关键词: 结核, 肺, 医师诊疗模式, 医院, 专科, 卫生计划实施

Abstract: Objective To evaluate the implementation status of tuberculosis designated hospitals mode supported by Global Fund project in China. Methods Quantitative research method was adopted. The overview of implementation status, and the information of patient detection and treatment management before and after the implementation (through Oct 01, 2008 to Sep 30, 2011) in 40 counties of 16 provinces was collected through the questionnaire and Tuberculosis Information Management System. Meanwhile, it was analyzed comparing with the situation nationwide and in control counties. SPSS 17.0 was utilized for data analysis. The Chi-square test was used to identify the differences of implementing status before and during project implementing, between the project areas and the whole country or control counties, with a P-value less than 0.05 considered statistically significant differences. Results The registration rates of active tuberculosis(TB) patients in project areas in 3 years before and during the project implementing were 74.5/100 000 (16 242/21 800 000), 69.4/100 000 (15 106/21 770 000) and 70.0/100 000 (15 421/22 040 000), while smear-positive TB patients were 30.2/100 000 (6572/21 800 000)、31.2/100 000 (6787/21 770 000) and 29.4/100 000 (6469/22 040 000), with significant statistic difference during 3 years(χ²=48.3，P<0.01；χ²=12.0，P<0.05). It had the same decline trend with the registration rates nationwide from 2008—2010(The registration rates of active TB patients was 76.2/100 000,71.9/100 000 and 67.9/100 000，χ²=6297.5，P<0.01, while smear-positive TB patients was 40.3/100 000,38.6/100 000 and 36.3/100 000，χ²=2790.0，P<0.01). The total arrival rate in project areas in 3 years before and during the project implementing were 88.2%（9339/10 589）,95.9%（10 069/10 496）and 96.9%（10 547/10 881）, with significant statistic increase（χ²=825.6，P<0.01）,more than control counties(92.9%,93.8% and 94.6%，χ²=20.6，P<0.01). The completion treatment rates of smear-positive TB patients in project areas in 3 years before and during the project implementing were 94.0%（6817/7252）,95.0%（6241/6572） and 94.2%（3082/3272）; while initial smear negative were 91.8%（6011/6547）,94.0%（6114/6502） and 92.8%（3087/3328）,with significant statistic increase(χ²=6.4，P<0.05；χ²=24.4，P<0.01). The completion treatment rates in control counties had no significant statistic difference (The completion treatment rates of smear-positive TB patients during 3 years was 95.0%,95.3% and 94.2%，χ²=4.9，P>0.05, while initial smear negative was 95.5%,95.2% and 96.4%，χ²=5.8，P>0.05). Conclusion Remarkable achivements were observed as a result of the TB designated hospital mode supported by Global Fund project in China. The level of patient detection and treatment management was improved. It also provided experiences to improve health service system of TB control.

Key words: Tuberculosis, pulmonary, Physician&, rsquo, s practice patterns, Hospitals, special, Health plan implementation