Evaluation Of Notifiable Communicable Diseases Reporting Quality In Tianjin From 2013 To 2018

ObjectiveTo analyze the notifiable communicable diseases reporting quality in Tianjin from 2013 to 2018,to make comparison with respect to years,medical institutions(classified based on primary,secondary and third levels,or based on,administrative level,i.e.,provincial,district level and township,or based on regions,i.e.,downtown,inner suburb and outer suburb),and to synthetically evaluate and explore the influence factors of the reporting quality,with the aim of revealing the existing problems in the management of notifiable communicable diseases reporting and providing a scientific foundation for improving the reporting quality of notifiable communicable diseases and identifying priorities for future management.MethodsThe survey was conducted in Tianjin from 2013 to 2018.360 medical institutions with different classification in 16 districts were selected by multistage stratified random sampling method.Reporting rate,timeliness rate,completeness rate,accuracy rate and concordance rate was calculated to evaluated reporting quality of notifiable communicable diseases and compared by years,classification,administrative division level and regions,as well as class b and class c infectious disease,outpatient and hospitalized cases using chi-square test.by Technique for order performance by similarity to ideal solution(TOPSIS method)was performed to synthetically evaluate the reporting quality.Multiple logistic regression analysis was used to explore the related factors affecting the reporting quality,with underreporting rate,tardy report rate,incompleteness rate,inaccuracy rate and unconcordance rate as the dependent variable.Results1.The notifiable communicable diseases reporting quality in Tianjin:360medical institutions and 6204 cases were investigated from 2013 to 2018,with the overall reporting rate,timeliness rate,completeness rate,accuracy rate and concordance rate and its 95%confidence interval of 97.79%(97.43～98.16),97.12%(96.69～97.54),97.52%(97.09～97.94),80.43%(79.34～81.53),93.15%(92.46～93.84),respectively.2.Comparison of notifiable communicable diseases reporting quality in Tianjin:The results with statistical significance(P<0.05)were as follows,the reporting rate,accuracy rate and concordance rate showed an upward trend with year(?~2trend test=13.768,P<0.001;?~2 trend test=43.334,P<0.001;?~2 trend test=4.287,P=0.038),whereas completeness rate showed an downward trend with year(trend test=15.518,P<0.001).The reporting rate,timeliness rate,completeness rate,concordance rate of third class medical institutions were lower than those of secondary or primary medical institutions.The accuracy rate of secondary medical institutions was the lowest,followed by third class,and that of primary medical institutions was the highest.The reporting rate,timeliness rate,completeness rate,accuracy rate and concordance rate of provincial medical institutions were lower than those of district level and township medical institutions.The reporting rate,timeliness rate and accuracy rate of downtown medical institutions were lower than those of outer suburb medical institutions.The timeliness rate of class b infectious diseases was lower than that of class c infectious diseases.The accuracy rate of outpatient cases reported was lower than that of inpatient cases reported.The accuracy rate of intestinal,respiratory,natural and insect-borne infectious diseases were lower than that of blood-borne and sexually transmitted infectious diseases.The reporting rate,accuracy rate and concordance rate during the 12th five-year plan period(from 2013 to 2015)were lower than that during the 13th five-year plan period(from 2016 to 2018),however completeness was higher by chi-square test.3.TOPSIS method was used for the synthetical evaluation of notifiable communicable diseases reporting quality in Tianjin.The results showed that the annual notifiable communicable diseases reporting quality from priority to inferiority were 2016,2018,2013,2015,2017 and 2014.The overall trend of fluctuation was on the rise.The synthetically evaluation results of TOPSIS method for medical institutions in different classification,administrative division level and regions were as follows.Secondary medical institutions reporting quality rank was the lowest,followed by third class,and that of primary was the highest in 2013 and2015 to 2018.Third class medical institutions reporting quality rank was the lowest,followed by primary,and that of secondary was the highest in 2014.Provincial medical institutions reporting quality rank was the lowest,followed by district level,and that of township was the highest from 2013 to 2015.District level medical institutions reporting quality rank was the lowest,followed by provincial,and that of township was the highest from 2016 to 2018.Downtown medical institutions reporting quality rank was the lowest,followed by inner suburb,outer suburb was the highest in 2013,2015,2016 and 2017.Outer suburb medical institutions reporting quality rank was the lowest,followed by inner suburb,and that of downtown was the highest in 2016 and 2018.4.Analysis of influencing factors on the notifiable communicable diseases reporting quality in Tianjin by multivariate logistic regression analysis showed that year,region,classification of medical institutions and classification of notifiable communicable diseases were related to underreporting rate.The risk of underreporting increased first and then decreased with the year.The risk of underreporting in outer suburbs was lower than that in downtown medical institutions,with an OR value of 0.50(95%CI:0.32～0.79).The risks of underreporting in secondary and primary medical institutions were lower than that in third class medical institutions,with OR values of 0.47(95%CI:0.30～0.73)and0.41(95%CI:0.22～0.78),respectively.The risk of underreporting of class c infectious diseases was 1.64 times than that of class b(95%CI:1.13～2.36).Multivariate logistic regression analysis showed that year,region,classification of medical institutions were related to tardy report.The risk of tardy report increased first and then decreased with the year.The risks of tardy report in inner and outer suburbs medical institutions were lower than that in downtown medical institutions,with an OR value of 0.37(95%CI:0.26～0.53)and 0.26(95%CI:0.17～0.40),respectively.The risk of tardy report in primary medical institutions was lower than that in third class medical institutions,with OR values of 0.16(95%CI:0.06～0.39).Multivariate logistic regression analysis showed that year and classification of medical institutions were related to incompleteness report.The risk of incompleteness report decreased first and then increased with the year.The risks of incompleteness report in secondary and primary medical institutions were lower than that in third class medical institutions,with an OR value of 0.04(95%CI:0.01～0.13)and 0.09(95%CI:0.03～0.28),respectively.Multivariate logistic regression analysis showed that year,region,classification of medical institutions and cases of source were related to inaccuracy report.The risk of inaccuracy report increased first and then decreased with the year.The risks of inaccuracy report in inner and outer suburb medical institutions were lower than that in downtown medical institutions,with an OR value of 0.68(95%CI:0.57～0.81)and 0.71(95%CI:0.59～0.87),respectively.The risk of inaccuracy report in secondary medical institutions was 2.97 times than that in third class medical institutions,with an OR value of 0.15(95%CI:0.10～0.22).The risk of inaccuracy report in hospitalized patients was lower than that in outpatient patients,with an OR value of 0.48(95%CI:0.38～0.60).Multivariate logistic regression analysis showed that year and classification of medical institutions were related to unconcordance report.The risk of unconcordance report increased first and then decreased with the year.The risks of unconcordance in secondary and primary medical institutions were lower than that in third class medical institutions,with an OR value of 0.31(95%CI:0.22～0.42)and 0.32(95%CI:0.20～0.49),respectively.ConclusionNotifiable communicable diseases reporting quality from 2013 to 2018 in Tianjin had achieved the goal of“the 12th Five-Year Plan”and“the 13th Five-Year Plan”.Reporting rate,timeliness rate and completeness rate have exceeded the goal rate of 95%,however accuracy rate and concordance rate still need to be improved.The overall notifiable communicable disease reporting quality was improving during 2013 to 2018.Year-to-year comparison found some fluctuation which indicated there were vulnerability in the whole management procedure,thus the internal management of the medical institutions needs further improvements.Year,classification of medical institutions and region were the factors that affected the notifiable communicable diseases report quality.Reporting quality in medical institutions with lower grade classification and lower administrative division level were better than that in higher level medical institutions.That is to say primary medical institutions and township medical institutions had a better quality than secondary and third class,district level and provincial medical institutions,respectively.Secondary and third class,district level and provincial,downtown medical institutions were the key points to strengthen the quality of reporting management.Focusing on the implementation of inner management among medical institutions for the sake of further improvement of the overall quality of notifiable communicable diseases reporting.Provide accurate and timely information for scientific diseases prevention and control.