Evaluating Tuberculosis Case Detection via Real-Time Monitoring of Tuberculosis Diagnostic Services
Evaluating Tuberculosis Case Detection via Real-Time Monitoring of Tuberculosis Diagnostic Services
复制标题
DOI：
10.1164/rccm.201012-1984oc
复制
发表时间：
2011-08-01
影响因子：
24.7
通讯作者：
Cattamanchi, Adithya
中科院分区：
文献类型：
--
作者：
Davis, J. Lucian;Katamba, Achilles;Cattamanchi, Adithya
理由：在高负担国家，结核病病例发现率低于国际既定目标。实时监测和评估对广泛认可的结核病治疗标准的遵守情况可能有助于改善病例发现。目的：监测和评估在一个结核病发病率较高的低收入国家的结核病病例检测和管理服务的质量。方法：在引入实时、电子绩效监测系统后，我们对乌干达五家初级卫生保健机构的结核病诊断服务进行了为期1年的前瞻性评估。我们收集了每一次临床就诊的数据，并使用国际结核病护理标准中的指标来衡量质量。衡量和主要结果：2009年，有62,909次成人初级保健就诊。在2009年第一季度，临床医生仅向咳嗽大于或等于2周的患者转介了21%的患者进行了痰涂片镜检，并仅有71%的患者的痰检查阳性用于结核病治疗。2009年第四季度，这两个比例分别增至53%和84%。对咳嗽大于或等于2周的涂阳患者进行适当评估并转诊治疗的累积概率从11%上升到34%(P=0.005)。每季度确诊和处方治疗的结核病病例数量也增加了四倍，从5例增加到21例。结论：在引入实时绩效监测后，对国际公认的结核病护理标准的遵守情况有所改善，这与结核病病例的发现增加有关。实时监测和评价可以加强低收入国家的卫生系统，并促进对干预措施的有效性和可持续性进行业务研究，以改进结核病病例的发现。
Rationale: Tuberculosis case-detection rates are below internationally established targets in high-burden countries. Real-time monitoring and evaluation of adherence to widely endorsed standards of tuberculosis care might facilitate improved case finding.Objectives: To monitor and evaluate the quality of tuberculosis case-detection and management services in a low-income country with a high incidence of tuberculosis.Methods: We prospectively evaluated tuberculosis diagnostic services at five primary health-care facilities in Uganda for 1 year, after introducing a real-time, electronic performance-monitoring system. We collected data on every clinical encounter, and measured quality using indicators derived from the International Standards of Tuberculosis Care.Measurements and Main Results: In 2009, there were 62,909 adult primary-care visits. During the first quarter of 2009, clinicians referred only 21% of patients with cough greater than or equal to 2 weeks for sputum smear microscopy and only 71% of patients with a positive sputum examination for tuberculosis treatment. These proportions increased to 53% and 84%, respectively, in the fourth quarter of 2009. The cumulative probability that a smear-positive patient with cough greater than or equal to 2 weeks would be appropriately evaluated and referred for treatment rose from 11% to 34% (P = 0.005). The quarterly number of tuberculosis cases identified and prescribed treatment also increased four-fold, from 5 to 21.Conclusions: Poor adherence to internationally accepted standards of tuberculosis care improved after introduction of real-time performance monitoring and was associated with increased tuberculosis case detection. Real-time monitoring and evaluation can strengthen health systems in low-income countries and facilitate operational research on the effectiveness and sustainability of interventions to improve tuberculosis case detection.