Manager Zdravoochranenia 2020 #3
CONTENT OF THE ISSUE
Collection of statistical data characterizing the quality and safety of medical activities and their analysis by order of the ministry of health of the Russian Federation № 381 of 07.06.2019: what andd how a medical organization should collect and analyze
In the article, the authors pay attention to the fact that in accordance with the Requirements for the organization and conduct of internal control of the quality and safety of medical activities, approved by the order of the Ministry of health of the Russian Federation from 07.06.2019, № 381n, medical organizations must ensure the collection of statistical data characterizing the quality and safety of medical activities, and their analysis. The authors show that, on the one hand, this work includes the collection and analysis of primary statistical data, traditionally carried out by medical organizations within the framework of Federal statistical observation, at the same time, on the other hand, now medical organizations must collect and analyze indicators that characterize the implementation of the tasks set by the Requirements. The publication presents and justifies a specific list of these indicators.
Modern approaches to the analysis of the formation of pathology in children
The mathematical method “oriented trees with estimates” is used to study the structure of 411,581 requests from 71,483 children to a medical organization for primary diseases. The data of the medical information system of the hospital for 2015–2018 were used. The regularities of the sequence of pathology formation in 35,288 children under 7 years old and 36,195 children from 7 to 17 years old and the average age of detection of diseases are established. So, the onset of the disease J06.9 (depending on age) is expected to be 1.9–4.6 times more likely if there was one of the diseases G93.8 or G94 before than after one of the diseases J20.9 or J20.8 according to ICD-10. The data obtained can be used for individual preventive work with children.
Organization of cleaning service in a modern hospital (icdc case study)
The experience of organization of cleaning service in a modern hospital is described in the article. It should be noted that one of the trends in designing buildings of modern medical facilities is increasing square footage per one patient. This tendency comes into contradiction to regulatory documents specifying established standards of junior medical staff work that leads to high and irregular work load for hospital attendants and cleaners of a medical facility. Labor division and creation a specialized cleaning service in the structure of the medical facility permitted to set cleaning apart into an independent area of operations, implement high standards of quality in indoor space cleaning and resolve the afore-referenced contradiction. This division of labor resulted in enhancement of degree of proficiency of cleaning service personnel in ICDC, and thus permitted amelioration of work quality and productivity of labor, which ultimately led to decrease of cleaning costs and had economic effect.
Standard operating procedures as the nursing acitivies quality and safety assurance system component
Nursing is a cornerstone component of the high-quality medical care organization assurance within a medical institution general activity. Standard operating procedures (SOP) when implemented into the nurse practice helps to standardize the performance of individual medical procedures. The SOP related activities results can be easily monitored and assessed. The most frequent activities to be assigned to SOPs are subcutaneous, intradermal, intravenous, intramuscular administration of drugs and solutions, taking blood from a finger, administering drugs with enemas, etc. The main advantages SOPs application include minimizing the risk of a contractor misunderstanding their duties, comparability and compliance with regulatory requirements assurance. International standards, Russian federal state standards (GOST), industry standards (procedures medical care, medical standards assurance), regional regulatory documents (orders, orders, regulations) are used as the basis to create a SOP. SOPs implementation in conjunction with the continuous nurses training, comprehensive material and technical equipment provision of medical institutions will contribute to improving the quality and safety of their activities.
To the question of integrating outpatient mental health module providing specialized care to patients
The article presents the result of the integration of a new organizational inpatient care – outpatient psychiatric module (APM) on the example of the medical rehabilitation Department (MPO), the Department of intensive psychiatric care (OIOPP) in one of the medical psychiatric institutions of the city of Moscow State budgetary institution of health “Psychiatric clinical hospital № 13 of the Department of health of the city of Moscow”. We used such methods as: the study and generalization of experience, analytical, sociological, comparative analysis. Presents certain advantages and characteristics of the MRO, OIOP in comparison with the provision of mental health care to patients in a hospital. The necessity of improvement of interaction, continuity of medical rehabilitation Department is noted. departments of intensive psychiatric care with other units of the new organizational form, other medical institutions.
Improving the regulatory and legal framework for delivering primary health care to the population in the field of non-communicable diseases prevention and the implementation of a healthy lifestyle standardization
In order to prevent non-communicable diseases and carry out measures to model a healthy lifestyle, the article proposes changes to the regulatory and legal framework for delivering primary health care and primary specialized health care, including the introduction of a position of a physician for common hygiene in medical organizations. It is proposed to introduce additions to the nomenclature of medical services provided. There was developed a section of occupational standards program “Specialist in hygiene”, on the job functions of a physician for common hygiene. It is proposed to include in the job functions of a physician for common hygiene the diagnostic testing in health centers in order to assess the functional reserves and adaptive capabilities of a person affected by adverse environmental factors, and the prescribing appropriate curative and preventive measures. Implementation of the proposed activities in the health centers will improve the efficiency of medical and preventive work of medical organizations and reduce the level of uncertainty of preventive activities carried out, and of the expected results of preventive work carried out by a therapist and a general practitioner (family doctor). The proposed changes will help to identify causal relationships between the health status of the population and the impact of adverse environmental factors, to form risk groups among adult population in accordance with diagnostic criteria of risk factors and other pathological conditions and diseases associated with the impact of adverse environmental factors that increase the likelihood of developing of chronic non-communicable diseases in risk groups, if there are diagnostic criteria of risk factors to send the indigent to health organization for in-depth examination and carrying out the necessary medical and preventive measures, to prepare research and information materials and to participate in hygiene education, to promote healthy lifestyles and to improve health literacy of population.
Population relation research to the healthy lifestyle (on the example of the fish and suburban region of Republic of Tatarstan)
One of the main tasks of modern health care is decrease in incidence and noninfectious diseases mortality of the population which are preventable at observance of a healthy lifestyle, early identification and timely effective treatment. Results of a sociological research of the relation to a healthy lifestyle on estimates of adult population of the Fish and Suburban Region of Republic of Tatarstan are presented in article. Purpose: reveal commitment of the population to a healthy lifestyle, investigate connection of a healthy lifestyle with presence of noninfectious diseases. The research is conducted on the basis of questionnaire by method of random check of adult population. 2346 respondents from 21 year to 74 years took part in questioning. Authors developed the questionnaire concerning commitment of the population to a healthy lifestyle and presence of noninfectious diseases.. The average physical activity among all respondents is slightly higher than 20%. The commitment to a healthy power supply in all groups does not exceed 25%. Respondents aged from 31 to 40 years are most committed to healthy nutrition. Among the polled respondents smoke 22.21%, regularly take alcohol of 0.2%. From among the respondents who noted presence of cardiovascular diseases of 98.6% monthly visit the doctor and regularly take medicines; with digestive tract diseases monthly visit the doctor of 16.3% and regularly take the drugs of 18.5% of respondents; from among respondents with diabetes regularly take the drugs and monthly visit the doctor of 100%. Analyzing data retrieveds, authors came to a conclusion that the commitment to a healthy lifestyle among the population does not exceed 30%. Results of questioning of the population can be used when developing the address program of treatment-and-prophylactic actions for forming of commitment to a healthy lifestyle for each age group.
Planning working time in the activities of heads of nursing services
The article presents the results of the analysis of the practice of using working time by the heads of nursing services of outpatient medical organizations providing primary health care. The data obtained will help the chief and senior nurses of health organizations to optimize professional activities in the management of nursing personnel by improving the organization of work processes and increasing the effectiveness of nursing work. Given the fact that organizational problems that impede the rationalization of managerial work, identified during the study, are mostly universal, the proposed recommendations can be used in the management of managers – health managers of any level and profile of medical activity working in state and non-state medical organizations any legal form.
The problems of paying for medical care provided to residents of other subjects of the Russian Federation within the framework of compulsory medical insurance
The legislation guarantees citizens the right to receive medical care under a compulsory health insurance policy (CHI) throughout the Russian Federation. But in some cases, in accordance with current legislation, a referral is required to receive medical care. This also applies to situations where a citizen receives medical care outside of the subject of the Russian Federation where the citizen is insured. The system of such referrals to medical organizations located in another region is more or less regulated only when they are sent to Federal medical organizations. The situation is further compounded by the fact that the Supreme court contrary to law, making decisions, actually leveling a direction. At the same time, payment for medical care provided outside the region in which the MHI policy is issued depends on the payment of this assistance from the Territorial Fund of this region. This leads to numerous delays in payment and, as a result, reduces the interest of medical organizations in providing medical care to "nonresidents". Patients suffer as a result. All this raises the question of the need to improve the current mechanism for conducting inter-territorial settlements in the MHI system.
The issues of pricing for paid medical services
Focus of problem
Management in health care
Sociology of health care
Manager of health care consults
Questions and answers