关键词: 结核, 管理医疗规划, 公共卫生管理, 结果评价(卫生保健), 广州市

Abstract: Objective: To evaluate the implementation effect of the existing tuberculosis management mode in Guangzhou, and to provide the evidence and examples for improving the tuberculosis prevention and control service system. Methods: From 2016 to 2020, the tuberculosis epidemic data under four tuberculosis prevention and control management models (chronic disease management model, “trinity” model, general hospital management model and entrusted service mode) in Guangzhou were collected from the tuberculosis surveillance information reporting management system of Guangzhou and the final evaluation report of the 13th Five-Year Plan for tuberculosis prevention and control in Guangzhou. The registration rate, etiological positive rate, successful treatment rate, management rate and standardized management rate of pulmonary tuberculosis patients under different modes were calculated, and the cost-effectiveness analysis of the implementation effect was carried out. Results: In 2016—2020, the average annual registration rate of tuberculosis in Guangzhou was 51.78/100000 (46228/89280200), the average annual registration rate of the four models from high to low, was entrusted service mode (74.37/100000 (10522/14148900)), “trinity” (50.17/100000 (11349/22619500)), chronic disease management (47.37/100000 (14588/30793700)) and general hospital management (44.98/100000 (9769/21718100)), statistically significant difference (χ²=222.422, P<0.001). The total etiological positive rate was 49.33% (22806/46228), the rate of chronic disease management model was the highest (50.98% (7437/14588)), and the entrusted service model was the lowest (48.07% (5058/10522)); the overall treatment success rate was 93.26% (43113/46228), the rate of general hospital management model was the highest (95.73% (9352/9769)), and the “trinity” model was the lowest (90.30% (10248/11349)); the total standard management rate was 89.08% (13254/14879), the rate of entrusted service mode was the highest (95.40% (2573/2697)), and the “trinity” model was the lowest (82.69% (3100/3749)); the differences were statistically significant (χ²=27.302, P<0.001; χ²=306.666, P<0.001; χ²=294.272, P<0.001). The per capita investment was 0.86 yuan (76477200/89280200), the maximum investment for one DALY loss was the “trinity” model (RMB 188.20 yuan (20326600/108003.67)), and the general hospital management model is the lowest (153.77 yuan (15155800/98560.73)). Conclusion: During the period, the four tuberculosis control management models in Guangzhou have its own advantages and disadvantages. In the future, it is still necessary to take active measures to improve the deficiencies in the existing tuberculosis prevention and control service system based on the demand orientation of various districts, from government departments, systems to talent construction, so as to further improve the patient registration rate, the etiological positive rate and the total standardized management rate.

Key words: Tuberculosis, Managed care programs, Public health administration, Outcome assessment (health care), Guangzhou City