發(fā)布時間：2018-01-17 23:06

  本文關鍵詞：典型醫(yī)療機構塵肺病低報情況研究　出處：《中國疾病預防控制中心》2017年碩士論文　論文類型：學位論文

  更多相關文章： 職業(yè) 塵肺病 低報

【摘要】：職業(yè)病低報研究屬于公共衛(wèi)生監(jiān)測系統(tǒng)評價的重要內容之一,它體現(xiàn)監(jiān)測系統(tǒng)發(fā)現(xiàn)和確認職業(yè)病危害問題的能力。開展塵肺病低報研究,從醫(yī)療可及性、漏診、漏報等角度,估計低報程度,了解低報原因并提出改進措施,對于改進和完善職業(yè)病監(jiān)測系統(tǒng)、提高監(jiān)測效率、確保監(jiān)測系統(tǒng)發(fā)現(xiàn)職業(yè)病數(shù)量的準確性、更好的了解分布特征和變化趨勢、發(fā)現(xiàn)爆發(fā)和流行等情況具有重要意義。[目的]調查塵肺病低報程度,了解造成低報的各種可能因素和關鍵環(huán)節(jié),提出改進措施。[方法]本研究采取文獻研究法進行研究設計,應用臨床職業(yè)病學方法回顧性分析4家典型醫(yī)療機構(分別為:具有診斷資質的職業(yè)病防治院1家、具有診斷資質的綜合醫(yī)院1家、不具有診斷資質的綜合醫(yī)院1家、不具有診斷資質的胸科醫(yī)院1家)2016年臨床病例信息來估計疑似塵肺病、塵肺病的低報程度,采用問卷調查和訪談法探索低報的原因,并提出改進建議。[結果]研究結果顯示4家醫(yī)療機構陽性病例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,報告信息與病例資料核對完整無誤,漏報率為0。問卷調查結果顯示綜合醫(yī)院相關科室非塵肺病診斷醫(yī)師的職業(yè)病知識知曉率為31.1%,接受培訓的知曉率高于未接受過培訓的醫(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)師普遍對本單位是否有職業(yè)病報告系統(tǒng)不太了解或理解錯誤,69.7%調查對象認為非職業(yè)病診斷機構有必要報告職業(yè)病。所有塵肺病診斷醫(yī)師都遇到過懷疑是塵肺病但無法診斷的情況,無法診斷的原因主要是:影像學表現(xiàn)不到診斷標準(73.9%)、無法獲取職業(yè)史資料(69.6%)和病人主動選擇中止診斷(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,沒有報告疑似職業(yè)病的原因是認為沒有疑似職業(yè)病的診斷標準。調查結果還顯示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)病診斷機構就診過,也存在醫(yī)生忽視塵肺癥狀、對診斷制度不了解的情況。訪談結果顯示流動工人的職業(yè)病診斷存在困難、非職業(yè)病診斷醫(yī)療機構存在漏診和誤診現(xiàn)象、用人單位抵觸、工人主動放棄職業(yè)性塵肺病診斷、疑似職業(yè)病低報是塵肺病低報的主要原因。[結論]調查顯示目前疑似塵肺病低報程度較高,主要存在于職業(yè)性塵肺病就診環(huán)節(jié),確診的塵肺病在報告環(huán)節(jié)低報程度較低,非職業(yè)病診斷機構的低報程度高于職業(yè)病診斷機構。低報主要受診斷標準設置、醫(yī)師診斷能力、病人無法獲取職業(yè)史資料和病人主動選擇中止診斷等因素影響。建議進一步加強職業(yè)病知識宣傳培訓、加強職業(yè)健康監(jiān)護工作、職業(yè)病臨床診斷與職業(yè)病認定程序分步實施、提高職業(yè)病診斷標準靈敏度、明確疑似職業(yè)病的定義和診斷標準、加強塵肺病鑒別診斷領域和特異性生物標志物研究、應用多種數(shù)據(jù)來源進行職業(yè)病監(jiān)測。
[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】：R135.2

【參考文獻】

相關期刊論文 前6條

1 秦克江;葉紹色;王力珩;鐘麗萍;王超英;李美雄;邱毅;麥志丹;;廣西省粉塵作業(yè)者職業(yè)健康檢查塵肺病漏診分析[J];環(huán)境與職業(yè)醫(yī)學;2015年04期

2 王海椒;陳俊華;譚利民;;四川省職業(yè)病報告漏報調查結果及分析[J];職業(yè)衛(wèi)生與病傷;2012年06期

3 石新山;楊新躍;朱德香;高燕華;肖舜華;;深圳市基層衛(wèi)生人員職業(yè)病相關知識培訓的效果[J];中華勞動衛(wèi)生職業(yè)病雜志;2012年02期

4 劉力平;捕獲再捕獲與捕獲移出模型的概念、方法和新進展[J];數(shù)學進展;2004年05期

5 陳曙e，

本文編號：1438356