关键词: 结核,肺, 哨点监测, 医院,专科, 登记, 对比研究

Abstract:

Objective: To analyze the implementation of the intervention measures to strengthen the registration and management of patients in tuberculosis designated medical institutions at the provincial and municipal levels that Sichuan Province has explored since 2022, as well as the changes in the level of detection and treatment management of tuberculosis patients before and after the implementation in Sichuan Province, so as to provide reference for further optimization of prevention and control strategies. Methods: Data on the registration and reporting of ordinary pulmonary tuberculosis cases in Sichuan Province between July 1, 2022, and December 31, 2023, were extracted from the Chinese Information System for Disease Control and Prevention. Descriptive analyses were conducted to assess patient registration coverage and treatment outcomes at both provincial and municipal designated medical institutions. A comparative analysis was performed between pre-intervention (2019) and post-intervention (2023) periods to evaluate changes in registration-to-reporting ratios, bacteriological positivity rates, and treatment success rates, thereby assessing the short-term impact of the intervention. Results: Between July 2022 and December 2023, a total of 5688 ordinary pulmonary tuberculosis cases were registered at the three provincial-level designated medical institutions, representing 50.27% of the 11315 reported cases during the same period. By 2023, 18 of the 21 municipal-level designated institutions (85.71%) had begun registering cases diagnosed outside their administrative jurisdictions, collectively reporting 6222 cases—accounting for 29.40% of the 21161 total reported cases that year. The registration-to-reporting ratio was significantly higher in city-owned hospitals (33.78%, 5892/17442) than in province-owned hospitals (8.87%, 330/3719), and similarly higher in institutions located in ethnic minority regions (37.63%, 1429/3797) compared to non-ethnic regions (27.60%, 4793/17364), with all differences being statistically significant (χ²=916.128 and 151.057; all Ps<0.001). The treatment success rate among patients registered at provincial-level designated institutions was 85.84% (1721/2005). Following the implementation of the intervention in 2023, the provincial registration-to-reporting ratio increased from 88.05% (44324/50337) in 2019 to 96.38% (43794/45393), while the bacteriological positivity rate rose markedly from 40.27% (17107/42482) to 71.05% (29854/42021). Both improvements were statistically significant (χ²=2247.317 and 8104.576, respectively; all Ps<0.001). By contrast, the overall treatment success rate remained stable, increasing slightly from 94.33% (42390/45516) before implementation to 95.49% (35495/38027) after, with no statistically significant difference (χ²=1.440, P=0.230). Conclusion: The implementation of tuberculosis registration measures at provincial and municipal designated medical institutions has substantially mitigated the risk of undetected and unmanaged cases, contributing positively to patient identification and treatment oversight in Sichuan Province. Nonetheless, suboptimal registration coverage persists, underscoring the need for enhanced and more standardized follow-up management systems.

Key words: Tuberculosis, pulmonary, Sentinel surveillance, Hospitals, special, Registries, Comparative studies