Evaluation On Laboratory Testing Capacity Of Disease Prevention And Control Institutions In China

1.Study SignificancesLaboratory testing is the basis of the disease prevention and control work; it requires rigorous and scientific coherence. Laboratory test results are essential to the process of law enforcement; it protects human health by its accurate, scientific, and fair test data, and safeguards the interests of the country, society and the masses as well.Evaluation on laboratory testing can be effective in promoting the level of research and laboratory management, raise the capacity of preventing and curing diseases, provide stronger technical support for public health emergency response disposal, and promote laboratory testing capabilities across the board.Two points can be seen from the current study on the assess progress of laboratory testing: First, the evaluation is lack of a uniform standard, and some experts do not even use any standard; second is there have been few evaluations on laboratory testing capacity of the disease prevention and control institutions up to now. What's more, most of the evaluations just focus on local region, not comprehensive and broad enough.Accordingly, this study conducts a systematic assessment on nationwide sample of the disease prevention and control institutions' laboratory testing capacity depending on the relatively authoritative standard made by the Ministry of Health and the State Development and Reform Commission in July 2004.2.Study Objectives and ContentsThe objective of this study is to judge the construction of laboratory testing capacity of the disease prevention and control institutions, point out the progresses, make clear the obstacles, shortcomings and the gap between the standards and the current status, and make directions for future construction.The objective upwards can be divided into 6 aspects of contents:a.The establishment of the dimensions and indexes of the evaluationb.The status of laboratory testing capabilities in the disease prevention and control institutions in 2005c.The 3-year construction of laboratory testing capacity in the disease prevention and control institutionsd.The status and trend analysis of lab test items carrying oute.Analyze the obstacles of laboratory testing capacity construction in the disease prevention and control institutionsf.Analyze the influencing factor and impact of laboratory testing capacity in the disease prevention and control institutions3.Research methods and Data SourcesIn this study, "macro model of the health system" and the "structure - the process - the result model" are used to design the evaluative index system as a guiding research methods; "trend analysis" is used to judge the construction of laboratory testing capacity of disease prevention and control institutions, the standard of variables are made clear by reading government documents and experts consultation; "gap analysis" is used to compare the standards with the current status; many statistical methods such as principal component analysis, correlation and regression are used to analyze the influencing factor and impact of laboratory testing capacity.Sampling methods is general investigation at province-level and system random sampling survey at city-level and county-level. The sampling areas include 133 city's regions (16.5%) and 458 county's regions (40%).The leader and the experts of disease prevention and control institutions at all levels are investigated in this study.4.Main study results(1) The establishment of the dimensions and indexes of the evaluationThrough macro model of the health system, expert consultation, we establish the evaluative dimensions of laboratory tests capabilities of the disease prevention and control institutions, including the structure (manpower resource; work place); the process(the status of lab testing work carrying out) and the outcome(the emergency response capabilities; the degree of public functions carrying out). Further more, representative indexes are chosen from all evaluative dimensions through expert consultation, and form the evaluative index system.(2)The status of laboratory testing capabilities of the disease prevention and control institutions in 2005a. The quality of lab testing manpower resource is relatively higher.There are 68 lab testing personnel per institution at province-level; while 23 at city-level and 8 at county-level. Comparing with other personnel in CDC, people working in the lab are relatively high-educated, especially at province-level, whom have obvious advantages to others in the technical title as well.b. Lack of laboratory areaUp to 2005 the average lab area has reached more than 9000m~2 at province-level, while less than 1000m~2 at county-level. The proportion of laboratory area to total area is 30.7% at province-level, 28.8% at city-level and 24.5% at county-level, but there is still a certain distance from the recommended standards made by the Ministry of Health in 2003.c. Basic test items (A test items) are carried out betterIn 2005, 327(75.5% of total) test items are carrying out per institution at province-level; while 168(46.7% of total) at city-level and 81 (45.3% of total) at county-level. The basic test items are carried out relatively better, the proportion of carrying out reaches 78.0% at province-level; 58.3% at city-level and 52.6% at county-level, which also reflects the nation's attention on the construction of basic test items.In addition, institutions with higher proportion of service revenue are proved to carry out more test items. Take basic test items for example, institutions with the highest proportion of service revenue carry out as high as 94.1% items, while the ratio is 76.3% in the institutions with the lowest proportion.Further more, it is found that the equity of laboratory testing capacity is best at province-level, and relatively not so well at city-level and county-level, which suggests that institutions at city-level and county-level should be paid more attentions in future.(3) The 3-year construction of laboratory testing capacity of the disease prevention and control institutionsa. The improvement of lab testing manpower in both quantity and qualityDuring three years, the number of lab testing personnel has increased 319, including 93 at province-level, 165 at city-level and 61 at county-level; from the area, 176 in the east, 128 in the middle and 15 in the west.The quality of manpower includes three aspects: education, the technical title and the overall quality index. In the three years, new lab testing staff are highly educated than the existing and the outflow of staff. Overall quality index is the same. Only the technical title of new staff is relatively lower, because of the no title of fresh graduates.b. Lab is becoming more rational and perfectDuring three years, the lab area of the disease prevention and control institutions has increased a lot at all levels and all districts: 57.7% at province-level, 43.1% at city-level and 29.9% at county-level. This growth trend narrows the gap among all levels. The proportion of laboratory area to total area has risen as well since three years: 15.8% at county-level and 10% at city-level.c. Obviously improvement in lab testing capacity, not in the equity.The lab testing capacity has raised a lot at all levels and all regions, the characters of which are as follows:Improvement in lab testing capacity has been made at all levels and all regions, city regions' lab testing capacity has raised fastest (8.4%), while province regions' has raised relatively slow (4.9%).Basic test items able to carry out have increased as well, but the increase rate is slower than un-basic test items (B test items): 4.3% at province-level, 6.6% at city-level and 4.9% at county-level. It reflects that CDC paid more attention on the construction of un-basic test items last 3 years.No obvious changes have been made in the equity of lab testing capacity since 3-year construction. The equity at province-level is best, and it's worst at county-level. Because of the local financial impact, the investment to CDC at city-level and county-level is much less than which at province-level, so they should be paid more attentions in future. Further more, from the test items, paid services items improved much quicker than disease control ones, which means that the investment mechanism that paid services is preferred because of the lack of the government input influenced lab testing a lot.(4) The status and trend analysis of lab test items carrying outComparing with the rate of test items carrying out in all the institutions 3 years ago, 194 ones rise, while 31 ones decline at province-level. Further more, pathogenic microorganism inspection items; conventional epidemic control items such as measles, rubella, meningitis B; animal-borne diseases such as leptospirosis disease and parasitic diseases; disinfection testing items; physical and chemical detection and occupational health items have made marked progress.At city-level, 73 items' rate rise with statistical significance: physical and chemical detection items, occupational health items testing pathogenic microorganisms items such as meningitis B, measles, rabies, hepatitis, schistosomiasis have risen markedly. At county-level, 87 items' rate rise with statistical significance.Analyze the reason of the decline rate of some items during three years: some ones are due to the currently ambiguous overlapping functions, such as radiation detection item; some ones are because of the drop in demand, such as the lower incidence of diseases (isolation and identification of leprosy mycobacterium); some are because of the impact of declining cycle, such as measles antibody assay; the lack of specific requirements is a reason as well, such as non-communicable diseases (e.g. detection of thyroid hormone)carried out by the hospital.(5) Analyze the obstacles of laboratory testing capacity construction in the disease prevention and control institutionsThis part includes intent analysis and the reason of low carrying out rate of certain items two aspects.From the intent analysis, it is found that the obstacles of laboratory testing capacity construction in the disease prevention and control institutions at all levels is the lack of government's requirements, fund, equipment and manpower. The answers of all kinds of institutions have obviously consistency: the lack of government's requirements is the major reason. The lack of government's requirements means no local demand for certain test items such as endemic or that some items are not carried out by CDC.Analyze the reason of low carrying out rate of certain items, including: currently ambiguous overlapping functions; the drop in demand, such as the lower incidence of diseases ; the impact of declining cycle, such as measles antibody assay; the lack of specific requirements, such as non-communicable diseases carried out by the hospital and so on.To sum up, "the lack of government's requirements" from intent analysis, "ambiguous overlapping functions" and "the drop in demand" from the other aspect, has some similar points: the obstacles of laboratory testing capacity are not only due to the supply of resource; but also lie on the local suitability. Therefore, we should make a more clear subdivision to these test items; distinguish the task that each level of institution should undertake, these upwards should be studied in future.(6) Analyze the influencing factor and impact of laboratory testing capacity in the disease prevention and control institutionsa. Laboratory testing capacity is influenced by lab manpower, equipment, investment and government's regard.At all levels, laboratory testing capacity in CDC is proved to be closely related to lab manpower, equipment and investment. The highest correlation coefficient is as high as 0.729.In addition, from the certain test items, the strengthening of laboratory testing capacities mostly performs in the improvement of detection and differential diagnosis of important infectious diseases such as SARS, which means that the bond-financed projects and the central transfer payments to the central and western regions play a fundamental role to the improvement of laboratory testing capacities. Government's needs and regards are very important as well; as many certain test items are not carried out because of "the lack of government's requirements".b. The strengthening of laboratory testing capacity directly promotes the outcome of CDC. At all levels, laboratory testing capacity in CDC is closely related to the emergency response capabilities and the degree of public functions carrying out. The correlation coefficient between lab testing process and outcome is as high as 0.498, which shows the important roles laboratory testing capacity construction plays on the improvement of the whole disease prevention and control system.5. Innovation and application1. This study carries out nationwide sample survey of disease prevention and control institutions in China. The study systematic collected related data about lab testing capacity in institutions of 28 provinces, 133 counties and 460 countries, 621 samples in total. Such a large-scale national survey in China's disease prevention and control system research is unprecedented, not only guaranteed the data and the outcome of the representation and credibility, but more important thing is which provided adequate data on the basis for follow-up studies as reference.2. Using "macro model of the health system" and the "structure - the process - the result model", the evaluative dimensions and indexes of laboratory tests capabilities of the disease prevention and control institutions are established.3. Refer to the "GINI coefficient" as basic principles, created the "regional balance of the index" which evaluated regional distribution of lab testing capacity.4. Using "structure - process - the results" as guide, many statistical methods such as principal component analysis, correlation and regression are used to analyze the influencing factor and impact of laboratory testing capacity.5. Using "area" as basic unit, which can be more rational.