专病防治网络在结核性缩窄性心包炎患者中的应用价值OA

Objective:To explore the value of a specialized disease prevention and control network based on a regional compact medical consortium in the whole-process management of patients with tuberculous constrictive pericarditis(TCP).Methods:Based on the patient's visit time,medical records of TCP patients aged ≥18 years with a history of tuberculosis who were hospitalized from June 2022 to June 2025 were collected from the Third Affiliated Hospital of Chongqing Medical University(Fangda Hospital)and Chongqing Public Health Medical Treatment Center.The effectiveness of the network was comprehensively evaluated by comparing the following indicators including diagnosis and treatment process efficiency,therapeutic approaches,multidisciplinary treatment(MDT)participation rate,discharge patterns,clinical outcomes,annual readmission rates,direct medical costs,hospitalization stay duration,and patient experience between the pre-implementation period(June 2022 to December 2023;pre-implementation group)and the post-implementation period(January 2024 to June 2025;post-implementation group).The specialized disease prevention and control network was a compact medical consortium with a'1+1+N'structure.A Grade Ⅲ-A general hospital served as the network's top-tier facility,a public health medical treatment center as the hub,and N primary hospitals and community health service centers.Results:Compared with the pre-implementation group,the post-implementation group showed the significant improvements:the initial identification rate of suspected TCP patients increased from 20.6％(14/68)to 75.7％(53/70),upward referral rate from 36.8％(25/68)to75.7％(53/70),diagnostic rate from 68.0％(17/25)to 96.2％(51/53),and the average time for referral to hub hospitals shortened from(14.2±4.8)days to(5.4±2.7)days(x2=41.212,P＜0.001;x2=19.738,P＜0.001;x2=12.217,P＜0.001;t=11.539,P＜0.001).The MDT participation rate increased from 0(0/68)to 100.0％(70/70),physician-ordered discharge rate from 75.0％(51/68)to 94.3％(66/70),positive clinical outcome rate from 79.4％(54/68)to 94.3％(66/70),and the annual readmission rate decreased from 44.6％(29/65)to 14.7％(10/68)(x2=138.000,P＜0.001;x2=9.640,P=0.003;x2=8.670,P=0.006;x2=15.830,P＜0.001).Direct medical cost decreased from 51 538.0(10 100.0,62 277.0)yuan to 50 121.5(19 384.0,77 212.0)yuan,hospitalization duration increased from 17.5(14.0,33.0)days to 22.0(12.0,32.0)days,and patient experience score increased from 11.0(8.0,12.0)to 12.0(12.0,12.0)(Z=-2.450,P=0.014;Z=-2.130,P=0.033;Z=1436.500,P＜0.001).Conclusion:The"1+1+N"architecture of TCP prevention and treatment network significantly improved the early identification,diagnosis and treatment efficiency,and patient outcomes of TCP by defining the functions of three-tier institutions,optimizing two-way referral process,and strengthening MDT collaboration.Its model of"hierarchical collaboration,resource integration,and closed-loop management"provides a practical paradigm for building prevention and treatment system for extrapulmonary tuberculosis.