Investigation And Analysis On The Current Situation Of Tuberculosis Discovery And Treatment In County - Level Tuberculosis Hospital

Objective:Questionnaire survey, field investigation and focus group discussion were used to understand the county (district) level TB designated hospital basic situation, and compare case detection and treatment before/after transition, describe trend of tuberculosis detection and treatment outcome of4years in the designated hospital. The problems addressed in the study can be further used for improving TB contrl and prevention in designated hospital.Methods:Questionnaire survey was used to collect the basic information of the designated hospitals, and describe and analysis the status. detection and treatment Status of patients was collected by field investigation, and then describe and analysis the status; A retrospective analysis was used by comparing designated hospital of tuberculosis detection and treatment outcome of the change before and after the transformation, and describe trends of tuberculosis detection and treatment outcome during4years, analysis of the above four parts, get conclusion and put forward some Suggestions.Results:The investigation carryed on Zhen-jiang in Jiang-su, Yi-chang in hu-bei, Han-zhong in Shan-xi. analysis seven counties social and economics situation in2011, Zhen-jiang income levels higher than the national per capita income over the same period, the western Hanzhong is lower than the national per capita income over the same period. Yi-du and Ju-rong active tuberculosis registered higher than the nationwide, the remaining five regions was lower than the nationwide.The new rural cooperative medical insurance give30%-40%compensation for outpatient in Dan-tu and Ju-rong, the amount of compensation for chronic disease clinics compensate￥200-540in Wuf-eng and Yi-du.compensation ratio is froml65%to80%in hu-bei and shan-xi. medical insurance for urban workers reimburse20%-40%for outpatient in zhen-jiang, Yic-hang impose a quota subsidy pays25%of patients,TB does not rank into chronic disease outpatient reimbursement range in Han-zhong. The same with NCMS and Medical insurance for urban residents in Zhenjiang, then impose a quota subsidy￥800one year in Han-zhong, reimbursement rate is40%in Yi-chang. Reimbursement rates for urban workers segmented according to medical expenses reimbursed, the reimbursement of92%in Han-zhong. Reimbursement of hospital reimbursement urban residents are60%in Yi-chang and Han-zhong.7designated hospitals set up at different times, of which six hospital after acceptance, six reached Second level of first-class, Hospitals in charge of the diagnosis and treatment of TB, TB registration and reporting and health education and screening.7designated hospitals are able to carry out sputum smears, three hospitals carry out sputum culture. TB infection control are weak in7hospitals, layout reasonable rates were22%,56%and25%in clinics, laboratories and wards, The proportion of ventilation rate target89%,56%and88%in clinics,laboratories and wards. Ultraviolet light intensity meet the standards were33%and44%in clinics and laboratories. The medical staff wearing masks was only11%. Referral in hospitals was more smoothly. Direct reporting network was97.11%. hospitalized tuberculosis patients was25%, average hospitalization costs￥6,160. The median length of hospital stay was20days,58.94%TB patient using a standardized treatment regimen.64.63%of the ordinary tuberculosis patients using second-line drugs.Descripe the four years after the discovery and of the transformation of TB treatment outcomes change in Yi-du. The results are as follows:the rate of patients with newly diagnosed sputum gradually decreased from2010to2012, Due to disease treatment constitutes an increase year by year. Referral sources constitute12.71%decline from2010to2011, increased2.4%from to2011-2012. Early registration rate of smear positive patients fell decline24.31%Non-network hospitals reported no significant difference in the rate of referral in place (χ2=18.8098P<0.05) track in place was no significant difference(χ2=6.8207P=0.0778), no significant difference in the overall availability rate (χ2=2.3926P=0.4950). Registration tuberculosis treatment outcomes in patients with no significant change (χ2=7.5151P=0.0572).Compared patients discover and compare treatment outcomes before and after the transition in Ju-rong, Zhi-jiang and Mian-xian,The results are as follows:the proportion of newly diagnosed patients decline6.57%after the transition. Active tuberculosis Patients registration rate decline9.48%after the transition. The registration rate of smear-positive patients decline66.79%after the transition. The initiative to see a doctor constitutes increased19.95%after the transition. The referral constitutes decline59.43%after the transition. The successful treatment of smear-positive rate of change was not statistically significant difference (x2=1.9620 P=0.1613). The successful treatment of Smear-negative patients rate of change was not statistically significant difference r(χ2=2.6892P=0.1010).Conclusion:County (district) level designated hospitals take on TB diagnosis and treatment work, did not cause tuberculosis detection and treatment outcome. Designated hospital is more suitable for the patient’s doctor. Designated hospital internal referral process more smoothly and better network report and data integrity, the network report rate is high. But there are some problems in the process of TB diagnosis and treatment in designated hospitals, mainly manifested in suspicious behavior is not standard, screening funds inadequacy, diagnosis and treatment, the infection control overall weak and active tuberculosis patients in the initial period of transition and initial smear-positive patient registration rates decline, especially in the initial smear-positive patients decreased significantly. Therefore, in order to ensure sustained and effective to carry out the designated hospital model, proposed increases in spending designated hospital, ensure fulfill the policy of free screening for tuberculosis patients.Set up administrative supervision mechanism, strengthen the supervision and examination of fixed-point hospital diagnosis and treatment behavior, to strengthen the assessment and evaluation of laboratory. Improve all kinds of outpatient medical insurance reimbursement ratio, helps to control proportion in hospital. Strengthen TB mycobacterium tuberculosis infection control, reduce the risk of cross infection medical staff and patients.