基于病例队列随访设计的流动人口肺结核病人DOTS实施质量改进策略研究

The rapidly increasing number of migrants puts forward new challenges to China tuberculosis prevention and control.As we know, DOTS implementation quality is a bottleneck to affect TB prevention and control among migrants.Hence,this study would focus on DOTS implementation quality among migrant tuberculosis patients.It aims to analyze DOTS implementation quality problems and its root causes based on a case cohort study design ,so as to provide a scientific basis for improving DOTS implementation quality among migrant tuberculosis patients. Based on the research framework of systematic quality improvement methodology,the study would comprehensively use theories and methods from subjects of policy,sociology,statistics and epidemiology,and would be carried out according to qualtiy improvement steps as follows：Firsyly,to establish a migrant tuberculosis patients cohort ,and form a DOTS quality problems pool through methods of carrying out investigation on patients in the cohort at time points which quality problems would easily caused , Fine-Gray partial competing risk model ,Kaplan-Meier,patients follow-up observation,key informants interviews , focus group discussion and literature analysis;Secondly,to diagnose the key quality problems by using AHP method,and then to analyze its root causes by using fish bone diagram method;Finally,to develop migrant-targeted strategies which could effectively solve the practical problems of improving DOTS implementation quality ,so as to improve the effect of tuberculosis control among migrant tuberculosis patients.

流动人口迅速增加给中国结核病控制提出新挑战，DOTS策略实施质量是影响流动人口结核病控制效果核心环节。研究以DOTS实施质量为切入点，基于病例队列设计法对流动人口病人DOTS实施质量主要问题及其根源进行分析，为DOTS实施质量优化提供科学依据。研究以质量改进系统思路为构架，综合运用政策学、社会学、数理统计学、流行病学等多学科理论与方法，以DOTS实施中易出现质量问题的环节为关键节点，通过对建立的病人队列在关键节点的问卷调查及随访观察收集数据，探索性应用Fine-Gray法、Kaplan-Meier 法等模型及方法，结合关键人物访谈、焦点组访谈、文献分析等方法，发现流动人口DOTS实施质量问题并形成问题集；使用层次分析法诊断主要质量问题并论证，通过因果分析图探索其产生根源。研究结果为制定针对性强且能切实解决实际问题的DOTS实施质量优化策略提供依据，其最终目标是提高流动人口结核病控制效果。