【作者】 吴腾燕；

【导师】 高枫；

【作者基本信息】 广西医科大学 ， 流行病与卫生统计学， 2014， 博士

【摘要】 第一部分广西现行结核病防治模式的实施效果评价目的了解2011年广西结核病防治医防合作相关工作开展情况，评价现行结防模式的实施效果及应用前景，为广西在“十二五”期间持续推行适合广西实际的结防模式提供科学的参考依据。方法采用目的抽样法，选取广西现行四种结防模式地区，通过机构调查、关键人物访谈、问卷调查和查阅专报系统等形式收集结防工作相关数据，并对各种结防模式的工作实施状况进行分析和综合评价。结果（1）形成了独具特色的广西结防模式。广西结核病防治模式以CDC模式为主，与定点医院模式、结防院模式和结防所模式共存，“八大模块”是四种模式的重要核心理论。（2）四种模式地区的结防机构建设突显三大特征：①有房无人：均配备结防工作用房，但结防人员配备率均未达到《指南》要求；②设备配置不均衡：CDC模式地区的结核病胸部影像学检查设备以200mA的普通X光机为主，其他模式地区均装备DR机；③痰涂片技术普及：均开展痰涂片显微镜检查工作，定点医院模式地区还开展结核分枝杆菌培养和抗结核药物敏感性试验。（3）四种模式的患者登记治疗情况存在六点差异：①患者构成差异。登记治疗的新涂阳、复治涂阳和涂阴肺结核患者的构成差异有统计学意义（χ2=82.791，P=0.000），定点医院模式地区登记治疗的新涂阳患者比例较高（52.4%，269/513）；②患者来源差异。患者来源构成差异有统计学意义（χ2=183.774，P=0.000），结防所模式地区因症就诊患者比例较高（46.9%，201/429），定点医院模式地区转诊患者比例较高（67.8%，348/513）；③查痰率差异。初诊患者查痰率差异有统计学意义（χ2=622.461，P=0.000），定点医院模式地区的初诊患者查痰率较高（86.3%，1404/1627）；④患者到位率差异。非结防机构网络报告患者的总体到位率差异有统计学意义（χ2=20.162，P=0.000），结防院模式地区的总体到位率较高（99.7%，583/585）；⑤治愈效果差异。新涂阳患者治愈率差异有统计学意义（χ2=11.586，P=0.009），结防所模式地区的治愈率较高（96.2%,177/184）；⑥信息管理差异。对疗程结束病案信息的录入及时率差异有统计学意义（χ2=556.218，P=0.000），定点医院模式地区的录入及时率较高（74.3%，381/513）；录入信息一致率差异有统计学意义（χ2=11.429，P=0.010），CDC模式地区的一致率较高（55.0%，22/40）。（4）四种模式的患者管理情况存在三点差异。①督导差异。县级对所辖乡（镇）级的督导任务完成率差异有统计学意义（χ2=79.037，P=0.000），定点医院模式地区的督导任务完成率较高（138.7%，233/168）；②访视差异。对肺结核患者的访视任务完成率差异有统计学意义（χ2=2612.537，P=0.000），定点医院模式地区的访视任务完成率较高（147.7%，1192/807）；③依时差异。患者平均治疗延迟天数差异有统计学意义（H=121.158，P=0.000），定点医院模式地区患者平均治疗延迟天数较短（中位数为17天）。（5）四种模式的实验室质量控制具有一致性。四种模式地区在结核病实验室批量测试复核的结果中均未出现假阳性和假阴性现象。（6）四种模式的工作环境存在差异。本研究共对85名结防人员进行工作满意度调查，结果不同模式地区结防人员的总体满意度及对工作设备的满意度差异有统计学意义（χ2值分别为18.348和9.730，P值分别为0.000和0.021），定点医院模式地区结防人员的总体满意度（44.7%，38/85）及对工作设备的满意度（64.7%，11/17）较高。（7）四种模式之间患者满意度存在差异。本研究共对102例完成疗程的肺结核患者进行治疗满意度调查，结果不同模式地区肺结核患者对治疗费用的满意度差异有统计学意义（χ2=10.228，P=0.017），结防所模式地区肺结核患者对治疗费用的满意度较高（71.4%,15/21）。（8）四种模式之间效果评价存在差异。根据TOPSIS综合评价结果显示，定点医院模式地区结防工作实施效果综合评价排序位居第一（C1=0.692）。（9）四种模式之间患者治疗费用存在差异。初治肺结核患者在定点医院模式地区接受治疗，需要支付的直接医疗费用较低（2336.3元/人）。（10）定点医院模式地区通过充分整合经费、积极推行惠民措施和创新工作管理机制等措施，促进结防模式不断完善。结论（1）“八大模块”是广西结防模式高效运行的重要理论，具有重要指导意义。广西四种结防模式通过医防合作机制，围绕“八大模块”核心内容开展结防工作，在肺结核患者的发现、报告、治疗和管理方面发挥重要作用。（2）四种结防模式亟待加强技术督导和质量管理。（3）结防人员的工作负荷和工作待遇亟待关注。（4）肺结核患者治疗满意度有待提高，减轻患者经济负担的问题亟待解决。（5）定点医院模式是“八大模块”的价值反映，具有持续发展后劲，具有较好的推广应用前景。第二部分“三位一体”结核病防治模式的构建目的了解广西构建“三位一体”结防模式的情况，对可能存在的问题提出合理性建议，为广西在“十二五”期间积极构建“三位一体”结防模式提供参考。方法采用方便抽样法，选取广西14个地级市及所辖27个县的卫生行政管理部门和结防机构的1位关键人物，进行“三位一体”结防模式接受意愿调查，分析广西推行该模式的可行性。采用目的抽样法，选取2012年广西新启动“三位一体”结防模式的16个县（市、区），通过关键人物访谈、问卷调查和查阅资料等形式，收集该模式构建过程资料及引入相关医疗保障机制的情况，并进行分析。结果（1）大部分卫生局分管局长、结防机构分管领导和结防科长赞成推行“三位一体”结防模式，赞成率分别为73.7%（28/38）、75.0%（30/40）和66.7%（26/39）。赞成的主要理由是该模式能更好地发挥各部门优势，有效利用医疗资源，有利于患者的诊治；不赞成的主要理由是目前综合医疗机构的公共卫生服务资源不足。（2）广西印发“三位一体”结防模式试行方案，明确结核病定点医疗机构的确立原则、各部门职责分工与要求、保障措施、工作监督与评价等内容。（3）16个县（市、区）在“三位一体”结防模式实施前的准备工作情况为：①制定有当地的工作实施方案的有16个（100.0%，16/16）；②成立工作领导小组的有12个（75.0%，12/16）；③召开领导小组会议的有11个（68.8%,11/16）；④卫生局组织召开各级卫生单位负责人会议的有15个（93.8%，15/16）；⑤发布当地定点医院相关信息公告的有10个（62.5%，10/16）；⑥进行人员培训的有11个（68.8%，11/16）；⑦80%以上的定点医院具有开展结防工作所需的工作用房、物品和药品等；⑧80%以上的结核病诊治定点医院具有接受过培训的临床诊治人员、结核病药品管理人员和信息管理人员，但仅有11个（68.8%,，11/16）具有接受过培训的结核病实验室人员；⑨按照工作职责分工进行结防经费分配的仅有7个（43.8%，7/16）；⑩对实施前的准备工作进行验收的仅有7个（43.8%，7/16）。（4）16个县（市、区）均将结核病诊疗费用纳入新农合、城镇职工医保和城镇居民医保范围。不同医保类型中，住院费用报销起付线差异无统计学意义（χ2=5.056，P=0.080）；但在门诊费用的报销起付线和封顶线、住院费用的报销封顶线和报销比例差异均有统计学意义（P<0.05）；城镇职工医保的报销额度和比例均较高。有7个县（市、区）将结核病诊疗费用纳入民政救助范围（43.8%，7/16），报销比例平均50%（中位数），报销封顶线平均10000元（中位数）。结论（1）在广西推行“三位一体”结防模式是可行的，但需在完善相关规章制度的基础上因地制宜地逐步推行。（2）试行方案是广西在“十二五”期间逐步构建“三位一体”结防模式的指导性文件，具有重要的理论参考价值。（3）做好模式实施前各项准备工作的评估验收，是确保结核病诊疗模式顺利转型的关键。（4）积极将结核病诊疗纳入医保报销和民政救助补偿范围，可有效促进“三位一体”结防模式的构建，但在确保医疗保障机制的公平性、科学性和规范性等方面仍需不断完善。第三部分“三位一体”结核病防治模式的实施现状分析目的了解“三位一体”结防模式在广西的实施现状，针对可能存在的问题探讨改进的对策，为广西在“十二五”期间顺利推行“三位一体”结防模式提供参考。方法选取2012年1月1日至2013年1月1日，广西新启动“三位一体”结防模式的17个县（市、区），通过机构调查、关键人物访谈、问卷调查及现场查阅资料等形式收集结防工作相关数据，并对该模式实施现状进行分析和评价。结果（1）17个县（市、区）多为经济发展较落后的少数民族山区，均将当地的1所综合医院设置为结核病定点医院。（2）17个县（市、区）中，各部门的职责工作开展情况为：①卫生行政部门负责工作的组织、协调和督导。每年召开1次工作协调会的有13个（76.5%，13/17）；每半年开展1次督导的有7个（41.2%，7/17）；制定工作激励机制的有10个（58.8%，10/17）；县级配套经费到位的有7个（41.8%，7/17）。②疾控中心均承担结核病防治规划督导、培训和健康教育工作。宣传活动的形式主要是在“3.24”结核病日开展现场宣传活动和印发宣传材料（100.0%，17/17）。③定点医院均负责患者报告、诊治和健康教育工作。设置有独立的结防门诊的有13所（76.5%，13/17）；结防人员以兼职为主（88.2%，276/313）；结防门诊医生佩戴N95口罩的有5所（31.3%，5/17）；涂阴和涂阳肺结核患者的病房分开设置的有3所（17.65，3/17）。④乡镇卫生院主要负责推荐可疑患者，开展患者服药督导管理；结防人员多为兼职（87.5%，35/40）。（3）对结防人员的问卷调查结果显示：①疾控中心和定点医院结防人员对患者服药督导工作的可接受度差异有统计学意义（χ2=7.510，P=0.006），92.6%的定点医院结防人员认为“疾控机构负责患者服药督导工作可行”。②疾控中心和定点医院结防人员对工作负荷、人员待遇及工作总体的满意度差异有统计学意义（P＜0.05），定点医院结防人员的满意度均较低，分别为66.7%，54.3%和75.5%。③乡镇卫生院结防人员自述工作中遇到的困难主要是卫生院对结防工作重视不够，工作补助经费较少和自身工作技能有限。（4）对36例在治患者的访视及调查结果显示：①能规律服药又能按要求填写服药记录卡的仅10例（27.8%，10/36）；②接受过医务人员访视的患者有21例（58.3%，21/36）；③有人每天提醒服药的有10例（27.8%，10/36）；④自述有漏服药现象的有10例（27.8%，10/36）；⑤就诊延迟的患者有21例（58.3%，21/36）；⑥患者对治疗总体满意度为73.1%（158/216）；⑦患者对免费政策满意度为13.9%（5/36）。（5）17个县（市、区）的涂阴肺结核患者诊断符合率为96.9%（126/130）。（6）17个县（市、区）在“三位一体”结防模式启动前后1年内的结防工作情况比较结果显示：①在患者诊治方面，初诊患者查痰率差异有统计学意义（χ2=32.072，P=0.000），启动后的查痰率较高（62.3%，8452/13568）；登记的各类肺结核患者构成比差异有统计学意义（χ2=159.934，P=0.000），启动后的新涂阳肺结核患者构成比例较低（24.9%，1173/4717）；肺结核患者来源构成比差异有统计学意义（χ2=169.025，P=0.000），启动后因症就诊的患者构成比例较高（45.0%，2125/4717）。②在信息录入方面，病案信息录入及时率差异有统计学意义（χ2=253.820，P=0.000），启动后的录入及时性较低（78.9%，3724/4717）；痰检信息漏填率差异有统计学意义（χ2=14.269，P=0.000），启动后的漏填率较高（1.1%，51/4717）。③在督导工作方面，启动后县级督导乡镇数比启动前减少191次；启动后县级访视患者数比启动前减少302人次。结论（1）充分利用综合医院的诊疗优势为结防工作服务，实现诊疗模式转型，符合国家“十二五”规划的总体要求。（2）“三位一体”结防模式启动后，各部门各司其职，在发现和治疗肺结核患者方面发挥重要作用，基本实现了结核病诊疗工作的平稳过渡。（3）实施过程中存在的主要问题包括：①结核病防治经费缺乏；②结防人力资源不足，人员工作待遇满意度较低；③卫生行政部门对工作的督导协调力度不够；④患者治疗管理工作质量下滑；⑤患者经济负担加重。（4）为不断完善“三位一体”结防模式，提出以下工作建议：①积极探索有效的结防经费补偿机制；②提高结防人员待遇，稳定结防队伍；③卫生行政部门加强工作监督和评价；④加强人员培训，不断规范患者治疗管理工作；⑤完善医疗保障制度和惠民措施，尽量减轻患者经济负担。更多还原

【Abstract】 Section one：Evaluate on the implementation effect of current tuberculosiscontrol mode in GuangxiObjective To investigate the implementation situation of tuberculosis（TB）prevention and control work，and evaluate the implementation effects andapplication prospect of TB control mode，in order to provide the scientificreference for establishing the most suitable TB control mode in Guangxi.Methods The four different TB control mode areas were selected by using thepurposive sampling method，the data of the implementation situation of TBcontrol work were collected by investigating the relevant organizations，keyfigures interviews，questionnaire survey，refering to the TB reported system andso on，and to carry out data analysis and comprehensive evaluation. Results（1）The mainly TB prevention and control mode in Guangxi was the Center forDisease Control and Prevention （CDC） mode，besides，there were the TBdesignated hospital mode，the TB hospital mode and the independent TBdispensary mode（.2）The results of analyzing the institution building situationwere as follows：①There were work places in the four TB control mode areas，but the numbers of personnel in TB control institutions were not fulfill the requirement of the TB guidelines；②The chest radiographic inspectionequipment in the CDC mode area was the ordinary X-ray machine of200mA，but there was the Digital Radiography machine（DR） in other three TB controlmode areas；③The sputum smear microscopy was carried out in all the TBcontrol mode areas, there were the mycobacterium culture and the anti-TBmedicine sensitivity test in the TB designated hospital mode areas.（3）Theresults of analyzing the registration and treatment situation of pulmonary TB（PTB）patients in the four TB control mode areas were as follows：①Therewas statistically significant difference in the constituent ratio of PTB patients ofnew smear-positive, retreatment smear-positive and smear-negative（χ2=82.791，P=0.000），there were the highest percentage of new smear-positivepatients（52.4%，269/513）in the TB designated hospital mode areas；②Therewas statistically significant difference in the constituent ratio of the source ofPTB patient（sχ2=183.774，P=0.000），there were the highest percentage of PTBpatients from clinic visit due to symptoms in the independent TB dispensarymode area（s46.9%，201/429），there were the highest percentage of PTB patientsfrom referral in the TB designated hospital mode areas（67.8%，348/513）；③There was statistically significant difference in the rate of sputum smearmicroscopy in first visit patient（sχ2=622.461，P=0.000），there were the highestrate in TB designated hospital mode areas（86.3%，1404/1627）；④There wasstatistically significant difference in the total arrival rate of PTB patientsreported by non-TB control institutions（χ2=20.162，P=0.000），there were thehighest total arrival rate in the TB hospital mode areas（99.7%，583/585）；⑤There was statistically significant difference in the cured rate of newsmear-positive PTB patients（χ2=11.586，P=0.009），there were the highestcured rate in the independent TB dispensary mode areas（96.2%,177/184）；⑥ There was statistically significant difference in the timeliness rate of theinformation input when the PTB patients completed treatment（χ2=556.218，P=0.000），there were the highest timeliness rate in the TB designated hospitalmode areas（74.3%，381/513）；⑦There was statistically significant differencein the consistent rate of the information input，there were the highest consistentrate in the CDC mode areas（55.0%，22/40）.（4）The results of analyzing thecompletion rate of the supervision task of TB control in the four TB controlmode areas were as follows：①There was statistically significant difference inthe completion rate of the supervision task at county level（χ2=79.037，P=0.000），there were the highest completion rate in the TB designated hospitalmode areas（138.7%，233/168）；②There was statistically significant differencein the completion rate of the supervision task of visiting the PTB patients（χ2=2612.537， P=0.000）， there were the highest completion rate in the TBdesignated hospital mode area（s147.7%，1192/807）（.5）The result of analyzingthe patients delay in the four TB control mode areas showed there wasstatistically significant difference in the number of days of patients delay（H=121.158，P=0.000），there were the shortest days of patients delay in theTB designated hospital mode areas（the median are17days）.（6）The result ofanalyzing the panel testing in the four TB control mode areas showed neitherarea appeared false positives and false negatives.（7）The result of analyzing thejob satisfaction of85workers in the four TB control mode areas showed therewere statistically significant difference in the overall workers satisfaction andthe workers satisfaction on working equipments，（the value of χ2were18.348and9.730respectively，the value of P were0.000and0.021respectively.）,therewere the highest overall workers satisfaction （44.7%，38/85）and the highestworkers satisfaction on working equipments （64.7%，11/17）in the TB designated hospital mode areas.（8）The result of analyzing the patientssatisfaction of102PTB patients completed treatment in the four TB controlmode areas showed there were statistically significant difference in the patientssatisfaction on the total treatment costs（χ2=10.228，P=0.017），there were thehighest satisfaction in the independent TB dispensary mode areas（71.4%，15/21）.（9）The result of the TOPSIS comprehensive evaluation showed thecomprehensive efficiency of TB control in the TB designated hospital modeareas ranked first （C1=0.692）.（10）It needed to pay for the lowest directmedical costs when the PTB patient received treatment in the TB outpatient ofthe TB designated hospital mode areas（￥2336.3per one）.Conclusions （1）The four TB control mode played an important role in the PTB patientsdiscovery，reporting，treatment and management，basing on the medicalcooperation mechanism and the“eight modules”theory in Guangxi. But therewere still needed to strengthen the construction of human resource，for ensuringthe quality and efficiency of TB control work.（2）There was lower workerssatisfaction，it should pay more attention on the workers workload and theworking conditions（.3）The patients satisfaction needed to be improved，and theproblem of reducing the patients economic burden needed to be solved.（4）Theadvantages in the TB designated hospital mode areas were as follows，theequipments of diagnosis and treatment was advanced， the division ofresponsibilities was clearly, the information communication mechanism wassmooth，the supervision system was more perfectly，the direct medical costs thatthe PTB patients needed to pay were the lowest. Therefore, the TB designatedhospital mode had a good application prospect under the condition of effectiveimplementation of the TB appropriation reimbursement and the supportingmeasures in Guangxi. Section two： Study on the establishment situation of the “trinity”tuberculosis control modeObjective To investigate the establishment situation of the “trinity” TBprevention and control service system，and provided reasonable suggestions forthe possible problems， in order to provide the scientific reference forestablishing this TB prevention and control service system in Guangxi. MethodsOne key figure in the health administration departments and the TB controlinstitutes of14cities and27counties was selected respectively usingconvenience sampling method， the acceptability survey on the “trinity” TBcontrol mode was carried out，and to analyze the feasibility of establishing thisservice system in Guangxi. The16counties started to establish the “trinity” TBcontrol mode in the year2012were selected using purpose sampling method，the data of the establishment process of this TB control mode and the relevantmedical security mechanism were collected by key figures interviews，questionnaire survey，refering to relevant data，and so on，and to carry out dataanalysis. Results （1）Most of the interviewees accepted the “trinity” TBcontrol mode， the acceptability proportion among the leaders of healthadministration departments，leaders in charge of TB control institutions，anddirectors of TB control institutions were73.7%（28/38）、75.0%（30/40）和66.7%（26/39）.The main supporting reasons were that this TB control modecould help each department better play its own advantages，and effectively usedmedical resource，and facilitate patient’s diagnosis and treatment. The mainreason not in favor of the “trinity” TB control mode was the insufficient publichealth resources in the general hospitals now.（2）The implementation schemeof the "trinity" TB control mode in Guangxi had been issued，the contents included the principle of the establishment of the TB designated hospital，theresponsibilities and requirements of each department，the supporting measures，the supervisions and evaluations，and so on.（3）The preparations for theimplementation of the “trinity” TB control mode in the16counties were asfollows：①The local implementation plan had been enacted in the16counties（100.0%，16/16）；②The work leadership group had been established in the12counties of all（75.0%，12/16）；③The leadership group meeting had beenheld in the11counties of all（68.8%,11/16）；④The meeting of leaders in everylevel health units organized by the health bureau had been held in the15counties of all（93.8%，15/16）；⑤The relevant information of the local TBdesignated hospital had been announced in the10counties of all（62.5%，10/16）；⑥The personnel training had been carried out in the11counties of all（68.8%，11/16）；⑦There were places，items and medicines for TB controlwork in more than80%of the designated hospitals；⑧There were personneltrained of the TB diagnosis and treatment，TB medicine management，and TBinformation management in more than80%of the designated hospitals，but therewere personnel trained of TB laboratory testing in the11counties of all（68.8%,，11/16）；⑨The TB control funds had been allocated based on theresponsibilities of every department in the7counties of all（43.8%，7/16）；⑩The preparation work had been carried out acceptance and evaluation in the7counties of all（43.8%，7/16）.（4）The TB diagnosis and treatment fees werebrought into the new medical insurance reimbursement for farmers，the medicalinsurance reimbursement for urban workers， and the medical insurancereimbursement for urban residents. In the three kinds of medical insurancereimbursement， there was not statistically significant difference in theminimum reimbursement of hospitalization expenditures（χ2=5.056，P=0.080）， but there was statistically significant difference in the minimum and themaximum reimbursement of outpatient expenditures and the maximumreimbursement of hospitalization expenditures（P<0.05），there were the highestproportions and amounts in the medical insurance reimbursement for urbanworkers. The TB diagnosis and treatment fees were brought into the civiladministration relief scope in the7counties of all（43.8%，7/16），the medianof the proportions and amounts of the reimbursement were50%and￥10000respectively. Conclusions （1）The implementation of the “trinity” TB controlmode was feasible in Guangxi，however this mode need to expand in a stepwiseway under the basic of improving the existing rules and regulations.（2）Theimplementation scheme of the "trinity" TB control mode as an instructionaldocument had important theoretical value in Guangxi.（3）It was importance tocarry out acceptance and evaluation for the preparation works，in order to insurethe establishment of the“trinity”TB control mode successful.（4）It waseffectively to bring the TB diagnosis and treatment fees into the medicalinsurance reimbursement and the civil administration relief scope， forfacilitating the establishment of the “trinity” TB control mode，but it still neededto improve the fairness，the scientificity and the normalization of the medicalinsurance mechanism.Section three：Analyze on the implementation situation of the “trinity”tuberculosis control modeObjective To investigate the implementation situation of the “trinity” TBprevention and control service system，exploring the countermeasures aiming atthe problems，in order to provide the scientific reference for implementing this TB prevention and control service system in Guangxi. Methods The17counties started to establish the “trinity” TB control mode on January1,2012toJanuary1,2013were selected， the data of the implementation situation of TBcontrol works were collected by organization investigation， key figuresinterviews，questionnaire survey，refering to relevant data，and so on，and tocarry out data analysis and evaluation. Results （1）The17counties wereeconomic development lag behind，minority and mountainous areas，each TBdesignated hospital was set in1local general hospital.（2）In the17counties，the implementations situation of responsibility works in each department wereas follows：①The health administrative department was responsible fororganization，coordination，and supervision in the TB control program. Thework coordination meeting was held once a year in the13counties of all（76.5%，13/17）；The supervision was carried out semiannually in the7counties of all（41.2%，7/17）；The work incentive mechanism was enacted inthe10counties of all（58.8%，10/17）；The matching funds of the county levelhad in place in the7counties of al（l41.8%，7/17）.②The CDC was responsiblefor supervision，training and carrying out the health education in the TB controlprogram. The main forms of the propaganda activities were carried out one-sitepropaganda activities and distributed the promotional materials on “3.24”world TB day in all the counties（100%，17/17）.③The TB designated hospitalwas responsible for the patients reporting，diagnosis and treatment，and carryingout health educations in the TB control program. The TB outpatient was set atindependent place in the13counties of all（76.5%，13/17）；The part-time dutypersonnel had the most proportion（88.2%，276/313）；The doctor for TBdiagnosis wear the N95respirator in5designated hospitals of al（l31.3%，5/17）；The wards for TB patients of smear sputum positive and smear sputum negative were set apart in3designated hospitals of all（17.65，3/17）.④The townshiphospital was responsible for patients recommendation for the suspected，patientssupervision for taking medicine；The part-time duty personnel had the mostproportion（87.5%，35/40）（.3）The results of the questionnaire survey in workerswere as follows：①There was statistically significant difference in theworkers work acceptability in CDC and in the designated hospital （χ2=7.510，P=0.006），the proportion of92.6%of workers in the designated hospitalconsidered it was feasible that the responsibility of patients supervision fortaking medicine was in CDC.②There were statistically significant difference inthe workers satisfaction degree on the workload，the staff treatment，and theoverall work in CDC and in the designated hospital（P＜0.05），the lowestworkers satisfaction degree was in the designated hospital，which was66.7%，54.3%and75.5%respectively.③The main difficult in TB control work for thestaff in the township hospital were that，there were not enough attention andworking funds in TB control work，and workers with limited working skills（.4）The results of patients visiting and questionnaire survey of36PTB patients wereas follows：①There were10patients of all could take medicine regularly and fillout the registration card according to the requiremen（t27.8%，10/36）；②Therewere21patients of all accepted workers supervision （58.3%，21/36）；③Therewere10patients of all gained medicine taking reminder（27.8%，10/36）；④There were10patients of all had the phenomenon of did not take medicine ontime（27.8%，10/36）；⑤There were21patients of all had the phenomenon ofclinic visit delay（58.3%，21/36）；⑥The patients satisfaction on the overalltreatment was73.1%（158/216）；⑦The patients satisfaction on the free policywas13.9%（5/36）.（5）The diagnose accordance rate of smear-negative PTBpatients was96.9%（126/130）in the17counties.（6）The results of comparing the implementation situations before and after the“trinity”TB control modeestablishment in the17counties were as follows：①In the aspect of TBdiagnosis and treatment，there was statistically significant difference in thesputum smears microscopy rate of the first visit patients（χ2=32.072，P=0.000），there was a higher rate after this mode establishment（62.3%，8452/13568）；②There was statistically significant difference in the register constituent ratio ofPTB patients （χ2=159.934，P=0.000），there was a lower register proportion ofthe smear-positive patients after this mode establishment（24.9%，1173/4717）；There was statistically significant difference in the source constituent ratio ofPTB patients（χ2=169.025，P=0.000），there was a higher proportion of PTBpatients from clinic visit due to symptoms after this mode establishment（45.0%，2125/4717）.②In the aspect of information input，there wasstatistically significant difference in the timeliness rate of the information inputwhen patients diagnosed （χ2=253.820，P=0.000），there was a lower timelinessrate after this mode establishment（78.9%，3724/4717）；There was statisticallysignificant difference in the information missing rate of the sputum smearexamination results（χ2=14.269，P=0.000），there was a higher informationmissing rate after this mode establishment（1.1%，51/4717）.③In the aspect ofthe supervision at the county level，the result of comparison before and after thismode establishment were that：the frequency of supervision had decreased by191after this mode establishment，the numbers of patients visit had decreasedby302after this mode establishment. Conclusions （1）It was reasonable ofrealizing the medical mode transformation for TB diagnosis， for making fulluse of the of the clinical advantages of general hospital.（2） After theestablishment of th“etrinity”TB control mode，it had played an important rolein detection and treatment of TB patients，and achieved a smooth transition of TB diagnosis and treatment work，as a result of each department doing workaccording to the responsibilities.（3） The main problems existing in theimplementation process were that：①The TB control funds were insufficient.②The personnel was insufficient，and the workers satisfaction was low.③Thesupervision and coordination of the TB control work conducted by the healthadministrative department were inadequate.④The quality of patientstherapeutic management was decline.⑤The economic burden of PTBpatients was heavy.（4）For perfecting th“etrinity”TB control service system，the suggestions were as follows：①It was needed to explore the effective fundscompensation mechanism.②It was needed to enhance the workers payment forstabilizing the personnel of TB control work.③It was needed to strengthen thesupervision and evaluation in the TB control work conducted by the healthadministrative departments.④It was needed to strengthen the personneltraining，and constantly standardize treatment management.⑤It was needed toperfecting the medical security system and huimin measures，for reducing theeconomic burden of PTB patients.更多还原