Brazilian National Registry of Healthcare Establishments as a tool for the analysis of decentralization of tuberculosis treatment to basic care services

Abstract: This study aimed to validate a method for classification of healthcare services in Brazil (basic care vs. other levels) and describe the decentralization of tuberculosis (TB) care to basic services (2002 to 2016). The healthcare services that reported and followed TB cases were classified as either “basic care” or “other levels” based on the type of establishment registered in the Brazilian National Registry of Healthcare Establishments (CNES, in Portuguese). The study estimated the agreement between this classification with a previous classification performed in 2013 by Brazil’s state and local tuberculosis programs. Using the CNES registry, the authors then calculated the percentage of TB patients treated in basic care from 2002 to 2016. Agreement was 94.4%, and overall kappa index was 0.86. There was a relative increment of 31.2% in TB care provided by basic services (from 50.9% in 2002 to 66.8% in 2016). All regions of Brazil showed an increase in this percentage, except the South. The classification based on the CNES registry allowed analyzing the trend in decentralization of TB treatment to basic healthcare services in Brazil.

摘要：本研究旨在验证一种巴西医疗服务分类方法（基础照护与其他层级照护），并描述2002年至2016年结核病（Tuberculosis, TB）照护服务向基层医疗机构下放的情况。本研究依据巴西国家医疗服务机构登记系统（葡萄牙语缩写：CNES）中登记的机构类型，将报告并跟进结核病病例的医疗服务机构划分为“基础照护”与“其他层级照护”两类。研究评估了该分类方法与巴西各州及地方结核病防控项目2013年采用的旧分类方法之间的一致性。研究人员借助CNES登记系统，计算了2002年至2016年在基础照护机构接受治疗的结核病患者占比。两类分类方法的一致性达94.4%，整体kappa系数为0.86。基层医疗服务提供的结核病照护占比相对增幅达31.2%，从2002年的50.9%升至2016年的66.8%。除巴西南部地区外，全国所有区域的该占比均实现增长。基于CNES登记系统的分类方法，可用于分析巴西结核病治疗向基层医疗服务下放的趋势。