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目的:描述纽约市结核病控制局(BTBC)的工作人员经过3年努力,探索与病人管理(CM)中存在的不足的相关因素,并改善CM的实施。设计:评估2003年第2季度报告的TB病例的管理情况,并与2002年进行的类似评估进行比较。在需要改进的目标领域实施相应的策略,并找出有助于改进工作的干预措施。结果:从2002年至2003年,病例管理的某些指标有了很大提高,如对病人进行直接面视下治疗重要性(32%vs.74%)、每月随访重要性(24% vs.51%)和发展为耐药的潜在可能性的宣教(36%vs.61%)。告知病人获得BTBC所提供的医疗服务的指标也提高了(16%vs.59%);然而, CM活动的文件记录、及时性以及督导活动的实施仍然较差。督导员们把主要原因归咎于对实际开展工作的不完善文件记录。结论:通过评估,发现了病人管理以及规划督导中的不足。这些发现将用于调整工作计划、制定有针对性的干预措施、加强教育和培训,以改进工作实施。
Objectives: Describe staff members of the New York City Tuberculosis Control Agency (BTBC) who, after three years of hard work, explore factors related to deficiencies in patient management (CM) and improve CM implementation. Design: Assess the management of TB cases reported for the second quarter of 2003 and compare them to similar assessments conducted in 2002. Implement appropriate strategies in the areas that need improvement and identify interventions that will help improve the job. Results: Some indicators of case management have been greatly improved from 2002 to 2003, such as the importance of direct face-down treatment (32% vs 74%), monthly follow-up importance (24% vs .51%) and mission to develop the potential for resistance (36% vs.61%). Indicators of patient access to BTBC-provided medical services also increased (16% vs.59%); however, the documentation of CM activities, timeliness, and stewardship activities remained poor. Supervisors blame the main reason for the incomplete documentation of the actual work carried out. Conclusion: Through the assessment, the problems found in patient management and planning supervision were discovered. These findings will be used to adjust the work plan, develop targeted interventions and strengthen education and training to improve job performance.