Objective: To explore quality of spirometry in Hunan province and the impact of education on it. Methods: Cross-sectional study and a prospective randomized cohort study. (1) A total of 460 public hospitals in Hunan province were investigated. Research assistants collected 20 consecutive reports of pulmonary ventilation test reports (PVTRs) and basal information of those hospitals which owned spirometry. (2) To measure the effect of education, 28 randomly selected 2(nd) level hospitals which owned spirometry were randomized to intervention and control group (1∶1). The intervention group received a short-time training which included face-to-face lectures and a hand-by-hand operation training course, while the control group received usual care. PVTRs were investigated 3 months after the intervention. All PVTRs were classified to grade A, B, C, D and E according to the Chinese pulmonary ventilation test (PVT) guidelines. Results: The recovery rate was 100%. The spirometry-equipped ratio was 1.6% (2/129) at 1(st) level hospitals, 39.0% (105/269) at 2(nd) level hospitals, 100% (62/62) at 3(rd) level hospitals in Hunan province. There were 100% (2/2), 91.4% (96/105) and 93.5% (58/62) utilization rate at 1(st), 2(nd) and 3(rd) level hospitals. Common reasons for not owning a spirometer were equipment cost and insufficient insurance. Lack of knowledge about spirometry and inadequate benefits were the top two reasons for low utilization rate. There were 3 120 PVTRs from 156 hospitals which used spirometry, a total of 50.4% (1 574/3 120) PVTRs got grade A, a total of 14.8% (462/3 120) PVTRs were judged as unreliable (grade D, E). There were 560 PVTRs and 28 questionnaires, respectively, before and after intervention. The technicians' knowledge improved after education compared to before (9.8±0.6 vs 8.6±1.1) (P<0.05). And 75.0% (210/280) PVTRs got A grade in the intervention group, which was significantly higher than those in the control group (75.0% vs 37.9%, P<0.05). While none of PVTRs was unreliable, which was lower than that in the control group (0 vs 14.6%, P<0.05). Conclusions: The equipment ratio and the utilization rate of spirometry are still low and imbalanced among three levels hospitals in Hunan. The short-time training is helpful to improve quality of spirometry.
目的： 调查湖南省肺功能检查开展现状，探讨对操作者短期培训的作用。 方法： 本研究采用横断面调查及前瞻性对照研究：（1）普查湖南省卫计委在册460家公立医院，获得开展肺功能检查医院2016年1月1日开始的连续20份肺功能报告单及基本资料信息；（2）对14家二级医院肺功能操作人员进行面对面讲座及手把手培训（干预组），干预组于培训前后回答问卷，获取培训前后3个月的连续20份肺功能检查报告单，比较前后问卷的正确率及培训前后的肺功能报告质量，并与同期未接受培训的14家同等级医院（对照组）进行对照，分析对操作者短期培训的作用。肺功能报告单质量根据指南分为A、B、C、D、E五个等级并进行评价。 结果： 在册460家（100%）公立医院均回复。一、二、三级医院肺功能仪配备率分别为1.6%（2/129）、39.0%（105/269）、100%（62/62），使用率分别为100%（2/2）、91.4%（96/105）、93.5%（58/62）。肺功能仪配备率低主要原因为设备昂贵及医保报销比例低，使用率低主要原因为缺乏肺功能相关知识及经济效益低。开展肺功能检查的医院有156家，共收集到3 120份报告单，其中1 574份（50.4%）为A级，687份（22.0%）为B级，462份（14.8%）为不可靠（D、E级）。操作者培训前、后均收到560份报告单及28份知识问卷。培训后干预组相关知识掌握程度显著高于培训前（9.8±0.6比8.6±1.1，P<0.05），报告单A级比例显著高于对照组（75.0%比37.9%，P<0.05），不可靠比例显著低于对照组（0比14.6%，P<0.05）。 结论： 湖南省肺功能仪配备率及使用率低且不平衡，肺功能检查质量低。短期培训可提高操作者相关知识水平及检查质量。.
Keywords: Data collection; Hunan; Quality control; Respiratory function tests; Teaching.