title: Experience of implementing the integrated TB model in Zhejiang, China: a retrospective observational study.
abstract: BACKGROUND
  This study aims to assess the implementation of the TB control program under the integrated model in China where TB diagnosis and treatment is provided in TB designated hospitals.
  
  
  METHODS
  Six counties under the integrated model in Zhejiang were randomly selected. TB referral and tracing was analyzed based on routine TB reporting data between January and December 2009 from county TB dispensaries. Regarding treatment and community management, we conducted face-to-face surveys with 50 new TB patients randomly selected from each county, and reviewed their medical charts.
  
  
  RESULTS
  A total of 7090 persons with presumptive TB were reported in 2009, of whom, 66.7% (4732/7090) were referred by other health facilities to TB designated hospitals, while 80.2% (3795/4732) were successfully referred. In total, 301 patients were surveyed and had a median medical expenditure of US$192. Ten percent (31/301) missed at least one dose during their treatment, and 64.5% (194/301) received direct observation, mostly by family members.
  
  
  CONCLUSIONS
  The integrated model performed better on case referral and community management, but higher medical expenditures than those reported by studies under the dispensary model in China. Clear guidelines should be issued on supervising TB treatment in designated hospitals.
authors: TB department, Zhejiang Centre for Disease Control and Prevention, Hangzhou, 310051, China.
authors: Jieming
authors: J
authors: Zhong
authors: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, N.T., China.
authors: Jia
authors: J
authors: Yin
authors: China Global Health Research and Development, Hong Kong SAR, and Shenzhen, 250012, China.
authors: Guanyang
authors: G
authors: Zou
authors: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, N.T., China.
authors: Yanhong
authors: Y
authors: Hu
authors: Nuffield Centre for International Health and Development, University of Leeds, Leeds, LS2 9JT, UK.
authors: John
authors: J
authors: Walley
authors: TB department, Zhejiang Centre for Disease Control and Prevention, Hangzhou, 310051, China.
authors: Xiaomeng
authors: X
authors: Wang
authors: TB department, Zhejiang Centre for Disease Control and Prevention, Hangzhou, 310051, China.
authors: Songhua
authors: S
authors: Chen
authors: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, N.T., China Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada xiaolin.wei@utoronto.ca.
authors: Xiaolin
authors: X
authors: Wei
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods* / Q000592:standards; D019468:Disease Management; D005190:Family; D005260:Female; D005102:Health Expenditures; D006761:Hospitals; D006782:Hospitals, Special; D006801:Humans; D015994:Incidence; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012017:Referral and Consultation; D012111:Residence Characteristics; D012189:Retrospective Studies; D014376:Tuberculosis / Q000188:drug therapy*
keywords: China; Implementation; Integrated model; Tuberculosis