张燕, 毕洪波, 王新旗, 王希江, 冯建宇, 刘年强, 王乐, 王森路, 曹明芹. 肺结核主动筛查结合传染期住院治疗与“集中服药+营养早餐”的患者发现与管理模式效果评价[J]. 疾病监测, 2023, 38(11): 1318-1323. DOI: 10.3784/jbjc.202307310386
引用本文: 张燕, 毕洪波, 王新旗, 王希江, 冯建宇, 刘年强, 王乐, 王森路, 曹明芹. 肺结核主动筛查结合传染期住院治疗与“集中服药+营养早餐”的患者发现与管理模式效果评价[J]. 疾病监测, 2023, 38(11): 1318-1323. DOI: 10.3784/jbjc.202307310386
Zhang Yan, Bi Hongbo, Wang Xinqi, Wang Xijiang, Feng Jianyu, Liu Nianqiang, Wang Le, Wang Senlu, Cao Mingqin. Evaluation of detection and management mode of tuberculosis patients by active screening, hospitalization in infectious phase and “centralized medication + nutritional breakfast”[J]. Disease Surveillance, 2023, 38(11): 1318-1323. DOI: 10.3784/jbjc.202307310386
Citation: Zhang Yan, Bi Hongbo, Wang Xinqi, Wang Xijiang, Feng Jianyu, Liu Nianqiang, Wang Le, Wang Senlu, Cao Mingqin. Evaluation of detection and management mode of tuberculosis patients by active screening, hospitalization in infectious phase and “centralized medication + nutritional breakfast”[J]. Disease Surveillance, 2023, 38(11): 1318-1323. DOI: 10.3784/jbjc.202307310386

肺结核主动筛查结合传染期住院治疗与“集中服药+营养早餐”的患者发现与管理模式效果评价

Evaluation of detection and management mode of tuberculosis patients by active screening, hospitalization in infectious phase and “centralized medication + nutritional breakfast”

  • 摘要:
      目的   客观评价肺结核主动筛查结合传染期住院治疗与“集中服药+营养早餐”的患者发现与管理模式(政策)在新疆维吾尔自治区(新疆)结核病疫情防治中的效果,并分析政策在不同结核病负担地区的实施效果差异,为结核病防治方案的调整及卫生干预政策的制订提供参考依据。
      方法   收集新疆阿克苏地区和巴音郭楞蒙古自治州2012年1月至2021年12月期间结核病患者登记数据,采用中断时间序列(ITS)前后对比分析政策实施前后肺结核登记率的变化,双重差分法(DID)对比分析政策在结核病高负担地区和低负担地区的实施效果差异。
      结果   2012—2021年阿克苏地区肺结核登记率高于巴音郭楞蒙古自治州,阿克苏地区和巴音郭楞蒙古自治州肺结核登记率在2018年之前呈现上升趋势,在2018年达到高峰,2018年之后登记率持续快速下降。 在政策实施后当年,阿克苏地区登记率显著增加248.800/10万(P<0.001);政策实施后的长期趋势,阿克苏地区和巴音郭楞蒙古自治州的登记率均呈现下降趋势(均β3 <0, P<0.05),阿克苏地区登记率的下降速度大于巴音郭楞蒙古自治州( \beta _1 + \beta _3 :139.747>48.712)。 阿克苏地区与对照地区之间每万人医疗机构床位数、医疗机构数、每万人医生数、人均国内生产总值、农村居民可支配收入、职工基本医疗保险存在差异,差异均有统计学意义(P<0.05),将其作为协变量构建DID模型结果显示:政策实施后,阿克苏地区政策效应与巴音郭楞蒙古自治州相比,平均政策效应差异为355.04,差异无统计学意义(P=0.205),其中,平均政策效应差异在2018和2019年有统计学意义,提示2018和2019年阿克苏地区政策干预效应大于巴音郭楞蒙古自治州。
      结论   在新疆结核病疫情高负担地区和低负担地区,政策对控制结核病疫情均具有降低登记率的长期效应,预期持续开展能有效遏制结核病的传播与流行。

     

    Abstract:
      Objective   To evaluate the performance of the detection and management mode of tuberculosis (TB) patients by active screening, hospitalization in infectious phase and “centralized medication + nutritional breakfast” in Xinjiang, and analyze the difference in the performance in areas with different TB burden and provide reference for the improvement of TB control programs and the formulation of health intervention policies in Xinjiang.
      Methods  The registration data of TB patients in Aksu and Bayingoleng of Xinjiang from January 2012 to December 2021 were collected. Interrupted time series (ITS) was used to analyze the change of TB registration rate before and after the implementation of the TB detection and management mode. Differences-in-Differences (DID) model was used to analyze the difference in the implementation effect of the mode between high-burden areas and low-burden areas.
      Results  From 2012 to 2021, the registration rate of TB in Aksu was higher than that in Bayingoleng. The registration rates of TB in both Aksu and Bayinguoleng showed upward trends before 2018, reached the peak in 2018, and continued to decline rapidly after 2018. In the year when the mode was taken, the TB registration rate in Aksu increased significantly by 248.800/100 000 (P<0.001); The analysis on long-term trend after the implementation of the mode indicated that the registration rates in Aksu and Bayingoleng all showed downward trends (β3<0, P<0.05), the registration rate in Aksu decreased more rapidly compared with Bayingoleng (β1+β3: 139.747>48.712). There were significant differences in the number of hospital beds per 10 000 people, number of medical institutions, number of doctors per 10 000 people, GDP per capita, disposable income of rural residents and basic medical insurance for employees between Aksu and the control area (P<0.05). The results of DID model constructed by taking them as covariates showed that after the implementation of the mode the average effect difference between Aksu and Bayinguoleng was 355.04, which had no significance (P=0.205), but the average effect difference was significant in 2018 and 2019, indicating that the intervention effects in Aksu in 2018 and 2019 were greater than those in Bayinguoleng.
      Conclusion  In the areas with high and low TB burden in Xinjiang, the detection and management mode of TB patients by active screening, hospitalization in infectious phase and “centralized medication + nutritional breakfast” had long-term effects on reducing the registration rate of TB, and it is expected that continuous implementation of the mode can effectively curb the spread of TB.

     

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