湖南省按病种付费方式下结核病防治机构门诊服务肺结核患者的调查  

Retrospective survey of outpatient TB service in TB institutions under Hunan case-based payment pilot project

作　　者：刘二勇[1] 王雪静[1] 薛晓[1] 高孟秋[2] 张立群[2] 白丽琼 彭国庆[4] 徐博[4] 周林[1] 成诗明[1] 

机构地区：[1]中国疾病预防控制中心结核病预防控制中心,北京102206 [2]北京市结核病胸部肿瘤研究所 [3]湖南省结核病防治所 [4]湖南省岳阳市疾病预防控制中心

出　　处：《中国防痨杂志》2011年第11期739-742,共4页Chinese Journal of Antituberculosis

摘　　要：目的评价在按病种付费方式下湖南省结核病防治机构(简称"结防机构")为门诊肺结核患者提供服务的质量。方法抽取岳阳汨罗和临湘结防机构2009年7月至2010年6月试点期间登记且完成治疗的结核病患者200例(每县100例)。通过病案查阅,对肺结核治疗过程中检查项目和不良反应处理情况进行回顾性调查。用Epidata进行数据整理,使用SPSS 17.0统计软件进行数据处理分析。结果除国家提供的免费检查项目以外,在初治涂阳患者中,接受尿常规、血常规、心电图检查的患者比例分别为79.12%(72/91)、61.54%(56/91)、54.95%(50/91),初治涂阴患者中,接受相应检查比例为73.33%(77/105)、49.52%(52/105)、36.19%(38/105)。初治涂阳和初治涂阴接受肝功能检查比例分别为90.11%(82/91)和93.33%(98/105)。结防机构不提供视觉、听觉、肾功能检查。无论患者是否存在肝功能检查异常,结防机构为全部患者免费提供保肝药作为预防性用药。结论按病种付费的方式增加了患者免费检查的范围和项目,尤其促使提供了肝功能检查,提高了结防机构门诊患者的诊疗质量。Objective To evaluate the quality of outpatient TB service in TB institutions under case-based payment pilot project. Methods Two hundreds of patients who registered from Jul. 2009 to Jun. 2010 in Miluo and Linxiang TB institutions and had completed full-course treatment before the survey were sampled （100 cases per county）. Through going through the patients~ medical records, retrospective survey was made on the tests the pa- tients took in the diagnosis and treatment process and treatment in dealing with adverse drug response. The data of the survey were input by Epidata, and SPSS 17.0 was used for statistical analysis. Results In addition to the na- tional TB free policy covered items, for new smear positive patients, 79.12% （72/91）, 61.54%（56/91）, 54. 95% （50/91） of patients were prescribed urine, blood, ECG test respectively; the corresponding proportions of new smear negative patients examined for these tests were 73.33%（77/105）, 49.52% （52/105） and 36.19% （38/105） respectively. 90. 11% （82/91）and 93.33%（98/105）of new smear positive and smear negative patients received liver function tests respectively. TB institution did not provide vision, hearing, kidney function tests. Regardless of the existence of patients with abnormal liver function tests, all patients were prescribed free liver protection drugs for preventive therapy. Conclusion The case-based payment methods increased the scope of free tests; especially pro- moted the patients＇ accessibility to liver function test, improved the outpatient TB service quality in TB institutions.

关 键 词：结核 肺/经济学 免费医疗 费用控制 湖南省 

分 类 号：R521[医药卫生—内科学]