Model collaboration between hospitals and public health system to improve tuberculosis control in China.

OBJECTIVE

Hospitals provide clinical care to many tuberculosis (TB) patients, but limited linkage with public health programmes is contributing to low TB case detection and rising TB drug resistance. We evaluated a hospital-public health collaboration to improve the follow-up of TB patients initially seen in hospitals.

DESIGN

In nine counties in eastern China, we evaluated a collaboration with three interventions: hospitals carried out internet-based reporting and patient referral to the local Center for Disease Control (CDC). The CDC regularly checked on hospital reporting and referrals and performed active follow-up of reported patients, and a government coordinating group facilitated implementation of collaborative activities.

RESULTS

Compared to the pre-intervention period, the percentage of TB suspects and patients needing referral from the hospitals who arrived in the CDC increased from 59.3% to 83.2% (P < 0.001). This increase was a result of improved hospital reporting (42.5% to 95.3%, P < 0.001), improved referral from hospitals (48.1% to 83.3%, P < 0.001), active CDC follow-up of 82.5% of reported patients who did not attend CDC by themselves, and successful tracing of 60.8% of these patients. This contributed to a 33% increase in reported smear-positive pulmonary TB cases.

CONCLUSION

This model collaboration successfully improved the follow-up of TB patients seen by hospitals, and contributed to an increase in TB case detection.