2015年醫(yī)療機構法定傳染病信息報告質量綜合評價及影響因素分析
發(fā)布時間：2018-08-25 15:03
【摘要】：背景法定傳染病網絡直報工作中,醫(yī)療機構是傳染病報告的主體對象,臨床醫(yī)護人員是傳染病報告的主體責任人,其報告病例的信息質量是掌握傳染病真實發(fā)病趨勢、追蹤病人及疫情決策的重要依據,是傳染病監(jiān)測的生命線。鑒于此,本研究選擇醫(yī)療機構作為研究對象,利用2015年全國法定傳染病報告質量調查數據做進一步研究分析,為傳染病報告管理和評價工作提供參考。目的掌握2015年我國醫(yī)療機構法定染病網絡直報現狀,評價不同地區(qū)、不同病例來源和不同級別法定傳染病信息報告質量,分析當前醫(yī)療條件下影響傳染病信息報告質量的因素,為法定傳染病科學管理、科學決策提供參考和依據。方法描述性分析全國2015年醫(yī)療機構傳染病信息報告質量及管理現狀,對報告率等指標的比較采用χ2檢驗;采用TOPSIS法綜合評價不同病例來源、不同地區(qū)、不同級別及116家醫(yī)療機構信息報告質量,以報告率等5指標、TOPSIS綜合評價質量結果和病例報告狀態(tài)作為因變量構建二分類logistic回歸模型,探討現有醫(yī)療資源條件下影響醫(yī)療機構法定傳染病信息報告質量的因素。結果2015年各級醫(yī)療機構法定傳染病報告率、及時率、完整率、準確率和一致率依次為 95.10%(1865/1961)、90.83%(1694/1865)、89.12%(1662/1865)、69.01%(1147/1662)和83.54%(1558/1865)。門診日志的報告率高于出入院報告率(X2=34.25,p0.0001),不同地區(qū)間及時報告率(χ2=8.32,P=0.02)、完整率(χ2=11.58,P=0.003)、準確率(χ2=77.10,P0.0001)和一致率(χ2=21.49,P0.0001)均有統(tǒng)計學差異;不同級別醫(yī)療機構的法定傳染病報告率(χ2=38.70,P0.0001)、及時率(χ2= 26.64,P0.001)、完整率(χ2=22.64,P0.0001)和準確率(χ2=53.92,P0.0001)均有統(tǒng)計學差異。以TOPSIS建模,傳染病報告質量綜合評價結果為中部地區(qū)最好、西部最差;不同級別醫(yī)療機構信息報告綜合質量鄉(xiāng)鎮(zhèn)級優(yōu)于縣區(qū)級,縣區(qū)級優(yōu)于地市級,地市級優(yōu)于省級;門診和出入院登記的信息報告綜合質量一致。logistic回歸分析顯示,單一評價指標中,醫(yī)療機構傳染病漏報與傳染病自查有無領導參與有關,及時性與出入院登記是否齊全規(guī)范有關,一致性與地區(qū)有關,完整性與出入院登記是否規(guī)范齊全、有無打印傳報卡功能有關,準確性與單位級別、出入院日志填寫是否規(guī)范齊全、傳染病直報管理人員總數有關。傳染病報告TOPSIS綜合質量與地區(qū)、單位級別、出入院是否齊全規(guī)范及專職傳報管理人員4個因素有關。以病例報告狀態(tài)構建logistic回歸分析模型顯示:1、漏報與單位級別有關;2、報告及時性與地區(qū)、單位級別、門診日志設置是否齊全、出入院登記設置是否齊全和是否具備自動打印電子傳報卡有關;3、完整性與地區(qū)、單位級別、門診日志填寫是否規(guī)范、出入院設置是否齊全、傳染病自查時分管領導是否參與有關、網絡直報管理人員總數有關及專用計算機使用年限有關;4、一致性與地區(qū)、單位級別、門診日志填寫是否規(guī)范、出入院設置是否齊全、針對自查是否及時整改、網絡直報管理人員總數、打印紙質報告卡是否有首診醫(yī)生簽名及所轄CDC用戶信息安全培訓有關;5、準確性與單位級別有關。結論根據衛(wèi)生事業(yè)發(fā)展規(guī)劃目標,2015年我國法定傳染病報告率達到95%的規(guī)劃目標,及時率達到90%的規(guī)劃目標,準確率、完整率和一致率仍需要提高。TOPSIS法彌補單一指標評價不能解決的復雜問題,其結果直觀、綜合,但在反映單一側面特性時需結合單指標評價方法更能說明問題。醫(yī)療機構應在傳染病自查時分管領導參與、門診和出入院日志登記設置齊全和規(guī)范填寫、傳染病網絡直報管理人員配置、針對自查發(fā)現問題及時整改、電子病歷具備打印傳染病報告卡功能和打印紙質傳報卡有首診醫(yī)師簽名、專用計算機使用年限、網絡信息安全培訓等方面加強內控管理,以期進一步提升傳染病報告質量。
[Abstract]:BACKGROUND In the network direct reporting of notifiable infectious diseases, medical institutions are the main objects of infectious disease reports, and clinical medical staff are the main responsible persons of infectious disease reports. The information quality of reported cases is an important basis for mastering the true incidence trend of infectious diseases, tracking patients and making decisions on epidemic situation, and is the lifeline of infectious disease monitoring. Objective To understand the current situation of network direct reporting of legal infectious diseases in medical institutions in China in 2015 and to evaluate the sources and levels of different cases in different regions and regions. The quality of notifiable infectious diseases information report was analyzed, and the factors affecting the quality of notifiable infectious diseases information report under current medical conditions were analyzed to provide reference and basis for scientific management and decision-making of notifiable infectious diseases. TOPSIS method was used to evaluate the quality of information reports of different cases, different regions, different levels and 116 medical institutions. The results of TOPSIS comprehensive evaluation and the status of case reports were used as dependent variables to construct a binary logistic regression model to explore the impact of existing medical resources on the quality of medical institutions. Results In 2015, the reporting rate of notifiable infectious diseases, timely rate, complete rate, accuracy rate and consistency rate were 95.10% (1865/1961), 90.83% (1694/1865), 89.12% (1662/1865), 69.01% (1147/1662) and 83.54% (1558/1865) respectively. The reporting rate of out-patient journal was higher than that of out-patient Journal (X2 = 34.25, p0). (9672 = 8.32, P = 0.02), completeness rate (962 = 11.58, P = 0.003), accuracy rate (962 = 77.10, P 0.0001) and consistency rate (962 = 21.49, P 0.0001) were statistically significant differences among different regions (962 = 21.49), timely reporting rate (962 = 38.70, P = 0.0001), timely rate (962 = 26.64, P = 0.001), completeness rate (962 = 77.10, P = 77.10, P 0.0001) and consistenrate (962 = 21.49, P 0.000 1) were statistically significant differences among medical institutions of different levels (962 = 38.70 = 38.70, P = 38.70, P = 38.In the meantime, it is necessary to study the relationship between the two. The TOPSIS model showed that the comprehensive evaluation results of infectious disease report quality were the best in the central region and the worst in the western region; the comprehensive quality of information report in different levels of medical institutions was better at the township level than at the county level; the county level was better than the prefecture level; the prefecture level was better than the provincial level; the outpatient and discharge registration information report was better at the township level; and the county level was better than the provincial level. Logistic regression analysis showed that the missing report of infectious diseases in medical institutions was related to the participation of leaders in the self-examination of infectious diseases, the timeliness of admission and discharge registration, the consistency of admission and discharge registration, the completeness of admission and discharge registration, and the function of printing report card. It is related to the unit level, whether the entry and exit logs are complete or not, and the total number of managers who report infectious diseases directly. Unit level related; 2, report timeliness and area, unit level, outpatient log settings are complete, whether the registration settings are complete and whether the automatic printing of electronic telex card is relevant; 3, integrity and region, unit level, whether the outpatient log filling is standardized, whether the discharge settings are complete, infectious disease self-examination in charge of leadership is Whether or not to participate in the relevant, the total number of network management personnel and dedicated computer related to the number of years of use; 4, consistency with the region, unit level, out-patient log filling is standardized, discharges and discharge settings are complete, for self-examination whether timely rectification, network management personnel, printing paper report card whether the first doctor's signature and Conclusion According to the planning target of the development of health undertakings, the reporting rate of notifiable infectious diseases in China will reach 95% in 2015 and 90% in time. The accuracy, completeness and consistency still need to be improved. The results are intuitive and comprehensive, but the evaluation method of single index should be combined when reflecting the characteristics of a single side. Medical institutions should take charge of leadership participation in the self-examination of infectious diseases, complete and standardized registration of outpatient and discharging diaries, allocate administrators for direct reporting of infectious diseases through network, and ask for self-examination findings. In order to further improve the quality of infectious disease report, the electronic medical record has the functions of printing infectious disease report card, printing paper report card with the signature of the first doctor, the use of special computer, network information security training and other aspects of strengthening internal control management.
【學位授予單位】：中國疾病預防控制中心
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R181.8
本文編號：2203238
[Abstract]:BACKGROUND In the network direct reporting of notifiable infectious diseases, medical institutions are the main objects of infectious disease reports, and clinical medical staff are the main responsible persons of infectious disease reports. The information quality of reported cases is an important basis for mastering the true incidence trend of infectious diseases, tracking patients and making decisions on epidemic situation, and is the lifeline of infectious disease monitoring. Objective To understand the current situation of network direct reporting of legal infectious diseases in medical institutions in China in 2015 and to evaluate the sources and levels of different cases in different regions and regions. The quality of notifiable infectious diseases information report was analyzed, and the factors affecting the quality of notifiable infectious diseases information report under current medical conditions were analyzed to provide reference and basis for scientific management and decision-making of notifiable infectious diseases. TOPSIS method was used to evaluate the quality of information reports of different cases, different regions, different levels and 116 medical institutions. The results of TOPSIS comprehensive evaluation and the status of case reports were used as dependent variables to construct a binary logistic regression model to explore the impact of existing medical resources on the quality of medical institutions. Results In 2015, the reporting rate of notifiable infectious diseases, timely rate, complete rate, accuracy rate and consistency rate were 95.10% (1865/1961), 90.83% (1694/1865), 89.12% (1662/1865), 69.01% (1147/1662) and 83.54% (1558/1865) respectively. The reporting rate of out-patient journal was higher than that of out-patient Journal (X2 = 34.25, p0). (9672 = 8.32, P = 0.02), completeness rate (962 = 11.58, P = 0.003), accuracy rate (962 = 77.10, P 0.0001) and consistency rate (962 = 21.49, P 0.0001) were statistically significant differences among different regions (962 = 21.49), timely reporting rate (962 = 38.70, P = 0.0001), timely rate (962 = 26.64, P = 0.001), completeness rate (962 = 77.10, P = 77.10, P 0.0001) and consistenrate (962 = 21.49, P 0.000 1) were statistically significant differences among medical institutions of different levels (962 = 38.70 = 38.70, P = 38.70, P = 38.In the meantime, it is necessary to study the relationship between the two. The TOPSIS model showed that the comprehensive evaluation results of infectious disease report quality were the best in the central region and the worst in the western region; the comprehensive quality of information report in different levels of medical institutions was better at the township level than at the county level; the county level was better than the prefecture level; the prefecture level was better than the provincial level; the outpatient and discharge registration information report was better at the township level; and the county level was better than the provincial level. Logistic regression analysis showed that the missing report of infectious diseases in medical institutions was related to the participation of leaders in the self-examination of infectious diseases, the timeliness of admission and discharge registration, the consistency of admission and discharge registration, the completeness of admission and discharge registration, and the function of printing report card. It is related to the unit level, whether the entry and exit logs are complete or not, and the total number of managers who report infectious diseases directly. Unit level related; 2, report timeliness and area, unit level, outpatient log settings are complete, whether the registration settings are complete and whether the automatic printing of electronic telex card is relevant; 3, integrity and region, unit level, whether the outpatient log filling is standardized, whether the discharge settings are complete, infectious disease self-examination in charge of leadership is Whether or not to participate in the relevant, the total number of network management personnel and dedicated computer related to the number of years of use; 4, consistency with the region, unit level, out-patient log filling is standardized, discharges and discharge settings are complete, for self-examination whether timely rectification, network management personnel, printing paper report card whether the first doctor's signature and Conclusion According to the planning target of the development of health undertakings, the reporting rate of notifiable infectious diseases in China will reach 95% in 2015 and 90% in time. The accuracy, completeness and consistency still need to be improved. The results are intuitive and comprehensive, but the evaluation method of single index should be combined when reflecting the characteristics of a single side. Medical institutions should take charge of leadership participation in the self-examination of infectious diseases, complete and standardized registration of outpatient and discharging diaries, allocate administrators for direct reporting of infectious diseases through network, and ask for self-examination findings. In order to further improve the quality of infectious disease report, the electronic medical record has the functions of printing infectious disease report card, printing paper report card with the signature of the first doctor, the use of special computer, network information security training and other aspects of strengthening internal control management.
【學位授予單位】：中國疾病預防控制中心
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R181.8
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