Objective: To understand the status of tuberculosis diagnosis and treatment capacity and the development and changes of tuberculosis diagnosis and treatment in provincial and municipal designated medical institutions in China from 2017 to 2022, so as to provide a basis for the formulation of relevant policies for the improvement and development of designated medical institutions for tuberculosis and the tuberculosis prevention and treatment service system, and to provide reasonable support for further strengthening the capacity of designated medical institutions for tuberculosis. Methods: This study was initiated and carried out by Beijing Chest Hospital affiliated to Capital Medical University/Clinical Center for Tuberculosis Prevention and Control of China CDC (hereinafter referred to as "Clinical Center") by means of questionnaire survey, and the investigation was carried out from March to November 2023. During this period, the clinical center distributed questionnaires to the hospital member units of "Beijing Tuberculosis Diagnosis and Treatment Technology Innovation Alliance", retrospectively collected their tuberculosis-related diagnosis and treatment data from 2017 to 2022, and used descriptive statistical methods to analyze the number of tuberculosis beds, outpatients and hospitalizations in medical institutions. The results were expressed in absolute numbers (percentages), and three-line tables, bar charts and line charts were drawn to describe the analysis results and changing trends. Results: The 54 medical institutions surveyed in this survey included 21 provincial-level designated medical institutions and 33 prefecture-level designated medical institutions. Most medical institutions have set up clinical departments, auxiliary departments and functional departments to undertake public health tasks of infectious diseases. The tuberculosis laboratory in the hospital has a comprehensive ability and has the detection technology needed for most tuberculosis diagnosis; The number of tuberculosis beds, children's tuberculosis beds and ICU beds all showed an increasing trend from 2017 to 2022. The proportion of tuberculosis beds in the hospital decreased slightly, from 39.31% in 2017 to 34.76% in 2022, showing a slight downward trend. Compared with the hospital surveyed, the number of tuberculosis outpatients in 2019 was 562 029, and the number of outpatients in 2020-2022 was 462 328, 519 630 and 424 069 respectively, which was significantly lower than that in 2019. The number of tuberculosis outpatients in medical institutions decreased significantly from 2020 to 2022. By analyzing the proportion of patients with different types of tuberculosis, the proportion of sensitive tuberculosis outpatients in 2017-2022 decreased from 84.49% in 2017 to 78.05% in 2022, showing a downward trend year by year. The proportion of patients with multidrug-resistant/ rifampin-resistant tuberculosis increased from 2.03% in 2017 to 7.18% in 2022. From 2017 to 2019, the total number of inpatients with tuberculosis showed an upward trend. Compared with 2019, the number of inpatients in 2020, 2021 and 2022 showed a downward trend, and the decline in 2020 was large (down 14.94% compared with 2019). Among the inpatients, the absolute number and proportion of patients with sensitive pulmonary tuberculosis remained relatively stable, and the number and proportion of inpatients with multidrug-resistant/rifampin-resistant pulmonary tuberculosis increased year by year. Conclusions: Most medical institutions have the capacity to carry out routine diagnosis and treatment of tuberculosis, but the public health function needs to be strengthened. The transformation of medical institutions requires proper guidance and adequate support. During 2019-2022, most medical institutions were affected by the COVID-19 epidemic, and their tuberculosis diagnosis and treatment work also changed to varying degrees. During this period, hospitals took various measures to overcome difficulties and tried their best to maintain the normal development of tuberculosis diagnosis and treatment, and the tuberculosis diagnosis and treatment work of various institutions gradually resumed in 2022.
目的： 了解我国省级及地市级结核病定点医疗机构2017—2022年结核病诊疗能力状况与结核病诊疗工作开展及其变化情况，为结核病定点医疗机构以及结核病防治服务体系的完善、发展相关政策的制定提供依据，为进一步加强结核病定点医疗机构的能力提供合理的支持。 方法： 本研究使用问卷调查的方法，由首都医科大学附属北京胸科医院 中国疾控中心结核病防治临床中心（简称“临床中心”）发起，调查开展时间为2023年3至11月。在此期间，临床中心向“北京市结核病诊疗技术创新联盟”的医院成员单位发放调查问卷，回顾性收集其2017—2022年结核病相关诊疗数据，采用描述性统计方法对医疗机构的结核病床位数、门诊量及住院量进行分析，结果以绝对数（百分比）表示，绘制三线表、柱状图、折线图等描述分析结果及变化趋势。 结果： 本次调查的54家医疗机构，包括21家省级定点医疗机构及33家地市级定点医疗机构；大多数医疗机构都设置了开展结核病诊疗所需的临床科室、辅助科室以及承担传染病公共卫生任务的职能科室。医院结核实验室能力全面，具备大多数结核病诊断所需的检测技术；结核病床位数、儿童结核病床位数和ICU床位数在2017—2022年均呈增长趋势。结核床位数在全院中的占比略有下降，由2017年的39.31%下降至2022年的34.76%。所调查医院2019年的结核病门诊量为562 029人次，2020—2022年的门诊量依次为462 328人次、519 630人次、424 069人次，较2019年相比均显著下降。分析不同类型肺结核患者的比例，2017—2022年门诊就诊的敏感肺结核患者比例由2017年的84.49%下降到2022年的78.05%，呈现逐年下降趋势；而耐多药/利福平耐药肺结核患者比例由2017年的2.03%增加至2022年的7.18%。2017—2019年，结核病患者住院病例总数呈上升趋势，与2019年相比，2020、2021、2022年住院量均呈下降趋势，2020年下降幅度较大（较2019年下降14.94%）。住院患者中，敏感肺结核患者绝对数以及占比相对保持稳定，耐多药/利福平耐药肺结核住院患者数及占比逐年增加。 结论： 绝大多数医疗机构具备开展结核病常规诊疗工作的能力，但公共卫生职能有待加强。医疗机构的转型需要正确的引导和合理的支持。2019—2022年，大多数医疗机构由于受到新型冠状病毒感染疫情的影响，其结核病诊疗业务也产生了不同程度的变化，在此期间，医院采取各种措施克服困难，尽可能维持结核病诊疗工作的正常开展，各机构的结核病诊疗工作在2022年逐步恢复。.