2015年医疗机构法定传染病信息报告质量综合评价及影响因素分析

发布时间：2018-08-25 15:03

【摘要】：背景法定传染病网络直报工作中,医疗机构是传染病报告的主体对象,临床医护人员是传染病报告的主体责任人,其报告病例的信息质量是掌握传染病真实发病趋势、追踪病人及疫情决策的重要依据,是传染病监测的生命线。鉴于此,本研究选择医疗机构作为研究对象,利用2015年全国法定传染病报告质量调查数据做进一步研究分析,为传染病报告管理和评价工作提供参考。目的掌握2015年我国医疗机构法定染病网络直报现状,评价不同地区、不同病例来源和不同级别法定传染病信息报告质量,分析当前医疗条件下影响传染病信息报告质量的因素,为法定传染病科学管理、科学决策提供参考和依据。方法描述性分析全国2015年医疗机构传染病信息报告质量及管理现状,对报告率等指标的比较采用χ2检验;采用TOPSIS法综合评价不同病例来源、不同地区、不同级别及116家医疗机构信息报告质量,以报告率等5指标、TOPSIS综合评价质量结果和病例报告状态作为因变量构建二分类logistic回归模型,探讨现有医疗资源条件下影响医疗机构法定传染病信息报告质量的因素。结果2015年各级医疗机构法定传染病报告率、及时率、完整率、准确率和一致率依次为 95.10%(1865/1961)、90.83%(1694/1865)、89.12%(1662/1865)、69.01%(1147/1662)和83.54%(1558/1865)。门诊日志的报告率高于出入院报告率(X2=34.25,p0.0001),不同地区间及时报告率(χ2=8.32,P=0.02)、完整率(χ2=11.58,P=0.003)、准确率(χ2=77.10,P0.0001)和一致率(χ2=21.49,P0.0001)均有统计学差异;不同级别医疗机构的法定传染病报告率(χ2=38.70,P0.0001)、及时率(χ2= 26.64,P0.001)、完整率(χ2=22.64,P0.0001)和准确率(χ2=53.92,P0.0001)均有统计学差异。以TOPSIS建模,传染病报告质量综合评价结果为中部地区最好、西部最差;不同级别医疗机构信息报告综合质量乡镇级优于县区级,县区级优于地市级,地市级优于省级;门诊和出入院登记的信息报告综合质量一致。logistic回归分析显示,单一评价指标中,医疗机构传染病漏报与传染病自查有无领导参与有关,及时性与出入院登记是否齐全规范有关,一致性与地区有关,完整性与出入院登记是否规范齐全、有无打印传报卡功能有关,准确性与单位级别、出入院日志填写是否规范齐全、传染病直报管理人员总数有关。传染病报告TOPSIS综合质量与地区、单位级别、出入院是否齐全规范及专职传报管理人员4个因素有关。以病例报告状态构建logistic回归分析模型显示:1、漏报与单位级别有关;2、报告及时性与地区、单位级别、门诊日志设置是否齐全、出入院登记设置是否齐全和是否具备自动打印电子传报卡有关;3、完整性与地区、单位级别、门诊日志填写是否规范、出入院设置是否齐全、传染病自查时分管领导是否参与有关、网络直报管理人员总数有关及专用计算机使用年限有关;4、一致性与地区、单位级别、门诊日志填写是否规范、出入院设置是否齐全、针对自查是否及时整改、网络直报管理人员总数、打印纸质报告卡是否有首诊医生签名及所辖CDC用户信息安全培训有关;5、准确性与单位级别有关。结论根据卫生事业发展规划目标,2015年我国法定传染病报告率达到95%的规划目标,及时率达到90%的规划目标,准确率、完整率和一致率仍需要提高。TOPSIS法弥补单一指标评价不能解决的复杂问题,其结果直观、综合,但在反映单一侧面特性时需结合单指标评价方法更能说明问题。医疗机构应在传染病自查时分管领导参与、门诊和出入院日志登记设置齐全和规范填写、传染病网络直报管理人员配置、针对自查发现问题及时整改、电子病历具备打印传染病报告卡功能和打印纸质传报卡有首诊医师签名、专用计算机使用年限、网络信息安全培训等方面加强内控管理,以期进一步提升传染病报告质量。
[Abstract]:BACKGROUND In the network direct reporting of notifiable infectious diseases, medical institutions are the main objects of infectious disease reports, and clinical medical staff are the main responsible persons of infectious disease reports. The information quality of reported cases is an important basis for mastering the true incidence trend of infectious diseases, tracking patients and making decisions on epidemic situation, and is the lifeline of infectious disease monitoring. Objective To understand the current situation of network direct reporting of legal infectious diseases in medical institutions in China in 2015 and to evaluate the sources and levels of different cases in different regions and regions. The quality of notifiable infectious diseases information report was analyzed, and the factors affecting the quality of notifiable infectious diseases information report under current medical conditions were analyzed to provide reference and basis for scientific management and decision-making of notifiable infectious diseases. TOPSIS method was used to evaluate the quality of information reports of different cases, different regions, different levels and 116 medical institutions. The results of TOPSIS comprehensive evaluation and the status of case reports were used as dependent variables to construct a binary logistic regression model to explore the impact of existing medical resources on the quality of medical institutions. Results In 2015, the reporting rate of notifiable infectious diseases, timely rate, complete rate, accuracy rate and consistency rate were 95.10% (1865/1961), 90.83% (1694/1865), 89.12% (1662/1865), 69.01% (1147/1662) and 83.54% (1558/1865) respectively. The reporting rate of out-patient journal was higher than that of out-patient Journal (X2 = 34.25, p0). (9672 = 8.32, P = 0.02), completeness rate (962 = 11.58, P = 0.003), accuracy rate (962 = 77.10, P 0.0001) and consistency rate (962 = 21.49, P 0.0001) were statistically significant differences among different regions (962 = 21.49), timely reporting rate (962 = 38.70, P = 0.0001), timely rate (962 = 26.64, P = 0.001), completeness rate (962 = 77.10, P = 77.10, P 0.0001) and consistenrate (962 = 21.49, P 0.000 1) were statistically significant differences among medical institutions of different levels (962 = 38.70 = 38.70, P = 38.70, P = 38.In the meantime, it is necessary to study the relationship between the two. The TOPSIS model showed that the comprehensive evaluation results of infectious disease report quality were the best in the central region and the worst in the western region; the comprehensive quality of information report in different levels of medical institutions was better at the township level than at the county level; the county level was better than the prefecture level; the prefecture level was better than the provincial level; the outpatient and discharge registration information report was better at the township level; and the county level was better than the provincial level. Logistic regression analysis showed that the missing report of infectious diseases in medical institutions was related to the participation of leaders in the self-examination of infectious diseases, the timeliness of admission and discharge registration, the consistency of admission and discharge registration, the completeness of admission and discharge registration, and the function of printing report card. It is related to the unit level, whether the entry and exit logs are complete or not, and the total number of managers who report infectious diseases directly. Unit level related; 2, report timeliness and area, unit level, outpatient log settings are complete, whether the registration settings are complete and whether the automatic printing of electronic telex card is relevant; 3, integrity and region, unit level, whether the outpatient log filling is standardized, whether the discharge settings are complete, infectious disease self-examination in charge of leadership is Whether or not to participate in the relevant, the total number of network management personnel and dedicated computer related to the number of years of use; 4, consistency with the region, unit level, out-patient log filling is standardized, discharges and discharge settings are complete, for self-examination whether timely rectification, network management personnel, printing paper report card whether the first doctor's signature and Conclusion According to the planning target of the development of health undertakings, the reporting rate of notifiable infectious diseases in China will reach 95% in 2015 and 90% in time. The accuracy, completeness and consistency still need to be improved. The results are intuitive and comprehensive, but the evaluation method of single index should be combined when reflecting the characteristics of a single side. Medical institutions should take charge of leadership participation in the self-examination of infectious diseases, complete and standardized registration of outpatient and discharging diaries, allocate administrators for direct reporting of infectious diseases through network, and ask for self-examination findings. In order to further improve the quality of infectious disease report, the electronic medical record has the functions of printing infectious disease report card, printing paper report card with the signature of the first doctor, the use of special computer, network information security training and other aspects of strengthening internal control management.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R181.8

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