民营医院作为结核病定点医院的新型防治模式实施效果分析

目的 分析民营医院作为定点医院的新型结核病防治服务模式在结核病防治工作的实施效果，为实施新型结核病防治服务模式提供参考依据。方法 选择重庆市采用民营医院作为定点医院模式和CDC模式的区各2个，收集分析人力资源、患者发现、转诊追踪、治疗转归、督导和抗结核药物使用等数据，探讨民营医院作为定点医院的新型结核病防治模式实施效果。结果 两区县实施新型结核病防治模式前后，结防人员数量减少了近50%。民营医院模式和CDC模式下的肺结核登记率（分别为54.24/10万和62.98/10万）、系统管理率（分别为99.68%和98.37%）、转诊到位率（分别为30.16%和36.48%）、涂阳患者治愈率（分别为94.14%和93.18%）、涂阴患者完成疗程率（分别为98.23%和96.43%）、督导完成率（分别为104.11%和101.57%）和保肝药使用率（分别为80.39%和80.39%）的差异均无统计学意义（P ＞0.05）。而民营医院模式与CDC模式比较，总体到位率（分别为91.50%和71.19%）、追踪到位率（分别为87.49%和54.65%）和标准治疗方案执行率（分别为88.65%和99.02%）存在统计学差异（P ＜0.001）。结论 民营医院作为定点医院的新型结核病防治模式是一个值得借鉴的结核病防治服务模式。加强医防合作，可有效提高结核病控制效果，降低结核病疫情。

Analysis on implementation effect of tuberculosis prevention using new service model of private hospital

Objective The aim of the study was to analyze the implementation effect of tuberculosis (TB) prevention using new service model of private hospital as the designated hospital, in order to provide evidence for implementation of new service model. Methods TB control conducted by private hospital (designated hospital model) and centers for disease control (CDC model) of two counties were selected respectively. The data of human resources, referral and tracing, treatment outcome, supervision and anti-TB drug usage were collected and analyzed. Meanwhile, the implementation effect on TB prevention was explored using new service model of private hospital as TB designated hospital. Results Compared to the effect of private hospital TB control model, the number of the staff was decreased by almost 50% in two counties. Between private hospital model and CDC model, the registration rates were 54.24/100000 and 62.98/100000 respectively. Systematic management rates were 99.68% and 98.37% respectively. Referral arrival rates were 30.16% and 36.48% respectively. Cure rates of smear positive TB cases were 94.14% and 93.18% respectively. Treatment completion rates of smear negative TB cases were 98.23% and 96.43% respectively. Supervision completion rates were 104.11% and 101.57% respectively. And rates of protect liver drug use were 80.39% and 80.39% respectively, which were not statistically significant (P＞0.05). The overall arrival rates were 91.50% and 71.19% respectively. Tracing arrival rates were 87.49% and 54.65% respectively. And rates of standard treatment were 88.65% and 99.02% respectively, which were statistically significant (P<0.001). Conclusion Using the new service model of private hospital as TB designated hospital is worth learning. Strengthening the medical cooperation can effectively improve the effect of TB control and reduce the TB epidemic.