目的 评价池州市结核病分级诊疗和综合防治服务模式试点工作成效,为推广试点成果提供科学依据。方法 通过收集结核病管理信息系统中报告登记的结核病患者治疗管理数据,对分级诊疗制度、医疗保障政策、信息化手段、实验室能力、激励机制等方面试点举措开展调查,比较试点实施前(2017年)和试点实施后(2019年)结核病患者发现、治疗管理等相关指标变化。结果 池州市2017年肺结核报告发病率87.25/10万,2019年61.78/10万;2019年病原学阳性检出率56.27%,痰培养率87.47%,总体到位率95.31%,高危人群耐药筛查率94.20%,病原学阳性患者耐药筛查率90.24%,分别与2017年(32.48%、44.95%、93.24%、39.73%、33.71%)相比均有显著提升,差异均有统计学意义(P＜0.05);菌阳患者密切接触者筛查率99.75%,比试点前有所下降,差异无统计学意义(P=0.449);2019年结核病患者规则服药率达到95.23%。结论 池州市建立完善了结核病分级诊疗和综合防治服务的“池州模式”,对提高结核病防治效果,具有重要作用,为结核病的防治提供了可供借鉴的实践经验和参考。

Objective To evaluate the effect of pilot project on tuberculosis (TB) hierarchical medical system and comprehensive prevention and treatment service in Chizhou City,and provide a scientific basis for the promotion of the pilot results. Methods By collecting the treatment and management data of tuberculosis patients reported and registered in the tuberculosis management information system,pilot measures such as the hierarchical diagnosis and treatment system,medical security policies,informatization methods,laboratory capabilities,and incentive mechanisms were investigated to compare the changes of tuberculosis patients' discovery,treatment management and other related indicators before and after the pilot implementation (2017) and after the pilot implementation (2019). Results The reported incidence rate of tuberculosis in Chizhou City in 2017 was 87.25/100,000,and in 2019 was 61.78/100,000.The positive pathogenic detection rate in 2019 was 56.27%,the sputum culture rate was 87.47%,the total completed referral rate was 95.31%,the drug resistance screening rate of high-risk groups 94.20%,and the drug resistance screening rate of pathogen-positive patients was 90.24%,which were significantly higher than those in 2017 (32.48%,44.95%,93.24%,39.73%,33.71%),and the differences were statistically significant (P<0.05).The screening rate of close contacts of bacteria positive patients was 99.75%,which was lower than that before the trial,and the difference was not statistically significant (P=0.449).In 2019,the rate of regular medication for TB patients reached 95.23%. Conclusion Chizhou City has established and perfected the "Chizhou mode" of tuberculosis hierarchical medical system and comprehensive prevention and treatment service,which plays an important role in improving the effectiveness of tuberculosis prevention and treatment,and provides a practical experience and reference for tuberculosis prevention and treatment.