传染病报告信息系统与结核病信息管理系统的肺结核病患者报告及登记数据一致性分析

摘要:目的 分析广西4个县传染病报告信息管理系统（大疫情）与结核病信息管理系统（专报）分别报告和登记的肺结核患者数据的不一致率以及原因。方法 选择两系统分别导出的报告与登记数差异较大的A、B、C、D 4个县进行现场核查和统计分析。内容包括:数据预分析、定性访谈、现场核查和抽样调查。结果 两系统的平均报告登记一致率为32.45%，最低17.09%。疑似肺结核患者被排除后没有从专报向大疫情推送占65.41%；专报 82例转诊到位未收治和未排除的疑似肺结核病例，其中15例（18.29%）为流动治疗患者，实则并未到位及登记；5例（6.10%）无诊疗资料；62例有资料者中，9例（14.52%）涂阳肺结核患者没有得到收治，10例（16.13%）既往有抗结核治疗史的涂阴肺结核病患者由于无法定性，未得到及时处理，其余43例到位后均未进行收治或排除；抽查40例排除活动性肺结核病例的排除符合率为67.50%。结论 专报系统排除活动性肺结核患者数据没有向大疫情推送，是导致两个系统报告和登记数据不一致的主要原因；结防机构过度排除患者成为疫情丢失的隐患；到位未收治或未排除体现了部分基层结防机构工作责任心和积极性不足；流动治疗患者及既往有抗结核治疗史涂阴肺结核患者的管理、收治是目前专报系统登记和管理的空白区。应加强基层人员能力建设，建立和优化两系统报告与登记数据质量定期核查机制。

Consistency analysis of the pulmonary tuberculosis reporting and registration based on NNDRS and TMIS in Guangxi

Abstract: Objective This work was to analyze the consistency between cases report from the National Notifiable Disease Reporting System (NNDRS) and tuberculosis Management Information System (TMIS) in four counties, and explore the influencing factors leading to the difference. Methods Four counties with relatively poor consistency were selected for spot checking and analysis, including pre-analysis, qualitative interview, spot checking, and sample survey. Results The general consistency was 32.45%. Among the four counties, the lowest rate was 17.09%. Among the causes, the percentage of those who were originally suspected as TB patients but later excluded by TMIS but not renewed the information to NNDRS accounted for 65.41%. 82 suspected TB patients were reported but not treated, and among them 15 (18.29%) were stream patients, 5 (6.10%) had no record about their diagnosis and treatment. Therefore, the remaining 62 cases were selected for spot checking. In this group, 9 (14.52%) cases were sputum smear positive, therefore theyshould have but failed to be registered. 10 (16.13%) cases that had the past medical history of anti-TB treatment but were smear negative, so that they could not be clearly defined. The rest 43 patients were registered but not treated or received testing for exclusion. Among them, 40 cases were included for sample survey, and the result showed that the consistency of rule out was 67.50%. Conclusion The major reason of the inconsistency was that the rule-out of suspected TB patients by TMIS was not renewed to the NNDRS. It became a hidden danger of the TB situation. No action to registered patients reflected the irresponsibility of some TB workers. The stream patient reported by the field of medical institutions and the patient who has the past medical history of anti-TB are the gap of our management and register system. Checking the information regularly and reinforce of the human resource can increase the consistency of two systems.