2021－2022年甘肃省武威市凉州区4家医疗机构丙型肝炎诊断与报告质量核查分析

杨鹏年; 李斌

doi:10.3784/jbjc.202301280009

2021－2022年甘肃省武威市凉州区4家医疗机构丙型肝炎诊断与报告质量核查分析

杨鹏年,
李斌

Analysis on hepatitis C diagnosis and reporting quality in 4 hospitals in Liangzhou district of Wuwei, Gansu, 2021−2022

摘要

摘要:
目的了解甘肃省武威市凉州区医疗机构丙型肝炎报告质量，为医疗机构下一步提高丙型肝炎报告质量提供依据。
方法选取武威市凉州区丙型肝炎报告、就诊量较大的A、B、C、D共4家不同级别的医疗机构为调查对象，对2021年6月1日至2022年5月31日网络报告的确诊病例和丙型肝炎病毒（HCV）核酸阳性者进行核查，再随机抽取20张丙型肝炎传染病报告卡，不满20例的全部抽取，与网络报告情况进行核对，以Excel 2010和SPSS 19.0软件分析比较病例的报告率、漏报率、报告及时率、报告卡信息完整率、报告卡信息准确率、上报信息一致率。
结果 B机构抗-HCV阳性患者的HCV核糖核酸（RNA）检测率（70.29%）明显高于其余3家（χ²＝30.700，P＜0.010）。 A、B 机构HCV RNA检测阳性率高于C与D机构（χ²＝24.300，P＜0.010）。共核查丙型肝炎确诊病例349例，确诊病例总误报率为45.84%，其中三级医疗机构误报率为43.12%，二级医疗机构误报率为75.86%，差异有统计学意义（χ²＝8.200，P＜0.010）；检验科检出的213例HCV核酸阳性者，上报信息系统109例，总漏报率为48.83%，其中三级医疗机构漏报率为50.24%，二级医疗机构漏报率为12.50%，差异有统计学意义（χ²＝4.500，P＜0.050）；报告质量核查显示总体报告及时率为86.30%，其中三级医院报告及时率为92.50%，二级医院报告及时率为80.00%，差异无统计学意义（χ²＝2.600，P＞0.050）；总体报告卡信息准确率为80.00%，其中三级医院准确率92.50%，二级医院准确率67.50%，差异有统计学意义（χ²＝7.800，P＜0.010）。
结论武威市凉州区二级医疗机构丙型肝炎报告的误报率高于三级，三级医疗机构漏报率高于二级，三级机构报告卡信息准确率优于二级机构，后期应加强医疗机构丙型肝炎诊断标准培训，提高实验室检测能力，降低丙型肝炎误报、漏报率。

Abstract:
Objective To understand the reporting quality of hepatitis C in medical institutions in Liangzhou district of Wuwei, Gansu province, and provide evidence for improving the reporting quality of hepatitis C in medical institutions.
Methods Hospital A, B, C and D at different levels in Liangzhou, with a large number of hepatitis C reporting and outpatient visits were selected for the survey. The verifications of confirmed hepatitis C cases and positive cases of hepatitis C virus reported by the 4 hospitals from June 1, 2021 to May 31, 2022 were conducted. Twenty hepatitis C reporting cards were randomly selected in each hospital for comparison with the reported data through internet. Software Excel 2010 and SPSS 19.0 were used to analyze and compare the case reporting rate, underreporting rate, timely reporting rate, reporting card completion rate, reporting card accuracy rate and reporting card consistency rate.
Results The detection rate of HCV RNA in anti-HCV positive patients in hospital B (70.29%) was significantly higher than those in other three hospitals ( χ²=30.700, P<0.010). The positive rates of HCV RNA detection in hospital A and B were higher than those in hospital C and D ( χ²=24.300, P<0.010). A total of 349 confirmed cases of hepatitis C were verified, and the overall misreporting rate of confirmed cases was 45.84%. The misreporting rate of hepatitis C was 43.12% in grade Ⅲ hospitals and 75.86% in grade Ⅱ hospitals, the difference was significant (χ²=8.200, P<0.010). Among the 213 HCV nucleic acid positive cases detected by the hospital laboratories, 109 were reported to the information system, the underreporting rate was 48.83%. The underreporting rate was 50.24% in grade Ⅲ hospitals and 12.50% in grade Ⅱ hospitals, the difference was significant (χ²=4.500, P<0.050). The reporting quality verification showed that the overall reporting timeliness rate was 86.25%, the timeliness rate s was 92.50% in grade Ⅲ hospitals, and 80.00% in grade Ⅱ hospitals, the difference was not significant (χ²=2.600, P<0.050). The overall accuracy rate of the reporting card was 80.00%, the accuracy rate was 92.50% in grade Ⅲ hospitals, and 67.50% in grade Ⅱ hospitals, the difference was significant (χ²=7.800, P<0.010).
Conclusion The false positive rate of hepatitis C reporting in grade Ⅱ hospitals was higher than that in grade Ⅲ hospitals in Liangzhou. The false negative rate in grade Ⅲ hospitals was higher than that in grade Ⅱ hospitals. The accuracy of reporting card in grade Ⅲ hospitals was better than that in grade Ⅱ hospitals. The training of hepatitis C diagnostic criteria in medical institutions should be strengthened to improve the laboratory detection ability and reduce the false positive and false negative reporting rate of hepatitis C.

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