Manager Zdravoochranenia 2023 #6

Published: 2023-06-14



    Focus of the problem
  • Payment methods for primary health care, specialized (including high-tech) medical care in the compulsory health insurance system: the logic of the most urgent changes in the tariff policy of 2023.

    The article discusses new methodological approaches to the methods of paying for medical care in the compulsory medical insurance system for 2023, including those approved by recently issued regulatory legal acts, as well as joint recommendations of the Ministry of Health of Russia and the Federal Compulsory Medical Insurance Fund (FOMS).
    The article analyzes the main reasons for changes in the tariff policy and their expected consequences in terms of increasing the motivation of medical organizations.
    It is noted that there is a need to revise the remuneration systems of employees of medical organizations (primarily state and municipal) in order to more closely link incentive payments with performance indicators used in determining the amount of payment for medical care, which is intended to become an important motivation tool for improving the availability and quality of primary health care and, as a consequence, reducing the need for specialized medical care.
    An overview of innovations in the payment of high-tech medical care is given.

    Authors: Kadyrov F. N. [123] Obukhova O. V. [28] Starodubov V. I. [40] Kobyakova O. S. [16] Chililov A. M. [24] Mitroshin P. V. [3]

    Tags: compulsory medical insurance18 high-tech medical care11 payment methods for medical care1 primary health care23 tariffs1

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  • On the need to improve federal legislation in terms of clarifying and fixing the legal status of junior medical personne.

    Currently, in the legislation of the Russian Federation, the legal status of persons from among the junior medical personnel in terms of classifying them as medical workers is not clearly defined. This is due to the fact that junior medical personnel do not pass the accreditation of a specialist and, in accordance with the requirements of Part 1 of Art. 69 of the Federal Law of November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” (hereinafter referred to as the Fundamentals) does not have the right to carry out
    medical activities. This circumstance significantly reduces the social security of junior medical personnel and requires mandatory legal correction.
    The article presents a detailed analysis of the legislation, which substantiates in detail the need to clarify and consolidate the legal status of junior medical personnel. To this end, the legislator is invited to state part 1 of Art. 69 of the Fundamentals as follows: “Persons who have received medical or other education in Russian organizations engaged in educational activities and who have been accredited by a specialist, as well as persons filling other positions of medical workers specified in the nomenclature of positions, have the right to carry out medical activities in the Russian Federation medical workers and pharmaceutical workers, approved by the authorized federal executive bodies.

    Authors: Piven D. V. [59] Kitsul I. S. [59]

    Tags: junior medical personnel2 medical activities2 medical workers5 nomenclature of positions1 professional standards7 professional training programs1 specialist accreditation1

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  • Management in healthcare

    R e l e v a n c e . Currently, the issues of ensuring the quality and safety of medical activities are one of the priority areas in healthcare management. The legislation of the Russian Federation has determined the organization and conduct of internal quality control and safety of medical activities as a licensing requirement. Identified inconsistencies/violations in the provision of medical care are one of the elements of risk management and should be used to improve the efficiency of medical organizations.
    T h e p u r p o s e of the study is to develop management practices to improve the quality and safety of medical activities using the results of external audits in the field of compulsory health insurance.
    M a t e r i a l s a n d m e t h o d s . The analysis of modern requirements of normative legal acts of quality control and safety of medical activity has been carried out, the main tools used in conducting external audits in the system of compulsory medical insurance have been systematized.
    R e s u l t s . The modern architecture of quality control and safety of medical activities includes 5 levels of control. The tools for monitoring the quality of medical care for identifying violations, applying financial sanctions to a medical organization are described. In order to improve the quality and safety of medical activities, the development of corrective measures and various management practices is recommended.
    C o n c l u s i o n s . The results of external audits are an important element of the modern model of quality management and safety of medical activities, which should be integrated into the work of a medical organization of any profile for use in a system of continuous quality improvement

    Authors: Khusainova D. K. [4] Zigangareeva G. G. [4] Koroleva O. I. [3]

    Tags: compulsory medical insurance18 examination of the quality of medical care4 internal quality control and safety of medical activities2 medical and economic examination1

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  • Overview of the state of dental care to the children’s population of the Tver region for the period 2016–2020 years.

    Taking care of the health of the population of the Tver region is an important area of social regional policy. The main task of the dental service of the Tver region is to preserve and strengthen the health of citizens of the Tver region, increase the role of prevention of dental diseases, form a model of the organization of the dental industry, ensuring the availability and quality of dental care, improving the efficiency of dental services, the volumes, types and quality of which should correspond to the level of morbidity and the needs of the population, advanced achievements of medical science.
    P u r p o s e . To review statistical data on the provision of dental care to children in public institutions of the Tver region.
    M a t e r i a l s a n d m e t h o d s . The review, analysis, collection and comparison of aggregated data for 2016–2020 in Tver and the Tver region were carried out: statistical data on demography, analysis of dental service performance indicators, analysis of indicators of accessibility of dental care to the children’s population by questioning parents/legal representatives of children’s patients, analysis of personnel potential and questioning of dentists in the profile “Pediatric dentistry”.
    R e s u l t s . This article is devoted to an overview of the activities of public health institutions of the Tver region providing dental care to the children’s population within the framework of compulsory medical insurance. The results of the study indicate that the prevalence of dental caries among children of the Tver region is consistently high. Further preventive programs and additional research are needed to improve the dental health of children.

    Authors: Konovalov O. E. [4] Zhukova K. V. [3]

    Tags: accessibility4 compulsory medical insurance18 dental care for children1 prevention of dental diseases1 qualification of doctors2 quality5 review2 statistics5

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  • Medical statistics
  • Statistical accounting improvement as a measure to increase the effectiveness of prevention of circulatory system diseases.

    Improving the provision of medical care for diseases of the circulatory system, including disease prevention, is an urgent problem, the solution of which is carried out in the Russian Federation at the state level.
    Purpose of the study is to evaluate information on the features of accounting for peripheral artery diseases and the level of their prevalence on the basis of information contained in official statistical reporting forms.
    Materials and methods. Based on the information of medical organizations contained in official statistical reporting forms No. 12 and No. 14, an assessment of the features of accounting for peripheral artery diseases and their prevalence in St. Petersburg for the period from 2015 to 2020 was carried out. In order to neutralize the influence of regional peculiarities of the organization of medical care during the pandemic of a new coronavirus infection, 2019 was chosen as the main research period. Extensive and intensive indicators were calculated with an assessment of the reliability of their difference, a correlation analysis was carried out.
    Results. The official statistical forms take into account a limited list of diseases of the peripheral arteries, which accounts for only 1,2% in the structure of diseases of the circulatory system in St. Petersburg. The proportion of other diseases of the circulatory system that are background is high: high blood pressure – 38,7%, cerebrovascular diseases – 25,5%, coronary heart disease – 22,5%. At the same time, the contribution of peripheral artery diseases in assessing their long–term consequences is significant – there is an increase in the level of surgical interventions, including amputations. In addition, a strong correlation was established between the prevalence of peripheral artery diseases and background diseases (p = 0,78; p < 0,01), which indicates a “cumulative effect” of peripheral artery diseases in the
    Conclusions. It is necessary to develop separate preventive programs for patients with peripheral artery diseases, the instrument of which can be the organization of their effective accounting by means of a register specially created for these purposes.

    Authors: Kochorova L. V. [2] Vishniakov N. I. [1] Apresyan A. Yu. [1]

    Tags: accounting of patients with circulatory system diseases1 atherosclerosis1 patient register1 peripheral artery diseases1

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  • Law
  • Regulatory and legal regulation of medical care in day hospitals.

    The program of state guarantees provides for a reduction in the amount of inpatient care due to the development of inpatient forms and planning an increase in part of the state’s expenses for outpatient care. The correct organization of medical care using hospital replacement technologies is possible only if the requirements of regulatory documents are met. This will allow faster implementation of the main provisions of the Health Concept for the development of hospital replacement forms. Day hospitals are organized in order to improve the organization and improve the quality of medical care in outpatient settings, as well as to increase the economic efficiency of medical organizations through the introduction and widespread use of modern resource-saving medical technologies for prevention, diagnosis,
    treatment and rehabilitation, which is achieved by following the regulatory documents discussed in the article.

    Authors: Demyankov K. B. [1] Yakushev D. Yu. [1]

    Tags: day hospital4 hospital replacement forms1 regulatory documents2

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  • Sociology of healthcare
  • Behavioural risk factors for chronic noncommunicable diseases in health care workers.

    Low physical activity, smoking and alcohol consumption are among the leading behavioural factors contributing to high morbidity and excess mortality from noncommunicable diseases. It can be assumed that health-care workers should be in the mainstream of population behavioural patterns. However, greater awareness of both the principles of healthy lifestyles and the harms of not following them may distinguish this population group in terms of behavioural responses.
    Purpose: to estimate the prevalence of behavioural risk factors for chronic noncommunicable diseases among health-care workers.
    Materials and methods. Study type: case-control study. Data source: results of the survey of the 28th wave of the Russian National Research University Higher School of Economics’ Monitoring of Economic Situation and Health, representative sample by individuals, survey year 2019. Responses received from respondents – health care workers about their use of tobacco, alcohol and exercise were analysed comparatively. Pearson Chi-square test at significance level p≤0,05 was used to find differences.
    Results. A sociological survey of 55 male and 257 female health workers of working age was carried out. We found that the incidence of a positive smoking response was lower in both male and female working-age health professionals than in the general population of working-age individuals. Compared with the general populations of men and women, no significant differences were found in responses to questions about alcohol consumption and exercise.
    Findings. We found that of the three behavioural factors (smoking, alcohol consumption, physical activity), only the first was significantly less prevalent among health professionals. The overall trends identified need to be investigated in more detail.

    Authors: Son I. M. [41] Menshikova L. I. [6] Shelygin K. V. [1]

    Tags: alcohol consumption2 chronic noncommunicable diseases3 exercise1 health workers1 risk factors15 smoking2

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  • Opinion of pediatric otorhinolaryngologists on the main problems in the organization of medical care and priority areas of activity of the professional medical community.

    A medical and sociological study was carried out in order to determine the opinion of specialists on current problems in the organization of children’s otorhinolaryngological care and on the priority areas of activity of the professional medical community. Five main medical and organizational problems in the organization of children’s otolaryngological care are identified: maintaining and developing human resources, stimulating the work of medical workers; improvement of resource support for assistance, stimulation of investments in the development of the material, technical and technological base; increasing the availability of qualified assistance; management optimization;
    improvement of methodological support and introduction of modern technologies for rendering assistance. Pediatric otorhinolaryngologists consider the main activities of the professional community to be: representing the legitimate interests of the Association members, promoting the protection of their professional and social rights; assistance and participation in advanced training and professional retraining of specialists; professional consolidation, strengthening and development of relations between specialists; meeting the needs of specialists in obtaining knowledge about the latest achievements, advanced domestic and foreign experience.

    Authors: Mingazova E. N. [34] Oleinik A. V. [3]

    Tags: association of pediatric otorhinolaryngologists1 children13 children’s ent doctors1 ent diseases3 otorhinolaryngological care3 professional medical communities1

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  • Informatization of healthcare
  • Experience in the application of artificial intelligence technologies for the development of preventive health care on the example of the Kirov region.

    Healthcare is one of the priority sectors for the practical application of artificial intelligence (AI) systems. In 2018, in the Kirov region, it was decided to launch its own regional project for the implementation of AI technologies in order to gain practical experience and understand the features, advantages and barriers to the use of AI. Improvement of preventive medicine was chosen as a priority direction.
    The Russian predictive analytics platform Webiomed was chosen as the base software product. The project implementation included 3 stages: pilot testing in 2019–2020, commercial operation in the “second opinion” mode in 2021–2022. and implementation in the digital assistant mode, launched in 2023. As a result of the implementation of the 1st and 2nd stages of the project, it was possible to prove that the main advantage of AI in the analysis of big medical data is the autonomous and high accuracy of interpretation of the information available in it. An AI system for independently extracting the data necessary for analysis from electronic medical records, comparing them with data from past periods, assessing the dynamics of changes in health indicators, and identifying the emergence of dangerous trends and risk factors. Together, this allows the formation of the so-called “digital profiles” of patients, which in turn are a valuable resource for supporting management and clinical decision-making.

    Authors: Gusev A. V. [5] Kurdyumov D. A. [1] Kashin A. V. [1] Ryabov N. Yu. [1] Novitsky R. E. [1]

    Tags: artificial intelligence8 big data2 healthcare12 kirov region1 machine learning4 predictive analytics1 preventive medicine1 risk assessment1

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  • Methodology for developing medical expert systems using graph databases and ontological approach.

    Expert systems are a complex software system that accumulates the knowledge of specialists in specific subject areas and disseminates this empirical experience for consultations with less qualified users, which reduces the number of medical errors caused, in particular, by a lack of specialist doctors in local areas and the time required for a single consultation.
    P u r p o s e of the study is to present a modern methodology for developing expert systems based on knowledge engineering using an ontological approach and graph databases.
    M a t e r i a l s a n d m e t h o d s . System analysis methods were applied during the creation of the methodology for developing expert systems, including analytical and descriptive methods, knowledge engineering methods such as structuring methods, knowledge representation, and fuzzy logic. The methodology assumes the use of a graph database as a storage for the knowledge base.
    R e s u l t s . The methodology describes the process of developing expert systems based on a graph database using an ontological approach. It includes the following components: a knowledge base, an intelligent editor of the knowledge base, a problem solver, and explanation subsystem. The methodology assumes the participation of a group of experts in the development of the expert system, with whom the development of two artifacts is carried out: a terminological database of the subject area and intermediate information objects describing the logic of solving the problem. Both artifacts should be formed automatically using the intelligent solver of the knowledge base, as well as filling the knowledge base, which will facilitate the subsequent maintenance of the knowledge base and keep it up-todate.
    According to the methodology, the solver and explanation subsystem work with a graph database, which is a means of storing the knowledge base, in order to find the optimal path in which nodes are used to solve the problem of the expert system, for example, supporting a specialist doctor in establishing a preliminary/final diagnosis, and the path is used by the explanation subsystem to argue the proposed solution of the expert system.
    F i n d i n g s . A methodology for creating expert systems using a graph database and an ontological approach has been developed and presented. The methodology describes the development of two components: a knowledge base and a combined component consisting of a solver and an explanation subsystem.

    Authors: Zarubina T. V. [3] Osmolovsky I. S. [1]

    Tags: cdss1 expert system1 intelligent knowledge base editor1 knowledge base1 ontology1

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  • The use of natural and climatic factors of North Ossetia in the treatment and rehabilitation chronic respiratory pathology.

    The effectiveness of treatment of patients with chronic respiratory pathology largely depends on an integrated approach that includes successive stages, including climate therapy in combination with natural factors.
    T h e p u r p o s e of the study: to analyze the activities of the republican center for pulmonological care and to show the importance of using the natural and climatic features of North Ossetia in the treatment and rehabilitation of patients with chronic respiratory pathology.
    R e s e a r c h m e t h o d s : statistical, expert assessments, direct observation. The statistical reporting materials of the Republican Center for Pulmonological care for 2018–2022 were analyzed.
    R e s u l t s . The expediency of organizing local specialized medical rehabilitation organizations and their relevance in the republic is shown.
    The activity of the pulmonological center became especially relevant in the post-ovarian period, when the need for rehabilitation measures for people who have had a coronavirus infection COVID‑19 has significantly increased. At the end of 2021, the flow of patients to the pulmonology center increased significantly compared to 2020. The growing trend in the number of patients treated with chronic respiratory pathology was noticeably manifested in 2022. Beds for the treatment of chronic obstructive pulmonary disease have been the most in demand for all years. In relation to 2020, the number of people treated in 2022 increased by 44.8%. Despite the fact that bronchial asthma occupies the second place in the structure of hospitalization for pulmonological beds, a more noticeable increase in patients is registered with chronic bronchitis (by 30%) and bronchiectatic disease (by 23.8%). The number of people treated with asthma and asthmatic status increased by 18.3% in 2022. More than 70% of the treated patients were persons over the working age. Taking into account the specifics of respiratory pathology, the expediency of organizing local specialized medical and rehabilitation medical organizations located in climatic conditions familiar to patients that do not require acclimatization is important. The organization of local pulmonological centers in the region is of particular importance for carrying out medical and rehabilitation measures for people with impaired respiratory system function after suffering from COVID‑19 coronavirus infection. The identified trends should be taken into account when planning the volume
    of specialized medical care in the republic.

    Authors: Alikova Z. R. [2] Serdyuk N. V. [1] Rodionova V. E. [1] Dzhioeva I. A. [2]

    Tags: chronic respiratory pathology1 natural and climatic factors1 pulmonological center1 structural features1 use1

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