基于信息平台区域内宫颈疾病防治双向转诊的实践与探讨

目的 探索建立闵行区域内基于信息平台的宫颈疾病防治双向转诊机制,有效管理宫颈疾病高危对象,早诊早治宫颈癌前病变和早期宫颈癌患者,降低宫颈癌的发病率和病死率。 方法 成立以闵行区妇幼保健院为主体的宫颈疾病双向转诊协作组,将实事项目妇女病筛查中宫颈疾病高危对象列入转诊对象,由试点逐步推广到全区13家社区卫生服务中心,与区内2家二三级综合性医院建立有信息平台支撑的集筛查、健康教育、专业培训、双向转诊、诊治随访为一体的宫颈疾病防治双向转诊管理模式。同时建立双向转诊信息数据库,有双向转诊的制度、流程、规范、考核细则、考核指标,并纳入社区公共卫生经费范畴。 结果 双向转诊就诊率逐年提高,2014-2017年诊断宫颈病变604例,以癌前病变为主。宫颈病变早诊率为91.56%,呈逐年上升趋势,宫颈癌早发现率86.27%。转诊对象宫颈疾病知晓率宣教前后比较差异有统计学意义(P<0.01),对象满意度达96.75%。 结论 闵行区开展基于信息平台的区域内社区卫生服务中心和上级医院之间宫颈疾病防治双向转诊的管理模式,有公共卫生经费保障,建立有效的转诊机制和信息数据库,提高宫颈癌前病变的发现率,实现了社区妇女保健的健康管理。 

Practice and discussion of two-way referral for prevention and treatment of cervical diseases in the region based on the information platform

Objective To explore the establishment of two-way referral for the prevention and treatment of cervical diseases based on information platform in Minhang district to reduce the morbidity and mortality of cervical cancer, thus to manage high risk population of cervical disease effectively for early diagnosis and treatment of cervical precancerous lesions and early cervical cancer patients. Methods We established a cooperation group for two-way referral of cervical diseases with Minhang District maternal and child health hospital as the main body. Women with high risk of cervical disease screening were included in the referral target. From the pilot to the all 13 community health service centers, we set up two-way referral on information platform to support the screening, health education, professional training, two-way referral, diagnosis and treatment, follow-up as one of the prevention and treatment of cervical diseases with the two or three level general hospitals in the district. Two-way referral set up a information database, system, process, specification, detailed examination rules, assessment index, and also included into the community public health funds. Results The two-way referral rate increased year by year. From 2014 to 2017, 604 cases of cervical lesions were diagnosed as precancerous lesions. The rate of early diagnosis of cervical lesion was 91.56% and rose year by year; the rate of early detection of cervical cancer was 86.27%. There were significant differences in the awareness rate of cervical diseases of transferred population (P<0.01) and the object satisfaction was 96.75%. Conclusion Minhang district established the two-way referral for prevention and treatment of cervical diseases between the regional community health service centers and hospitals based on the information platform and financial support for public health. It also established an effective referral mechanism and information database. It increased the detection rate of precancerous lesions of the cervix, and ensured the purpose of health management of community women's health care.