Section of Infectious Diseases, Department of Internal Medicine, Shuang-Ho Hospital, Taipei, Taiwan.
Int J Tuberc Lung Dis. 2010 Jan;14(1):72-8.
A referral hospital in Kaohsiung, Taiwan.
To evaluate the impact of an in-hospital tuberculosis (TB) quality care programme initiated in May 2005 on health provider delay and outcome of newly diagnosed TB cases.
Retrospective chart review of newly diagnosed TB cases presenting in 2002 and 2006. Health provider delay, clinical manifestations, management and outcome were recorded.
Overall, 327 patients before (2002) and 262 patients after (2006) the programme began were enrolled. Patients were older men (mean age 65.9 years) and 23.4% (138/589) had diabetes; 84.4% had received anti-tuberculosis treatment. The programme shortened the time for doctors to order a chest X-ray (P < 0.01), and the reporting time for smear (P < 0.0001) and culture (P < 0.0001). On multivariable analysis, risk factors for attributable mortality included age >/=65 years (OR 4.4, 95%CI 1.8-10.9, P = 0.001) and liver cirrhosis (OR 4.3, 95%CI 1.1-16.6, P = 0.04). Treatment reduced mortality by 81% (OR 0.2, 95%CI 0.1-0.4, P < 0.001) and the programme halved overall mortality (OR 0.5, 95%CI 0.3-0.8, P = 0.01), and reduced attributable mortality by 62% (OR 0.4, 95%CI 0.2-0.8, P < 0.01).
Intervention at the hospital level for quality control of TB care was instrumental in reducing health provider delay and led to a significant reduction in mortality.
台湾高雄的一家转诊医院。
评估 2005 年 5 月启动的院内结核病（TB）质量护理计划对新诊断 TB 病例的卫生服务提供者延迟和结局的影响。
对 2002 年和 2006 年新诊断 TB 病例的病历进行回顾性分析。记录卫生服务提供者延迟、临床表现、管理和结局。
共有 327 例（2002 年）和 262 例（2006 年）患者入组。患者均为老年男性（平均年龄 65.9 岁），23.4%（138/589）患有糖尿病；84.4%接受过抗结核治疗。该计划缩短了医生开具胸部 X 光检查的时间（P < 0.01），以及痰检（P < 0.0001）和培养（P < 0.0001）的报告时间。多变量分析显示，可归因于死亡的危险因素包括年龄≥65 岁（OR 4.4，95%CI 1.8-10.9，P = 0.001）和肝硬化（OR 4.3，95%CI 1.1-16.6，P = 0.04）。治疗降低死亡率 81%（OR 0.2，95%CI 0.1-0.4，P < 0.001），该计划使总死亡率减半（OR 0.5，95%CI 0.3-0.8，P = 0.01），并降低可归因于死亡的比例 62%（OR 0.4，95%CI 0.2-0.8，P < 0.01）。
医院层面的结核病护理质量控制干预措施有助于减少卫生服务提供者延迟，并显著降低死亡率。
