All articles by Orlov S. A.
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2022 № 10 Approaches to developing an information resource for managing patient flows in a medical organization during a global biological challenge (on the example of COVID-19)
Patient flow management in medical organizations and rational use of human, material, medical and technical resources during the period of global biological challenge are the key to the effective functioning of the health care system.
The formation of a set of indicators and criteria that allow the organization, planning and management of hospitalizations should be carried out with using of modern information aggregators integrated with medical information systems both at the level of a single hospital and in general across a network of medical organizations in the region that provide specialized medical care in hospitals.
Purpose of the study is to develop an information system architecture that allows assessing the level of use of the resources of a medical organization during a global biological challenge (on the example of COVID-19) and distributing patient flows depending on its current capabilities.
Materials and methods. Based on the data on the results of hospitalization of 7576 patients with COVID-19 in the Noginsk Central District Hospital, 6 consecutive stages of developing an information system were formed, including user stratification and determining roles and levels of access to information for them, classifying the resources of a medical organization, developing digital models of databases data, standardization and mapping of work processes in the structural divisions of the hospital, compiling a list of input (accounting) and output (reporting) indicators correlated with each other through the use of directories and registers, as well as on the basis of logical links.
Results. Digital layouts of 4 registration cards were developed (data of medical workers; data of patients, medical services provided to them and the time for their implementation; use of medical equipment and time spent on research; registration of hospitalizations in hospital departments), 10 reporting forms (on the activities of medical workers and medical services rendered by them; on the structure of hospitalized and diagnostic tests carried out by them; on the use of medical equipment; on hospitalizations and the use of hospital beds) and templates of analytical reports for making management decisions based on the data of reporting forms for 6 categories of users (for medical workers of the relevant structural units of the hospital heads of structural subdivisions, deputy heads of a medical organization and head of a medical organization, a specialist of a public authority of a constituent entity of the Russian Federation in the field of health protection).
Conclusion: The information resource proposed for development makes it possible to carry out a current assessment of the workload of medical workers and medical equipment, the employment of the bed fund, compliance with time parameters when performing standard operating procedures in the structural divisions of the hospital and ensure operational management of patient flows. -
2020 № 8 Model of interaction between medical organizations based on the principles of Fund management – a way to improve the efficiency of primary health care
The article analyzes the experience of per capita financing of primary health care based on the principles of
stock provision in the system of compulsory health insurance (MHI). The article shows the features of practical implementation of Fund-forming models of per capita financing, their impact on the final results of the activities of medical organizations of Fund-holders. A unified scheme of interaction between the MHI participants (medical organizations, insurance medical organizations, territorial MHI Fund) (medical and economic model of business processes) is proposed for the implementation per capita financing of primary health care, with provision of decoding with partial filling of the Fund for the implementation of a patient-oriented model of medical care. -
2023 № 9 Analysis of architectural and planning solutions of polyclinics as a management tool in the implementation of lean manufacturing.
In the clinics of the Moscow region, within the framework of the project «A new model of a medical organization providing primary medical care», there is difficulty in achieving the target indicators of the project criteria. The analysis of the architectural and planning characteristics of polyclinics that affect the achievement of the criteria of this project was carried out.
Purpose: analysis and evaluation of the architectural and planning capabilities of polyclinics in the Moscow region for the successful implementation of lean production technologies.
Materials and methods: 224 polyclinics of the Moscow region were included in the project, statistical reporting forms were evaluated:
Analysis of data from the federal register of medical organizations, forms of federal statistical observation No. 30, No. 47. shortage of polyclinic capacity), depreciation of polyclinic buildings. Research methods – analytical, observation, expert, mathematical, statistical.
Results. In the clinics of the Moscow region, there is an imbalance between the attached population and the design capacity of the clinics.
Also, a pronounced variability in the area of polyclinics in the Moscow region was revealed, 34% of polyclinics have a shortage of space.
The physical deterioration of buildings leads to a limitation in their operation.
Conclusions. Polyclinics of the Moscow region differ in variability in terms of capacity, shortage or redundancy of the area of polyclinics, wear and tear of the building, architectural and planning features of polyclinics. These criteria must be taken into account when choosing projects for the most effective achievement of results. -
2022 № 9 The evaluation of the provision of specialized medical care to patients with COVID‑19 in the conditions of the central district hospital
Planning and managing the activities of a medical organization in the context of a biological challenge associated with the spread of a new coronavirus infection (COVID‑19) is an urgent task for the healthcare system, determining the possibilities of its functioning in the conditions of transformation and re-profiling of the bed fund, mobilization of human, material and technical resources. Based on the results of assessing the parameters of the activities of a medical organization, it is possible to systematize and streamline the work of its structural divisions.
P u r p o s e of the study is to determine the optimal burden on medical workers, to establish factors that affect the duration of hospitalization and determining the outcomes of the disease among patients with COVID‑19.
M a t e r i a l s a n d m e t h o d s . The retrospective continuous study of hospitalizations of 7576 patients was planned and conducted with an analysis of the duration of hospitalization, the dependence of the results of hospitalization on gender and age, as well as the impact on this indicator of the severity of the disease (using Pearson’s linear correlation coefficient (r-Pearson)) and analysis of survival by evaluating Kaplan-Meier.
R e s u l t s . The results of the analysis showed that the average number of patients per doctor per month was 28,23 ± 13,27 patients [IQR: 16,93; 41,25]. The dependence of the duration of hospitalization on sex and age showed the absence of statistical significance between these indicators (r-Pearson = 0,079; p < 0,001). The dependence of the duration of hospitalization on the severity of the course of the disease showed no statistical significance between these indicators (r-Pearson = 0,04; p < 0,001). The risk of death was increased with the length of hospitalization.
C o n c l u s i o n . The results of study are relevant for public health specialists who plan the resources of medical organizations and assess the possibilities of using the bed fund. -
2023 № 11 Methodological principles of determining the directions of development of primary healthcare in the Russian Federation based on the cognitive matrix.
The main approaches to assessing the level of development of primary health care (PHC) in the Russian Federation generally correspond to global trends, however, to a greater extent it is still concentrated on individual areas and not fully systematized. To solve this problem and create a common methodological basis for determining the most acceptable classification features for the Russian Federation, allowing to verify the current state of PHC, identify problem areas and gaps in its development, as well as to form priorities for scientific and practical research and public policy, it seems appropriate to develop a unified cognitive matrix of taxonomic features for the analysis and evaluation
of PHC based on at the country level.
O b j e c t i v e . To develop a cognitive matrix of taxonomic features for the analysis and evaluation of PHC in the Russian Federation based on international approaches to assessing the level of PHC development, the conceptual structural hierarchy and concrete steps to achieve the targets laid down in the strategic documents of the Russian Federation and elements of the healthcare system studied in scientific researches.
M a t e r i a l s a n d m e t h o d s . Based on the previously prepared analytical review of WHO strategic documents, scientific research and publications [1, 2] by correlating with them on the principles of semantic or logical identity attributes, indicators, criteria or measures that determine the directions for research and evaluation of the current level of PHC development and directions of its prospective development, a content analysis of domestic publications (n = 41,824) with subsequent terminological adaptation.
R e s u l t s . A cognitive matrix of taxonomic features has been developed to analyze and assess the current level of PHC development in the Russian Federation, as well as to search for existing gaps for concentrating the efforts of health policy makers and the scientific community in solving the problems of its long-term development.
C o n c l u s i o n . The cognitive matrix of taxonomic features for the analysis and evaluation of PHC in the Russian Federation is a working tool for researchers, specialists of executive and legislative authorities in the field of health protection, experts in the field of health care and public health, allowing to determine the degree of study of certain areas of PHC, to identify gaps and unresolved legal provisions that create obstacles to its effective functioning and long-term development, directions for new fundamental and applied research, to unify approaches to determining priorities in the implementation of public policy.