近日,國(guó)家衛(wèi)生健康委發(fā)布《關(guān)于印發(fā)出生缺陷防治能力提升計(jì)劃(2023-2027年)的通知》(下稱《計(jì)劃》)。
![](data:image/png;base64,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)
通知指出:每個(gè)縣(市、區(qū))至少有1個(gè)獨(dú)立開(kāi)展生化免疫實(shí)驗(yàn)室檢測(cè)的產(chǎn)前篩查機(jī)構(gòu)。《計(jì)劃》中提及多項(xiàng)與檢驗(yàn)科高度相關(guān)的任務(wù),整理如下:
1.布局建設(shè)區(qū)域產(chǎn)前診斷中心,每個(gè)?。▍^(qū)、市)均設(shè)置省級(jí)產(chǎn)前診斷中心,原則上每個(gè)地市均設(shè)置產(chǎn)前診斷機(jī)構(gòu),每個(gè)縣(市、區(qū))至少有1個(gè)獨(dú)立開(kāi)展生化免疫實(shí)驗(yàn)室檢測(cè)的產(chǎn)前篩查機(jī)構(gòu)。
2.產(chǎn)前篩查機(jī)構(gòu)加強(qiáng)生化免疫實(shí)驗(yàn)室、醫(yī)學(xué)影像科室和咨詢門(mén)診建設(shè)。
3.結(jié)合行業(yè)發(fā)展趨勢(shì),加強(qiáng)對(duì)掌握生物醫(yī)學(xué)信息、基因檢測(cè)、醫(yī)學(xué)人工智能等前沿技術(shù)的人才建設(shè)。
4.提高專業(yè)能力。加強(qiáng)醫(yī)學(xué)影像、檢驗(yàn)專業(yè)人員能力建設(shè),強(qiáng)化標(biāo)準(zhǔn)化操作和質(zhì)量控制。
5.規(guī)范產(chǎn)前篩查和產(chǎn)前診斷。落實(shí)產(chǎn)前篩查和產(chǎn)前診斷技術(shù)標(biāo)準(zhǔn)、規(guī)范和指南,規(guī)范新技術(shù)臨床應(yīng)用。強(qiáng)化孕婦外周血胎兒游離DNA產(chǎn)前篩查檢測(cè)后咨詢及處置。
6.推進(jìn)新生兒疾病篩查和診斷治療。全面開(kāi)展苯丙酮尿癥、先天性甲狀腺功能減低癥、聽(tīng)力障礙、先天性心臟病篩查。逐步擴(kuò)大篩查病種,有條件的地區(qū)將先天性腎上腺皮質(zhì)增生癥、葡萄糖-6-磷酸脫氫酶缺乏癥和髖關(guān)節(jié)發(fā)育不良以及聽(tīng)力障礙基因檢測(cè)納入新生兒疾病篩查。新生兒遺傳代謝病篩查率達(dá)到98%,聽(tīng)力障礙篩查率達(dá)到90%。
7.強(qiáng)化唐氏綜合征等染色體病防治。科學(xué)確定產(chǎn)前篩查方案,嚴(yán)格按照技術(shù)規(guī)范,提供早、中孕期超聲篩查、血清學(xué)篩查和孕婦外周血胎兒游離DNA產(chǎn)前篩查。規(guī)范開(kāi)展致病性拷貝數(shù)變異等其他染色體病產(chǎn)前診斷,規(guī)范知情告知和遺傳咨詢。
8.強(qiáng)化地中海貧血等單基因遺傳病防治。針對(duì)常見(jiàn)單基因遺傳病提供個(gè)性化篩查,開(kāi)展精準(zhǔn)的遺傳學(xué)診斷、生育風(fēng)險(xiǎn)評(píng)估和遺傳咨詢。深入實(shí)施地貧防控公共衛(wèi)生服務(wù)項(xiàng)目,提高攜帶同型地貧基因夫婦孕期產(chǎn)前診斷率。
9.健全質(zhì)量管理體系。積極發(fā)揮各級(jí)醫(yī)療質(zhì)量控制中心、臨床檢驗(yàn)中心作用,建立健全機(jī)構(gòu)全覆蓋、涵蓋三級(jí)預(yù)防全流程、職責(zé)明確、分工負(fù)責(zé)、運(yùn)轉(zhuǎn)高效的出生缺陷防治質(zhì)量管理體系。
10.完善質(zhì)量管理制度。加強(qiáng)對(duì)開(kāi)展產(chǎn)前篩查和診斷、新生兒疾病篩查和診斷及出生缺陷相關(guān)遺傳檢測(cè)等檢驗(yàn)項(xiàng)目的醫(yī)學(xué)檢驗(yàn)實(shí)驗(yàn)室監(jiān)督檢查。
11.加強(qiáng)重點(diǎn)環(huán)節(jié)質(zhì)量管理。落實(shí)檢查檢驗(yàn)全過(guò)程質(zhì)量管理,加強(qiáng)室內(nèi)質(zhì)量控制和室間質(zhì)量評(píng)價(jià),對(duì)于第三方合作單位應(yīng)當(dāng)核實(shí)其資質(zhì)能力并簽署協(xié)議,明確責(zé)任。
12.發(fā)揮科技創(chuàng)新支撐作用。按照國(guó)家有關(guān)規(guī)定,醫(yī)療機(jī)構(gòu)規(guī)范自行研制應(yīng)用于出生缺陷防治的體外診斷試劑,提高檢測(cè)診斷水平。
《計(jì)劃》到2027年,實(shí)現(xiàn)以下主要目標(biāo):
三級(jí)預(yù)防措施覆蓋率進(jìn)一步提高,婚前醫(yī)學(xué)檢查率、孕前優(yōu)生健康檢查目標(biāo)人群覆蓋率分別保持在70%和80%以上;產(chǎn)前篩查率達(dá)到90%,篩查高風(fēng)險(xiǎn)孕婦產(chǎn)前診斷服務(wù)逐步落實(shí);苯丙酮尿癥、先天性甲狀腺功能減低癥等新生兒遺傳代謝病2周內(nèi)診斷率、2周內(nèi)治療率均達(dá)到90%,新生兒聽(tīng)力障礙3個(gè)月內(nèi)診斷率、6個(gè)月內(nèi)干預(yù)率均達(dá)到90%。
一批致死致殘重大出生缺陷得到有效控制,聚焦嚴(yán)重先天性心臟病、唐氏綜合征、先天性聽(tīng)力障礙、重型地中海貧血、苯丙酮尿癥等重點(diǎn)出生缺陷防治取得新進(jìn)展,全國(guó)出生缺陷導(dǎo)致的嬰兒死亡率、5歲以下兒童死亡率分別降至1.0‰、1.1‰以下。
《計(jì)劃》重點(diǎn)任務(wù)包括:
健全服務(wù)網(wǎng)絡(luò)
1.加強(qiáng)網(wǎng)絡(luò)建設(shè)。落實(shí)國(guó)家醫(yī)療衛(wèi)生服務(wù)體系相關(guān)規(guī)劃關(guān)于出生缺陷防治網(wǎng)絡(luò)建設(shè)的要求,完善區(qū)域、省、市、縣防治機(jī)構(gòu)設(shè)置。優(yōu)化婚前保健、孕前保健資源配置和服務(wù)供給,推進(jìn)婚前醫(yī)學(xué)檢查機(jī)構(gòu)與婚姻登記場(chǎng)所就近設(shè)置方便群眾。布局建設(shè)區(qū)域產(chǎn)前診斷中心,每個(gè)?。▍^(qū)、市)均設(shè)置省級(jí)產(chǎn)前診斷中心,原則上每個(gè)地市均設(shè)置產(chǎn)前診斷機(jī)構(gòu),每個(gè)縣(市、區(qū))至少有1個(gè)獨(dú)立開(kāi)展生化免疫實(shí)驗(yàn)室檢測(cè)的產(chǎn)前篩查機(jī)構(gòu)。省級(jí)和地市級(jí)均至少建設(shè)1個(gè)新生兒遺傳代謝病診治機(jī)構(gòu)、1個(gè)新生兒聽(tīng)力障礙診治機(jī)構(gòu)、1個(gè)新生兒先天性心臟病診治機(jī)構(gòu)。推動(dòng)具有??苾?yōu)勢(shì)的國(guó)家級(jí)、省級(jí)醫(yī)療機(jī)構(gòu)牽頭組建出生缺陷疾病防治??坡?lián)盟或協(xié)作網(wǎng),促進(jìn)預(yù)防、篩查、診斷、治療、康復(fù)一體化防治服務(wù)。
2.夯實(shí)機(jī)構(gòu)作用?;鶎俞t(yī)療衛(wèi)生機(jī)構(gòu)加強(qiáng)出生缺陷防治宣傳動(dòng)員和健康教育,有條件地區(qū)將出生缺陷防治服務(wù)納入家庭醫(yī)生簽約服務(wù)包。婚前醫(yī)學(xué)檢查、孕前優(yōu)生健康檢查機(jī)構(gòu)規(guī)范婚前孕前保健門(mén)診,提供優(yōu)質(zhì)高效便捷服務(wù)。產(chǎn)前篩查機(jī)構(gòu)加強(qiáng)生化免疫實(shí)驗(yàn)室、醫(yī)學(xué)影像科室和咨詢門(mén)診建設(shè),產(chǎn)前診斷機(jī)構(gòu)強(qiáng)化對(duì)產(chǎn)前篩查機(jī)構(gòu)業(yè)務(wù)指導(dǎo),省級(jí)產(chǎn)前診斷中心做好全省人才培養(yǎng)、質(zhì)量管理和疑難病例轉(zhuǎn)會(huì)診,區(qū)域產(chǎn)前診斷中心發(fā)揮技術(shù)輻射作用。推進(jìn)新生兒遺傳代謝病篩查機(jī)構(gòu)建設(shè)評(píng)估,加強(qiáng)新生兒聽(tīng)力障礙篩查機(jī)構(gòu)設(shè)備配備,推動(dòng)新生兒先天性心臟病篩查機(jī)構(gòu)提質(zhì)增量。開(kāi)展新生兒疾病篩查質(zhì)控機(jī)構(gòu)建設(shè)。省級(jí)出生缺陷防治管理機(jī)構(gòu)做好本?。▍^(qū)、市)業(yè)務(wù)指導(dǎo)和項(xiàng)目管理。
加強(qiáng)人才培養(yǎng)
3.優(yōu)化人才隊(duì)伍。嚴(yán)格出生缺陷防治專項(xiàng)技術(shù)培訓(xùn)和考核,規(guī)范從事產(chǎn)前篩查、產(chǎn)前診斷技術(shù)人員持證上崗。按照機(jī)構(gòu)設(shè)置標(biāo)準(zhǔn)和服務(wù)需求合理配置專業(yè)技術(shù)人員。持續(xù)實(shí)施全國(guó)出生缺陷防治人才培訓(xùn)項(xiàng)目,到2027年,全國(guó)完成1.5萬(wàn)名緊缺人才培養(yǎng)。開(kāi)展出生缺陷防治人才培訓(xùn)項(xiàng)目專項(xiàng)培訓(xùn),針對(duì)重點(diǎn)專業(yè)和重點(diǎn)疾病防治培養(yǎng)學(xué)術(shù)骨干和學(xué)科帶頭人。結(jié)合行業(yè)發(fā)展趨勢(shì),加強(qiáng)對(duì)掌握生物醫(yī)學(xué)信息、基因檢測(cè)、醫(yī)學(xué)人工智能等前沿技術(shù)的人才建設(shè)。
4.提高專業(yè)能力。加強(qiáng)醫(yī)學(xué)影像、檢驗(yàn)專業(yè)人員能力建設(shè),強(qiáng)化標(biāo)準(zhǔn)化操作和質(zhì)量控制。加強(qiáng)醫(yī)學(xué)遺傳學(xué)專業(yè)住院醫(yī)師規(guī)范化培訓(xùn),強(qiáng)化遺傳性疾病篩查診斷能力。提高出生缺陷咨詢水平,重點(diǎn)提升婚前保健、孕前保健主檢醫(yī)師對(duì)影響孕育風(fēng)險(xiǎn)因素識(shí)別和咨詢能力,婦產(chǎn)科、兒科醫(yī)師對(duì)常見(jiàn)胎兒異常識(shí)別和咨詢能力,從事遺傳咨詢的臨床醫(yī)師對(duì)遺傳檢測(cè)結(jié)果和常見(jiàn)遺傳性疾病遺傳風(fēng)險(xiǎn)分析和評(píng)估能力。推動(dòng)出生缺陷防控咨詢師等職業(yè)技能培訓(xùn)、評(píng)價(jià)和規(guī)范服務(wù)。加強(qiáng)新生兒疾病篩查專業(yè)技術(shù)人員培訓(xùn),提高遺傳代謝病、聽(tīng)力障礙、先天性心臟病等先天性疾病的識(shí)別、咨詢和篩查、診斷、治療、康復(fù)服務(wù)能力。加強(qiáng)兒童內(nèi)分泌遺傳代謝科專業(yè)醫(yī)師培訓(xùn),強(qiáng)化聽(tīng)力檢測(cè)、助聽(tīng)器驗(yàn)配、人工耳蝸植入、聽(tīng)覺(jué)康復(fù)與語(yǔ)言訓(xùn)練專業(yè)人員培養(yǎng),推進(jìn)嬰幼兒先天性心臟病外科手術(shù)和介入治療專業(yè)隊(duì)伍建設(shè)。
深化防治服務(wù)
5.加強(qiáng)知識(shí)普及和健康教育。豐富出生缺陷防治科普資源,用好全媒體宣傳平臺(tái)和融媒體傳播手段,提高育齡人群防治知識(shí)知曉率。結(jié)合“預(yù)防出生缺陷日”等衛(wèi)生健康節(jié)日紀(jì)念日加強(qiáng)主題宣傳,持續(xù)開(kāi)展“愛(ài)心傳遞防治出生缺陷”公益行,營(yíng)造全社會(huì)支持出生缺陷防治氛圍。開(kāi)展婚育健康知識(shí)進(jìn)企業(yè)、社區(qū)、校園活動(dòng),加強(qiáng)重點(diǎn)人群宣教。鼓勵(lì)開(kāi)展出生缺陷防治知識(shí)科普作品創(chuàng)作、征集和演講宣講競(jìng)賽活動(dòng)。
6.強(qiáng)化風(fēng)險(xiǎn)因素預(yù)防控制。促進(jìn)育齡婦女在孕前、孕期注重合理營(yíng)養(yǎng)和心理健康,科學(xué)補(bǔ)服葉酸等營(yíng)養(yǎng)素,預(yù)防病毒感染和風(fēng)險(xiǎn)因素暴露,在醫(yī)生指導(dǎo)下謹(jǐn)慎用藥。推動(dòng)加強(qiáng)女職工勞動(dòng)保護(hù),避免準(zhǔn)備懷孕和孕期婦女接觸有毒有害物質(zhì)和放射線。推進(jìn)婚前保健、孕前保健特色??平ㄔO(shè),推廣婚姻登記、婚前醫(yī)學(xué)檢查、生育指導(dǎo)“一站式”服務(wù)。強(qiáng)化孕前優(yōu)生健康檢查風(fēng)險(xiǎn)評(píng)估和咨詢指導(dǎo),促進(jìn)孕前、圍孕和孕產(chǎn)期保健系統(tǒng)連續(xù)服務(wù)。
7.規(guī)范產(chǎn)前篩查和產(chǎn)前診斷。落實(shí)產(chǎn)前篩查和產(chǎn)前診斷技術(shù)標(biāo)準(zhǔn)、規(guī)范和指南,規(guī)范新技術(shù)臨床應(yīng)用。加強(qiáng)產(chǎn)前篩查隨訪服務(wù),提升篩查高風(fēng)險(xiǎn)孕婦產(chǎn)前診斷率,規(guī)范遺傳咨詢。強(qiáng)化孕婦外周血胎兒游離DNA產(chǎn)前篩查檢測(cè)后咨詢及處置,對(duì)檢測(cè)結(jié)果為高風(fēng)險(xiǎn)的孕婦,要全面落實(shí)產(chǎn)前診斷措施。開(kāi)展產(chǎn)前篩查與產(chǎn)前診斷典型病案剖析和分享。規(guī)范胎兒宮內(nèi)疾病診斷和治療,促進(jìn)胎兒醫(yī)學(xué)技術(shù)在出生缺陷防治領(lǐng)域應(yīng)用。
8.推進(jìn)新生兒疾病篩查和診斷治療。全面開(kāi)展苯丙酮尿癥、先天性甲狀腺功能減低癥、聽(tīng)力障礙、先天性心臟病篩查。逐步擴(kuò)大篩查病種,有條件的地區(qū)將先天性腎上腺皮質(zhì)增生癥、葡萄糖-6-磷酸脫氫酶缺乏癥和髖關(guān)節(jié)發(fā)育不良以及聽(tīng)力障礙基因檢測(cè)納入新生兒疾病篩查。新生兒遺傳代謝病篩查率達(dá)到98%,聽(tīng)力障礙篩查率達(dá)到90%。加強(qiáng)篩查陽(yáng)性病例召回、診斷、治療、干預(yù)和隨訪,在提高篩查率的基礎(chǔ)上,重點(diǎn)提升及時(shí)診斷率和及時(shí)干預(yù)率。針對(duì)新生兒遺傳代謝病,逐步提高2周內(nèi)診斷率、2周內(nèi)治療率;針對(duì)新生兒聽(tīng)力障礙,逐步提高3個(gè)月內(nèi)診斷率、6個(gè)月內(nèi)干預(yù)率,強(qiáng)化聽(tīng)覺(jué)康復(fù)與語(yǔ)言訓(xùn)練。擴(kuò)大新生兒先天性心臟病篩查項(xiàng)目實(shí)施區(qū)域,到2025年覆蓋全國(guó)所有縣(市、區(qū)),到2027年篩查率、診斷率、干預(yù)率均達(dá)到80%。不斷健全新生兒疾病篩查、診斷、治療連續(xù)服務(wù)鏈條,推動(dòng)早篩、早診、早治。
9.推進(jìn)出生缺陷疾病治療。指導(dǎo)醫(yī)療機(jī)構(gòu)嚴(yán)格遵循臨床診療指南、臨床技術(shù)操作規(guī)范、行業(yè)標(biāo)準(zhǔn)和臨床路徑等要求開(kāi)展出生缺陷疾病診療工作,進(jìn)一步暢通嚴(yán)重、疑難、復(fù)雜疾病轉(zhuǎn)會(huì)診機(jī)制。圍繞常見(jiàn)出生缺陷疾病,推動(dòng)?jì)D幼保健機(jī)構(gòu)相關(guān)診療??平ㄔO(shè),強(qiáng)化康復(fù)訓(xùn)練和心理疏導(dǎo)服務(wù),將結(jié)構(gòu)性、功能性出生缺陷等小兒外科診療能力水平納入婦幼保健機(jī)構(gòu)績(jī)效考核。配合相關(guān)部門(mén)建立健全多層次醫(yī)療保障制度,深入開(kāi)展出生缺陷干預(yù)救助項(xiàng)目,提高出生缺陷患兒醫(yī)療保障水平。
聚焦重點(diǎn)疾病
10.強(qiáng)化先天性心臟病等結(jié)構(gòu)畸形防治。研究建立常見(jiàn)結(jié)構(gòu)畸形孕期篩查預(yù)警指征和預(yù)后評(píng)估指標(biāo)體系,加強(qiáng)影像學(xué)診斷、遺傳咨詢和??圃u(píng)估,推進(jìn)多學(xué)科診療協(xié)作,強(qiáng)化產(chǎn)兒科聯(lián)合救治和術(shù)后康復(fù)服務(wù)。加強(qiáng)先天性心臟病預(yù)后分級(jí)及圍產(chǎn)期風(fēng)險(xiǎn)評(píng)估,開(kāi)展篩查、診斷、治療一體化防治特色單位遴選,提供產(chǎn)前產(chǎn)后一體化管理服務(wù),減少嚴(yán)重先天性心臟病所致新生兒死亡和嬰兒死亡。
11.強(qiáng)化先天性聽(tīng)力障礙等功能性出生缺陷防治。圍繞神經(jīng)、消化、免疫、內(nèi)分泌等系統(tǒng)常見(jiàn)功能性出生缺陷,對(duì)高風(fēng)險(xiǎn)夫婦提供遺傳咨詢與檢測(cè)和產(chǎn)前診斷,加強(qiáng)出生后治療干預(yù)。結(jié)合基本公共衛(wèi)生服務(wù)0-6歲兒童健康管理服務(wù),強(qiáng)化0-6歲兒童聽(tīng)力障礙篩查,加強(qiáng)遲發(fā)性耳聾診斷、治療、康復(fù)服務(wù),為確診聽(tīng)力障礙患兒提供助聽(tīng)器精準(zhǔn)驗(yàn)配、人工耳蝸植入、語(yǔ)言訓(xùn)練等干預(yù)服務(wù)。
12.強(qiáng)化唐氏綜合征等染色體病防治??茖W(xué)確定產(chǎn)前篩查方案,嚴(yán)格按照技術(shù)規(guī)范,提供早、中孕期超聲篩查、血清學(xué)篩查和孕婦外周血胎兒游離DNA產(chǎn)前篩查,落實(shí)高風(fēng)險(xiǎn)孕婦產(chǎn)前診斷,指導(dǎo)低風(fēng)險(xiǎn)孕婦規(guī)范進(jìn)行孕產(chǎn)期保健,降低唐氏綜合征發(fā)生率。規(guī)范開(kāi)展致病性拷貝數(shù)變異等其他染色體病產(chǎn)前診斷,規(guī)范知情告知和遺傳咨詢。
13.強(qiáng)化地中海貧血等單基因遺傳病防治。針對(duì)常見(jiàn)單基因遺傳病提供個(gè)性化篩查,開(kāi)展精準(zhǔn)的遺傳學(xué)診斷、生育風(fēng)險(xiǎn)評(píng)估和遺傳咨詢。深入實(shí)施地貧防控公共衛(wèi)生服務(wù)項(xiàng)目,提高攜帶同型地貧基因夫婦孕期產(chǎn)前診斷率。地貧基因人群攜帶率較高省份根據(jù)發(fā)病情況、區(qū)域分布特點(diǎn)等,研究制訂地貧專項(xiàng)防治計(jì)劃,減少重型地貧發(fā)生。加強(qiáng)地貧患兒診療工作,研究建立地貧診療協(xié)作網(wǎng)或?qū)?坡?lián)盟。
提升質(zhì)量管理
14.健全質(zhì)量管理體系。國(guó)家衛(wèi)生健康委制定出生缺陷防治服務(wù)質(zhì)量評(píng)價(jià)指標(biāo)體系,省級(jí)衛(wèi)生健康部門(mén)建立完善質(zhì)量管理方案,確定質(zhì)量改進(jìn)目標(biāo)并推進(jìn)落實(shí)。省級(jí)出生缺陷防治管理機(jī)構(gòu)、產(chǎn)前診斷中心、新生兒疾病篩診治質(zhì)控機(jī)構(gòu)牽頭負(fù)責(zé),積極發(fā)揮各級(jí)醫(yī)療質(zhì)量控制中心、臨床檢驗(yàn)中心作用,建立健全機(jī)構(gòu)全覆蓋、涵蓋三級(jí)預(yù)防全流程、職責(zé)明確、分工負(fù)責(zé)、運(yùn)轉(zhuǎn)高效的出生缺陷防治質(zhì)量管理體系。
15.完善質(zhì)量管理制度。制訂一批出生缺陷防治服務(wù)質(zhì)量行業(yè)標(biāo)準(zhǔn)并推動(dòng)實(shí)施。探索建立母嬰保健技術(shù)隨機(jī)抽查制度,督促機(jī)構(gòu)落實(shí)出生缺陷防治服務(wù)質(zhì)量安全主體責(zé)任,嚴(yán)格規(guī)范服務(wù)。建立出生缺陷防治服務(wù)質(zhì)量監(jiān)測(cè)評(píng)價(jià)結(jié)果排名、通報(bào)和信息公開(kāi)制度,促進(jìn)服務(wù)質(zhì)量持續(xù)改進(jìn)。加強(qiáng)對(duì)開(kāi)展產(chǎn)前篩查和診斷、新生兒疾病篩查和診斷及出生缺陷相關(guān)遺傳檢測(cè)等檢驗(yàn)項(xiàng)目的醫(yī)學(xué)檢驗(yàn)實(shí)驗(yàn)室監(jiān)督檢查。
16.加強(qiáng)重點(diǎn)環(huán)節(jié)質(zhì)量管理。規(guī)范病歷書(shū)寫(xiě),提升病歷內(nèi)涵質(zhì)量和完整性、及時(shí)性。落實(shí)檢查檢驗(yàn)全過(guò)程質(zhì)量管理,加強(qiáng)室內(nèi)質(zhì)量控制和室間質(zhì)量評(píng)價(jià),對(duì)于第三方合作單位應(yīng)當(dāng)核實(shí)其資質(zhì)能力并簽署協(xié)議,明確責(zé)任。強(qiáng)化評(píng)估、咨詢質(zhì)量管理,提高評(píng)估、咨詢科學(xué)性、規(guī)范性。加強(qiáng)會(huì)診管理,提高多學(xué)科參與度,促進(jìn)臨床決策。提高隨訪質(zhì)量,嚴(yán)格按照規(guī)范指南落實(shí)隨訪要求,提升后續(xù)服務(wù)連續(xù)性、及時(shí)性。加強(qiáng)信息、數(shù)據(jù)和樣本管理,保障信息和生物安全。
強(qiáng)化支撐保障
17.運(yùn)用信息技術(shù)賦能服務(wù)。推進(jìn)人工智能、大數(shù)據(jù)和5G技術(shù)在輔助出生缺陷疾病臨床篩查診斷、數(shù)據(jù)管理和質(zhì)量控制、遠(yuǎn)程醫(yī)療等方面創(chuàng)新和規(guī)范應(yīng)用,提高服務(wù)水平。充分利用“云上婦幼”等遠(yuǎn)程醫(yī)療平臺(tái),開(kāi)展出生缺陷防治遠(yuǎn)程培訓(xùn)、遠(yuǎn)程指導(dǎo)、遠(yuǎn)程會(huì)診、線上轉(zhuǎn)診等,強(qiáng)化遠(yuǎn)程超聲診斷指導(dǎo)的業(yè)務(wù)支撐作用,促進(jìn)優(yōu)質(zhì)醫(yī)療資源下沉。完善出生缺陷監(jiān)測(cè)網(wǎng)絡(luò),進(jìn)一步提高監(jiān)測(cè)質(zhì)量,加強(qiáng)數(shù)據(jù)分析應(yīng)用,有條件省份適當(dāng)擴(kuò)大監(jiān)測(cè)范圍。
18.發(fā)揮科技創(chuàng)新支撐作用。加強(qiáng)病因?qū)W研究,明確重大出生缺陷風(fēng)險(xiǎn)因素和致病因子,促進(jìn)出生缺陷疾病早期預(yù)警和監(jiān)測(cè),提高防控措施針對(duì)性。緊密結(jié)合臨床需要,加強(qiáng)防治關(guān)鍵技術(shù)和適宜技術(shù)研發(fā),強(qiáng)化科研成果示范推廣和轉(zhuǎn)化應(yīng)用。按照國(guó)家有關(guān)規(guī)定,醫(yī)療機(jī)構(gòu)規(guī)范自行研制應(yīng)用于出生缺陷防治的體外診斷試劑,提高檢測(cè)診斷水平。國(guó)家、省級(jí)出生缺陷防治研究平臺(tái)和重點(diǎn)實(shí)驗(yàn)室整合優(yōu)勢(shì)科研力量,在出生缺陷防治領(lǐng)域科技創(chuàng)新和成果轉(zhuǎn)化中積極發(fā)揮作用。
2023-8-30 |