發(fā)布時(shí)間：2018-01-17 23:06

  本文關(guān)鍵詞：典型醫(yī)療機(jī)構(gòu)塵肺病低報(bào)情況研究　出處：《中國(guó)疾病預(yù)防控制中心》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 職業(yè) 塵肺病 低報(bào)

【摘要】：職業(yè)病低報(bào)研究屬于公共衛(wèi)生監(jiān)測(cè)系統(tǒng)評(píng)價(jià)的重要內(nèi)容之一,它體現(xiàn)監(jiān)測(cè)系統(tǒng)發(fā)現(xiàn)和確認(rèn)職業(yè)病危害問(wèn)題的能力。開(kāi)展塵肺病低報(bào)研究,從醫(yī)療可及性、漏診、漏報(bào)等角度,估計(jì)低報(bào)程度,了解低報(bào)原因并提出改進(jìn)措施,對(duì)于改進(jìn)和完善職業(yè)病監(jiān)測(cè)系統(tǒng)、提高監(jiān)測(cè)效率、確保監(jiān)測(cè)系統(tǒng)發(fā)現(xiàn)職業(yè)病數(shù)量的準(zhǔn)確性、更好的了解分布特征和變化趨勢(shì)、發(fā)現(xiàn)爆發(fā)和流行等情況具有重要意義。[目的]調(diào)查塵肺病低報(bào)程度,了解造成低報(bào)的各種可能因素和關(guān)鍵環(huán)節(jié),提出改進(jìn)措施。[方法]本研究采取文獻(xiàn)研究法進(jìn)行研究設(shè)計(jì),應(yīng)用臨床職業(yè)病學(xué)方法回顧性分析4家典型醫(yī)療機(jī)構(gòu)(分別為:具有診斷資質(zhì)的職業(yè)病防治院1家、具有診斷資質(zhì)的綜合醫(yī)院1家、不具有診斷資質(zhì)的綜合醫(yī)院1家、不具有診斷資質(zhì)的胸科醫(yī)院1家)2016年臨床病例信息來(lái)估計(jì)疑似塵肺病、塵肺病的低報(bào)程度,采用問(wèn)卷調(diào)查和訪談法探索低報(bào)的原因,并提出改進(jìn)建議。[結(jié)果]研究結(jié)果顯示4家醫(yī)療機(jī)構(gòu)陽(yáng)性病例821例,其中70人已經(jīng)診斷職業(yè)性塵肺病,其他未做職業(yè)病或疑似職業(yè)病的診斷,總漏診率91.47%,具有非診斷資質(zhì)的兩家醫(yī)院疑似塵肺病漏診率為100%。已經(jīng)診斷的70例職業(yè)性塵肺病人均已上報(bào),報(bào)告信息與病例資料核對(duì)完整無(wú)誤,漏報(bào)率為0。問(wèn)卷調(diào)查結(jié)果顯示綜合醫(yī)院相關(guān)科室非塵肺病診斷醫(yī)師的職業(yè)病知識(shí)知曉率為31.1%,接受培訓(xùn)的知曉率高于未接受過(guò)培訓(xùn)的醫(yī)師。呼吸科(100%)、感染科(100%)接診塵肺病人比例較高,50%以上的醫(yī)師不具有鑒別診斷職業(yè)病的能力,醫(yī)師普遍對(duì)本單位是否有職業(yè)病報(bào)告系統(tǒng)不太了解或理解錯(cuò)誤,69.7%調(diào)查對(duì)象認(rèn)為非職業(yè)病診斷機(jī)構(gòu)有必要報(bào)告職業(yè)病。所有塵肺病診斷醫(yī)師都遇到過(guò)懷疑是塵肺病但無(wú)法診斷的情況,無(wú)法診斷的原因主要是:影像學(xué)表現(xiàn)不到診斷標(biāo)準(zhǔn)(73.9%)、無(wú)法獲取職業(yè)史資料(69.6%)和病人主動(dòng)選擇中止診斷(60.99%),塵肺病診斷醫(yī)師同樣存在不能鑒別診斷塵肺病現(xiàn)象,沒(méi)有報(bào)告疑似職業(yè)病的原因是認(rèn)為沒(méi)有疑似職業(yè)病的診斷標(biāo)準(zhǔn)。調(diào)查結(jié)果還顯示96.2%的確診職業(yè)性塵肺病人受教育水平在初中以下,從事礦山行業(yè)的占85.7%,對(duì)職業(yè)病診斷所需資料的知曉情況較差,68.5%的患者信息來(lái)源于親眼看到別人的經(jīng)歷。32.1%的患者在非職業(yè)病診斷機(jī)構(gòu)就診過(guò),也存在醫(yī)生忽視塵肺癥狀、對(duì)診斷制度不了解的情況。訪談結(jié)果顯示流動(dòng)工人的職業(yè)病診斷存在困難、非職業(yè)病診斷醫(yī)療機(jī)構(gòu)存在漏診和誤診現(xiàn)象、用人單位抵觸、工人主動(dòng)放棄職業(yè)性塵肺病診斷、疑似職業(yè)病低報(bào)是塵肺病低報(bào)的主要原因。[結(jié)論]調(diào)查顯示目前疑似塵肺病低報(bào)程度較高,主要存在于職業(yè)性塵肺病就診環(huán)節(jié),確診的塵肺病在報(bào)告環(huán)節(jié)低報(bào)程度較低,非職業(yè)病診斷機(jī)構(gòu)的低報(bào)程度高于職業(yè)病診斷機(jī)構(gòu)。低報(bào)主要受診斷標(biāo)準(zhǔn)設(shè)置、醫(yī)師診斷能力、病人無(wú)法獲取職業(yè)史資料和病人主動(dòng)選擇中止診斷等因素影響。建議進(jìn)一步加強(qiáng)職業(yè)病知識(shí)宣傳培訓(xùn)、加強(qiáng)職業(yè)健康監(jiān)護(hù)工作、職業(yè)病臨床診斷與職業(yè)病認(rèn)定程序分步實(shí)施、提高職業(yè)病診斷標(biāo)準(zhǔn)靈敏度、明確疑似職業(yè)病的定義和診斷標(biāo)準(zhǔn)、加強(qiáng)塵肺病鑒別診斷領(lǐng)域和特異性生物標(biāo)志物研究、應(yīng)用多種數(shù)據(jù)來(lái)源進(jìn)行職業(yè)病監(jiān)測(cè)。
[Abstract]:One of the important content of low report on occupation disease belongs to public health surveillance system evaluation, it embodies the monitoring system to find and confirm the ability of occupation disease harm problem. To carry out the research on low reported pneumoconiosis, from the medical accessibility, misdiagnosis, negative angle estimation reported lower degree, understand low reported reasons and propose the improvement measures. For improving and perfecting the occupation disease monitoring system, improve monitoring efficiency, ensure the accuracy of the monitoring system that the number of occupation disease, a better understanding of the distribution characteristics and change trend, found that the outbreak and epidemic situation has important significance. In order to investigate the pneumoconiosis reported lower degree of understanding, cause a variety of understating the possible factors and key links put forward the improvement measures. Method: this research adopts literature research method to research design, clinical application of occupation disease methods: a retrospective analysis of 4 typical medical institutions (respectively: a diagnostic qualification Occupation Disease Prevention Hospital 1, general hospital has diagnostic qualified 1, does not have a comprehensive hospital diagnosis qualification 1, does not have the qualification of the diagnosis of Chest Hospital 1 2016) clinical information to estimate the suspected pneumoconiosis, reported lower degree of pneumoconiosis, and explore the reasons for underreporting by questionnaire and interview method, and put forward the improvement proposal. The results showed that 4 medical institutions were 821 cases, 70 of whom have occupation of diagnosis of pneumoconiosis, the other without occupation disease or suspected occupation disease diagnosis, the total misdiagnosis rate 91.47%, with a diagnosis of non qualification of the two hospital suspected pneumoconiosis misdiagnosis 70 cases occupation of the pneumoconiosis patients have been diagnosed as 100%. have been reported, the report information and case data check is complete and accurate, the miss rate of 0. survey results show that the occupation disease knowledge related department of General Hospital of non physician diagnosis of pneumoconiosis awareness rate was 31 .1%, know the training rate is higher than that of untrained doctors. The Department of respiration (100%), infectious diseases (100%) admissions of pneumoconiosis patients in high proportion, more than 50% of the physicians do not have the ability of differential diagnosis of occupation disease, doctors generally on the unit whether the occupation disease reporting system don't know or understand the mistake, the 69.7% survey the object of diagnosis that non occupation disease is necessary to report occupation disease. All pneumoconiosis diagnosis physicians have encountered suspected pneumoconiosis but not diagnosis, reason cannot diagnose is mainly: imaging to diagnosis standard (73.9%), unable to obtain the occupation history (69.6%) and the patients actively choose to abort diagnosis (60.99%), physician diagnosis of pneumoconiosis is also unable to be differential diagnosis of pneumoconiosis, no reason to report suspected occupation disease is that there is no diagnostic criteria for suspected occupation disease. The survey also showed that 96.2% indeed Diagnosis of pneumoconiosis occupation education in junior high school, engaged in the mining industry accounted for 85.7% of the required information for the diagnosis of occupation disease awareness is poor, 68.5% of the patients with information from the experience of others to see.32.1% patients in diagnosis of non occupation disease, there are also doctors do not understand the neglect of pneumoconiosis symptoms. The diagnosis system. The result of the interview shows occupation disease diagnosis problems of migrant workers, non occupation disease diagnosis medical institutions exist misdiagnosis phenomenon, conflict with the employer, workers take the initiative to give up the occupation of pneumoconiosis diagnosis, suspected occupation disease is a major cause of low reported pneumoconiosis reported lower. Conclusion] investigation shows that at present the suspected pneumoconiosis reported lower level high, mainly exists in the occupation of the pneumoconiosis medical aspect diagnosed pneumoconiosis in reporting aspects of low reported low level, low degree of organization occupation disease diagnosis report high In the diagnosis of disease. The main occupation mechanism of low reported by diagnostic standard setting, physician diagnosis ability, patients cannot obtain the occupation history data and patient diagnosis active choice and other factors. It is recommended to further strengthen the occupation disease knowledge training, strengthen the occupation health supervision work, occupation disease diagnosis and occupation disease identification procedure step by step, improve the standard of sensitivity the diagnosis of suspected occupation disease, clear definition and diagnostic criteria of occupation disease, strengthen the pneumoconiosis differential diagnosis and field studies on specific biomarkers of occupation disease monitoring application of multiple data sources.

【學(xué)位授予單位】：中國(guó)疾病預(yù)防控制中心
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R135.2

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