【摘要】：背景法定傳染病網(wǎng)絡(luò)直報(bào)工作中,醫(yī)療機(jī)構(gòu)是傳染病報(bào)告的主體對(duì)象,臨床醫(yī)護(hù)人員是傳染病報(bào)告的主體責(zé)任人,其報(bào)告病例的信息質(zhì)量是掌握傳染病真實(shí)發(fā)病趨勢(shì)、追蹤病人及疫情決策的重要依據(jù),是傳染病監(jiān)測(cè)的生命線。鑒于此,本研究選擇醫(yī)療機(jī)構(gòu)作為研究對(duì)象,利用2015年全國(guó)法定傳染病報(bào)告質(zhì)量調(diào)查數(shù)據(jù)做進(jìn)一步研究分析,為傳染病報(bào)告管理和評(píng)價(jià)工作提供參考。目的掌握2015年我國(guó)醫(yī)療機(jī)構(gòu)法定染病網(wǎng)絡(luò)直報(bào)現(xiàn)狀,評(píng)價(jià)不同地區(qū)、不同病例來(lái)源和不同級(jí)別法定傳染病信息報(bào)告質(zhì)量,分析當(dāng)前醫(yī)療條件下影響傳染病信息報(bào)告質(zhì)量的因素,為法定傳染病科學(xué)管理、科學(xué)決策提供參考和依據(jù)。方法描述性分析全國(guó)2015年醫(yī)療機(jī)構(gòu)傳染病信息報(bào)告質(zhì)量及管理現(xiàn)狀,對(duì)報(bào)告率等指標(biāo)的比較采用χ2檢驗(yàn);采用TOPSIS法綜合評(píng)價(jià)不同病例來(lái)源、不同地區(qū)、不同級(jí)別及116家醫(yī)療機(jī)構(gòu)信息報(bào)告質(zhì)量,以報(bào)告率等5指標(biāo)、TOPSIS綜合評(píng)價(jià)質(zhì)量結(jié)果和病例報(bào)告狀態(tài)作為因變量構(gòu)建二分類logistic回歸模型,探討現(xiàn)有醫(yī)療資源條件下影響醫(yī)療機(jī)構(gòu)法定傳染病信息報(bào)告質(zhì)量的因素。結(jié)果2015年各級(jí)醫(yī)療機(jī)構(gòu)法定傳染病報(bào)告率、及時(shí)率、完整率、準(zhǔn)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(bào)告率高于出入院報(bào)告率(X2=34.25,p0.0001),不同地區(qū)間及時(shí)報(bào)告率(χ2=8.32,P=0.02)、完整率(χ2=11.58,P=0.003)、準(zhǔn)確率(χ2=77.10,P0.0001)和一致率(χ2=21.49,P0.0001)均有統(tǒng)計(jì)學(xué)差異;不同級(jí)別醫(yī)療機(jī)構(gòu)的法定傳染病報(bào)告率(χ2=38.70,P0.0001)、及時(shí)率(χ2= 26.64,P0.001)、完整率(χ2=22.64,P0.0001)和準(zhǔn)確率(χ2=53.92,P0.0001)均有統(tǒng)計(jì)學(xué)差異。以TOPSIS建模,傳染病報(bào)告質(zhì)量綜合評(píng)價(jià)結(jié)果為中部地區(qū)最好、西部最差;不同級(jí)別醫(yī)療機(jī)構(gòu)信息報(bào)告綜合質(zhì)量鄉(xiāng)鎮(zhèn)級(jí)優(yōu)于縣區(qū)級(jí),縣區(qū)級(jí)優(yōu)于地市級(jí),地市級(jí)優(yōu)于省級(jí);門診和出入院登記的信息報(bào)告綜合質(zhì)量一致。logistic回歸分析顯示,單一評(píng)價(jià)指標(biāo)中,醫(yī)療機(jī)構(gòu)傳染病漏報(bào)與傳染病自查有無(wú)領(lǐng)導(dǎo)參與有關(guān),及時(shí)性與出入院登記是否齊全規(guī)范有關(guān),一致性與地區(qū)有關(guān),完整性與出入院登記是否規(guī)范齊全、有無(wú)打印傳報(bào)卡功能有關(guān),準(zhǔn)確性與單位級(jí)別、出入院日志填寫是否規(guī)范齊全、傳染病直報(bào)管理人員總數(shù)有關(guān)。傳染病報(bào)告TOPSIS綜合質(zhì)量與地區(qū)、單位級(jí)別、出入院是否齊全規(guī)范及專職傳報(bào)管理人員4個(gè)因素有關(guān)。以病例報(bào)告狀態(tài)構(gòu)建logistic回歸分析模型顯示:1、漏報(bào)與單位級(jí)別有關(guān);2、報(bào)告及時(shí)性與地區(qū)、單位級(jí)別、門診日志設(shè)置是否齊全、出入院登記設(shè)置是否齊全和是否具備自動(dòng)打印電子傳報(bào)卡有關(guān);3、完整性與地區(qū)、單位級(jí)別、門診日志填寫是否規(guī)范、出入院設(shè)置是否齊全、傳染病自查時(shí)分管領(lǐng)導(dǎo)是否參與有關(guān)、網(wǎng)絡(luò)直報(bào)管理人員總數(shù)有關(guān)及專用計(jì)算機(jī)使用年限有關(guān);4、一致性與地區(qū)、單位級(jí)別、門診日志填寫是否規(guī)范、出入院設(shè)置是否齊全、針對(duì)自查是否及時(shí)整改、網(wǎng)絡(luò)直報(bào)管理人員總數(shù)、打印紙質(zhì)報(bào)告卡是否有首診醫(yī)生簽名及所轄CDC用戶信息安全培訓(xùn)有關(guān);5、準(zhǔn)確性與單位級(jí)別有關(guān)。結(jié)論根據(jù)衛(wèi)生事業(yè)發(fā)展規(guī)劃目標(biāo),2015年我國(guó)法定傳染病報(bào)告率達(dá)到95%的規(guī)劃目標(biāo),及時(shí)率達(dá)到90%的規(guī)劃目標(biāo),準(zhǔn)確率、完整率和一致率仍需要提高。TOPSIS法彌補(bǔ)單一指標(biāo)評(píng)價(jià)不能解決的復(fù)雜問(wèn)題,其結(jié)果直觀、綜合,但在反映單一側(cè)面特性時(shí)需結(jié)合單指標(biāo)評(píng)價(jià)方法更能說(shuō)明問(wèn)題。醫(yī)療機(jī)構(gòu)應(yīng)在傳染病自查時(shí)分管領(lǐng)導(dǎo)參與、門診和出入院日志登記設(shè)置齊全和規(guī)范填寫、傳染病網(wǎng)絡(luò)直報(bào)管理人員配置、針對(duì)自查發(fā)現(xiàn)問(wèn)題及時(shí)整改、電子病歷具備打印傳染病報(bào)告卡功能和打印紙質(zhì)傳報(bào)卡有首診醫(yī)師簽名、專用計(jì)算機(jī)使用年限、網(wǎng)絡(luò)信息安全培訓(xùn)等方面加強(qiáng)內(nèi)控管理,以期進(jìn)一步提升傳染病報(bào)告質(zhì)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(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)】：R181.8

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 朱敏;向倫輝;袁國(guó)平;楊興堂;;2015年上海市寶山區(qū)傳染病報(bào)告質(zhì)量和管理現(xiàn)狀調(diào)查[J];河南預(yù)防醫(yī)學(xué)雜志;2017年02期

2 金麗珠;葛輝;杜雪杰;陳孟;于萌;鄭環(huán);郭青;;2015年全國(guó)醫(yī)療機(jī)構(gòu)法定傳染病報(bào)告質(zhì)量調(diào)查分析[J];疾病監(jiān)測(cè);2016年10期

3 田向陽(yáng);柴燕;方麗;程玉蘭;陳繼彬;;中國(guó)公眾傳染病健康素養(yǎng)評(píng)價(jià)指標(biāo)體系構(gòu)建[J];中國(guó)公共衛(wèi)生;2016年11期

4 黃淑瓊;蔡晶;楊雯雯;;2011-2015年湖北省醫(yī)療機(jī)構(gòu)法定傳染病信息報(bào)告質(zhì)量綜合評(píng)價(jià)[J];疾病監(jiān)測(cè);2016年09期

5 張冬然;黃少平;闞震;石磊;董瑞強(qiáng);李麗麗;;應(yīng)用TOPSIS法綜合評(píng)價(jià)北京市房山區(qū)2011-2015年碘缺乏病監(jiān)測(cè)結(jié)果[J];首都公共衛(wèi)生;2016年04期

6 王春暉;劉露;吳學(xué)朕;廖惠貞;;感染性疾病實(shí)驗(yàn)室診斷方法的Logistic回歸分析[J];檢驗(yàn)醫(yī)學(xué)與臨床;2016年07期

7 黃夏萍;郭亮永;徐斌;楊建敏;蔣碧玲;;南寧市2014年基層醫(yī)療衛(wèi)生機(jī)構(gòu)傳染病報(bào)告質(zhì)量和管理現(xiàn)狀調(diào)查[J];中國(guó)初級(jí)衛(wèi)生保健;2016年04期

8 王曉風(fēng);郭青;張春曦;于萌;蘇雪梅;;法定傳染病網(wǎng)絡(luò)報(bào)告系統(tǒng)質(zhì)量評(píng)價(jià)指標(biāo)體系評(píng)價(jià)[J];疾病監(jiān)測(cè);2016年03期

9 張昕;徐哲;陳威巍;姜天俊;王福生;;2014—2015年我國(guó)新發(fā)傳染病臨床診治與相關(guān)研究進(jìn)展[J];傳染病信息;2016年01期

10 冷姝芳;王鍵;楊曉青;呂焱;;基于醫(yī)院信息系統(tǒng)的傳染病監(jiān)測(cè)報(bào)告系統(tǒng)的應(yīng)用效果評(píng)價(jià)[J];上海交通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2015年12期

相關(guān)會(huì)議論文 前1條

1 劉影;劉文妮;康藝齡;王訪;;我國(guó)區(qū)域傳染病狀況分析[A];2015年（第四屆）全國(guó)大學(xué)生統(tǒng)計(jì)建模大賽論文[C];2015年

相關(guān)博士學(xué)位論文 前1條

1 張松榮;深圳市慢性病防治機(jī)構(gòu)服務(wù)質(zhì)量評(píng)估指標(biāo)體系與綜合評(píng)價(jià)模型研究[D];中南大學(xué);2010年

相關(guān)碩士學(xué)位論文 前6條

1 吳田勇;重慶市傳染病經(jīng)濟(jì)負(fù)擔(dān)研究[D];重慶醫(yī)科大學(xué);2014年

2 張未寒;傳染病監(jiān)測(cè)系統(tǒng)綜合評(píng)價(jià)指標(biāo)體系研究[D];中國(guó)疾病預(yù)防控制中心;2011年

3 龔海燕;醫(yī)療機(jī)構(gòu)在傳染病預(yù)防和控制中的作用[D];中國(guó)疾病預(yù)防控制中心;2010年

4 張海濱;2009年法定傳染病報(bào)告調(diào)查數(shù)據(jù)質(zhì)量現(xiàn)狀及影響因素分析[D];中國(guó)疾病預(yù)防控制中心;2010年

5 肖達(dá)勇;中國(guó)人感染高致病性禽流感監(jiān)測(cè)系統(tǒng)評(píng)價(jià)[D];中國(guó)疾病預(yù)防控制中心;2009年

6 王軼;河南省農(nóng)村法定傳染病報(bào)告質(zhì)量低下的原因研究[D];鄭州大學(xué);2007年

，

本文編號(hào)：2203238