The Research For A Method Of Improving Diagnosis Of Chronic Obstructive Pulmonary Disease In Basic Hospitals

Objective: To investigate the effect of short-term training on affecting physicians' knowledge about chronic obstructive pulmonary disease(COPD), and the effect of short-term training combined lung function measuring equipment on diagnostic ratio of COPD in basic hospitals, hope to find an effective method to raise diagnostic rate of COPD in basic hospitals.Methods: 6 basic hospitals without lung function measuring equipment are sampled and divided into two groups randomly: intervention group and control group (n=3). Physicians are provided with short-term training about COPD and hospitals are provided with lung function measuring equipments freely in intervention group, but control group gets neither. Physicians in intervention group are required to answer questionnaires about COPD before and after training respectively, 1 point for each question and full score is 10 points, and the differences are compared. In a same period of 3 months before and after intervention, clinical doubtful diagnostic ratio and confirmation ratio of COPD in both groups are compared, and implementation of lung function test is observed. The cost of each elevated percentage point of clinical doubtful diagnostic ratio and confirmation ratio of COPD are calculated, to analyze cost of the intervention. Data is analyzed by statistical product and service solutions 13.0, individual scoring of physicians is expressed by median and tested by independent samples Mann-Whitney rank-sum test, correct rate of each question and diagnostic ratio of COPD are both expressed by the form of percentage and tested by chi square test. Inspection levelα=0.05, when P value is smaller than 0.05, there is significant difference between two groups.Results: (1) Before training, there are only 43.0% physicians getting more than 6 points, and the median is 5 points; correct rates of most questions are also very low, only correct rates of 1st,4th and 9th questions are higher than 60% but lower than 70%. After training, there are 95.2% physicians getting more than 6 points, and the median is 9 points; except correct rate of 1st question, correct rates of questions ascend and most are higher than 80%. The difference of individual scoring,pass rate and correct rate of questions between before and after training is significant (P <0.05). (2)Before intervention, clinical doubtful diagnostic ratio of COPD is 0.69% in control group and 0.84% in intervention group, there is no significant difference between them (P >0.05) , both confirmation ratio are 0%; after intervention, clinical doubtful diagnostic ratio of COPD is 0.67% and confirmation ratio of COPD is 0% in control group, and clinical doubtful diagnostic ratio of COPD is 14.40% and confirmation ratio of COPD is 2.87% in intervention group, there is significant difference between them (P<0.05). There is no significant difference in clinical doubtful diagnostic and confirmation ratio of COPD in control group between before and after intervention (P >0.05), but there is in intervention group (P <0.05). During the period of intervention, 10.10% patients hospitalized in internal medicine wards older than 40 receive lung function test. (3)In intervention group, the cost of each elevated percentage point of clinical doubtful diagnostic ratio and confirmation ratio of COPD in each hospital are 1556.0Yuan and 7351.9Yuan respectively.Conclusions: (1)The way, combined with physician short-term training and providing lung function measuring equipment, could improve the level of diagnosis of COPD in basic hospitals effectively. (2)Short-term training could raise the level of physicians' understanding of COPD effectively.