染病报告程序,传染病报告培训,传染病报告督导和检查,传染病报告制度及执行情况,传染病报告的管理情况等。法定传染病疫情报告调查包括:试验组和对照组的2005年11月至2006年3月间法定传染病报告的疫情数据和信息,包括医生填写报告卡片的完整性与准确性、网络直报系统中的传染病重卡情况以及传染病疫情的报告率与报告及时性等。 4.数据的统计学处理:Epidata录入数据,Excel和SPSS12.0软件进行数据的分析。结果 1.经过干预后,试验组的调查对象在传染病报告5个方面,即法定传染病分类、传染病诊断、报告卡填写、报告时限、报告方式的知晓率均高于对照组,分别高出了37.41%、54.18%、30.31%、27.86%、13.40%。 2.经Logistic回归分析显示,干预措施是提高法定传染病报告相关知识知晓率的主要影响因素。 3.在干预阶段,试验乡镇的报告发病率为1.89‰,对照乡镇的报告发病率为1.46‰;试验乡镇在上一年同一时期的报告发病率为1.18‰。 4.试验乡镇与对照乡镇相比,报告卡质量提高了11.25%;重报率和漏报率分别降低了30.86%和56.33%,报告及时率提高了36.12%,以上指标两组之间的差异有统计学意义(P＜0.05)。 5.法定传染病疫情报告信息质量综合指数,试验乡镇高于对照乡镇。结论课题组采取的干预措施科学、合理、有效,可进一步推广。首先,法定传染病诊断知识的培训、基本报告工具的配备和报告方式、时间、程序的显著增加了疫情责任报告人报告法定传染病的能力,提高了法定传染病的报告发病率;其次,医务人员报告知识和网络直报人员网络直报知识的培训,提高了传染病报告卡填写的质量,缩短了诊断至填卡、填卡至报告和报告至审核的时间,降低了重复报告率;法定传染病报告法律、法规的宣传,督导制度、奖惩制度的制定和实施,减少了各个环节的漏报率。为了进一步提高农村法定传染病报告的信息质量,根据干预措施实施提出以下政策建议:加大传染病报告的监督执法力度;、建立健全法定传染病报告的激励机制;广泛采取多种培训方式,加强对基层医务人员的在职培训,特别要加强对广大乡村医生的培训力度。
[Abstract]:The struggle between human and infectious diseases is an eternal subject. The disease spectrum is transformed from infectious disease to heart, cerebrovascular disease and malignant tumor. People have neglected the importance of the prevention and control of infectious diseases. In recent years, due to the intensification of globalization, the development of transportation and tourism, the increase of the mouth of the mobile people, the abuse of antibiotics and the environmental factors. The influence of the virus, the speed of virus variation and transmission is accelerating, which leads to the reemergence of controlled infectious diseases and the emergence of new infectious diseases. Infectious diseases aggravate the burden of people's disease. In the developing countries, which account for about 85% of the world's population, infectious diseases are a serious public health problem.
Infectious disease report is an important content of the management of infectious diseases. Comprehensive, timely and accurate epidemic report is the information source to prevent the spread of the epidemic, and information plays a very important role in the prevention and control of infectious diseases. Most of the foreign countries use the national electronic disease monitoring report system to improve the quality of the epidemic report. In China, SAR The epidemic report system of S has exposed the serious defect of "incomplete, inaccurate, and not timely" in China's epidemic reporting system. In the year.2003, our government invested 3 billion yuan to strengthen the construction of the legal infectious disease information system. In April 2004, the national network direct reporting system of the legal infectious disease was established. The system has enabled the reporting work of infectious diseases in China to take place. The quality of reporting of infectious diseases has improved and the reporting rate has been greatly improved.
At present, the network direct information system adopted in China has improved the speed of information transmission, but it still can not solve the problem of low quality of information source data. The network direct report has gradually extended to the rural level in the countryside. The village level still uses the traditional media to transmit the epidemic situation. China is a big agricultural country, and the rural population accounts for 70% of the total population of the country. 66% of the rural residents were in the village health room and the 16% outpatients were in the township health centers. The rural health conditions were poor, and the infectious diseases were easy to grow and spread. From November 16, 2005 to July 2006, 19 cases of highly pathogenic avian influenza were reported in China. Except for 2 cases of urban residents, the other cases were all farmers or children living in the countryside. It is urgent to assess the quality of notifiable infectious diseases in rural areas and to evaluate the information quality of legal infectious diseases reports scientifically and accurately.
objective
This study is one of the sub subjects of the Henan provincial bank loan / foreign grant for infectious atypical pneumonia and other infectious diseases (the research on the information transmission mechanism of the report of the rural notifiable infectious diseases in Henan province). The purpose of this study is to clarify the intervention measures and effects of the social test of the rural grass-roots legal infectious diseases in Henan Province, and to do a good lesson. Further promotion of the problem, and provide scientific basis for the government policy makers to formulate more perfect policies and policies, and improve the information transmission mechanism of the report of the rural legal infectious diseases in Henan province.
Method
1. research subjects: Songxian and Yiyang in Henan province were 2 sample counties of this study. The subjects included all of the 4 pilot towns and 4 control towns and 8 townships in all 8 villages and towns, namely, the rural doctors and the medical staff of the township hospitals, with 305 people. The test group and the control group were from November 1, 2005 to March 2006 31. The reporting of notifiable infectious diseases included: the integrity and accuracy of the doctor to fill in the report card, the situation of the infectious disease heavy card in the network direct reporting system, the reporting rate and the timeliness of the epidemic situation.
2. research method: the sample towns were determined by multi-stage stratified cluster sampling and simple random sampling, then the sample towns were divided into the experimental group and the control group according to the principle of random and equilibrium, and the effect of the intervention test was evaluated by the combination of qualitative and quantitative research.
3. investigation content: the survey included the general situation of the subject, the basic knowledge of the diagnosis of the legal contagion and the report of the notifiable infectious disease, the procedure of the report of the legal communicable disease, the training of the infectious disease report, the supervision and examination of the report of the infectious disease, the system and execution of the infectious disease report, the management of the infectious disease report, and so on. The investigation included the data and information of the report of the notifiable infectious disease between the test group and the control group from November 2005 to March 2006, including the integrity and accuracy of the doctors filling in the report cards, the situation of the infectious disease heavy cards in the network direct reporting system, the reporting rate and the timeliness of the epidemic situation.
4. statistical processing of data: Epidata input data, Excel and SPSS12.0 software for data analysis.
Result
1. after the dry prognosis, the subjects of the test group were in 5 aspects of the report of infectious diseases, namely, the classification of the notifiable infectious diseases, the diagnosis of infectious diseases, the filling of the report cards, the time limit of the report, and the rate of awareness of the reporting methods higher than those of the control group, which were 37.41%, 54.18%, 30.31%, 27.86%, 13.40% respectively.
2. Logistic regression analysis showed that intervention measures were the main factors to increase the awareness rate of notifiable infectious diseases related knowledge.
3. in the intervention stage, the reported incidence of the test township was 1.89 per thousand, the reported incidence of the control township was 1.46 per thousand, and the reported incidence of the test Township in the same period of last year was 1.18 per thousand.
4. compared with the control Township, the quality of the report card was increased by 11.25%, the rate of rereporting and the rate of missing report were reduced by 30.86% and 56.33% respectively. The timely rate of the report was increased by 36.12%, and the difference between the two groups was statistically significant (P < 0.05).
5. the comprehensive index of the information quality of the epidemic report of legal infectious diseases is higher than that of the control villages and towns.
conclusion
The intervention measures taken by the group are scientific, reasonable and effective, and can be further promoted. First, the training of the diagnostic knowledge of the legal infectious diseases, the allocation and reporting of the basic reporting tools, the time and the procedure have significantly increased the ability of the reporting person to report the legal infectious disease, and increased the incidence of the reporting of the legal infectious diseases; secondly, the medical workers. Staff report knowledge and network direct report personnel training of direct information network, improve the quality of the report card filling, shorten the diagnosis to the filling card, fill the card to report and report to the time, reduce the repetition rate; legal infectious disease report law, regulations, supervision system, the formulation and implementation of the reward and punishment system, reduced The rate of failure in each link.
In order to further improve the information quality of the report of the rural legal infectious diseases, the following policy suggestions are put forward according to the intervention measures: to strengthen the supervision and enforcement of the report of infectious diseases; to establish and improve the incentive mechanism for the report of the legal infectious diseases; to adopt a wide variety of training methods to strengthen the on-the-job training for the medical staff at the grass-roots level, and to strengthen the practice in particular. The training of the vast rural doctors.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R181.8

【参考文献】