本文選題：嚴(yán)重急性呼吸道感染(SARI) + 侵襲性肺炎球菌病(IPD)��； 參考：《中國(guó)疾病預(yù)防控制中心》2013年碩士論文

【摘要】：目的：旨在評(píng)價(jià)湖北省荊州市“基于人群的住院急性呼吸道感染(Severe Acute Respiratory Infection, SARI,以下同)和侵襲性肺炎球菌病(Invasive Pneumococcal Disease, IPD,以下同)監(jiān)測(cè)”系統(tǒng)的特征(準(zhǔn)確性、完整性及一致性),發(fā)現(xiàn)監(jiān)測(cè)活動(dòng)中的薄弱環(huán)節(jié)和與監(jiān)測(cè)目標(biāo)的差距,以期不斷提高監(jiān)測(cè)質(zhì)量,進(jìn)一步完善監(jiān)測(cè)提供依據(jù)。 方法：參照世界衛(wèi)生組織(WHO)和美國(guó)疾病預(yù)防控制中心(US CDC)疾病監(jiān)測(cè)系統(tǒng)評(píng)估方法,依據(jù)本監(jiān)測(cè)方案的要求,結(jié)合當(dāng)?shù)夭僮髑闆r,采用現(xiàn)場(chǎng)督導(dǎo)與評(píng)估的方法,收集定量資料,得到監(jiān)測(cè)系統(tǒng)的特征值,再與理想的評(píng)價(jià)值進(jìn)行比較。輔助以過程評(píng)估方法,建立邏輯框架,選取投入指標(biāo)(人力資源及資金保障)、過程指標(biāo)(項(xiàng)目活動(dòng),即培訓(xùn)、督導(dǎo))及產(chǎn)出指標(biāo)(培訓(xùn)醫(yī)務(wù)人員的數(shù)量及實(shí)施評(píng)價(jià)的次數(shù))進(jìn)行評(píng)價(jià)。收集荊州市四家監(jiān)測(cè)醫(yī)院2010年7月-2012年6月的監(jiān)測(cè)數(shù)據(jù),使用EPI DATA3.0和SPSS19.0統(tǒng)計(jì)軟件進(jìn)行分析。 結(jié)果：投入指標(biāo)為：監(jiān)測(cè)項(xiàng)目自2010年1月正式運(yùn)行起,從建立到維持監(jiān)測(cè)系統(tǒng)運(yùn)行,共計(jì)花費(fèi)九百萬人民幣(包括人員費(fèi)用、實(shí)驗(yàn)室設(shè)備、試劑、培訓(xùn)、會(huì)議、差旅等)。前后共計(jì)十二家單位和部門,459人參與監(jiān)測(cè)活動(dòng)；制定SARIIPD監(jiān)測(cè)方案1份：項(xiàng)目執(zhí)行手冊(cè)1份；數(shù)據(jù)錄入與管理規(guī)定1份；呼吸道標(biāo)本操作流程1份；呼吸道標(biāo)本流感病毒實(shí)驗(yàn)室檢測(cè)標(biāo)準(zhǔn)操作規(guī)范1份；臨床標(biāo)本的采集、運(yùn)輸、處理與分裝、流感病毒的保存及管理和流感病毒的快速檢測(cè)方法的標(biāo)準(zhǔn)操作程序1份；實(shí)驗(yàn)室耗材管理方案1份；項(xiàng)目督導(dǎo)評(píng)估方案1份。過程指標(biāo)：國(guó)家級(jí)、省級(jí)現(xiàn)場(chǎng)考察、調(diào)研、協(xié)調(diào)會(huì)共計(jì)25次；SARIIPD監(jiān)測(cè)方案修訂版1份；產(chǎn)出指標(biāo)：培訓(xùn)、督導(dǎo)類活動(dòng)共計(jì)35次。培訓(xùn)醫(yī)務(wù)人員共計(jì)690人次。SARIIPD工作簡(jiǎn)報(bào)24份；省級(jí)地市級(jí)定期工作總結(jié)20份；截至2012年9月30日,四家監(jiān)測(cè)醫(yī)院,共登記了25,438例病例,其中SARI病例25,319例、腦膜炎病例119例�？傆�(jì)檢測(cè)24,340份鼻咽拭子,完成4,259份血培養(yǎng),其中26份(0.6%)肺炎鏈球菌陽性。共開展尿抗原檢測(cè)2,049份,其中88份(4.3%)肺炎鏈球菌陽性。通過不同時(shí)間對(duì)各監(jiān)測(cè)醫(yī)院的督導(dǎo)和評(píng)估,發(fā)現(xiàn)除兒童血標(biāo)本采集率(11.97%)和尿標(biāo)本采集率(64.62%)沒有達(dá)到預(yù)先設(shè)定的監(jiān)測(cè)方案評(píng)價(jià)標(biāo)準(zhǔn)外,其余指標(biāo)均達(dá)到評(píng)價(jià)標(biāo)準(zhǔn)。在各監(jiān)測(cè)醫(yī)院之間各監(jiān)測(cè)指標(biāo)存在較大差異：①病例納入準(zhǔn)確率：最高的是婦幼保健院,準(zhǔn)確率為99%,最低是第二人民醫(yī)院,準(zhǔn)確率為86%；②病例納入的漏報(bào)率：最高的是中心醫(yī)院,漏報(bào)率為19.86%,最低是婦幼保健院,漏報(bào)率為11.03%；③尿采集率：最高的是第一人民醫(yī)院,采集率為87.86%,最低的是第二人民醫(yī)院,采集率為72.94%；通過四次不同時(shí)間核心指標(biāo)評(píng)價(jià),結(jié)果顯示：病例納入的準(zhǔn)確率由第一次的79.86%上升至第四次的100%；漏報(bào)率由第一次的23.33%下降至16.84%；鼻咽拭子標(biāo)本采集率由第一次的95.99%上升至98.79%；成人血標(biāo)本采集率由第一次的77.47%上升至第四次的94.57%；尿標(biāo)本采集率由第一次的64.62%上升至83.17%。 結(jié)論：①本研究發(fā)現(xiàn),通過所選取的評(píng)價(jià)指標(biāo)可以密切關(guān)注監(jiān)測(cè)活動(dòng)的進(jìn)展及變化。如實(shí)反應(yīng)監(jiān)測(cè)系統(tǒng)特征的完整性、一致性和準(zhǔn)確性。②通過四次不同時(shí)間的評(píng)價(jià),選定的七項(xiàng)核心中,病例納入的準(zhǔn)確性、鼻咽拭子、成人血標(biāo)本和尿標(biāo)本的采集率不斷提升,監(jiān)測(cè)質(zhì)量得到明顯的改善,但由于基于人群監(jiān)測(cè)系統(tǒng)組織實(shí)施的復(fù)雜性,評(píng)價(jià)指標(biāo)如病例的漏報(bào)率,并不穩(wěn)定,且有一定的波動(dòng),監(jiān)測(cè)質(zhì)量還有待進(jìn)一步提高。③評(píng)價(jià)工作可有助于明確差距及潛在項(xiàng)目運(yùn)行的障礙,為相關(guān)利益者下一步計(jì)劃提供依據(jù)。
[Abstract]:Objective : To evaluate the characteristics ( accuracy , completeness and consistency ) of monitoring system in Jingzhou city of Hubei Province based on population - based hospitalized acute respiratory tract infection ( SARS ) , and to find out the weak links in monitoring activities and the gap with monitoring target , with a view to continuously improving the monitoring quality and further improving the basis for monitoring .

Methods : According to the requirements of the World Health Organization ( WHO ) and the United States Centers for Disease Control and Prevention ( CDC ) disease surveillance system , according to the requirements of the monitoring plan , the method of site supervision and evaluation was adopted to collect quantitative data to obtain the characteristic values of the monitoring system , and then compared with the ideal evaluation value .

Results : The input indicators were : the monitoring items were formally run from January 2010 and were run from the establishment of the maintenance monitoring system to a total cost of 9 million RMB ( including personnel costs , laboratory equipment , reagents , training , meetings , travel , etc . ) . A total of 12 units and departments and 459 persons were involved in the monitoring activities .
Development of 1 part of the SARIAT monitoring programme : 1 copy of the project implementation manual ;
1 part of data entry and management ;
1 part of respiratory specimen operation flow ;
Standard operation specification for influenza virus laboratory in respiratory tract : 1 part ;
1 part of the standard operating procedures for the collection , transportation , treatment and packaging of clinical specimens , the preservation and management of influenza virus and the rapid detection method of influenza virus ;
1 part of laboratory consumable management scheme ;
1 . Project supervision evaluation scheme : 1 . Process indicators : national , provincial , field investigation , investigation and coordination for 25 times ;
Rev . 1 of the SARIAT Monitoring Protocol ;
Output indicators : 35 training and supervision activities , 690 person - times for training medical personnel .
The provincial prefecture - level regular work is summarized in 20 parts ;
As of September 30 , 2012 , there were 25,438 cases in four monitoring hospitals , including 25 , 319 cases of SARI and 119 cases of meningitis .
( 2 ) The incidence rate of the cases included : the highest is the central hospital , the leakage rate is 19.86 % , the lowest is the maternal and child health care center , the leakage rate is 11.03 % ;
( 3 ) urine collection rate : the highest is the first people ' s hospital , the collection rate is 87.86 % , the lowest is the second people ' s hospital , the collection rate is 72.94 % ;
The results showed that the accuracy of cases was increased from 79.86 % for the first time to the fourth 100 % .
The leakage rate decreased from 23.33 % to 16.84 % in the first time .
The collection rate of nasopharyngeal swab specimens increased from 95.99 % to 98.79 % for the first time .
The collection rate of adult blood samples increased from 77.47 % for the first time to 94.57 % in the fourth time .
The rate of urine collection increased from 64.62 % to 83.17 % for the first time .

Conclusion : 鈶，

本文編號(hào)：2073298