Comparison Of Results Of Two Surveys Pulmonary Tuberculosis Reporting And Registration And Influencing Factors In County-level Medical Institutions In Yunnan Province

Objectives:1.To compare and analyze the changes in the under-reporting rate of patients with active and suspected tuberculosis in county-level medical institutions in Yunnan Province in 2015 and 2020 and the influencing factors,to assess the changes in tuberculosis reporting in county-level medical institutions before and after the transformation of the tuberculosis control service model in Yunnan Province,and to explore the factors affecting tuberculosis under-reporting.2.To compare and analyze the changes in the under-reporting rate of active TB patients in county-level medical institutions in Yunnan Province in 2015 and 2020 and the influencing factors,to assess the changes in TB registration in county-level medical institutions before and after the transformation of the TB prevention and control service model in Yunnan Province,and to explore the factors influencing TB under-reporting.3.Understanding the workflow of tuberculosis reporting and registration at county-level medical institutions in Yunnan Province in 2020 and the construction of related systems.4.To provide scientific data support for research and judgment on the level of tuberculosis epidemic in Yunnan Province,and to provide a reference basis for improving the quality of tuberculosis epidemic reporting and registration in medical institutions.Methods:1.This study used a cross-sectional study approach,Patients diagnosed with pulmonary tuberculosis and suspected pulmonary tuberculosis according to the diagnostic criteria in the outpatient department,inpatient department and testing department of county-level medical institutions in Yunnan Province from January to December 2015 and from July to December 2020,respectively,were used as study subjects,and information on patients diagnosed with pulmonary tuberculosis in medical institutions was collected on site,data were collated and patients’diagnoses were reviewed and compared with those collected by the tuberculosis surveillance system The data were matched with the TB patient reporting and registration information collected by the TB surveillance system,the TB under-reporting and under-registration rates were calculated,the changes in TB reporting and registration were compared and analyzed,and relevant influencing factors were explored using chi-square tests and multi-factor Logistic regression analysis.Information on TB reporting and registration in medical institutions in 2020was obtained in the form of self-administered questionnaires by medical institutions,which included the level and type of medical institutions,TB epidemic reporting process,TB registration process,reward and punishment mechanism establishment,management system,and training and assessment situation.2.Using a qualitative interview approach,medical staff(one to two chiefs or attending physicians of infection departments)and staff of the disease control and nodule prevention institutions(one to two chiefs or staff of nodule prevention departments)of six surveyed medical institutions(including designated treatment institutions and non-designated treatment institutions)were randomly selected for interviews.The interviews included the work system and process of TB reporting and registration in medical institutions,relevant training and assessment,main reasons for under-reporting and under-registration,improvement measures and suggestions,etc.Results:1.The results of the analysis showed that the overall under-reporting rate of active TB in county-level health facilities was 25.1%in 2015,and the overall under-reporting rate of active TB in county-level health facilities decreased to 1.7%in 2020,a decrease of 93.2%.The results of multifactorial analysis showed that in 2015,the under-reporting of active TB in non-specified treatment facilities for diagnosis(a OR=11.118,95%CI:8.582 to 14.405),inpatient departments(a OR=1.404,95%CI:1.111 to 1.774),high epidemic areas(a OR=1.899,95%CI:1.543 to 2.337),no pathogenic findings(a OR=2.212,95%CI:1.176 to 4.161)and simple TB pleurisy(a OR=9.398,95%CI:5.595 to 15.789)were risk factors for under-reporting of active TB in health care settings(all P<0.05);low age in 2020(a OR=4.363,95%CI:1.250to 15.321),testing department(a OR=3.871,95%CI:1.657 to 9.042),high prevalence area(a OR=2.040,95%CI:1.146 to 3.629)and no pathogenic findings(a OR=52.531,95%CI:26.184 to 105.386)patients were risk factors for under-reporting of active TB in health care facilities(all P<0.05).2.The results of the analysis showed that the overall under-reporting rate of suspected TB in county-level health facilities was81.0%in 2015,and the overall under-reporting rate decreased to 50.6%in 2020,a decrease of 37.5%.Results of multifactorial analysis showed that non-low epidemic areas(a OR=1.751,95%CI:1.055 to 2.908)were risk factors for suspected TB under-reporting in health facilities in 2015(all P<0.05);low age in 2020(a OR=7.106,95%CI:2.630 to 19.205),outpatient department(a OR=12.837,95%CI:3.737 to44.096)and no pathogenic findings(a OR=6.745,95%CI:1.431 to 31.790)were risk factors for suspected TB under-reporting in health care facilities(all P<0.05).3.The results of the analysis showed that the overall under-registration rate of patients with reportable active TB in county-level medical institutions was 27.5%in 2015 and 5.5%for patients in 2020,and the overall under-registration rate of patients decreased significantly from 2015 to 2020,by 80.0%.The results of the multifactorial analysis showed that in 2015 there was a significant decrease in the number of patients diagnosed in non-scheduled treatment facilities(a OR=11.064,95%CI:8.646 to14.158),inpatient units(a OR=1.428,95%CI:1.130 to 1.804),high prevalence areas(a OR=1.952,95%CI:1.585 to 2.404),no pathogenic findings(a OR=1.878,95%CI:1.081 to 3.261)and simple tuberculous pleurisy(a OR=10.750,95%CI:6.319to 18.290)patients were risk factors for under-registration of active tuberculosis to be reported by health care facilities(all P<0.05);diagnosed in 2020 at non-specified treatment facilities(a OR=2.898,95%CI:1.477 to 5.690),inpatient units(a OR=1.607,95%CI:1.084 to 2.383)and laboratory departments(a OR=1.955,95%CI:1.252 to3.051),and no pathogenic findings(a OR=52.065,95%CI:33.825 to 80.140)were risk factors for under-registration of patients with reportable active TB in county health facilities(all P<0.05).4.Among the reported active TB patients,103 patients were not registered in 2015,with an under-registration rate of 3.2%,and 177 patients were not registered in 2020,with an under-registration rate of 3.8%of patients,with no statistically significant difference in the under-registration rate of reported active TB patients between the two surveys(χ~2=2.575,P>0.05).The results of multifactorial analysis showed that in 2015 age<15 years(a OR=5.330,95%CI:2.071 to 14.086),diagnosis at non-specified treatment facilities(a OR=6.792,95%CI:3.726 to 12.380),high prevalence areas(a OR=1.688,95%CI:1.013 to 2.812)and simple tuberculosis pleurisy(a OR=6.674,95%CI:2.285 to 19.492)patients were risk factors for under-registration of reported active TB in health care settings(all P<0.05);diagnosis in non-specified treatment facilities in 2020(a OR=3.653,95%CI:1.873 to 7.126)and no pathogenic findings(a OR=32.070,95%CI:19.779 to 51.998)were risk factors for under-registration of reported active TB in county health facilities(all P<0.05).5.The median monthly average number of outpatient visits in healthcare facilities in 2020was 13,057 and the median monthly average number of inpatient visits was 1,071;the average monthly number of outpatient visits and inpatient visits in sentinel treatment facilities was greater than that in non-sentinel treatment facilities;the proportion of sentinel treatment facilities with three or more people dedicated to epidemic reporting was higher(17.2%)than that of non-sentinel treatment facilities(3.6%);82.8%of sentinel treatment facilities used a combination of manual and online methods to fill out the patient’s infectious disease report card information for the first time,while57.1%of non-specified treatment facilities mostly used manual filling;most of the auxiliary departments of both fixed-point and non-specified treatment facilities did not need to carry out infectious disease report cards;55.2%of the fixed-point treatment facilities used the reporting card filled out by the first doctor in the hospital HIS system,and the epidemic reporting department was responsible for reviewing and then all(100.0%)of the sentinel treatment facilities have established a mechanism for rewarding and punishing epidemic reporting;all sentinel treatment facilities have conducted at least one training and assessment on knowledge related to epidemic reporting in 2020;both sentinel and non-sentinel treatment facilities have conducted self-examination on epidemic reporting The number of self-inspections conducted by both sentinel and non-sentinel treatment institutions was concentrated in the range of1 to 12 times,and 3.6%of non-sentinel treatment institutions did not conduct self-inspections;the supervisory department conducted at least 1 inspection of sentinel treatment institutions on epidemic reporting each year,but 14.3%of non-sentinel treatment institutions were not inspected.6.72.5%of the sentinel treatment facilities had dedicated staff to register information in the TB reporting system;more than 90%of the sentinel treatment facilities used a combination of manual and online methods to fill in patient registration information for the first time;only 3.4%of the facilities did not have a management system for registering TB patients;48.3%of the facilities had a registration process of registering a paper information register before entering it into the reporting system or entering it into the reporting system before extracting the paper register;all(100.0%)of the facilities had a regulatory management system for patient referral;89.7%of the facilities used a doctor to issue a referral and then extracted the paper register.All institutions(100.0%)had established a system for the management of patient referrals;89.7%of the sentinel treatment facilities had a referral process based on the doctor issuing a referral form and instructing the patient to bring the referral form to the referring department or institution;the majority of sentinel treatment facilities have set up mechanisms for rewarding and punishing the management of TB patient registration(65.5%)and the management of TB patient referral and follow-up(62.1%);most of the sentinel treatment facilities conducted training and assessment on TB diagnosis criteria,TB registration and management,and TB referral and follow-up knowledge for one to two times in 2020;100.0%of the sentinel treatment facilities conducted self-examination on the management of TB patient registration in their hospitals;the TB prevention and control institutions conducted training on TB registration and management for sentinel treatment facilities.Most of the TB registration management guidance training work is concentrated in 1 to 2 times,and 6.8%of the institutions have not received guidance training in 2020.Conclusions:1.The under-reporting rate and under-registration rate of TB in county-level medical institutions in Yunnan decreased significantly,indicating that the quality of TB reporting and registration work in medical institutions had been improved,and the accuracy of monitoring data in TB surveillance system(Large epidemic system and TB special report system)had been improved.2.First diagnosis at non-specified TB treatment facilities,absence of pathogenic test results,low age and high prevalence areas are still influential factors for under-reporting and under-registration of TB in county-level medical institutions in Yunnan Province.3.At present,the under-reporting rate and under-registration rate of TB in county-level medical institutions in Yunnan province are at a low level.The monitoring data of TB surveillance system can provide scientific and reliable data support for the surveillance and estimation of TB incidence in Yunnan province.4.The system of reporting and registration of tuberculosis in medical institutions at county level in Yunnan Province is relatively complete,and the transformation of tuberculosis control service model is effective in the prevention and treatment of tuberculosis in Yunnan Province.