内蒙古地区医疗机构梅毒报告质量及影响因素调查  

Investigation on the diagnosis quality and influencing factors of syphilis cases reported by medical facilities in Inner Mongolia

作　　者：迟富利 杨景元 张艳萍[2] 杨虹 刘静 裴迎新[3] 龚向东[4] CHI Fuli;YANG Jingyuan;ZHANG Yanping;YANG Hong;LIU Jing;PEI Yingxin;GONG Xiangdong(Inner Mongolia Autonomous Region Center for Disease Control and Prevention,Hohhot,Inner Mongolia 010031,China;Tong Liao Center for Disease Control and Prevention,Tong Liao,Inner Mongolia 028000,China;Chinese Field Epidemiology Training of Chinese Center for Disease Control and Prevention,Beijing 100050,China;National Center for STD Control,China CDC,Nanjing,Jiangsu 210042,China)

机构地区：[1]内蒙古自治区综合疾病预防控制中心,内蒙古呼和浩特010031 [2]通辽市疾病预防控制中心,内蒙古通辽028000 [3]中国疾病预防控制中心中国现场流行病学培训项目,北京100050 [4]中国疾病预防控制中心性病控制中心,江苏南京210042

出　　处：《中国热带医学》2023年第11期1187-1192,共6页China Tropical Medicine

摘　　要：目的 调查内蒙古地区医疗机构梅毒病例报告质量和诊断准确性,了解报告和诊断中可能存在的问题及影响因素,为梅毒防控措施的制定提供依据。方法 在内蒙古12个盟市中,各随机抽取2个旗县,对其不同类别医疗机构于2019年7月-2020年6月期间报告的梅毒病例进行抽样核查;按照《梅毒诊断(WS 273-2018)》及《全国性病病例报告质量管理方案(2018年版)》中有关指标,对梅毒病例报告质量和准确性进行评价。另外调查医疗机构的基本信息及实验室开展梅毒检测情况,访谈首诊医生了解其对梅毒诊断和报告的掌握,综合分析影响报告准确性的主要因素。结果 内蒙古地区医疗机构梅毒的报告率为99.04%(311/314),漏报率0.96%(3/314);报告及时率98.05%(1 659/1 692),报卡填写完整率99.64%(1 686/1 692),报卡填写正确率99.35%(1 681/1 692),网络录入正确率84.63%(1 432/1 692);不同类型、级别的医疗机构报告及时率(χ^(2)=13.95,P<0.05;χ^(2)=11.40,P<0.05)及网络录入正确率(χ^(2)=30.06,P<0.05;χ^(2)=44.93,P<0.05)差异均有统计学意义。医疗机构梅毒报告准确率86.17%(1 458/1 692),分类正确率为87.06%(1 473/1 692),分期正确率90.25%(1 527/1 692)。多因素logistic回归结果显示,临床首诊医生近3年是否参加过培训[OR=6.26,95%CI:(2.12~18.46)]、是否掌握梅毒分期要点[OR=2.79,95%CI(1.21~6.46)]影响报告准确性。结论 内蒙古医疗机构梅毒报告质量水平较高,但报告准确率及网络录入正确率尚未达到95%目标要求,报告和诊断能力仍需提升,建议进一步加大临床医生诊断和报告标准培训力度和覆盖面。Objective The study aims to investigate the diagnosis quality and accuracy of syphilis cases reported by medical facilities in Inner Mongolia,understand possible problems and influencing factors in reporting and diagnosis,providing evidence for the better formulation of syphilis control and prevention.Methods Cross-sectional survey was conducted with 2 counties sampled randomly from 12 municipals of Inner Mongolia,different medical facilities were covered.Syphilis cases reported from July 2019 to June 2020 in medical institutions of different categories were sampled and checked.The quality and accuracy of syphilis case reporting were evaluated according to the identifiers in"Syphilis Diagnosis(WS 273-2018)"and"National STD Case Reporting Quality Management Scheme(2018)".In addition,the basic information of medical institutions and the implementation of syphilis detection in laboratories were investigated,and the physicians who reported the case first were interviewed to understand their mastery of syphilis diagnosis and reporting,thus analyzing the major factors influencing the accuracy of reports.Results The reporting rate of syphilis in medical institutions in Inner Mongolia was 99.04%(311/314),the missing-report rate was 0.96%(3/314),the timely reporting rate was 98.05%(1659/1692),the completeness rate was 99.64%(1686/1692),the correct rate was 99.35%(1681/1692),the accuracy rate of internet-based input was 84.63%(1432/1692).There were statistical differences in the quality(χ^(2)=13.95,P<0.05;χ^(2)=11.40,P<0.05)and accuracy(χ^(2)=30.06,P<0.05;χ^(2)=44.93,P<0.05)of reports among different municipals and different types of medical facilities.The accuracy rate of syphilis reporting by medical institutions was 86.17%(1458/1692),the correct rate for classifying diagnosis was 87.06%(1473/1692),and the accuracy rate of staging was 90.25%(1527/1692).Multivariate logistic regression results showed that whether the first-clinic physician attended training in the past three years[OR=6.26,95%CI:(2.12-18.46)]and whethe

关 键 词：梅毒 病例报告 准确性 影响因素 诊断 医疗机构 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]