| 北京市卫生局发热门诊课题组.北京市后SARS时期发热门诊现状和合理设置模式的研究[J].Chinese journal of Epidemiology,2003,24(11):999-1004 |
| 北京市后SARS时期发热门诊现状和合理设置模式的研究 |
| Evaluation on the functions and cost of 'fever clinics' during theperiod of severe acute respiratory syndrome epidemics in Beijing |
| Received:September 09, 2003 |
| DOI： |
| KeyWord: 严重急性呼吸综合征 门诊病例监测 发热 价值分配 |
| English Key Word: Severe acute respiratory syndrome Outpatient monitoring Fever Cost allocation |
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| Abstract: |
| 目的研究SARS疫情解除后北京市发热门诊设置和功能执行上存在的问题,提出合理的设置模式.方法采用定量和定性调查相结合的方式.定量调查包括(1)后SARS时期18区县各发热门诊设置和运行方式的调查,调查对象为北京市所有现存的63家医院发热门诊的管理人员.(2)发热门诊就诊的发热患者的整群抽样调查.(3)在发热门诊工作的医生的调查.定性调查包括:北京市发热门诊负责人调查、北京市18区县分层随机抽取的23家不同级别医院主管领导、发热门诊负责人及发热门诊工作的医生个人或小组访谈和实地考察,未设置发热门诊的医院中随机抽取了28家进行了电话调查.结果 SARS疫情解除后,这种仍然以集中就诊的方式对一种疾病进行长期常规监测的系统存在如下问题:(1)监测网覆盖率低.全市89%的医院和所有的门诊部均未在监测范围内,而未设发热门诊的医院和门诊部已逐渐自发的接受发热患者.但无规范化的管理和完善的信息系统支持.(2)目前建立的SARS监测信息系统对SARS疫情的监测功能尚可,但对发热病例监测的信息准确性、完整性存在明显问题,实名制未真正实施.(3)多数发热门诊的人力物力投入和就诊病例的数量明显不成比例,造成不同程度的医疗资源利用不足,特别是发热定点医院的投入和产出差别极大,医疗资源浪费严重.结论根据研究发现的问题和分析,对今冬明春发热门诊的设置方式提出了建议,同时对其长期发展提出了建议. |
| English Abstract: |
| Objective To identify the experiences and lessons learned on fever clinics during the severe acute respiratory syndrome (SARS) epidemic in Beijing and to propose a better model in monitoring SARS tofiTthefever clinics into currenTsituation. Methods Both qualitative and quantitative Methods were used in data collection and analyses. Quantitative surveys would include ( 1) the setting, functions and administration of currenT63 fever clinics in Beijing; ( 2) survey on patients with fever who had visitedfever clinics and randomly selected from the 63 fever clinics; (3)survey on physicians working in the fever clinics. Qualitative studies would include discussion or interviewwith administrators, physicians working in the fever clinics and field studies on 23 randomly selectedfever clinics as well as telephone interviewto the staff working in the hospitals thaTdid noThave the fever clinics. Results A couple of significanTproblems raised during the study including: ( 1)lowcoverage of currenTsurveillance system. 89% of the hospitals were noTcovered by the surveillance system which reflecting the misjudgmenTon the patients with fever thaTthey would only attendfever clinics to seek for medical help. The facTwas thaTmosTof the hospitals where fever clinics had noTbeen seTalsoreceived patients with fever. ( 2) information related to patients with fever needs to improve regarding its completeness and accuracy. ( 3) significanTunbalance in daily cosTand effectiveness in mosTof the fever clinics was noticed. Conclusion Fever clinics needs to be adjusted to meeTthe possible SARS epidemic in coming winter and spring. ShorT-term andlong-term suggestions were proposed regarding SARS monitoring through the functions of fever clinics in Beijing. |
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