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Manager Zdravoochranenia 2019 #3
Published: 2019-03-05
1348
CONTENT OF THE ISSUE
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Corporate competency model in a medical organization practice as a quality improving factor
The aim of the article is to describe the process of medical organization corporate competency approach in personnel management in health care system. The model of relations between professional standarts, key performances indices, functional responsibilities and competency model in practice of personnel management in medical center is examined. The model of personnel (corporate) and managerial competencies of Tatarstan cancer center is presented.
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Performance optimization of the operating unit in conditions of high patient turnover using economical technologies
Presents optimization methods of functioning of the operating unit. The efficiency and validity of the implementation of these methods in the work of the operating unit, and in the units involved in the preoperative preparation, is shown. Analyzed the effectiveness of innovations on the example of two departments of the surgical profile. An assessment of the result is given.
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The formation of a new model of medical organization providing primary health care. Treatment of patients in the clinic: analysis and modeling
As part of the formation of a new model of medical organization providing primary health care to children promising mathematical apparatus for management decision-making are Markov chain with estimates. The generation of models with different scenarios in the treatment of children in the clinic revealed that the activation of dispensary work leads to a decrease in both the number of visits for diagnostic and treatment purposes, as well as the total number of visits to the clinic. The experience of dispensary work will be replicated in other regions from 2019.
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Cost performance of the selective laser trabeculoplasty for patients with primary open-angle glaucoma
Primary open-angle glaucoma, as the most common form of glaucoma, is an important medico-social problem. Selective laser trabeculoplasty is an effective and safe method of treatment of primary open-angle glaucoma. The purpose of this work was to estimate the cost performance of the treatment of patients with primary open-angle glaucoma using selective laser trabeculoplasty and their stagewise dynamics during the treatment. The analysis of 250 patients (338 eyes) with primary open-angle glaucoma, operated using selective laser trabeculoplasty in the Orenburg branch of S. Fyodorov Eye Microsurgery Federal State Institution of the Ministry of Health of the Russian Federation, was carried out. The patients are from 42 to 86 years old, of which 118 are women (47.2%) and 132 are men (52.8%), all of them being residents of the Orenburg region. Intraocular pressure before selective laser trabeculoplasty ranged from 20 to 30 mm Hg. All the patients attended standard ophthalmological examination before the operation. Selective laser trabeculoplasty was performed on the apparatus Quantel Medical Optimis with Solutis attachment at standard parameters. During the postoperative period, nonsteroidal anti-inflammatory drugs were prescribed to the patients for 7 days. The follow-up period after selective laser trabeculoplasty: 1 day; 1, 3, 6, 12 months. The linear method and cluster analysis were used as mathematical methods; the processing was carried out using STATISTICA 10 software package. Statistical analysis was performed on subsamples drawn on the basis of qualitative characteristics: gender code; age code; code “working/not working”; disease severity code; OD diagnosis code and OS diagnosis code. All 250 patients were divided into 5 clusters with the help of cluster analysis applied to the characteristics listed above. Clusters, in which patients have the lowest and the highest average expenditures for antihypertensive drugs for the entire period of treatment, were identified. The results of cluster analysis can be the basis for constructing a model of the average estimated expenses of patients with primary open-angle glaucoma operated with selective laser trabeculoplasty. Determining the ratio of material expenditures and the result of treatment allows to effectively plan ophthalmological care for patients with primary open-angle glaucoma.
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The role of air ambulance in reducing mortality in acute myocardial infarction in the Vologda region
The incidence of acute myocardial infarction (AMI) in the Vologda region exceeds the average Russian indicators and the average in the North-West Federal District. The Vologda region has a number of geographical features, which makes it relevant to use air ambulance services to evacuate patients with acute myocardial infarction from remote locations to regional clinics. Purpose. To study the role of air ambulance in reducing the mortality of patients with acute myocardial infarction. Material and methods: statistical data on the frequency of hospitalization of patients with acute myocardial infarction in medical institutions of the Vologda region and data on the use of air ambulance to evacuate patients with the specified diagnosis for the period from 2015 to 2018. Results and its discussion. Mortality rates from acute myocardial infarction of the Vologda region exceed the average Russian level. There are significant differences in certain areas of the region, Vologda and Cherepovets, where regional vascular centers are deployed. However, mortality rates remain high in many remote and inaccessible areas of the region. Analysis of the work of air ambulance showed that with its help, at best, up to 12.5% of patients with acute myocardial infarction from among those who need to be transferred to specialized vascular centers from central regional hospitals are evacuated. Conclusion. Air ambulance is a tool of “point” medical care for people living in hard-to-reach settlements. The real improvement of statistical indicators is possible only with a complex of organizational measures.
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Prevalence of socio-biological risk factors in pregnant women of Krasnoyarsk region and their impact on adverse pregnancy outcomes
The aim of the study was to study the prevalence of socio-biological risk factors in pregnant women of the Krasnoyarsk territory and their impact on the risk of adverse pregnancy outcomes. The analysis includes data on 122 250 cases of pregnancy in the period from 2014 to 2017 in the Krasnoyarsk region. All analyzed cases of pregnancy were divided into 2 groups: group I – cases of pregnancy with unfavorable outcomes (8 290 cases), group II – cases of pregnancy with favorable outcomes (113 960 cases). The paper analyzes the following factors: mother’s age less than 18 years or 40 years or more, father’s age 40 years or more, the presence of the mother and father of occupational hazards, bad habits (smoking 1 pack of cigarettes a day, alcohol abuse), mother’s height 158 cm or less, as well as the mother’s body weight 25% higher than normal. To assess the impact of the studied factors on the risk of adverse pregnancy outcomes, the odds ratio was calculated. The results of the study indicate that the presence of occupational hazards in the mother and her age less than 18 years do not affect the risk of adverse pregnancy outcomes. To the greatest extent, this risk is influenced by the presence of bad habits in the mother (smoking and alcohol abuse) and the father (alcohol abuse), as well as the presence of occupational hazards in the father. The use of information on the impact of various factors on the risk of adverse pregnancy outcomes will allow the most effective routing of pregnant women by levels of care to reduce, ultimately, the number of these outcomes. The results show that the risk of adverse pregnancy outcomes is influenced by a fairly wide range of factors. In this case, each factor has a different degree of impact on the risk. Given these circumstances, it is necessary to further develop an integrated assessment of the risk of adverse pregnancy outcomes.
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Models of Geriatric Care in Russia and Europe: Preconditions, Current State, Prospects
The article analyses directions and problems of the developing model of geriatric care in Russia. Key preconditions, organizational forms and problems are reviewed. A comparison with the most developed European models of geriatric care allows to formulate recommendation for future development. In particular, some promising directions include increased integration of medical and social care, development of medical staff’s geriatric competences, establishment of comprehensive geriatric assessment, introduction of advanced assistive technologies.
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Historical background the scientific organization of labour in health care: the experience of the early twentieth century
The active introduction of lean production technologies in the activities of medical organizations, conducted in recent years, was the occasion to study the history of the origin and formation of management science in Russia, as well as the study and rethinking of the Russian and Soviet experience of health care organization. Analysis of documents and literature related to 20–30 years of the last century, a period when the rapid pace of construction and development of the national economy of the USSR makes rethink the place and role of the Soviet experience of production management, which was at one time called “scientific organization of labor and production”, and later – “rationalization”. The universality of technologies and methods of scientific organization of labor (SOL) allows to use them both in production and non-production spheres, including health care. Note that the Soviet experience, as a rule, is not reflected in Western textbooks on management, or only mentioned, although the achievements of Soviet scientists 20-ies of the last century anticipated many areas of modern management and remain relevant even after almost a hundred years.
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Examination of the quality of medical care in the system of compulsory medical insurance: where is your place?
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Рayment for medical care provided in excess of the volumes of granting of medical aid in system of obligatory medical insurance
Сurrently, health organizations are extremely important are the issues associated with excess of volumes of granting of medical aid in system of obligatory medical insurance. This is the so-called problem of "super-planned patients". The current legislation does not provide for payment of super-planned volumes of medical care.. But the incidence rate is difficult to predict with a high level of accuracy. Within the framework of the current regulatory framework, all financial risks in this situation are assigned to the medical organization, which does not correspond to the logic of insurance. However, there are some options to mitigate this problem. This is illustrated by the court practice in this area.
сompulsory medical insurance, volumes of medical care, insurance medical organizations, medical organizations, sanctions, the Commission on development of the territorial judicial practice. -
Issues of provision of paid medical services by state (municipal) healthcare institutions…
