勐腊县医疗机构症状监测系统的建立及数据报告质量影响因素研究

发布时间：2018-05-19 04:19

本文选题：症状监测 + 数据质量　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[背景]云南传染病具有疾病谱广、发病率高、危害严重、控制困难的特点。云南省西南部与缅甸、老挝、越南三国相邻,经贸往来频繁,存在传染病跨境传播、引发突发公共卫生事件的风险。为提高云南边境地区传染病暴发或流行的早期预警能力,云南省疾病预防与控制协同创新中心创建了“云南省边境地区症状监测预警防控体系开发与应用”项目。[目的]1.描述勐腊县医疗机构“云南边境地区症状监测预警防控体系”的建立过程;2.评价2016年勐腊县医疗机构监测点“云南边境地区症状监测系统平台”搜集的数据质量;3.找出影响数据质量的相关因素,提升数据质量,为及时准确预警提供数据支持。[方法]通过专家咨询法,选定监测地点,确定症状监测系统的目标疾病与目标症状,并建立了云南边境地区症状监测数据收集平台。采用整群抽样和目的抽样的方法在勐腊县抽取80家医疗机构作为监测点,连续一年收集患者主诉症状并进行质量控制,报告至云南边境地区症状监测数据收集平台。从不同级别医疗机构及时间序列方面描述数据,从完整性、及时性、准确性方面评估数据质量;采用自行设计的调查表对数据收集者开展数据质量影响因素的调查。[结果]选定勐腊县作为监测地点,确定16种目标疾病与14种目标症状作为监测对象。从整体来看,系统平台共收集到监测症状患者记录数227007条,其中及时报告数204228条,达89.96%;零报数2401条,占1.06%;迟报数20378条,占8.98%。从机构级别来看,县级医疗机构数据报告质量优于乡镇卫生院,乡镇卫生院报告质量显著优于村卫生室。其中县级监测点完整性为98.59%,及时报告天数比率96.91%,及时报告例数比率97.95%,准确率93.33%;乡镇监测点完整性为97.43%,及时报告天数比率95.32%,及时报告例数比率96.98%,准确率89.67%;村级监测点完整性为54.70%,及时报告天数比率64.36%,及时报告例数比率78.02%,准确率87.25%;而在时间序列的分布上,监测点数据报告质量随着时间推移逐步提高并逐渐稳定,且每次督导过后数据完整性、及时性均升高。影响报告数据完整性的因素包括单位级别、日均门诊量,影响数据及时性的因素包括日均门诊量,报告员学历、日均报告例数与每个单位参加症状监测的人数。[结论]:从系统1年的运行情况来看,在云南边境地区医疗机构中建立症状监测系统是可行的。县乡医疗机构报告的数据质量在完整性、及时性和准确性方面均达到较高水平,而村卫生室存在的问题较多。提高数据质量,需要加强对村卫生室的管理,根据需要根据影响因素做出相应调整,并加强督导力度。
[Abstract]:Background: Yunnan infectious diseases have the characteristics of wide disease spectrum, high incidence, serious harm and difficult control. The southwest of Yunnan Province is adjacent to Burma, Laos and Vietnam, with frequent economic and trade exchanges, and there is a risk of cross-border spread of infectious diseases, which may trigger public health emergencies. In order to improve the ability of early warning of infectious disease outbreak or epidemic in Yunnan border area, Yunnan Provincial Cooperative Innovation Center for Disease Prevention and Control has established the project "Development and Application of symptom Monitoring, early warning and Control system in Yunnan Border area". [objective] 1. This paper describes the establishment process of Yunnan border area symptom monitoring, warning, prevention and control system for medical institutions in Mengla County. Evaluation of the 2016 Mengla County medical institutions monitoring point "Yunnan Border area symptom Monitoring system platform" collected data quality. Find out the relevant factors that affect the data quality, improve the data quality, and provide data support for timely and accurate early warning. [methods] the target disease and the target symptom of the symptom monitoring system were determined by the method of expert consultation, and the data collection platform of symptom monitoring in Yunnan border area was established. Cluster sampling and objective sampling were used to select 80 medical institutions in Mengla County as monitoring points. The main symptoms of patients were collected and quality control was carried out for one consecutive year, which was reported to the data collection platform of symptom monitoring in Yunnan border area. It describes the data from different levels of medical institutions and time series, evaluates the data quality from the aspects of completeness, timeliness and accuracy, and carries out a survey of the factors affecting the data quality of the data collectors by using a self-designed questionnaire. [results] Mengla County was selected as surveillance site, 16 target diseases and 14 target symptoms were selected as surveillance objects. As a whole, the system platform collected a total of 227007 records of patients monitoring symptoms, including 204228 reports in time, up to 89.96; 2401 reports in zero, accounting for 1.06; 20378 late reports, 8.98. From the level of organization, the data reporting quality of county-level medical institutions was better than that of township health centers, and the quality of township health centers was significantly better than that of village clinics. The integrity of county level monitoring points is 98.59, the rate of timely reporting days is 96.91, the timely reporting rate is 97.95 and the accuracy rate is 93.33; the integrity of township monitoring points is 97.43; the rate of timely reporting days is 95.32; the timely reporting number ratio is 96.98; the accuracy rate is 89.67; The integrity of the point is 54.70, the ratio of the number of days reported in time is 64.36, the ratio of the number of cases reported in time is 78.02, the accuracy rate is 87.25; but in the distribution of the time series, The quality of monitoring data report is improved and stabilized with time, and the data integrity and timeliness are improved after each supervision. The factors affecting the integrity of the report data include the unit level, the daily average number of outpatients, the factors affecting the timeliness of the data, including the daily average number of outpatients, the degree of the rapporteur, the number of daily reports and the number of patients participating in the symptom monitoring in each unit. Conclusion: it is feasible to establish the symptom monitoring system in the medical institutions of Yunnan border area from the operation of the system for one year. The quality of data reported by county and township medical institutions reached a higher level in terms of completeness, timeliness and accuracy, while there were more problems in village clinics. To improve the data quality, we should strengthen the management of village clinics, adjust according to the influence factors, and strengthen the supervision.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R181.8

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