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Abstract：
OBJECTIVE: The aim of this study was to assess the quality of tuberculosis (TB) care for the whole course and assess factors that affect completing treatment.
METHODS: This is an observational retrospective study using chart abstraction for the whole course of TB care conducted at two underserved provinces in China.
METHODS: The study was conducted from June 2021 to July 2021. All medical records (outpatient and inpatient) for the whole course (6-8 months) of patients with TB newly registered from July 2020 to December 2020 were reviewed and abstracted using predetermined checklists.
METHODS: A total of 268 outpatient medical records and 126 inpatient records were included.
METHODS: The primary outcome included diagnostic quality, treatment quality and management quality. The secondary outcome was completing treatment.
RESULTS: For diagnostic quality, 94.2% of the diagnosis were based on adequate evidence. For treatment quality, 240 (91.6%) outpatients and 100 (85.5%) inpatients took the standard chemotherapy regimens. 234 (87.3%) patients completed treatment. 85.1% of the inpatients prescribed with second-line drugs were inappropriate. For management quality, 128 (47.9%) patients received midterm assessments, but only 47 (19.7%) received sufficient services for the whole course. Patients with TB symptoms were 1.8 times more likely to complete treatment (p=0.011).
CONCLUSIONS: Patients with TB received high-quality diagnosis and treatment services, but low-quality whole-course management. Integration of medical and public health services should be strengthened to improve whole-course quality.
METHODS: This is an observational retrospective study using chart abstraction for the whole course of TB care conducted at two underserved provinces in China.
METHODS: The study was conducted from June 2021 to July 2021. All medical records (outpatient and inpatient) for the whole course (6-8 months) of patients with TB newly registered from July 2020 to December 2020 were reviewed and abstracted using predetermined checklists.
METHODS: A total of 268 outpatient medical records and 126 inpatient records were included.
METHODS: The primary outcome included diagnostic quality, treatment quality and management quality. The secondary outcome was completing treatment.
RESULTS: For diagnostic quality, 94.2% of the diagnosis were based on adequate evidence. For treatment quality, 240 (91.6%) outpatients and 100 (85.5%) inpatients took the standard chemotherapy regimens. 234 (87.3%) patients completed treatment. 85.1% of the inpatients prescribed with second-line drugs were inappropriate. For management quality, 128 (47.9%) patients received midterm assessments, but only 47 (19.7%) received sufficient services for the whole course. Patients with TB symptoms were 1.8 times more likely to complete treatment (p=0.011).
CONCLUSIONS: Patients with TB received high-quality diagnosis and treatment services, but low-quality whole-course management. Integration of medical and public health services should be strengthened to improve whole-course quality.
摘要：
目的：本研究的目的是评估整个疗程的结核病（TB）护理质量，并评估影响完成治疗的因素。
方法：这是一项观察性回顾性研究，对中国两个服务不足的省份进行了结核病治疗的整个过程进行图表抽象。
方法：该研究于2021年6月至2021年7月进行。对2020年7月至2020年12月新登记的结核病患者的整个疗程（6-8个月）的所有医疗记录（门诊和住院）进行审查，并使用预定的清单进行提取。
方法：共纳入268份门诊病历和126份住院病历。
方法：主要结果包括诊断质量，治疗质量和管理质量。次要结果是完成治疗。
结果：对于诊断质量，94.2%的诊断是基于充分的证据。对于治疗质量，240例（91.6％）门诊患者和100例（85.5％）住院患者接受了标准化疗方案。234例（87.3%）患者完成治疗。85.1%的住院患者使用二线药物的处方不合适。为了管理质量，128名（47.9％）患者接受了中期评估，但只有47人(19.7%)在整个课程中获得了足够的服务。有TB症状的患者完成治疗的可能性是其1.8倍（p=0.011）。
结论：结核病患者接受了高质量的诊断和治疗服务，而是低质量的全程管理。应加强医疗与公共卫生服务的整合，以提高全程质量。
方法：这是一项观察性回顾性研究，对中国两个服务不足的省份进行了结核病治疗的整个过程进行图表抽象。
方法：该研究于2021年6月至2021年7月进行。对2020年7月至2020年12月新登记的结核病患者的整个疗程（6-8个月）的所有医疗记录（门诊和住院）进行审查，并使用预定的清单进行提取。
方法：共纳入268份门诊病历和126份住院病历。
方法：主要结果包括诊断质量，治疗质量和管理质量。次要结果是完成治疗。
结果：对于诊断质量，94.2%的诊断是基于充分的证据。对于治疗质量，240例（91.6％）门诊患者和100例（85.5％）住院患者接受了标准化疗方案。234例（87.3%）患者完成治疗。85.1%的住院患者使用二线药物的处方不合适。为了管理质量，128名（47.9％）患者接受了中期评估，但只有47人(19.7%)在整个课程中获得了足够的服务。有TB症状的患者完成治疗的可能性是其1.8倍（p=0.011）。
结论：结核病患者接受了高质量的诊断和治疗服务，而是低质量的全程管理。应加强医疗与公共卫生服务的整合，以提高全程质量。
