Articles from rubric: «Management in health care»
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2022 № 6 Expert validation of the clinical laboratory service models’ standardized descriptors
Introduction. The growing demand for the availability and quality of clinical laboratory tests has necessitated the search for new approaches to organizing and management of laboratory services. At the same time, needs a systematic description of the laboratory services organization models as a background for further improvement. Objective: to validate the description of the laboratory services organization models by standardized characteristics. Methods. A sociological study carried out on the principles of a systematic approach. Research methods: sociological (expert assessments), analytical, statistical. Results and discussion. The inter-expert agreement for the centralization (consolidation) model was 0,626 (95% CI 0,516–0,711), outsourcing (decentralization) – 0,747 (95% CI 0,672–0,804), horizontal integration – 0,784, 95% CI 0,720–0,833, mobile (pointto-care) model – 0,883 (95% CI 0,848–0,909). The first value interpreted as doubtful, significant adjustments made to the model characteristics. The second and third values – as sufficient, minimal adjustments made. Fourth – as good, the description was not changed. The final SWOT-analysis matrices for four models formed. Conclusions. Thanks to expert validation, a methodical change from an empirical to a scientifically based standardized description of the four basic laboratory services organization models made.
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2022 № 6 The impact of patient loyalty on the economic indicators of the activities of a medical organization providing paid medical services
I n t r o d u c t i o n . In modern conditions of the paid medical services market, the vector of competition development is shifting from the concept of classical marketing to relationship marketing, and in these circumstances the issues of forming, retaining and managing patient loyalty come to the fore. The authors propose to consider a fundamentally different approach to measuring patient loyalty by a medical organization. In their opinion, the most effective method for studying the level of loyalty in combination with economic indicators is the consumer loyalty index (English Net Promoter Score, NPS), developed and first introduced in 2003 by Fred Reichheld.
T h e p u r p o s e o f t h e r e s e a r c h is to study the impact of patient loyalty on improving the economic efficiency of a medical organization providing paid medical services.
M a t e r i a l s a n d m e t h o d s . A study was planned and conducted using the NPS methodology to study patient loyalty. The survey of patients was carried out through SMS messages in automatic mode using a service integrated into the medical information system (MIS) of a medical organization. Previously, patients provided consent to the processing and transfer of their personal data.
The results of the survey and data on the actual payment for paid medical services for each respondent were integrated into a consolidated database for further statistical processing.
R e s u l t s . The study involved 39320 patients of the dental clinic. The results obtained during the study period coincided with the calculations of Fred Reichheld and confirmed the relevance of the application of this methodology in the current conditions of the paid medical services market. It has been established that the loyalty of patients to a medical organization affects the increase in economic indicators, and achieving a sustainable growth rate of a medical organization and predictable positive financial indicators is impossible without creating a base of loyal repeat patients. In addition, increasing the level of loyalty of repeat patients has a positive effect on NPS, which is directly related to an increase in the average cost of medical appointment and net sales.
C o n c l u s i o n . Thus, the level of patient loyalty has a direct impact on the main economic indicators of the medical organization activity. -
2022 № 1 Features of the state of the network and the provision of a bed fund of medical organizations in Russia
The implementation of the healthcare development strategy, effective management of the healthcare system is impossible without monitoring and comprehensive comparative analysis at various levels of the state and development of the network, resources and activities of medical organizations, individual services and the healthcare system as a whole.
P u r p o s e of the study is scientific assessment of the state of the network of medical organizations providing medical care in outpatient and inpatient settings, as well as analysis of the provision of beds for the population of the Russian Federation in 2012–2019.
M a t e r i a l s a n d m e t h o d s . Within the framework of the conducted research, official statistics data were analyzed, modern trends and trends in the provision of beds and the state of the network of medical organizations in Russia at the regional level were determined. Statistical data processing was carried out using SPSS, Excel‑2007 packages. Such methods as analytical, statistical methods, study and generalization of experience, comparative analysis were used.
R e s u l t s . The analysis has shown that the unevenness and the level of high differentiation of indicators of provision of beds by subjects of the Russian Federation remains. Thus, over the period 2012–2019, the provision of specialized beds for all the main profiles of beds is decreasing, the largest reduction affected socially significant beds – dermatovenerological – by 1,5 times, as well as therapeutic – by 32,5%, gastroenterological – by 28,2%, pediatric – by 24,4%, and infectious – by 20,3%.
F i n d i n g s . The results of this study confirm the reduction in the number of beds of the main profiles, as well as the conversion of part of the bed stock, especially in the context of a pandemic of a new coronavirus infection, which showed the need for structural and functional transformations of health resources in general and the bed stock in particular. -
2022 № 1 Experience of increasing the availability high-technological ophthalmic care in the organization of the diagnostic department of the federal clinic in the Smolensk region
P u r p o s e – to analyze the development of the availability of ophthalmological care in the Smolensk region after the organization
of the work of the Smolensk medical diagnostic department.
M a t e r i a l s a n d m e t h o d s . The analysis was carried out on the basis of data from the medical records of patients insured in the Smolensk region and received medical care at the Smolensk medical diagnostic department, as well as directly at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution.
R e s u l t s . During the period of 2016–2021 activity of the Smolensk medical diagnostic department, diagnostic studies were carried out in 43274 patients, of which 2457 were children from 3 years old, the volume of ophthalmological care to residents of the Smolensk region was increased and expanded: 25972 surgical and laser interventions were performed in a one-day day hospital, of which 10692 were interventions in the treatment of cataracts, 8675 laser interventions were performed, 2689 interventions for various vitreoretinal pathologies, 2043 refractive and 694 anti-glaucomatous operations, 457 scleroplasty, 232 operations for strabismus, 246 oculoplastic operations, 132 implantations of corneal segments and 112 keratoplastics.
C o n c l u s i o n . For residents of the Smolensk region, the staging period between the initial appointment with an ophthalmologist and the period of hospitalization has been reduced, which makes it possible to minimize the waiting time for the necessary treatment. -
2022 № 1 Irregular antibodies to red blood cells in patients of a multidisciplinary clinic
We studied the practice of transfusion therapy for patients at the Pirogov National Medical and Surgical Center, who
were diagnosed with irregular antibodies to red blood cells (RBC) in 2020. Among hospital patients, the part of such
immunized persons was 1,62% (200 people). Of these, the selection of donor RBC was performed in 29 (14,5%) patients.
45 cross-matching procedures were performed, which involved 177 units of RBC. 121 units were found compatible and
56 – incompatible. Of 29 patients with matched blood, transfusion of matched RBC was received by 14 (48,3%) people.
They received 54 units of RBC compatible in the indirect antiglobulin test. In 2 patients, antibodies were detected during
transfusion therapy. It is advisable to: a) create a centralized laboratory for federal medical organizations with the possibility of identifying irregular anti-RBC antibodies and individual selection of compatible donors; b) include identification of antibodies in the range of medical services; c) standardize the number of segments of the donor container tube from which RBC can be taken for cross-matching; d) establish the frequency of screening for irregular antibodies while continuing transfusion therapy; e) in a clinic of comparable scale, it is sufficient to maintain a daily supply of RBC in the amount of 2,1% – 2,8% of the annual consumption in order to provide an individual selection of blood for patients with irregular anti-RBC antibodies. -
2021 № 10 MODERN APPROACHES TO SOLVING THE TASKS OF MANAGEMENT OF MEDICAL ORGANIZATIONS
A large amount of data is currently appearing in the information systems of medical organizations, which requires a revision of those industrial relations that exist in the practice of health care institutions.
T h e p u r p o s e o f t h e s t u d y is to study the possibilities of mathematical methods using the concept of “an object with estimates in a certain state” to solve management problems that are in the practice of medical organizations.
R e s u l t s . The authors use the term “production process”, which is not typical for the classical description of the activities of a medical organization. This is due to the fact that the approaches to solving management problems available in a medical organization are valid not only for medical and diagnostic work, but also for other household work. New approaches to solving the existing management problems of a medical organization consist in the fact that the description of the solution to the control problem is made in the form of some algorithm, which can then be implemented in some programming language. The digitization of production processes leads to the need for their formalized description in the language of mathematics, as well as the widespread use of mathematical methods, on the basis of which algorithms for solving control problems are built. Markov chains make it possible to find general patterns in the behavior of control objects within the framework of the problem being solved, which can be used to construct a tree giving a detailed description of the behavior of each control object. Further, the method of oriented
trees with estimates is applied, which provides information for writing job descriptions for employees of the Ministry of Defense, on the basis of which the management problem will be more optimally solved. It is necessary to highlight four features of the method of oriented trees with estimates: it allows to give a detailed analysis of the sequence of transitions of each object for the selected states; in the presence of a large number of analyzed objects, the resulting tree is difficult to analyze; you can rebuild the branches of the tree; in the course of building a tree, it is possible to change a set of states without changing the obtained chronological sequences of states of each control object in the initial data. Oriented trees with estimates can be used to simulate the production process, which is based on the possibility of simultaneously changing both quantitative and qualitative characteristics of the tree.
The article presents two options for modeling using changes in the qualitative characteristics of the tree.
F i n d i n g s . The introduction of digitalization in healthcare requires a different approach to solving management problems, which should be carried out with extensive use of mathematical methods at the stages of analysis and modeling. The work on the use of mathematical methods in solving management problems should be organized by regional medical information and analytical centers.
It is necessary to carry out work on the formalization of production processes, the creation and storage of algorithms for solving control problems. Promising methods that allow solving most of the management problems available in the practice of medical organizations are the methods of Markov chains with estimates, branching processes with estimates and oriented trees with estimates. -
2021 № 10 EXISTING APPROACHES TO ASSESSMENT THE EFFECTIVENESS OF THE IMPLEMENTATION OF STATE PROGRAMS IN HEALTHCARE AND THE POSSIBILITIES OF THEIR IMPROVEMENT
In recent years, health care has been in the focus of reform. Additional allocations of funds from the federal budget and extrabudgetary funds are allocated for national development goals until 2030. The results of research work in the state task of the RANEPA 2021 are presented by the authors in this article. Scientific and practical approaches and mechanisms of budgeting and administration of the financial sector are studied and the positions of an important addition to management tools and methods of social design are revealed.
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2021 № 10 AVAILABILITY OF HIGH-TECH MEDICAL CARE TO THE POPULATION OF THE ASTRAKHAN REGION
I n t r o d u c t i o n . In article problems of availability of high-tech medical care for residents of separately taken region are considered.
Communication of an increase of the rendered medical care depending on sources of financing and a regulation of a level cofinancing is analyses.
T h e p u r p o s e o f t h e s t u d y : a background of principles of realization of the program of the state guarantees of free rendering of medical aid at availability of insufficient financing the region, based on the analysis of existing problems in the organization of maintenance of availability of high-tech medical care.
M a t e r i a l s a n d m e t h o d s . In research were used a database of a subsystem of monitoring of realization of the state task on rendering high-tech medical care of information-analytical system of Ministry of Health of Russia and regulatory legal documents.
The statistical, analytical method and a content-analysis were applied.
R e s u l t s a n d d i s c u s s i o n . It is revealed, that at a quadruple increase of medical institutions rendering the given type of the help in territory of region, the percent of its rendering decreases, not leaving for its limits. Since 2012, decrease in grants from the federal budget almost twice is ascertained. Thus during last four years financing from means of the budget of the Astrakhan area remains at a constant level.
C o n c l u s i o n . For the big percent of the patients leaving for limits of region, the given type of the help in fact is not at all «free» as there is an indispensability of payment of additional inspection and travel. And absence of a precise regulation of a level cofinancing provides the way to allocate money resources from the federal budget by «a residual principle». -
2021 № 10 IMPROVING THE SYSTEM OF PREVENTIVE DRUG TREATMENT FOR TEENAGERS IN THE CONDITIONS OF THE DRUG TREATMENT DISPENSARY OF THE UDMURT REPUBLIC
The article presents data on the organizational activities of the republican drug treatment dispensary in the subject of the Russian Federation to improve the system of preventive drug treatment for.teenagers. A SWOT analysis was carried out, as a result of which strong and weak characteristics were identified in the preventive work of the prevention department and the office of preventive care for teenagers in preventing the development of dependence on the use of narcotic drugs and surfactants.
The risks and opportunities of improving the system of preventive drug treatment for adolescents in a drug dispensary are identified by increasing the level of interaction with various interdepartmental structures, introducing distance learning aimed at the target audience (adolescents at risk, their parents, healthy teenagers who have not tried at least once surfactants and narcotic drugs with their parents for consultations on motivation for healthy lifestyle, primary health care workers, specialists of related departments, law enforcement agencies, ministries, volunteers; creation of a separate organizational and methodological center for the implementation of remote network modern technologies in the municipalities of the republic for drug prevention work, namely, working in groups according to the cognitive metastil and the style of information encoding. -
2021 № 10 QUALITY AND COMPETITIVENESS OF THE HEALTH AND SPA COMPLEX: MODELS, CRITERIA AND METHODS
The urgency of the problem. One of the directions of state policy in the field of modernization of health care and sanatoriumresort business in particular, should be the development of methods and technologies for improving management systems. Regulators should take on the sponsor function, primarily with their policies and budgets, and professional associations should implement this policy by initiating and organizing assessment and competitive procedures to support sanatorium-resort organizations that are actively introducing and applying systematic quality management technologies in their activities. their services for sustainable longterm development.
Purpose of the study – development of a Sectoral model for assessing the management system of a sanatorium-resort
organization on the basis of internationally recognized criteria in order to improve the results and improve the activities of a sanatorium-resort organization and the industry as a whole.
Materials and methods. The analysis of models for assessing various aspects of the activities of organizations (ISO 9001, EFQM, JCI), incl. applied in health care using the methods of comparative and logical-structural analysis of their characteristics, which made it possible to identify the strongest solutions in the models under consideration and became the basis for building a model for assessing the management system of a sanatorium-resort organization.
Results. The criteria of the Sectoral Assessment Model and their content are harmonized with globally recognized management models, the principles of which emphasize the priority of consumers, the creation of sustainable values and the satisfaction of their needs, as well as the needs of stakeholders in the face of partners and the ecosystem and contain a re- the list of aspects of activities in which the organization must be successful.
Conclusions. An independent assessment of the level of maturity of the management system of a sanatorium-resort organization and the publication of its results form trust on the part of patients, vacationers, members of their families, large customers of sanatorium-resort services, as well as regulatory bodies and investors, help to attract investments in a sanatorium-resort complex and its sustainable development. The assessment model can also be used for self-diagnosis and improvement of the management system of any health resort organization. -
2021 № 8 Theoretical approaches to the effective interaction of the state and private medical institutions in the format of public-private partnerships
Expanding the sphere of interaction between the state and the medical business is one of the priorities for the development of the medical services market in the Russian Federation. The healthcare reform, based on the principles of evidence-based medicine, digital healthcare, and high medical technologies, is primarily aimed at improving the quality of medical services and the availability of highly qualified medical care for all segments of the population. Accessibility, quality and timeliness of medical care are the main postulates of the daily activities of a private medical institution. during the period of increasing crisis phenomena in the economy and social sphere, private medicine can provide significant assistance to the state health service, become the “lifesaver” for the domestic health protection system, which today is mostly represented by the public sector. One of the most effective mechanisms of interaction between the state and private business, adopted all over the world, is the system of public-private partnership.
The purpose of the study is to analyze possible forms and mechanisms of interaction between the medical business and the state within the framework of public-private partnership.
M a t e r i a l s a n d m e t h o d s . The assessment of the current regulatory framework was carried out, a significant volume of domestic and foreign literary publications was analyzed, the main theoretical hypothesis was formulated on the basis of the systematic scientific method and a research plan was built.
R e s u l t s . In the course of the conducted research, objective main cause-and-effect factors affecting the development of an adequate system of public-private partnership in the field of medicine and healthcare have been identified and analyzed, in terms of the distribution of benefits, costs and risks carried out on the principles of long-term, voluntary, manageability, legal validity between a private medical organization and federal and/or municipal executive authorities. The main causal factors include insufficient funding, an unfavorable demographic situation, low efficiency of using the resource base, a reduction in the bed fund under the guise of “optimization”, a decrease in the social level of the population and the redistribution of the medical and diagnostic structure due to the COVID‑19 infection pandemic.
It should be recognized that the state system of medical care is not always able to fully meet the needs of societies for high-quality qualified medical care. The analysis of foreign literature has shown that medical services abroad successfully use the principle of public-private partnership, redistributing efforts to form the necessary institutional environment in healthcare between private business and the state. Such a form of interaction as concession, leasing, franchise, outsourcing, aufstaffing allows us to optimally balance the interests of the medical business and public health, significantly optimize the budget costs for health protection, especially in a difficult epidemiological period.
The result of the research was the development of a conceptual and theoretical model of various forms of interaction between private medical business and government agencies within the framework of public-private partnership programs.
C o n c l u s i o n s . Thus, public-private partnership is an effective economic tool that ensures the coincidence of the interests of private medical business and the state, allowing to make a profit for both subjects of medical activity, with a reduction in state budget expenditures for healthcare purposes, but with the preservation of high quality medical services and resource provision. -
2021 № 8 A self-assessment methodology for improving the activity of a health resort based on the global model EFQM 2020
Improving the quality of health resort services through effective management is one of the key tools to increase their competitiveness, which increases the demand, ensures year-round occupancy and increases their financial results. An independent assessment of the management system in a health resort and the publication of the results build the trust of guests as well as authorities and investors, which contributes to attracting investment in the resort and its sustainable development.
Purpose of the study. This study develops a methodology for managing changes in accordance with standardized international criteria to improve the results and ensure the development of a health resort.
Materials and methods. An express self-assessment of the health resort's management system was carried out by means of a questionnaire, which reveals the development level according to the most effective approaches within each criterion of the global model EFQM 2020. These criteria emphasize consumer priorities, sustainable values, the satisfaction of stakeholder needs, and the environment. The approaches characterizing the health resort’s activity, help to estimate the level of its maturity in accordance with the principles of sustainable development. The results were used to plan improvements in the health resort's operations.
In comparison with the results of past self-assessments, these results record the current state of the management system and demonstrate the levels of development and tendencies in work practices, showing possibilities for the development of the resort. To assess the activities of the health resort organization for each element of the model, four options for assessing the levels of maturity were selected.
Conclusions. Express self-assessment gives a rapid assessment of the activities of health resorts based on the questionnaire and information supplied verbally. The results can be obtained within one day and can represent graphically the evaluation profile of the health resort. The method can be used in any health resort, regardless of its organization, ownership, or medical specialization. Indirectly, the methodology develops patient- and risk-oriented thinking among management, which forms a culture of quality and innovation in the health resort itself and in the professional community of organizations in order to contribute to the growth and prosperity of the spa industry in Russia as a whole. Improving the methodology of express self-assessment includes clarifying and adding statements to the questionnaire in relation to the best management practices of health resorts, new goals, objectives, and
business technologies, as well as challenges at the regional and global levels. -
2021 № 8 Assessment of the efficiency of leasing when operating a mobile medical clinic in russia (on the example of the Rostov region)
In recent years, especially during the COVID‑19 pandemic, the need for mobile medical clinics has increased. For the effective implementation of the project of mobile medical clinics in Russia (by the example of the Rostov region), it is necessary to purchase expensive medical equipment using leasing technologies.
P u r p o s e of the study was to assess the effectiveness of leasing when operating a mobile medical clinic in the Rostov region.
M a t e r i a l s a n d m e t h o d s . The article investigated the cost-effectiveness of operating leasing compared to the standard purchase of medical equipment. The amount of lease payments was calculated and compared with payments for the purchase of medical equipment. Payments were calculated for a standard set of medical equipment for a medical clinic, including 5 cars on KAMAZ chassis No. 1 with offices of a therapist, surgeon, otolaryngologist, endocrinologist and neurologist, dentist, gynecologist, urologist and ophthalmologist, laboratory and fluorographic, mammographic and CT complexes.
R e s u l t s . According to the results of the study, it was found that in the modern conditions of the spread of coronavirus infection, the need for mobile medical clinics has increased significantly. Effectiveness of medical equipment leasing technology: supplier (equipment manufacturer) – lessee (mobile medical clinic) with the assistance of a leasing company (lessor), lease payments for operating leasing have been estimated.
F i n d i n g s . The effectiveness of leasing in the Rostov region with full depreciation of medical equipment by 30–80% within 10 years of operation has been established. -
2021 № 8 Study of temporary losses of patients when receiving medical services in ambulatory-polyclinic conditions
The study of the patient’s temporary losses when receiving medical services in an outpatient clinic and their minimization contribute to an increase in patient satisfaction with the quality of medical care.
Objective of the stud y: to assess the temporary losses of patients when visiting outpatient clinics of the city municipality.
Methods and materials. The temporary losses of patients were studied by analyzing route maps compiled using a special technique. The analysis of the questionnaires made it possible to assess the patient’s satisfaction with the conditions of providing medical services, the information received in the healthcare institution and the attitude of the nursing staff to the visitor. Statistical processing of the results was carried out using the programs Statistica 5.0 and Microsoft Office Excel.
Results. As a result of the conducted research, significant time costs of patients were identified when receiving medical care in polyclinics of the district center: when visiting a district doctor, a registry, a treatment room and a laboratory, which directly affected the results of assessing their satisfaction with the temporary criteria for visiting a medical organization.
Scope of the results. The data obtained during the study can be used as basic information when developing measures to optimize key processes in outpatient health care institutions. -
2021 № 8 Ways of optimizing the organization of providing ambulatory coloproctological assistance to the population
The article substantiates the priority directions of optimization of the organization of outpatient coloproctological care to the population of the Perm Region.
The purpose of the study is to substantiate the priority directions for optimizing the organization of outpatient coloproctological care to the population.
Materials and methods. The data on the reasons for 4822 calls to outpatient polyclinic offices for specialized medical care in the profile of «Coloproctology» in the Perm Region in 2018, as well as about 2222 calls to the Center of Coloproctology with a day-long hospital stay were analyzed.
Results. It is shown that the frequency of detection of DND in the center of coloproctology was 22.50%, with the frequency at polyclinic appointments‑11,83%, p<0,001. At polyclinic appointments, the frequency of detection of ZNO was 5,96%, in the center of coloproctology – 12,15%. The results obtained can be explained by the number and quality of diagnostic measures performed at the Coloproctology Center, which allows for almost complete coverage of all patients of the center with rigid rectoscopy – 98,38%, with 33,80% (at outpatient appointments (p<0,001). Sigmoscopy, which is not available in the coloproctologist’s offices at the Coloproctology Center, was performed in 7,02% of patients, FCS was performed in 34,29% of cases, compared to 9.49% in the polyclinic (p<0,001).
The presence of an emergency appointment in the Center of Coloproctology explains the higher frequency of detection of acute hemorrhoids – 7,06%, versus 3,2% in polyclinics; acute paraproctitis – 2,29% and 0,62%, respectively; ECC – 1,53% and 0,5%, respectively; anal itching – 1,44% and 0,64%, respectively; proctitis – 0,99% and 0,16%, respectively; rectocele – 0,99% and 0,18%, respectively; injuries of the colon and rectum – 0,72% and 0,16%, respectively; anal insufficiency – 0,72% and 0,37%, respectively; p<0,005.
Conclusions. The traditional model of providing outpatient coloproctological care (offices in polyclinics) is not effective even in diagnostics, since it does not have its own endoscopic and anesthesiological service, which significantly affects the volume and quality of the necessary studies. It is proposed to reorganize the service in order to organize a primary link on the basis of an outpatient coloproctology center with a day-long hospital, separate or at the coloproctology department of the State Clinical Hospital. -
2021 № 5 Organization of medical care for patients with cancer on the basis of lean production in the interests of developing organizational health-saving technologies during the pandemic
The article presents the results of the application of lean manufacturing (LM) technologies for the successful implementation of the state task of a clinical medical organization to provide high-tech medical care during the restrictions caused by the COVID19 pandemic. The highest degree of implementation of LM values and technologies was achieved in the section of respect for the person and corporate culture – 89%, compliance with specialized standards – 86%, satisfaction with quality and safety, as well as quick response to changes‑85% for each,
which allows implementing organizational health-saving technologies. The most accessible and widespread health-saving technology can be considered specialized information on the prevention of non-communicable diseases posted on the website of a medical organization in a special section and attracting the attention of patients in a voluntary informed consent. The organizational and methodological department can become the organizing structural unit of a medical organization for testing the introduction of lean production technologies and testing organizational health-saving technologies, whose specialists should be engaged in improving the level of professional training of doctors,
specialists in clinical profile and secondary medical personnel on health-saving issues, conducting communication campaigns aimed at increasing the responsibility of patients who come for examination and treatment for their health, their relatives and relatives, awareness of the value of human life and health, the formation of a culture of health in various age and social groups. -
2021 № 5 Methodology of creating Proposals (Practical recommendations) on the organization of internal quality control and safety of medical activity in medical organizations providing care in the profile of nephrology (renal replacement therapy)
Until 2020 in the Russian Federation there were no general approaches to the quality and safety management system in dialysis centers, which take into account the specifics of the organization of centers and allow to minimize the risks of adverse events associated with the conduct of replacement renal therapy.
An urgent problem of healthcare organization in the Russian Federation is the creation of a methodology for organizing internal control and approaches to building a quality and safety management system in dialysis units and dialysis centers.
Purpose is to design and prove the effectiveness of practical recommendations for quality and safety of medical practice in organizations providing care in the field of nephrology by methods of replacement kidney therapy.
M a t e r i a l s a n d m e t h o d s . Methodology of creation of a system of internal control of quality and safety of medical activity is based on practical recommendations for the organization of internal control of quality and safety of medical activity in a polyclinic and in a hospital.
R e s u l t s . On September 29, 2020, experts of FGBU “National Institute of Quality” of Roszdravnadzor assessed the system of organization and implementation of internal control of quality and safety of medical activity in separate subdivision № 1 of “B. Brown Avitum Russland Clinics” LLC in Saint Petersburg (Nevsky Nephrological Center).
According to evaluation results experts made a unanimous decision on correspondence of the system of internal control of quality and safety of medical activity of “B. Braun Avitum Russland Clinic” LLC to standards of the system of voluntary certification “Quality and Safety of Medical Activity”.
The cooperation of B. Braun Avitum Russland Clinic LLC and FGBU “National Institute of Quality” of Roszdravnadzor resulted in the development and successful practical application of propositions (Practical Recommendations) on the organization of internal control of quality and safety of medical activity in medical institutions providing nephrological care (Renal Assisted Therapy).
F i n d i n g s . The proposed methodology has proved its practical orientation and can be used in medical organizations irrespective of their geography, size and form of property. -
2021 № 5 Experience and prospects of palliative care in a multidisciplinary hospital
Experience of rendering palliative medical (PMC) care in a versatile hospital is presented – in the St. Petersburg City geriatric medico-social center (CGMSC). Clinical records of 4561 patients receiving treatment on office of PMC CGMSC during 2015–2020 underwent the analysis. Characteristic of stages of hospitalization of oncological patients, patients with somatic pathology and patients with neurodegenerative diseases in office of palliative medical care is given. Presented clinical cases from the practice of managing difficult patients. The prospects of rendering palliative medical care in the conditions of a versatile hospital are described.
The conclusion is drawn that only during creation of offices of palliative medical care in versatile hospitals it is possible to render this type of specialized medical care for patients adequately and in full.
The purpose of the study is to analyze the activities of the Department of palliative care in the City Geriatric Medical and Social Center of St. Petersburg.Materials and methods.
A n a n a l y t i c a l s t u d y of the medical records of patients of the Department of Palliative Care of St. Petersburg State Medical Institution City Geriatric Medical and Social Center was conducted. The case histories were selected for three nosologies typical for geriatric patients.
R e s u l t s . The analysis included the medical records of 4,561 patients treated in the department of PMP GHZ in the period from 2015 to 2020. The article describes the stages of hospitalization of cancer patients, patients with somatic pathology and patients with neurodegenerative diseases in the department of palliative care. Clinical cases from the practice of managing difficult patients are presented. The prospects of providing palliative care in a multidisciplinary hospital are described.
C o n c l u s i o n s . Only with the establishment of palliative care units in multi-specialty hospitals is it possible to provide this type of specialized medical care to patients adequately and in full. -
2021 № 5 Health centers – a tool for improving the prevention of chronic non-communicable diseases in the Russian Federation
There are Health Centers in Russia that deal with the early diagnosis and prevention of risk factors for chronic non-communicable diseases (NCD).
M a t e r i a l a n d m e t h o d s : the data of 9505 visitors who applied to the Health Centers of Tomsk were analyzed.
Purpose to identify the most significant combinations of risk factors for the development of NCD among visitors to Health Centers.
R e s u l t s : 70% of people had two or more behavioral risk factors. Two or more metabolic risk factors were identified in 37% of people. The prevalence of combinations of behavioral risk factors remains almost constant in all age groups, while the prevalence of metabolic risk factors significantly increases starting from the age of 30–34 years. The combination of physical inactivity and inappropriate nutrition is most significant for the development of high blood pressure, hypercholesterolemia and excess body weight in persons under 30 years of age. Individuals under 30 years of age have a higher risk of developing coronary artery disease and diabetes in the presence of combinations of metabolic risk factors (excess body weight, increased blood pressure and hypercholesterolemia). The risk of developing hypertension, ischemic heart disease and diabetes mellitus significantly increases with an increase in BMI for each unit, starting from a BMI of 22 kg/m2. It is noteworthy that this is still within the normal range. The risk of developing hypertonic disease and coronary artery disease significantly increases with an increase in cholesterol for every 0.5
mmol/l, starting from normal values.
C o n c l u s i o n s : the primary goal of preventive measures should be persons under 30 years of age without metabolic risk factors and with a combination of behavioral factors. -
2021 № 5 Error in the regulation of bacteria screening in donor blood components
We searched for standards for monitoring the sterility of donor blood and blood components. The legal nullity of the “Instructions for the control of the sterility of canned blood, its components, preparations, canned bone marrow, blood substitutes and preservative solutions” was established. For proper sterility control of donor blood and its components, the “Standard for equipping a blood transfusion station (blood center)” (approved by Order of the Ministry of Health of Russia No. 1167n dated October 28, 2020) needs to be amended by replacing the “Bacteriological analyzer for the identification of microorganisms” with “Analyzer of blood cultures“.
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2021 № 4 QUALIMETRIC ASSESSMENT OF THE EFFECTIVENESS OF IMPLEMENTING THE RESULTS OF PROJECT ACTIVITIES IN THE WORK OF MEDICAL ORGANIZATIONS AND HEALTH MANAGEMENT BODIES
In addition to the economic assessment of the effectiveness of the implementation of the results of project activities in the practice of medical organizations and health management bodies, for a qualitative assessment of the implementation results, a qualimetric analysis of the implementation effectiveness can be carried out. A complex qualimetric indicator in a dimensionless form from 0 to 1,0 or as a percentage from 0 to 100% can be reflected by color symbols and at the same time has a certain logical meaning. It shows the degree of deviation of the value of the estimated indicator before and after the implementation of the project results from the original (normative or standard).
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2020 № 10 Possibilities of application of the toolkit for independent assessment of the quality of service providing conditions by medical organizations for analysis of effectiveness of system transformations at the ambulatory stage
Successful achievement of goals of the national projects «Healthcare» and «Demography» is impossible without the
active participation of subjects of the Russian Federation. At the same time, choice of optimal tools for assessing the transformations carried out on a regional scale is of particular importance. The aim of the study was to analyze the effectiveness of implementation of the Standard for the organization of outpatient care in the Tomsk region using tools for independent assessment of the quality of conditions for the provision of services by medical organizations. The results of the questionnaire survey of patients of medical organizations participating in the implementation of the project were analyzed before (2018, 896 patients from 18 medical organizations) and after (2019, 252 patients from 5 medical organizations) implementation of its main activities using the Questionnaire approved by the Ministry of Health of Russia. The informativeness of the questions of the questionnaire used to assess the effectiveness of a regional project depended on their nature. It is shown that the results of a questionnaire survey on issues affecting technical aspects of the process of receiving services (waiting times for an appointment with a doctor, research) should be interpreted comprehensively in combination with an assessment of technological indicators and data on the resource availability of the processes under study. Questions related to various aspects of patient satisfaction with the services received and the conditions for their provision showed positive dynamics in a number of parameters, indicating the effectiveness of the project implementation. The questions that concretize the object of satisfaction
or dissatisfaction, in comparison with the questions involving an integrated assessment of the institution, were of great
information content. The survey data obtained in the course of an independent assessment of the quality of the conditions for the provision of services in medical organizations can become an effective tool for an integrated assessment of the implementation of regional projects, allowing to determine the correctness of the selected directions of systemic transformations. -
2020 № 10 Efficiency indicators of the round-the-clock hospital beds of the oncologic profile in the Russian Federation
The steady growth trend of oncological diseases in Russia in recent years requires a response from the health
care system: development of prevention aimed at early detection of diseases; improvement of methods of diagnostics and treatment of oncopathology; improving the quality and effectiveness of medical care.
A i m : to identify trends in changes of the neoplasms incidence and performance indicators of oncological beds for
round-the-clock stay of the state health care system in the Russian Federation, federal districts and regions of the Russian Federation in dynamics for 2010–2019.
M a t e r i a l s a n d m e t h o d s . Using the data of federal statistical observation (forms NoNo. 12, 30) by the method of
descriptive statistics, the main indicators of the neoplasms incidence in the population are analyzed, as well as the work
of round-the-clock oncological beds in the Russian Federation, federal districts and regions of the Russian Federation in
dynamics for 2010–2019.
R e s u l t s . On the background of an increase in the neoplasms incidence in the population (by 24.9%), including malignant (1.5 times), for the period 2010–2019 in the Russian Federation increased: the absolute number of oncology beds of round-the-clock stay from 30,970 to 36,186 (+ 16.8%), the provision with these beds from 2.17 to 2.47 per 10,000 population (+ 13.8%), hospitalization rate from 6.1 to 9.6 per 1000 population (+ 57.4%), and decreased: the average length of stay in an oncological bed (from 12.1 days to 8.4 – by 30.6%), as well as the average bed occupancy per year (from 345 to 330 days – by 4.3%). The extreme values of the indicators of the hospitalization rate for round-the-clock oncological beds in the regions of the Russian Federation in 2019 differ 12.8 times, the provision of these beds – 9.2 times, the average bed occupancy per year – 1.5 times, the average length of stay in a bed – 2.4 times. Mortality in oncological hospital beds increased from 0.76% in 2010 to 0.95% in 2019 (by 25%).
C o n c l u s i o n . The 24-hour oncological bed capacity, against the background of the growth of oncological morbidity,
has naturally increased, but at the same time it is characterized by an extreme disproportionality of development in the
Federal Districts and the regions of the Russian Federation. Optimization of the bed fund should be carried out based on
the objective needs of a particular region, taking into account its characteristics and with the simultaneous development
of alternative medical services. -
2020 № 10 Analysis of practical experience in development and implementation of standard operating procedures in the activity of medical personnel
Innovative technologies use in the daily nurse practice makes their work more professional, comfortable, ensures safety and convenience of performing basic professional duties, reduces labor costs, and allows to quickly and efficiently ensure the implementation of new diagnostic and treatment process.
Aim: analysis of the experience in the development and implementation of SOPs for nurses for 2018–2019. in Central
City Clinical Hospital № 6, Yekaterinburg.
Methods. The work analyzed reporting documents (SOP implementation logs for each subdivision of Central City Clinical Hospital № 6, Yekaterinburg during 2018–2019 period), characterizing the number, type of developed SOPs, depending on their purpose, the timing of their implementation.
Results. During 2018–2019 period there have been all main nomenclatures SOPs developed and implemented into the
nursing practice. The main stages of the development of SOPs are analyzed, illustrative examples are given. Encountered by the staff of the medical institution SOPs development and implementation related difficulties are discussed. Main prospective activity directions in the field are determined.
Conclusion. On the basis of municipal Central City Clinical Hospital № 6, Yekaterinburg, SOPs development and implementation for various types of nursing activities have been successfully carried out. -
2020 № 9 Improving the technology of work of heads of therapeutic departments of Central district hospitals
The article presents the results of studying the organization of work of heads of departments of central district hospitals (CRH) and the quality of therapeutic care for the rural population. The study was conducted in 2017–2019. on the basis of
26 Central District Hospital of the Republic of Dagestan. The quality of therapeutic care was studied through an expert assessment
of 1,085 inpatient and 748 outpatient patient records. The timing of the working time spent by the heads of the departments of
the Central District Hospital for 845 hours. It was found that under the current conditions the heads of departments devote up to
50.7% of their working time to the fulfillment of the main duties. Waste of time is 15.1%.
In the therapeutic departments of the Central District Hospital, an untimely and complete examination of a significant part of the
patients took place; treatment is not always complete and complete, there is no continuity in the examination and treatment of
the patient between the clinic and the hospital.
On the basis of the research materials, a set of recommendations was developed to improve the technology of work of heads of
departments of the Central District Hospital and improve the quality of medical care. Experimental verification of the recommendations confirmed their effectiveness: the time spent on the main work increased from 51.2% to 72.4%, the share of time spent on organizing and managing the treatment and diagnostic process increased by 15.5%. Improving the organization of work of heads of departments during the experiment had a positive effect on the quality of medical care: the proportion of patients examined at the prehospital stage increased by 25.4%; the number of those fully surveyed increased from 58.4% to 90.3%; the number of patients who received full treatment increased by 14.7%. -
2020 № 9 A technique of the analysis of subjective and objective characteristics of medical services for design of quality of medical services
In a control system of quality of medical services the important part is assigned to estimates of results of activity of the medical organization, in particular degree of satisfaction of patients with quality of the received services. Now
the question of quality of medical services is extremely relevant, a need for development of instruments of improvement
of quality of services is had.
Methods: The technique of measurement of satisfaction with quality of SERVQUAL provided to medical care based on
provisions of GOST “Quality Management …” and a technique of expansion of functions of quality of QFD which elements
are defined in GOST “Quantitative methods of improvement of processes “Six sigma are used”.
Results: Approach on the basis of integration of techniques of measurement of satisfaction of consumers of medical services of SERVQUAL and expansion of function of quality of QFD which realization allows to build the House of quality is
stated and to create data for carrying out design of quality of medical services.
Conclusion: The conducted research allowed to create tools for elaboration of the adjusting and warning operating influences directed to demanded change of quality of medical services and, as a result, the recipients of services increasing
satisfaction. -
2020 № 9 From patient-centered medicine to 4p-medicine: the semantic aspect of the trend
The step-by-step guidelines for the formation, development and implementation of the direction defined as “patient-oriented medicine” in the scientific and practical segments of healthcare are presented. It reflects not only the historical aspect of
this semantic plot, but also gives a characteristic of the diverse models of interaction between subjects – a doctor and a patient.
The analysis of definitions of “patient-oriented medicine” in the framework of foreign and domestic scientific schools, as well as
the analysis of the relationship of the pattern with the new concept of health care development – 4P-medicine is given. The structure of the 4R-medicine concept is characterized, the ideological implications of the prospects for its development are given. The legislative and organizational initiatives for the development of patient-oriented medicine are outlined. -
2020 № 9 Organization, current state and immediate prospects of the problem «bloodless surgery»
The research focus of the publication is the problem of preserving the blood of the operated patient. The variety
of blood preservation methods shows the multidisciplinary nature of the problem and the importance of well-coordinated
teamwork of busy doctors. For more than 20 years, surgical, anesthetic, transfusion technologies of blood saving have
been used mainly in cardiac surgery patients. The use of a complex of blood-saving technologies allows you to reduce
the amount of blood loss and the consumption of donor blood components. Over 7 years in cardiac surgery, the number
of recipients of donor hemocomponents decreased by 41% (erythrovesue) and 61% (FFP). Autologous plasma is 68-78%
of the total volume transfused to cardiac patients. 50% of patients operated on the ascending aorta do not need a blood
transfusion. Blood loss during extensive liver resections has decreased three times in 10 years and does not require allogeneic blood transfusions. An adequate multidisciplinary approach to solving the problem of blood conservation can improve
the results of surgical treatment of patients. -
2020 № 9 Organization of the orthopedic and neurological service in the practice of a gerontologist
Integrating neurological services into primary health care should be an important policy goal in both developing
and developed countries. Providing neurological care through primary health care requires significant investment in training
primary health care professionals to identify and treat neurological disorders. Such training should meet the specific practical needs of different groups of primary health care professionals, such as doctors, nurses, and community health workers.
Preferably, continuous training is necessary to provide follow-up support to strengthen new skills. In many countries, this is
not possible, and therefore suboptimal assistance is provided.
Purpose: to analyze the organization of orthopedic and neurological services in the practice of a gerontologist.
Methods: General clinical, neurological examination using diagnostic criteria of the DISEASE, PKP syndrome, 3-stage
scale of global Deterioration (Global Determination Scale – GDS) and Clinical Dementia Rating scale (clinical Dementia
Rating – CDR); neuroimaging methods – MRI/CT of the brain; quantitative EEG; experimental psychological examination:
MMSE test, coding subtest, special experimental psychological study using Schulte tables, tests for memorizing 10 words
and 8 numbers, Wechsler Memory Scale – Revised – WMS-R, spielberger-Hanin anxiety scale, geriatric Depression Scale;
discriminant analysis was used to predict the development of dementia.
Results: As a result of repeated studies, it was found that after three years in the group of patients with ART. II with PKP syndrome in 35.3%, dementia syndrome was diagnosed. Depending on the subtype of the PKP syndrome, dementia syndrome
was detected in 55% of patients with the amnesic subtype, in 34.8% – with multi – domain, in 15.8% – with non-amnesic.
The most vulnerable to the development of dementia were patients with the amnesic subtype of PKP syndrome.
Conclusion: Using discriminant analysis of testing data of patients WITH stage II diabetes with advanced age PKP syndrome, informative and independent predictors of dementia development were established, which were included in the
prognostic formula, namely, indicators of maximum reproduction of 10 words, coding subtest, complex verbal paired associations (short-term memory), visual reproduction (short-term memory), light verbal paired associations (long-term memory).
There was a significant increase in pronounced correlations between various cognitive indicators in the group of patients
with art. II WITH PKP syndrome in comparison with the groups of patients with ART. II without PKP syndrome, practically
healthy elderly and young people, which indicates the formation of a stable pathological state in the cognitive sphere in
patients with PKP syndrome.
As we can see, the activity of a gerontologist is often closely related to neurology, so we consider it necessary to point
out in conclusion the high efficiency of the neurology service based on a gerontologist. -
2020 № 9 Donor platelets collection in a pandemic of COVID‑19 infection
The work of the Samara Regional Clinical Blood Transfusion Station, the collection and delivery of platelet concentrates in
2018, 2019 and in the first 6 months of 2020 was assessed. The annual demand for platelet concentrates in 2019 increased by 22.9%, and in the first half of 2020 the issue of platelet concentrate decreased by 12.1%, which is associated with a change in treatment work during the period of infection COVID‑19. The proportion of platelets isolated from whole blood in the first half of 2020 decreased from 24.7% (the end of 2019) to 17.4%, (p <0.001). This maneuver made it possible to accept all donors wishing to donate apheresis platelets. -
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. -
2020 № 8 Medical and social aspects of the development of health resources in the Federal districts of Russia
An important area of health care is the implementation of equal rights of citizens to preserve health throughout
Russia. In order to analyze the dynamics of the development of the main forces and means of the medical industry in
the territory of the macroregions of our country, we used the following methods: analytical, logical, statistical and direct
ranking. The results of the study were established, the dynamics of primary morbidity of the population, the security of
citizens medical staff capacity outpatient organizations and hospital beds Fund, and the differences of these indicators in the federal districts. -
2020 № 8 Improving rural health care through business process management
Meeting the needs of the rural population in all types of primary health care (pre-medical and general medical
care), as well as specialized medical care, improving the quality of medical care for the rural population is an important
public health problem that is difficult to solve and is of particular concern to government structures at all levels of government. The article presents an analysis of the literature on the use of business processes in modern healthcare, the main tasks of which are the creation and development of effective models for the provision of medical care that increase not only its accessibility and quality, but also the satisfaction of the population. As part of the activities of the modernization program for the implementation of information technology in healthcare, it is planned to create information resources and services that would allow, using this system tool, to move to a qualitatively new level of organization of industry management. It is noted that at present, at the level of management of the medical organization as a whole, and in the management of individual areas of its activity, the application of the process approach is becoming relevant, in which the medical organization can be considered as a separate business system, which is a related set of business processes, the ultimate goal which, undoubtedly, is the provision of quality medical services. It is shown that the development and modeling of business processes will increase the relevance of management information, will make it possible to focus on rationalizing cross-functional processes to significantly reduce time and / or costs, increase revenue, improve service quality and reduce risks, the information system allows you to simulate processes and carry them out further optimization.
The analyzed works examine the experience of process-oriented management in medical organizations and its role in ensuring the improvement of the quality of medical services provided. In addition, the introduction of a process approach will allow the application of certain managerial decisions necessary in each specific situation, including in the field of medical services for the rural population. -
2020 № 8 Organization of tertiary hospital functioning during novel coronavirus pandemic.
We analyzed organizational changes in the structure and functioning of Moscow Clinical Scientific Center named after A. S. Loginov during novel coronavirus pandemic. The paper presents challenges in the implementation of N. A. Semashko “mobilizational” system of healthcare provision and reasoned conclusions on its advantages.
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2020 № 7 Covid‑19 pandemic: the realized decisions and the forthcoming tasks in the sphere of public health care
The response measures taken in the Russian Federation allowed to avoid the “explosive” nature of epidemic of a
new coronavirus and also a critical overload of the health care system weakened by spontaneous “optimization”. The flash
of COVID‑19 reminds that modern society is extremely vulnerable before threats of infectious pandemics. Important not
only to support and strengthen infrastructure of the medical organizations, but also to provide the mobilization readiness
of a health care system reflecting ability of the industry effectively to react to emergency situations. -
2020 № 7 Modern approaches to the construction of an effective model of preventive work with children
The approaches to the analysis of the information of the medical information system about the child population
attached to the medical organization (22,950 children) are described to identify homogeneous groups in order to build a
preventive work plan with each. The team of experts of the medical organization has developed an electronic work plan for
4,745 options for monitoring a child, which is implemented as a computer program that allows you to automatically rearrange
the plan. It is considered as a sequence of standard operating procedures. The program automatically “restructures”
the calendar plan of work with the child, allowing you to complete the missed work in an acceptable time for the child
and the performer. The use of such planning is especially necessary for work in the conditions of prevention of COVID‑19. -
2020 № 7 On the question of the organization of outpatient psychiatric care in the city of Moscow
The article analyzes the organization and financing of psychiatric care in in-hospital conditions and hospital-replacing care for patients in the dispensary. The results of the study of the composition of patients on the basis of GBUZ “PB No. 13 DZM” for 2015–2017 years are given. The number of patients treated in a dispensary, a day hospital by nosological forms for the last period of time, the number of patients treated by gender were analyzed; considered age categories of patients, the structure of the professional status of patients. During the analyzed period, the main indicators of day hospital were investigated: the average duration of stay of patients, bed turnover, number of bed-days.
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2020 № 7 Productivity indicators of the daily stay bed fund in the Russian Federation
The process of reducing round-the-clock bed fund with simultaneous development of hospital-replacing technologies, namely
daily stay hospitals, has been going on in the Russian Federation, for more than twenty-five years, a similar trend has been observed in recent decades in most developed countries of the world. From 2010 to 2018 provision of the population with beds of daily stay hospitals in the Russian Federation moderately increased from 15.4 per 10,000 to 17.0 (an increase of 10.7%). Hospitalization rate of the population in daily stay hospitals in the country increased from 41.9 per 1,000 population in 2010 to 56.3 in 2018 (an increase of 34.5%). At the same time, the average bed occupancy per year in daily stay hospitals for the study period decreased from 311 days to 301 days (the decrease was 3.1%). The average length of stay in daily hospitals bed decreased from 11.4 to 10.1 days (the decrease was 11.7%). The positive dynamics of most of the studied indicators testifies to the development of the network of daily stay hospitals in the Russian Federation, the negative point is the reduction of average bed occupancy per year, what may indicate a decrease of the intensity of use of the bed fund of daily stay hospitals in the country. -
2020 № 3 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.
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2020 № 3 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.
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2020 № 3 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.
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2020 № 3 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.
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2020 № 2 Dynamics of indicators of the hospital bed fund of round-the-clock and daily stay in the Russian Federation
For the period 2010–2018 the number of hospitals in the Russian Federation decreased from 5705 to 4323
(by 24.2%), both due to the reduction in the number of beds and in connection with the unification of medical organizations.
The number of beds of round-the-clock stay decreased from 1250120 to 1044875 (by 16.4%); the following
indicators decreased: provision with these beds (from 87.5 to 71.1 per 1000 population – by 18.7%), the average treatment
duration (from 12.6 days to 10.7 – by 15.1%) and, unfortunately, average bed occupancy per year (from 325 to
313 days – by 3.7%). In 2018, the extreme values of the indicator of hospitalization rate for 24-hour hospital beds in
the regions of the Russian Federation differ 1.8 times, provision with hospital beds – 2.9 times, average bed occupancy
per year – 1.2 times, average treatment duration – 1.8 times. The revealed differences are significant, what indicates
the imbalance of the ongoing structural transformations. The overall hospital mortality rate in the Russian Federation increased:
from 1.5% in 2010 to 1.9% in 2018 (by 28.4%), similar dynamics – in all Federal Districts. The provision of the
population of the Russian Federation with places in day time hospitals increased from 15.4 per 10 000 in 2010 to 17.0
in 2018 (by 10.7%). Multidirectional tendencies are noted, both toward increasing and decreasing the number of places
in day hospitals both in the Federal Districts and in the regions of the country; the extreme values of the indicator of the
provision of places for day hospitals in the constituent regions of the Russian Federation differ by 30 times, what reflects the
disproportionate organization of the network of day time hospitals in the country’s regions. During the observation period
in the Russian Federation the level of hospitalization in round-the-clock hospitals decreased from 222.0 to 203.5 per 1000
population (–8.3%), while the level of hospitalization in day time hospitals steadily increased from 26.4 to 35.0 per 1000
population (by 32.8%), what indicates the implementation of the expected hospital-replacing function of day time hospitals
in the country. The issue of further structural and functional optimization of the bed fund of the country remains relevant. -
2020 № 2 Оrganization of extracorporeal care in a multidisciplinary medical institution
Organization of round-the-clock extracorporeal (EC) treatment in required volumes and options is one of the
most important tasks of a modern surgical hospital. The annual volume of extracorporeal procedures at the B. V. Petrovsky
National Research Center for Surgery (NRCS) is 1.5–2.0 thousand. The most significant methods are transfusiological blood
saving, high-volume plasmapheresis, and renal replacement therapy. Doctors of various specialties are traditionally engaged
in conducting EC procedures: resuscitators, nephrologists, transfusiologists. In modern medicine, EC hemocorrection
methods are in wide demand. Their effectiveness can be determined by the start time of the procedure. Therefore, roundthe-
clock access to all the necessary manipulations is important. In the absence of specialized departments of extracorporeal
treatment with around-the-clock working schedule the implementation of the necessary extracorporeal procedures is
possible in close contact with resuscitators, nephrologists, transfusiologists, in collaboration with the doctor of the clinical
diagnostic laboratory. The quality of providing high-tech extracorporeal care depends on the adequacy of the treatment
process management in a particular medical institution. Collegial performance of EC procedures for one patient by specialists
of various profiles – resuscitators, nephrologists, transfusiologists – gives a high clinical result. -
2020 № 2 Evaluation of the organization and transport accessibility of medical care to rural residents
The basis of the study was the Orenburg region. According to the MIAC health care in the Orenburg region
in 2015, the number of rural settlements was 1036, and the number of FAPs was 945. Sociological studies were conducted
in three pilot rural areas with different populations and distances from the regional center: Abdulinsky, Orenburg, Svetlinsky.
The total number of adults in the three districts is 19,356. The results of a sociological survey indicate a low availability of medical assistance to rural residents, the lack of a preventive focus among doctors on the prevention of exacerbations of chronic pathology, primarily of villagers living in localities attached to FAP. The need to improve the organizational forms of the work of medical organizations in the countryside, the development of mobile field complexes and general medical (family) practices, the development of medical and social assistance in rural areas is determined. -
2020 № 2 Improving the quality of organization and provision of medical care for children with injuries in order to reduce their disability
Children’s disability is an urgent medical and social problem of modern society, one of the main characteristics
of public health and social well-being of the country. This article provides additional data on the main trends in primary
childhood disability, depending on the age and type of injury, type of injury and a damaging factor; presents a medium-
term prognosis of primary childhood disability due to injuries for the Kursk region. The types of psychological status of a
family with a child with an injury are determined, and their effect on the implementation of measures for its rehabilitation in
various types of injuries is studied. The results obtained indicate the importance of an individual approach to each specific
family with a child with an injury, and the need for work aimed at achieving optimal treatment outcomes and preventing
the formation of disability. A scheme has been developed for the interaction of various organizations and departments
involved in the prevention of childhood injuries and the comprehensive rehabilitation of children with the consequences of
injuries. A scheme of the relationship between the types of rehabilitation and the level of adaptation (somatic, psychological,
socio-environmental) of children with the consequences of injuries under the age of 12 years is proposed. -
2020 № 2 The clinical significance of the relationship between doctor and patient (literature review)
This literature review collects research, laws, and various models of physician-patient interaction in the health
care system. The question of the patient’s adherence to treatment based on the level of trust in the doctor is considered in
detail, the analysis of the concepts of different models of interaction is carried out, and their specific conditions are defined,
presented in the scientific literature by the authors of the CIS and Europe. The purpose of the review was based on the
analysis of various options aimed at the development of the doctor-patient relationship in health care. Based on the data,
the authors suggested that it is necessary to search for new approaches to increase the legal, economic responsibility of
the patient, both for the performance of medical appointments and for their own health. -
2020 № 1 New model of ambulatory healthcare operation as a form of sustainable development of healthcare organization
The article presents a review of the literature and the data of our own research on the problem of introduction of certain elements of the lean production model in the work of the ambulatory healthcare and assessment of its impact on the sustainable development of the healthcare organization as a whole. It was revealed that the new model of the am¬bulatory healthcares increases the efficiency of activities in the following areas: the achievement of long-term development strategy by 6.8 times, the introduction of organizational improvements and training of personnel by 5 times, synchronizes processes and optimizes resource provision 3 times more often than the initial level of work of the healthcare organization. In this regard, the sustainability potential of the healthcare organization providing primary health care to the population has increased by 3.47 times, which indicates an increase in the efficiency of the organization.
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2020 № 1 Implementation of principles of lean production providing paid services in a medical organization
The aim of the study is to optimize the processes leading to increasing patient satisfaction level, providing accessibility to medical services, increasing efficiency and eliminating existing temporary financial and other losses using the implementation of lean manufacturing principles and tools. The experience of organizing medical services on a paid basis allowed us to establish a patient-oriented system in the provision of primary health care to the population.. Legislative and regulatory framework governing the provision of medical services on a paid basis, guidelines for the implementation of lean manufacturing principles in medical organizations. Mathematical, analytical and descriptive methods were used. Schemes for the implementation of medical services based on optimizing the flow of created values for the patient are proposed. Changes of some indicators of the medical organization activity are analyzed. Implementation of the principles and tools of lean production leads to the solution of the problems of the current healthcare system – the effective use of the personnel potential of a medical organization, the possibility of creation additional income source for medical workers within one healthcare facility.
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2020 № 1 Assessment of the demand of population with cataract for specialized medical care
The Study of the adequate demand of population in specialized medical care is one of the problematic issues in the process of planning of medical care. The aim of the study was to develop an indicator to assess the demand of population with cataract for specialized medical care. Information on the research topic was collected from books and electronic sources, including Internet sites in order to achieve the aim. A comparative analysis of ophthalmological data from the official statistical reporting forms (№ 12, № 14) of Orenburg, Samara, Penza and Perm regions was performed. As part of the study, significant spread in the values of indicators of general and primary morbidity of the population with eye diseases, both within the region and between regions, was defined. The values of the indicator for assessing the demand of population for specialized medical care for cataracts were obtained.
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2020 № 1 Aspects of medical rehabilitation in the reform of psychiatric services
This article examines the medical documentation of patients and materials of the medical rehabilitation depart¬ment at the base of the Psychiatric Hospital of the Moscow Department of Health for the period April-December 2018. The results of the quality of treatment of 352 patients who were treated in the medical and rehabilitation department of the psychiatric hospital № 13 were evaluated.
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2020 № 1 The effectiveness of the reorganization of dermatovenerological care in the Samara region in terms of “lean production”
By implementing “lean manufacturing”, medical organizations can save on all costs, while improving acces¬sibility and improving the quality of care.
The roadmap “Changes in social sectors aimed at improving the efficiency of health care” set the task of increasing the share of outpatient care costs in the total costs of the “Program of state guarantees of free medical care” from 25.3% in 2013 to 31.7% in 2018. the Share of inpatient care costs should be reduced from 60.3% to 50.3%. In providing effective treatment of patients with dermatovenerological pathology of great importance is the use of the necessary amount of der¬matological care, as well as therapeutic methods of diagnosis and treatment, which determines the need for continuity in the work of PHC and PHC. In 2010. in the Samara region the restructuring of the bed Fund and partial reduction of der-matovenerological beds, improvement of selection of patients for inpatient treatment according to the developed criteria of hospitalization in hospitals of round-the-clock stay and day hospitals on the profile of dermatovenerology were carried out, clinical protocols were introduced at the outpatient stage – all of the above contributed to the efficiency of the use of the bed Fund in dermatovenerology. The reorganization of dermatovenerological care improved the quality of medical care for patients with dermatovenerological diseases and clinical and organizational indicators of dermatovenerological care. -
2019 № 1 Organization of specific prevention of infectious diseases to ensure sanitary and epidemiological welfare of the population
The achievement of high coverage of preventive vaccinations of participants of mass events is an important link in ensuring epidemiological well-being in the territory. Aim: to analyze vaccination coverage in the framework of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications among the personnel involved in the maintenance of the 2018 FIFA world Cup in Kazan (world Cup). Materials and methods. The analysis of coverage of preventive vaccinations against diphtheria, measles, rubella, influenza, viral hepatitis A, dysentery 8 food facilities of the world Cup, 7 objects of placement of the main client groups, 2 training bases, 27 food facilities and accommodation of the given forces and 1 object of water and sewage facilities, 43 other food facilities and accommodation of guests of the world Cup; against diphtheria, measles, rubella, flu-among volunteers, medical workers, employees of the attached forces involved in the maintenance of the world Cup. Results and discussion. According to the results of the analysis of immunization status within the national calendar of preventive vaccinations of public catering workers, hotel institutions involved in the maintenance of the world Cup, vaccination coverage against diphtheria and tetanus was 98.3%, against measles – 97.9%, against influenza – 45.7%, against rubella – 90.2%. Vaccination coverage of health workers against diphtheria and tetanus was 97.8%, against measles – 97%, against influenza – 92.2%, against rubella – 98.5%. Among the personnel of the forces attached to the world Cup, vaccination coverage against diphtheria and tetanus was 95.1%, against measles – 94.8%, against influenza – 76.9%, against rubella – 92.7%. Immunization coverage of volunteers against diphtheria and tetanus was 94.0%, against measles – 93.8%, against rubella –94.4%, against influenza – 49.8%. According to epidemic indications, 94.9% of the staff were vaccinated against hepatitis A, 94.3% against dysentery
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2018 № 10 Methodologikal aspects of evaluation of effectiveness in health care
Modern health care is characterized by a number of problems and contradictions in the field of performance evaluation. Analysis of the research and legal documents indicates the absence of a common approach to the issue. In this regard, the development and implementation of evaluation systems in the public sector is still relevant and very difficult task.The article provides information on the main stages of the development of the assessment methodology in accordance with the various stages of reforming domestic health care. Conceptual approaches to the terminology of the problem are being conceptualized and the variety of techniques to study this phenomenon is visually demonstrated.The authors draw attention to the need to systematize the accumulated knowledge in this field and to find a clear conceptual basis for constructing an evaluation system.It is concluded that existing theoretical, methodological and practical developments, including those fixed at the legislative level, do not allow an objective and unambiguous assessment of the phenomenon under study.
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2018 № 10 To the issue of strengthening and preserving health of employees in the enterprises of the russian Federation
Тhe problem of strengthening and preserving the health of workers at the enterprises of the Russian Federation is сonsidered. It is shown that improving the effectiveness of preventive measures to strengthen and preserve the health of workers is possible with the active participation of employers. This requires control by the trade Union organization, the medical service of the enterprise and preventive organizations of the region (center for medical prevention, health centers).
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2018 № 10 Analysis of morbidity, mortality from malignant neoplasmsand organization specialized medical care for the population with oncological pathology in Moscow region
The article presents morbidity and mortality in the Moscow (MO) from cancer for improvement organization of specialized medical care with oncology pathology. An analysis is made of the reasons for the excess of the specialized Medical Assistance (MSP) (including high-tech medical care - ВМП) for residents of the Ministry of Defense for malignant neoplasms more than 2 times mean values for the Russian Federation, in a 24-hour hospital due to a larger residents of the Moscow region of the NSR and the VMP at the expense of federal medical centers in Moscow.
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2018 № 10 The experience of interregional Clinic and Diagnostic Centerin health care delivery within the mandatory medical insurance and charged services
An article discusses differences in the legal and regulatory framework in regulating the mandatory medical insurance and charged services. It is found out that conditions that lie at the root of the mandatory medical insurance system could be fully implemented using the causal approach to diagnostics and disease treatment. The causal approach within the mandatory medical insurance allows responding to the cause of the disease quickly and affordably. It is concluded that implementing mandatory medical insurance systems and charged services in a medical facility requires their different positioning, and in this case they will not repeat each other or compete with each other, but complement each other perfectly. The article describes the experience of Interregional Clinic and Diagnostic Center in organizing charged services using a system approach that allows forming an aggregate picture of a disease taking into account a plenty of factors and opinions from various experts. The conceptual differences in organizing the health care delivery in the mandatory medical insurance systems (causal approach) and charged services (system approach) within the activities of Interregional Clinic and Diagnostic Center allowed to define both systems as mutually supportive systems that fully meet the needs of people in medical services.
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2018 № 3 On the problem of forming a new model of the primary medico-sanitary management for the patients with pathology of digestion organs in Moscow Region
The article presents monitoring results of the independent evaluation of the work quality of the Moscow Regional medical institutions as well as medico-statistical analysis of morbidity, hospitalization, and lethality indices in different groups of population with digestion organs diseases in Moscow Region which are necessary to form the new model of the primary medico-sanitary management. The special attention in the presented new model is paid to the standard of polite and careful treatment of patients by the medical staff, to increasing the doctor’s work time with an individual patient, to reducing the registration time, the queue to medical specialists, and the time period of pending one’s turn before the doctor’s room. The same attention is paid to shortening the period of prophylactic medical observation and examination
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2018 № 3 Organization of alimentary therapy: outsourcing or own nutrition service? (case study)
An analysis of experience of alimentary therapy organization in Interregional Clinical Diagnostic Center (ICDC) is presented in the article. The aim of the article is to study conditions and factors of outsourcing efficiency by the organization of alimentary therapy in healthcare institutions. Materials and methods: review of scientific literature, study and analysis of statistical data on ICDC performance in 2007–2016. Specific features of alimentary therapy outsourc- ing are contemplated, reasons for organization transfer to outsourcing and conditions of its efficiency are highlighted in the paper. Two patient feedback instruments to appraise quality of nutrition are proposed and time tested: monitoring of quantity of waste and patient satisfaction assessment. A benchmarking study based on the quality coefficients data of clinical nutrition prepared by own efforts and submitted to outsourcing is conducted. Efficiency of feedback instru- ments for the organization of alimentary therapy for patients of Neurosurgery and Neurology Departments is shown. Conclusions: Outsourcing as an approach to clinical nutrition organization has a right to existence, however before its implementation a comprehensive risk-benefit analysis of this decision should be carried out. As the experience of ICDC has showed, alimentary therapy outscoring is not always the best solution for a healthcare institution. Clinical nutrition outsourcing entails additional risks, which have to be minimized and managed, that is not often possible in real life situations. The experience of ICDC suggests that clinical nutrition organization by own efforts is able to meet competition in comparison with specialized third-party contractors and besides has its advantages as it considerably reduces risks
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2018 № 1 About the requirements of the identification and design of preliminary and clinical diagnoses: what you need to pay attention in a medical organization
The article discusses issues related to the organization of the identification and registration of clinical and preliminary diagnoses in accordance with the requirements of order of Ministry of Public Health from 10.05.2017 № 203н. Practical recommendations for filling approved by the Ministry of the Russian Federation of forms of medical documents (medical card of a patient receiving medical care in outpatient facilities, and medical card of the inpatient), taking into account new requirements for the establishment and design of the preliminary and clinical diagnoses. Brought to the attention of healthcare leaders that we now have a criterion of quality of medical care is the fulfillment of the requirements for the compulsory consultation of doctors in case of difficulty of establishing a clinical diagnosis within the specified time
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2018 № 1 The Department of Medical and Social Assistance to the Adult Population and the Department of Nursing: the concept and principles of organization
The concept of the organization of medical and social assistance to the most socially vulnerable population contingents (people in the residential and senile age, the disabled and citizens with a temporary restriction of the ability to move and self-care after the transferred diseases and injuries) is proposed. This includes the creation departments of medical and social assistance in medical organizations that provide assistance to the adult population on an outpatient basis
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2018 № 1 To the question about the strengthening and preservation of health of employees in the enterprises (on the example of the Central Federal district)
Considered the issues of strengthening and preservation of health of people working in enterprises. Studied the role of the leader and trade Union organization in the preventive measures aimed at risk factors that influence the development of chronic noncommunicable diseases. Studied prevention of specific diseases associated with the specific activities of the enterprise, the provision of sanatorium-resort treatment. Examined measures to strengthen and preserve the health of the population, conducted in the territory of the project location. The scheme of interaction of all structures of the region in strengthening health work force
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2018 № 1 Availability of the medical diagnostic care and continuity in its organization at various stages of exercise of medical and diagnostic process
One of important social problems of a health care system is ensuring availability and quality of a medical care. For the purpose of complex assessment of availability of diagnostic testings reports of federal forms of statis¬tical observation were analysed and expert assessment of medical documentation of the medical organizations in the Republic of Bashkortostan is carried out. As a result of the integrated analysis of data key criteria and indicators of availability of diagnostic testings which indicate the need of differentiation of the medical organizations for levels of the diagnostic help for balancing of the offered nomenclature and ensuring adequate availability of diagnostic testings at various stages of delivery of health care were taped. Centralization of clinical diagnostic laboratories is the confirming result of repeated rising of availability of diagnostic services (by 5-10 times) that proves similar organizational and structural transformations of diagnostic sectionings, forming of three-level system of diagnostics under WHO recommendations that increases the methodical level and quality of medical and diagnostic process, especially at a pre-hospital stage and considerably improves satisfaction of patients.
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2018 № 1 Experience of use of medico-economic standards for the endovascular treatment of diseases
Endovascular surgery and interventional radiology is the most modern technologies in interventional medicine. The standardization of endovascular methods is the main condition for application in practice.
Materials: Reports of the main specialists on X-ray and endovascular diagnostics and treatment of MZRF and MZ of the Moscow region. Regional medico-economic standards (MES) for endovascular treatment of diseases are developed and implemented by the Ministry of Health of the Moscow Region in 2012-2014. The results of the work showed a significant increase (6,4 times) of the performed endovascular procedures for various diseases in medical organizations involved in the implementation of the Moscow region Medical Insurance Program. This made it possible to increase the efficiency of the work of cardiology, surgery, oncology and gynecology departments, to reduce hospital mortality from acute myocardial infarction in vascular centers from 22 in 2012 to 7-8% in 2015, and mortality from cardiovascular dis¬eases in the Moscow Region from 878.5 in 2012 to 680.5 in 2015 per 100 thousand of the population. The opening of 10 catheterization centers in the Moscow region, the introduction of MES treatment of patients with acute coronary syndrome according to routing, ensured the effective hospitalization of patients in "invasive" centers from 2% in 2012 to 82.8% in 2015. The standardization of the endovascular methods of treatment leads to an increase in the use of hospital beds, improved routing of patients' flows, provision of endovascular care of patients. -
2017 № 5 Analysis of maternal deaths in the Russian Federation in 2016
The article presents analysis of information of constituent entities of the Russian Federation on 183 cases of maternal death in 2016 Identified a reduction in the direct and relative increase in indirect obstetric causes. On the background of a General decline direct causes increase of postpartum hemorrhage, septic and iatrogenic complications. Among the indirect to the greatest extent growing diseases of the circulatory system. The maximum role in the death women UFO antisocial environment; the deaths of women CFD foci of chronic infection and iatrogenic; women PFO fetoplatzentarnyi violations. Offers advanced unified scheme of collecting information on maternal deaths for the realization of the possibility of introducing specific reasons and to develop effective measures for their correction and prevention
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2017 № 5 The integration of the systems of internal control of the quality and safety of medical activity and quality management of medical organizations
For example, regarding the system of quality management large dental enterprises in conformity to national standard of Russian Federation GOST R ISO 9001–2015 «quality management System. Requirements» shown the possibility and feasibility of the integration of the system of internal control of the quality and safety of medical activities in specific internal standards and the documents of QMS of the medical organization. The integration of the two systems will allow to avoid the duplication of monitoring procedures and its documenting, will provide a more detailed study of the internal control procedures of the quality and safety of medical activities by binding them to the production processes in medical organizations
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2017 № 4 Operational parameters and characteristics of MRI workflow in outpatient clinics of Moscow
We present continuous data of outpatient MRI units in Moscow, 2016. Unit uniformity, identical working conditions, compensation schemes, study justification, process monitoring and result analysis as well as first-time adoption of newest information technologies in Moscow allowed for process characterization and advanced result analysis of 28 outpatient MRI units. Presented data encompasses operational parameters of 64326 MRI examinations with results being evaluated on-line. Yearly median number of examinations for one MRI unit was 2076, with first and third quartile being 1830 and 2836. Reasons of low workload were analyzed. For instance, average number of work shifts in a month varied from 24 (95% CI 18-30) to 49 (95% CI 43-52). Workload during the day also varied. In first four hours of work shift up to 40% of all examinations were performed (95%; CI 40.5-41.2). In last four hours of work shift only 20% of all examinations were performed (95% CI 19.7-20.2). Additionally, the interval between sequential studies was 38 minutes, with first quartile being 29 minutes, and third quartile being 55 minutes. The delay was observed in 50.7 cases (95% CI 50.3-51.4). Every fifth delay was longer than 60 minutes, and in 7.4% of cases - longer than 90 minutes (95% CI 7.2-7.6). In best outpatient clinics, the prevalence of these intervals was only 4.8%. Average waiting interval in outpatient clinics was 7.8 days (95% CI 7.7-7.9). In 44.9% of cases, it was shorter than 6 days (95% CI 39.6-47.5) and in 8.2% of cases examination was performed on the day of study reservation. In several clinics waiting interval did not exceed one day without any detrimental effect on overall workload. The results highlight the need to improve operational processes and overall quality of diagnostic services.
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2017 № 4 Functional features of the system of ultrasound examination of patients with urinary malignant neoplasms
The incidence of the urinary malignant neoplasms has been steadily growing in Russia. However, in the Russian Federation there is no document, approving the standard of primary health care in this pathology. In practice, the burden of primary and specialized ultrasound of the urinary malignant neoplasms rests on the shoulders of Oncology Center doctors. Purpose - analysis of the effectiveness of the ultrasound diagnostic services in Kursk and the Kursk region at the urinary malignant neoplasms examination of patients at primary inspection, the specialized treatment, dispensary observation, uptake of this population in commercial structures. The study includes 309 patients assigned to Cancer registration in Kursk Regional Clinical Oncology Center from 2012 to 2015 diagnosed with kidney cancer and bladder cancer. Statistical analysis of the data is performed using SPSS «STATISTICS20.0». Our study shows that the majority of patients with primary urinary malignant neoplasms holds ultrasound examination in primary health care facilities. Often, however, the survey volume is carried out incomplete. The main factor determining the effectiveness of the primary ultrasound is an establishment of the meeting (p < 0,01). The greatest problems encounter in the study of retroperitoneal lymph nodes and the inferior vena cava, and the detection of tumors of small dimensions (T1). The ways of elimination of shortcomings of the ultrasound system and direction of further scientific research are proposed in this article.
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2017 № 4 The load on the blood service of medical establishments depending on the volume of platelet transfusions per days of week
Rate of the frequency of transfusions, goal-setting, and the stratification of 1519 doses of donor platelets on different days of the week have been evaluated in 16 clinics in the Republic of Bashkortostan. The proportion of transfused platelets in the different days of the week has been different at 5.1 times. The needs of clinics, from Sunday to Tuesday inclusive in platelets make up 17.2% of the total consumption and at 61,3% (p < 0,01) more often than on other days of the week are met by apheresis platelets. Maximum uniformity of platelet transfusion dates identified in Children Republic Clinical Hospital, which from Wednesday to Friday inclusive, transfuses 51.2% of platelets, whereas in other hospitals – 76,8% (p < 0,01). Increased frequency of platelet therapy beginning on Friday in small clinics can cause compliance audit for transfusion rules. The results may be useful for evaluating workflow of blood service clinics, improve the efficiency of clinical work.
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2017 № 4 SWOT-analysis in the practice of forming the main directions of counteraction to the spread of HIV infection
The paper presents the results of a strategic analysis of the system of medical care for HIV-infected patients at the regional level. The data of the analysis on the basis of expert assessments made it possible to identify the key areas for counteracting the spread of HIV infection in the region. The results of the research show the priority of the program activities to improve the material and technical and personnel support of medical organizations that provide medical and social assistance to patients with HIV infection, as well as activities aimed at raising awareness and attracting the population of the region to HIV testing
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2017 № 3 The application of the system of strategic indicators in health and rehabilitation centres at the regional level (theoretical-methodological analysis)
This paper presents an analysis of strategic indicators as an effective method for organizing medical and rehabilitation centres at the regional level. Justified its advantage compared to traditional methods, fleshed out the mechanisms for its implementation. Identified the difficulties and contradictions of the MTP application in the Organization of the system of medical rehabilitation, identified ways to overcome them.
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2017 № 3 Organization of medical attendance to the patients with extremely low birth weight: specialists’ sight
Annotation. The ongoing reform of the health care in the fields of Obstetrics and Gynecology and Neonatology lead to problems in the Russian Federation, reflected in official statistics. Head specialist of the nine regions of the Russian Federation took part in the study, expressing their opinions and expressing their view on the problems. It reveals a significant shortage of staff (doctors and midwives), with working professionals in need of additional training. Another problem is shortage of nursing beds of the second stage. Available separating poorly equipped, mostly a problem with the diagnostic studies. Experts in the field insist on the revision of the criteria of birth with 500 grams and 22 weeks of gestation upwards.
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2017 № 3 Quality analysis of specialized medical aid for patients with craniocerebral injury in medical institutions of the Ryazan region
The article contains the results of target and topical medical aid quality evaluation for patients with brain injury. According to the results of the expert quality report of 265 clinical records of patients with craniocerebral injuries, 59.2% of the cases had medical aid defects, that didn’t affect the patient’s health, such as: incomplete examination provided by clinical practice guidelines and by approved medical standards – absence of medical specialist consultation or it’s delay; and absence of recommendations on further treatment and rehabilitation during inpatient discharge. Based on the data, obtained from the expert quality judgement of medical aid, suggestions on improving specialized medical aid for patients with craniocerebral injury were made.
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2017 № 3 The analysis of prevalence of mental disturbances and socially dangerous actions mentally sick with intellectual backwardness and obtained organic damage of a brain (according to data from Tyumen region)
Socially dangerous actions mentally sick are an important performance indicator of work of mental health service, and the analysis of number of criminal delicts at mentally sick in the conditions of the proceeding epidemic of mental diseases is an urgent task. In work prevalence of organic damages of a brain and socially dangerous actions of patients with organic damage of a brain in the Tyumen region are analysed. As a source of information annual statements in a form No. 10, and also annual databases of the conclusions of the out-patient forensic-psychiatric commission of the Tyumen region are used. For handling of the SPEK databases the automated information system «SPEK-analytics» is used. In Russia decrease in prevalence of mental diseases is noted. The same tendency is noted also in the Tyumen region. The powerful share among all diseases is constituted by organic damages of a brain, including intellectual backwardness. At the same time this contingent of patients makes considerable amount of socially dangerous actions – annually more than 60% of their total number. It is noted that against the background of decrease in prevalence of mental diseases in the Tyumen region more, than for 35% for all researched period, the number of socially dangerous actions by 2,7 times increased, the share of the persons committing crimes more, than twice grew. By results of the obtained data measures for decrease in number of socially dangerous actions are proposed. In particular, it is about need of application of measures of primary prevention taking into account the revealed risk groups on the basis of the factors influencing making socially dangerous actions mentally sick.
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2017 № 2 The application of the process approach for operations management of the medical organization
The article noted the possibility of using as a tool the creation of an internal control of medical organizations quality and safety of medical activities of the quality management system in accordance with the principles and requirements of the national standard is identical to ISO 9001:2015 «Quality management systems – Requirements». Using the principle of process approach, the authors in the activities of medical organizations identified the main macro-processes that determine the outcome. Describes the organizational role and direction of the actions of the process owners. Formulated own definition of diagnostic, therapeutic, and expert processes from the standpoint of the analysis of their content. Marked by close integration relationship and mutual influence of these processes on each other. Outlined the prospects for improving the quality of medical activities of the organization and its results by introducing a process-centric technologies to enhance business processes.
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2017 № 2 A three-tier model of management of large state dental Association
Presents a three-level model of the system of management of large state dental Association built on the basis of a combination of linear-functional and divisional guidelines. The structure and specific mechanisms of functioning of the units strategic, tactical and operational levels, with a vertical subordination and the cycle: planning – implementation – control – improvement. A distinctive feature of the levels of strategic and tactical management is the addition of block execution solutions – branch network of enterprises, continuously operating educational level, including the effective management of School resources and School quality the quality management System of enterprises. Ring operational management includes all structural units of enterprises, data, indicators and operation parameters which come in a comprehensive system of weekly monitoring, forming a set of actual data about medical operation clinics enterprises, financial and economic condition of the clinic, the medical support materials, tools and medicine, repair, construction and engineering works. Analysis of the obtained data allows managers to quickly in the field if necessary to develop corrective solutions.
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2017 № 2 Analysis of resourse utilization for laboratory diagnostics by Russia’s hospitals
For evaluate the use of human and material resources for laboratory services was study the structure and expenses for laboratory diagnostics in 82 hospital institutions from eleven Russian regions. The data showed that the laboratories occupy 2.5% of hospital areas (median), they employed 4.2% of all employees, including 4.5% of hospital doctors. In the structure of total institutions costs \ laboratory costs account for 4.4% (1st quartile, 2.9%, the third – 6.4%). These costs are 93.7% for wages and the purchase of reagents and materials. The share of labor costs were twice as high as on the reagents and materials (62.9% and 28.7%, respectively). Median costs for community charges amounted to 1.9%, and equipment maintenance – 1.2%. As an additional task carried out a separate assessment of the resource costs of microbiological laboratories. In half of health facilities, these costs amounted to less than 1% of hospital expenditures, although ten of the thirty-nine – exceeded 1.8%. The median labor costs, reagents and materials amounted to 92.6%. For all laboratory expenditure in general, the predominant contribution here was added labor costs.
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2017 № 1 The experience of forming public dental service in a regional centre
The experience of formation of public dental service by combining dental clinics in the city with a population of over 400 thousand people in a single institution. Centralization has allowed to consolidate and flexible use of financial and material resources to optimize the management, improve the work efficiency of all services, further systematic and phased development of large-scale enterprises. Today it is a medical organization consisting of nine competitive branches-clinics that meet modern requirements for design, engineering, technology and staffing. The Association provides a full range of dental services in the compulsory health insurance system, LCA and cost accounting, quality assured, safety and comfort. Multifunctional structure of the Association, formed working relationships with regional and national academic and academic medical centers created the preconditions for the formation and further development of the clinic of the dental cluster in the region. Currently, the resource potential of enterprises has reached such a level that allows continuing the reference to centralization, to move to the next stage of its implementation – the policy of «centralized decentralization» – to the enterprises network dental micropolygons walking distance, as well as the development and implementation of major social projects in the field of prevention of dental diseases in children and adolescents.
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2017 № 1 The organizational model is improving the examination of temporary disability in the city hospital
The article presents a model of organizational improvement examination of temporary disability, realized in the city hospital number 10 in Samara. The model is based on the organizational and methodological aspects and methodological approaches to quality control examination of temporary disability, which allows to take timely and instructive-methodological documents, raise the level of training, develop information support expertise of temporary disability, to ensure its quality control. As part of the organizational model to improve the organization of the examination of temporary disability from 2010 to 2013 increased quality of expertise of temporary disability. This reduces the number of defects, reduced the proportion of wrongly granted sick leave, increases the integral evaluation of the quality of care in terms of the model of end results of activity of temporary disability examination services in the city hospital from 0.75 in 2010 to 0.85 in 2013.
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2017 № 1 Basic trends of mortality from external causeson the territory of the Russian Federation
Annotation. The analysis of the statistics of the Russian Federation, the mortality rate as a whole, as well as by federal districts and subjects for the period 1990–2015 years. It was revealed that the death rate from external causes has specific regional characteristics, and its level in some subjects of the Russian Federation remains at extremely high values. Over the period 2011–2015 there is a noticeable slowdown to reduce mortality from external causes, which highlights the need for the development and adoption of organizational measures with the involvement of the health authorities and other agencies of the Russian Federation.
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2017 № 1 The incidence of malignant neoplasms
The article provides an analysis of the incidence of malignant neoplasms in Russia in dynamics for 10 years. The main feature of formation and development of cancer care in Russia is its preventive orientation. The experience of early diagnostics of malignant neoplasms expedient from the economic point of view a long-term strategy for the fight against cancer.
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2016 № 10 Some results of modernization programms in health system in the Russian Federation
The article presents the estimation of the results of health care system’s modernization programs in 2011–2013 from the point of view of infrastructure changes, health care availability and results. On the base of the Ministry of Health’ statistics data the analyses of structure, staff, main results of health institutions and some medico-demographic indices as well was run before the modernization programs (2009–2010), in the last year of the programs (2013), and in 2014. The number of the health institutions decreased following their integration up on 1,9 thousands accordingly to the modernization programs. Primary health care was developed, the number of day-surgery beds increased up on 34 thousands. The number of district doctors decreased by 10%, number of ambulance doctors decreased by 3,2 thousands. In the same time number of general practitioner increased up to 9838 doctors. The number of out-patient’s visits decreased to 9,1 per year, the number of ambulance calls became normative, hospitals’ results followed to optimize. Standardized mortality rate decreased up on 16% including reasons of circulatory diseases and of external factors. Morbidity has practically not changed. Conclusion: The modernization programs have optimized health care system’ infrastructure including primary health care development. Modernization programs failed to solve the medical staff problems of the Russian health system. Availability and quality of health care increased as diseases were educed actively but the mortality rate decreased.
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2016 № 10 State and tendencies of the organization of medical care by the patient with rheumatic diseases in the orenburg region
In the Orenburg region there are multidirectional and nonuniform tendencies of incidence of rheumatic diseases, the possibly bound to decrease in availability of the specialized rheumatological help to patients. Medical care by the patient with rheumatic diseases in the Orenburg region does not meet the modern expectations of necessary level to its organization and an operating order of rendering. Level of primary specialized rheumatological help is not provided with necessary quantity of positions, and territorial distribution of available, causes its transport inaccessibility. The specialized stationary help, including hi-tech turns out in one office at regional hospital what is also represented poor. The calculated quantity of necessary established posts of rheumatologists makes from 17 to 32 rates, depending on the applied calculation procedures. The number of necessary beds for rendering the specialized rheumatological help varies from 94 to 250. The organizational model of the rheumatological help to adult population of area developed on the basis of analytical and normative methods includes creation of interdistrict offices of rheumatologists for rendering primary specialized rheumatological help, two interdistrict rheumatological offices for rendering the specialized help taking into account preservation of the office in a regional hospital providing specialized and high-tech medical care to patients. This model is the first stage in development of the concept of development of the rheumatological help in area.
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2016 № 10 Experience the reorganization of outpatient ophthalmologic services in the Kaluga region with the participation of the Federal medical institutions
The article presents the experience of the reorganization of the outpatient ophthalmic services in the Kaluga region with the aim of improving the quality of outpatient services; improve the availability and proximity of high-tech eye care in conditions of the respective Federal agencies for the population of the region. To achieve this goal was proposed the algorithm for providing ophthalmological care, which allowed accelerating the provision of specialized high-tech diagnostic and surgical eye care to the needy residents of the city of Kaluga. For today in hospitals of the regional center there are 5 rooms of the IRTC «Eye Microsurgery». For the period 2009–2015 in the outpatient clinics were adopted 587 103 patients of them sent to the Kaluga branch of IRTC «Eye Microsurgery» 23 230 patients (22,4%) with different ophthalmopathology. The cases in the branch was extended to 31 192 medical services, including 7 565 patients underwent surgical treatment. The obtained results testify to the relevance and prospects of the work done, which would merit its continuation in other medical institutions in Kaluga region.
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2016 № 9 New mechanism for financing high-tech medical care in 2017: characteristics and risks
Federal hospitals will receive state funds to provide high-tech medical aid from the Federal mandatory medical insurance Fund directly, and not from the budget of its founder or of insurance companies in 2017. Thus, in relation to Federal clinics it is planned to implement the mechanism of financing expensive medical interventions, which, according to the authors, is neither the budget nor the insurance. The authors have shown that legislative innovations and their associated risks will require from the Ministry of health of Russia and the Federal mandatory medical insurance Fund serious work to ensure the necessary accessibility for citizens is costly, but most effective methods of medical care.
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2016 № 9 Modern approaches to an estimation of efficiency and an assessment of quality of medical diagnostic researches
Perfection of the medical diagnostic help, including its pre-hospital level, demands the working out and the realization of a series of measures on diagnostic interventions’ management and their quality assessment. The list of the common and specific indicators of efficiency of diagnostics is developed on the basis of the researches made and offered, modern approaches to quality management, carrying out of internal and external quality assurance are described, the problems demanding the decision for the further increase of efficiency and quality of medical diagnostics are defined.
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2016 № 8 Family-oriented approach to child health care
In this review article you can consider the parent involvement in children medical care, because in paediatric practise precisely parents can influence good relationship with parents and whole healthcare system, what is more they can influence the compliance on attitude between patient (parents or legal representatives) and health provider. The last decade researches indicate the necessity of parent involvement in all stages of medical assistance to children, moreover the last surveys showed that family-centred approaches are highly-efficient. The competence of paediatricians in working with parents and the concept of family-oriented approach in foreign literature are being considered in this topic. Moreover, the advantages of using family-centred approach and barriers, including staff shortages, interrupting the process of using this model, are being under special control in this topic. There are many variants of changing and ways of implementation offering in this article. In conclusion, there is a statement that implementation family-centered medical care to children in whole medical care system requires comprehensive changes in all stages of medical care quality ensuring, including medical care organizers professional outlook, adjusting the regulatory framework and standards of training specialists.
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2016 № 8 Clinical and economic decisions for the oncology patients with choices of the treatment of the cachexia – anorexia syndrome at the patients with malignant tumors for acceptance of administrative decisions
Present day the crucial object of cancer palliative care is improving patients quality of end-of-life and to optimize patient outcomes when they face intolerable suffering. The lack of success of unimodal treatment in cachexiaanorexia is one of the key questions that clinicians responcible and deal with a difficalty. Outcome based on our clinicoeconomic research and comparision analysis of two treatment technologies for cancer cachexia patients illustrates how and in which sequence we should make use of medical technologies and choose the most effective for the patient and save the cost of budget.
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2016 № 7 The activities of day hospitals in the Russian Federation in 2000–2014
The article analyzes legal documents, which that regulate the work of day hospitals in the Russian Federation since the late 90-ies of XX century to the present. Presents an analysis of the performance of activities of day hospitals in health institutions providing medical care in ambulatory and stationary conditions in the country in 2000–2014. Marked increase in the number of beds in day hospitals 2,3 times, which is mainly due to the increase of beds in day hospitals in health institutions providing medical care in ambulatory conditions. Spend the evaluation of use of hospital beds hospitals for 15 years. During the study period the number of beds in hospitals has decreased by 27,7%, the number of discharged patients has almost not changed, which is associated with the intensity of the work beds. Shows the comparison of the number of persons treated in day hospitals and hospitals round-the-clock stay. The total number of patients treated in day hospitals and round hospitals, the proportion of patients treated at a convenience care hospitals declined from 92,5 to 80,3%, the proportion of patients treated in day hospitals increased from 7,5 to 19,7%.
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2016 № 7 Methodology of creation and using of clinicoeconomic simulator for decision-makers by the example of GEP nets and pNETs
Health technology assessment (HTA) in the condition of a limited budget is an actual problem for Ministry of Health employee and persons who make a decision. Switching to single-channel financing, increasing of budgets in the hospital segment and the interaction with insurance companies force us to use the principles of technology assessment made in developed countries and to create our own tools for decision-making. We’ve designed a clinical and economic decision-making simulator for socially – significant diseases by the example of GEP NETs and pNETs.
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2016 № 7 Problems of formation of health of mothers and their offspring in modern Russia
The article presents the morbidity and mortality of mothers and newborns in Russia for the years 2013‑2014‑2015 a growth of negative phenomena in the vital signs of women’s and children’s organisms, evidence of systemic violations of their health (the formation of the fetal-placental complex, the implementation of compensatory protective mechanisms of women and development of the fetus). In order to optimize demographic processes, the preservation of life and health of women and newborn offspring, you must consider the trends and direct the efforts and funds to maintain the social status of the family and women’s health before and during pregnancy.
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2016 № 6 Dynamics of injuries among adult population in Russian Federation in 2010–2014
Dynamics of injuries among adult population based on the state statistical observations for 2010–2014 is presented. The structure, rate of out-of-hospital and hospital injuries was studied. Accuracy and completeness of injury registration was evaluated. Recommendations for close interaction in injury registration between out- and in-hospital patients were suggested.
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2016 № 5 Performance analysis and ways of reforming the health village
Annotation. The analysis of the incidence of the rural population in the Russian Federation and the Federal District. Based on the results of the study developed proposals to reform the health of the village.
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2016 № 4 Public Health and Formation of the Uniform Preventive Space
Annotation. The task of unifying the efforts of all participants of the preventive process, the whole society in order to create a preventive space became urgent In the last decade. The development of the public health system is suggested as such а unite. A great number of discussions on public health at various levels allowed us to formulate the definition and the core functions of public health. It is crucial to realise the public health system both as a totality of different structures and as their purposeful and coordinated activity. Of particular importance is the municipal level as a place of direct contact of the population, bodies of local self-government, the realization of the actions directed on preservation and strengthening of health of the population, with the active participation of citizens themselves.
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2016 № 4 The analysis of the experience of the organization of treatment of TB patients under the program «hospital at home»
Annotation. The new organizational model of treatment of TB patients – hospital at home was developed and introduced with the purpose to increase efficiency of TB patients’ treatment. We defined indicators for patients’ referral to the «hospital at home». It was proved that the directly observed treatment in a «hospital at home» has high efficiency and low frequency of treatment defaults: completed effectively the course of chemotherapy 90.7% of patients, ineffectively – 2.0%, interrupted treatment – 3.5%, departed – 0.3%, transferred to in-patient departments – 3.5%.
Pharmacoeconomic analysis showed that treatment cost at a «hospital at home» is 2.5 times lower than that for treating patients in an in-patient department and 1.6 times lower than that in an in-patient department for MDR-TB patients. -
2016 № 3 Primary Health care. Medical Network organization features and staff provision
Annotation. Changes of Medical organizations network, providing ambulatory treatment, were studied, for past 10 years. In addition, trends of manning tables formation in outpatient clinic were analyzed, as well as population provision by district doctors (uchastkoviy doctor) and general doctors. The analysis of main indicators of doctors’ activities in medical organizations, providing ambulatory treatment, is provided.
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2016 № 3 Provision of medical rehabilitation care for the population of Russian Federation on an outpatient basis
Annotation. Demographic changes in the direction of increasing of older age groups in the population structure, chronicity diseases, disability height, high premature mortality from chronic non-communicable diseases and due to this enormous economic damage to the national economy of the country pose the problem of organizing measures of effective medical rehabilitation of patients to the category modern Russian health priority issues. The results of analysis of medical institutions and professionals activities, that provide assistance for medical rehabilitation in outpatient settings, indicate that there is a low level of cabinets and experts providing assistance on medical rehabilitation in Russia. The low number of visits to the professionals of all profiles in combination with a high coefficient of combining and low understaffing, indicates lack of sending patients for this type of restorative treatment, that is unfairly against a background of increased morbidity, especially chronic and disabling forms of diseases. This, in turn, shows the lack of organizational and legal forms of regulating the flow of patients from the active treatment to the rehabilitation, that leads to the dissatisfaction of the population need for this type of care. The structural analysis of the situation and identify unsolved problems so far give us basis for looking for priority actions for the development of provided medical rehabilitation on an outpatient basis – a necessary condition for the implementation of medical and social functions of the state to preserve and strengthen health of the population.
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2016 № 3 Analysis of the efficiency of the use of hospital beds in the hospital urology department
Annotation. The article presents the results of the examination of the validity of hospitalization in the urology department of City Clinical Hospital (CCH) in Zhukovsky, Moscow region. Carrying out of examination the validity of hospitalization in the urology department of the hospital showed that there had been excessive periods of treatment in 22% of patients. Share unreasonably executed patient days was 15.8%. Of the total number of bed days saved the largest part of the final period of treatment (37.3%), almost the same amount for an initial period (41.7%) and 21.0% – for the period of active treatment of the patient. Calculate the economic effect of follow-up care of patients in day hospital (DS).
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2016 № 3 Organization of preventive care in the health center medical institutions without an attached population in modern conditions
A structural-functional model of the health center’s medical institutions without an attached population adapted to in modern conditions. It can improve the effectiveness of the promotion of preventive health services center and the quality of services at the health center.
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2016 № 2 Needs of the population Nizhny Novgorod region in cardiac surgery procedures
The article presents the analysis of security of the population of Nizhny Novgorod region with medical staff and bed capacity cardiology; analyzed actually existing cardiac surgery volumes in the Nizhny Novgorod region; designed neediness of the adult population of the Nizhny Novgorod region in cardiac surgery based on data from a multicenter epidemiological study СТЕРХ.
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2016 № 2 Management of blood donor: platelet pooling
Based on the cost analysis of different types of platelet concentrates (PC) assessed the effectiveness of the introduction of technology pooling of platelets in the Irkutsk Regional Blood Transfusion. Comparative cost analysis of different types of PC, the cost of consumables for the same therapeutic dose PC was performed. It was found that the content of pooled PC cells does not give in to apheresis. The introduction of technology pooling of platelets allows significantly (by 54,4% or more) to reduce the cost of issuing PC. To evaluate provision of PC in the regions it is advisable to consider the number of harvested PC through methods for preform at therapeutic doses.
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2016 № 1 Organisation and outcomes of monitoring medical-economical factors of high-technology medical aid
This article explores individual organisational-methodological approaches to constructing monitoring informational systems of high technology medical aid. Authors conclude that there is a necessity to create unique monitoring systems and databases, formed by personified audit of the most significant signs of surveillance subject. Article’s materials can be used while modelling information systems for practical implementation of high medical technology in circumstances of one stream financing.
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2016 № 1 Chronic complications of diabetes mellitus: specialized outpatient medical service organization and efficacy according to experts’ opinion survey
Multidisciplinary outpatient care structures for patients with late complications of diabetes (diabetic foot, retinopathy, and somewhere – for diabetic nephropathy) were established in Russia since late 1990s. We conducted a survey of 22 experts from 12 regions of the Russian Federation for the analysis of the current state of specialized outpatient care for patients with these conditions, assess demand in this type of care and develop possible improvements. The necessity of outpatient diabetic foot clinics was obvious for 100% of the experts, of diabetic retinopathy consultative rooms – for 95%, of diabetic nephropathy consultative rooms – for 52%. Eighty five percent, 52% and 15% of the experts respectively reported about work of such outpatient structures in their regions. In all three fields lack of funding and lack of qualified personnel were pointed as the main barriers for establishment and development of such outpatient structures. The efficacy of patients treatment in outpatient diabetic foot clinics (where they work) was considered an effective by 47% of experts, in diabetic retinopathy consultative rooms – by 55%. In conclusion, (1) the demand in outpatient diabetic foot and diabetic retinopathy specialized structures is obvious, but is questionable with regard to diabetic nephropathy; (2) the performance of these service is not sufficiently high, which requires appealing of qualified specialists there (which is impossible without adequate funding), training of specialists and quality management; (3) we found evidence of inadequate availability of such specialized outpatient care for patients with diabetes, which requires increase of such offices number, and targeted referral of patients there from primary care physicians.
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2016 № 1 SWOT analysis as an instrument of strategic planning while enhancing private medical clinic diagnostic service
The analysis of the reorganization of diagnostic service of a big Chelyabinsk private medical clinic by means of joining of a high-profitable ultrasound diagnostic department and endoscopic cabinets with low marginal profitability in the one whole. SWOT-analysis gave basis for pointing out inner and outer factors, influencing the diagnostic service development. As a result of two previously separated material development funds and introducing the system of complex examination of patients the material basis of the whole department was strengthened, that caused economic efficiency at its activity, analysed with the help of profitability markers: assets, production and selling.
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2016 № 1 Optimization of organizational models sanatorium treatment as a factor in the effectiveness of international integration in the field of health
In the article is shown the possibility for Russia as one of the leading positions in sphere of the provision of services in sanatorium treatment in relation to the tasks of the national preventive health areas (for example, analysis of the thematic sub-programs of the Russian Federation’s State program «Health Development» for the period up to 2020).
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2015 № 10 Cancer patients routing experience of the Sverdlovsk Region and the Republic of Tatarstan
In the research, we analyzed the experience of the regions, that have implemented and have been using effective automated routing systems of cancer patients, that allow to optimize the use of resources in the region. We studied and described the key elements of an effective system for the routing of patients with malignant tumors. We propose optimum steps for implementation of the routing system in the regional oncology service.
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2015 № 10 About formation of new content of work of the head of the medical organization to ensure and control the quality and safety of medical activity
The article deals with the problems and issues that impede the implementation of legislative requirements on ensuring and monitoring the quality and safety of medical activities in medical organizations. The article presents and justifies a specific list of the main activities of the head of the medical organization to ensure and control the quality and safety of medical activity. Proposed and substantiated the areas of control that should be reflected in the internal control of quality and safety of medical activity. Reasonable changes in the activities of medical commissions. Emphasized the need for active and systematic participation of the health authorities and the territorial departments of Roszdravnadzor in the formation of a new content of the work of the head of the medical organization to ensure and control the quality and safety of medical activity.
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2015 № 10 Prospects for rehabilitation assistance in the region on the example of private medical Center
The need of the population of the region in medical rehabilitation can be resolved through active cooperation between private business and the state of health. One possible solution to this problem is considered on the example of the initiative of private medical companies.
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2015 № 9 The condition and renovation of capital assets of TB-institutions in the Russian Federation (2012–2014)
The state of capital assets of TB organizations in the Russian Federation: buildings and structures, machinery and equipment, motor vehicles evaluated. Discovered increased depreciation of capital assets, imbalance of wear, imbalances of renovation. The ways of harmonization of state assets offer.
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2015 № 9 Upgrading of organizational technologies for improvement of availability of high-tech medical care to cardiosurgical patients by the example of the Moscow Region
Annotation. The paper describes the mechanism for upgrading of organizational technologies for improvement of availability of high-tech medical care to cardiosurgical patients, based on regional vascular centers and primary vascular departments in medical organizations in the Moscow Region, as well as on Vascular Center of MONIKI and availability of the leading Federal clinics of MoH RF and RAS. Positive trends in decreasing cardiovascular mortality among population of the Moscow regions are presented with compatible parameters.
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2015 № 9 Organizational planning the third phase of the rehabilitation of children with congenital heart disease of different age groups
Annotation. Analysis of surgery for children and adolescents with congenital heart disease (CHD) in Bakulev Scientific center of cardiovascular surgery in 2013 allowed to justify the quantitative need for the 3rd phase of the rehabilitation of patients with this pathology. Achieved grouping of patients after surgical treatment of CHD for the third phase of rehabilitation depending on the diagnosis, the type and the deggree of disorders of the cardiovascular system.
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2015 № 8 Adult population’s quality clinical examination management in outpatient organizations on the basis of the process approach
Aim of the study: Development of quality management system in health care organization in periodic health examination of target adult population groups. The developed materials could be exploited in similar institutions engaged in the periodic health examinations.
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2015 № 7 The role of medical panel in providing medical aid: why is it not fulfilled in the total capacity and what the action plan should be
The article demonstrates and proves that in most of the medical organizations today medical panels do not play a leading role in the activities aimed to enhance the provision of medical aid. Authors draw attention to the issues of incomplete development of panel’s responsabilities and functional described in the Federal Law dated 21 November 2011 N 323-FL «On the principals of Health Protection of citizens of Russian Federation» and in the Order on creation and conducting medical panels in a medical organization, certified by the Order of Russian Ministry of Health Care and Social Development dated 05.05.2012. № 502. Authors suggested and justified additions and changes, which these documents must include.
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2015 № 6 The need for more continuity and cooperation the relationship between quality of medical care in the mandatory medical insurance system and control of quality and safety of medical activities
The article shows the lack of continuity and the relationship between the quality of medical care in the mandatory medical insurance system (MMI) and control of the quality and safety of medical activity. Named a number of problems in this regard in public health practice, one of which is the absence in most of the medical organizations of the country internal control systems of quality and safety of medical activity. Asked to create one for the whole health of the Russian Federation the Order of evaluation of the quality and safety of medical care, regardless of whether this examination in a medical organization that is involved in the implementation of insurance programmes, or it is performed in a medical organization, in which the implementation of the programs of the MMI is not involved.
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2015 № 6 Organizational and methological activities of chief specialists of the Ministry of Health of the Moscow Region in current conditions
Organizational and methological activities of chief specialists (CS) is any creative practical, organizational and educational activity aimed at development and implementation of modern medical and organizational technologies into regional system of public healthcare, including diagnostics and treatment of patients, analysis of populational morbidity and mortality, organization of scientific events and various tasks within specific profiles and types of medical activity. A Coordination Council has been established for planning, supervision and assessment of efficiency of CS activities in the Moscow Region, with a special informational monitoring system being run.
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2015 № 5 Risk factor for mortality from cardiovascular diseases: the expert estimation doctors of various specialties
No statistically significant differences in the average score evaluation by physicians of different specialties of each indicator (p > 0,05 for each item). Average effect on mortality from cardiovascular diseases comorbid somatic pathology according to the doctors is 3,5±1,5, and more than a third of experts evaluated the contribution of comorbid somatic pathology in maximum 5 points. Average impact of comorbid psychopathology — 2,7±1,4; comorbid diseases caused by alcohol and drug use — 3,5±1,5; failure to doctor's recommendations — 4±1,3; ignorance of the major risk factors for the Ivory Coast, or the rejection of their correction — 3,8±1,4; ignorance of the main manifestations (symptoms) of life-threatening diseases or complications requiring first aid and emergency medical services — 3,9±1,4. Almost 50% of specialists have put the maximum score in the answers to the last two questions. Аccording to doctors at the level of regional mortality from BSK is strongly influenced by physical and mental comorbid pathology, ignorance of the risk factors, symptoms and methods of providing emergency assistance in the Ivory Coast.
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2015 № 4 Supply of general practitioners and their activity in different federal districts of the country in the period from 2007 to 2013 biennium
In the Russian Federation from 2007 to 2013 biennium. indicator of the availability of general practitioners has steadily increased. The most pronounced positive trend registered in the southern federal district (53,9%), the lowest-in the Siberian federal district (2,6%), along with the indicators of the medical and the coefficients of its rejection had considerable variability (maximum in the North Caucasus federal district: +40,6%, minimum-VLS: +14,6%) Also decreased the number of specialists, particularly in the Northwest and Vls, which contributed to the growth in health care ISSUES for the country as a whole, over the period from 2007 to 2013 biennium. was +31,4%. Increased proportion of patients and GPS at home, especially rural people. The overwhelming number of visits to doctors in that specialty was about diseases. This situation requires re-evaluation of the primary health care for the population in order to increase the availability of care provided by general practitioners, and the basis of the positive experience of a number of constituent entities of the Russian Federation.
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2015 № 4 List of vital and life critical drugs; meanings of the definition for specifying state guarantees for free drug medical aid
There is analysed an issue of specifing state guarantees for free medical aid provided to citizens within the standard medical aid system, clinical recommendations, lists of medications. State guaranteed free medications for citizens are those mentioned in the List of vital and life critical drugs.
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2015 № 3 New technologies for enhancing quality and accessibility of ambulatory medical aid
Healthcare Ministry of Moscow region initiated a contest among children's polyclinics. There were developed and adopted standards for children's polyclinics management, criteria for evaluation, time schedule for running the contest and membership of the committee. Chief executives of healthcare regulatory bodies were given an advancing timeframe, which allowed them to create comfortable conditions for providing medical aid services. The contest allowed to reduce queues to registration desk and the waiting time for a doctor's appointment, increase satisfaction rate with the quality of medical aid among the population.
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2015 № 3 Organization of prenatal diagnosis of congenital malformations and hereditary diseases in the Chelyabinsk region
In this article the topicality of detection of congenital malformations and hereditary diseases during pregnancy has been considered. The order and organization of prenatal diagnosis of congenital malformations have been shown in the Chelyabinsk region for the period 2007 to 2012. Changes in the organization of prenatal diagnosis of Chelyabinsk region in 2009 have been presented.
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2015 № 2 Work with citizen's applications in a medical organization as one of the mostimportant indicators of quality and safety of medical practice
The article presents the characteristics of modern features and challenges of working with citizens applications in a healthcare organization. Attention to the fact that this activity is often underestimated chief physicians. It is proved that work with citizens applications in a healthcare organization, being one of the most important indicators of the quality and safety of medical practice, requires allocation of this area in a separate section of the internal control quality and safety of medical practice.
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2015 № 2 Logistics research in healthcare management. The principles and implementation of road maps
Logistics research in the medical management is a modern approach to health management that combines the use of traditional management techniques (analytical, statistical, sociological and other) General economic, market and other modern methods, with modeling of processes and their possible outcomes. Implementation of the logistics research in the theory and practice of health management is especially important in the development and implementation of road maps in the period of formation of market economy and the associated transformation of the health system.
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2015 № 2 Conditions and accounting of factors affecting the level of provision of medical employees serving the public
Provision of healthcare system with medical employees personnel is conducted in accordance with demand in medical staff methodology. To clarify the indicators in different parts of the country it was suggested to factor housing and transport convenience conditions in regions. There are amendments developed to the established forecast capacity.
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2015 № 2 The characteristics of supplying junctions and military units stationed outside Russian Federation with medical property
It was carried out the analysis of the characteristics of supplying junctions and military units stationed outside the Russian Federation with medical property. There were made some proposals for the implementation of timely and uninterrupted supply with medical property military units performing tasks outside the Russian Federation.
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2015 № 1 Activity of the first medical aid center at the railway station
The analysis of legal status and practice of first-aid posts on railway stations has been performed. It was established that the incumbent functionality does not fully correspond to the order of primary care internal medicine. Proposed the concept of development of the legal status and activities of the first-aid posts as a provider of emergency medical care services on an outpatient basis and beyond the medical organization. The expected effects include decreasing of legal risks and improvement the quality of medical services.
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2014 № 10 Problems with providing specialized (rehabilitation) aid in medical organizations (Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia)
Annotation. The article is dedicated to the questions of potential and normative supply of medical-social rehabilitation in Russian Federation. It is demonstrated that, there is a tendency remained on decreasing the number of medical staff employees with higher and secondary education with rehabilitation majors as well as there is shown how accessibility of medical aid through Mandatory Health Insurance system is being limited. The main aspects of solving the problem include: profiling of hospital beds, managing the work of specialists according to a team work frame, their preparation for new basis modules.
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2014 № 10 National blood transfusion reporting features (National Pirogov Medical and Surgical Center, Moscow, Russia)
Existing indicators of statistical reporting on blood transfusions in the Russian hospital are invalid and suggest keeping mixed blood and blood components and are not subject to unequivocal interpretation. Scholastic use of the existing statistical indicators makes them practically unusable, and the impossibility of any analysis of transfusion therapy in Russian clinics.
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2014 № 9 Main morbidity trends of population of the Russian Federation in 2012–2013 (Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia)
There was conducted an analysis of dynamics of general and primary morbidity rates among Russian population in the period of 2012–2013 years. There was noticed an increase in the general morbidity rates of population in Russian Federation by 5,2% in 2013. The structure of general morbidity of population in Russian Federation hasn't changed significantly: the first place is taken by lung diseases, second — by diseases related to a blood circulation system, third — by diseases of a musculoskeletal system. The level of primary morbidity rates among the whole population of Russian Federation has increased by 0,8%. The structure of general morbidity among Russian population hasn't changed significantly: the first place is taken by lung diseases, second — by the injuries and intoxications, third — by diseases of genitourinary system.
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2014 № 9 Promising model of medical aid management on in Russian Federation (Ministry of Health Care of Novosibirsk region, Novosibirsk, Russia)
This article describes a promising model of medical insurance system implemented on the territory of Russian Federation. Its benefits and disadvantages were analyzed and there were given additional recommendations on reforming the system of healthcare.
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2014 № 9 Certain aspects of public-private partnerships in non governmental hospitals (Departmental Hospital station Astrakhan 1 corporation «Russian Railways», Astrakhan, Russia; Astrakhan Medical Academy, Astrakhan, Russia)
A model of treatment phase, considered in the future as an innovative form of institutional treatment of patients with neurological development of public-private partnership. Attempt to examine the feasibility of a public-private partnership in the Non-State Health Department. A systematic economic analysis of the functional activity of the innovation model phased treatment.
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2014 № 9 Algorithm of rehabilitation institution creation in Russia (Nizhegorodskaya medical academy, Nizhniy Novgorod, Russia)
Annotation. In this article the concept of rehabilitation institution creation is stated. The criteria for assessing of rehabilitation institutions activities are proposed. An algorithm of creation of rehabilitation centers in any subject of the Russian Federation is described. The question of rehabilitation financing possible sources in the Russian Federation is discussed.
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2014 № 8 Circulation of medical products: numerous problems regulatory or what chief doctor have to do. Part 2 (Saint Petersburg; Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)
In the article the characteristic of a number of issues in the sphere of medical products circulation: insufficient legislative regulation, absence of the system of training, lack of secure rights of a patient and, as a consequence, serious problems at the level of the medical organization. The authors offer concrete solutions as part of the normative regulation of the sphere of medical products circulation, and of the expanded operation algorithm at the level of medical organization in this area, namely those actions that must initiate the chief doctor.
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2014 № 8 A number of results of a survey conducted among the medical employees on self-regulating professional activity in the aim of improving health care (Ministry of health care of Moscow region, Krasnogorsk, Russia, MHMH Moscow region MONIKI after Vladimirskiy M.F., Moscow, Russia)
There were 15 323 people, among whom, 9048 physicians, and 6277 middle level medical staff members from Moscow region, that took part in the survey. They were asked questions aiming revelation of priority solutions to existing problems in the health care system. Obtained answers represent a foundation for creating a self-regulation system for medical employee's activities for making improvement in the health care of Moscow region.
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2014 № 8 Working hours expenses of doctors on an out-patient basis according to photochronometric researches (Federal research institute for health organization and informatics of ministry of health of the Russian Federation, Moscow, Russia)
For the implementation of the Russian Federation President Decree of May 7, 2012 № 598 «About improvement of a state policy in the health care sphere» and according to the Plan of measures on work rationing in health care of the Interdepartmental working group on the organization of rationing of work, development of professional standards and skill levels in the health care sphere, within 2 working weeks phototime observation over work of two experts — therapists of district police officers, pediatricians of district police officers, general practitioners, neurologists, otorhinolaryngologists, ophthalmologists and obstetricians-gynecologists in 17 pilot territories of the country is made. Results of research testify the need of improvement of normative documents on setting standards for the doctors rendering the out-patient help to the population towards increase in time for visit of one patient.
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2014 № 8 Work ethics of physicians, entering the labor force after internship training and clinical studies (Bashkirskiy State Medical University, Ufa, Russia)
There has been a survey conducted on work ethics of physicians, prepared in the system of postgraduate education towards their chosen profession and organization of professional activity. There were validated opinions of physicians on such topics as fulfilling their professional goals, perspectives of career growth in regards to migration and change of work place.
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2014 № 7 Rules and law regulations for the labor of general practitioner in Russian Federation (Federal research institute for health organization and informatics of ministry of health of the Russian Federation, Moscow, Russia)
The current regulatory framework in a grate measure ignores aspects of the labor of general practitioner, and does not ccorrespond modern requirements for primary health care. In consequence of that, possibility of a general practitioner, capable because of its approachability to the public and competence, cconsiderably attend both primary medical health care and emergency medical services, is used inefficiently. One of the main tools in solving this problem in the process of modernization of health care is the revision of regulations governing the labour of general practitioners and nurses with taking account of changed social conditions of society and the epidemiological situation, as well as a significant improvement of material and technical base of medical organizations and the new requirements to the organization of the diagnostic and treatment process.
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2014 № 7 Circulation of medical products: numerous problems regulatory or what chief doctor have to do. Part 1 (Saint Petersburg; Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)
In the article the characteristic of a number of issues in the sphere of medical products circulation: insufficient legislative regulation, absence of the system of training, lack of secure rights of a patient and, as a consequence, serious problems at the level of the medical organization. The authors offer concrete solutions as part of the normative regulation of the sphere of medical products circulation, and of the expanded operation algorithm at the level of medical organization in this area, namely those actions that must initiate the chief doctor.
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2014 № 7 The application of Balanced Scorecard for the evaluation of the medical organization (Samara State Medical University, Samara, Russia)
The article is devoted to questions of application of Balanced Scorecard for the evaluation of the medical organization. The result of the work is theoretical substantiation of causality prospects and compilation of the list of indicators for measuring the achievement of objectives within the system of balanced scorecard of outpatient organization. The article concludes on the need to develop methodological approaches to the development of strategic objectives in the framework of the system of balanced indicators.
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2014 № 7 Organizational and legal aspects of internal control of health and safety performance (Rostov State Medical University, Rostov-on-Don, Russia)
In the article the legal acts in the field of health in order to develop recommendations for establishing a system of internal control quality and safety of medical practice at the level of medical organization.
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2014 № 6 Process approach - innovative technology of organization of medical examinations (FSBI <Central scientific research institute of the organization and information of public health services Ministry of HealthCare of the Russian Federation>, Moscow, Russia; Higher School of Economics, Moscow, Russia; Medical-sanitary health clinic, Astrakhan, Russia)
The article describes algorithms and results of integration of process approach for medical examinations.
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2014 № 6 Problems of evaluation and interpretation of indicators of morbidity, morality and disability from diseases of the circulatory system (Federal State Budgetary Institution <State Research Center for Preventive Medicine under the Ministry of Health of the Russian Federation>, Moscow, Russia; South Ural State Medical University under the Ministry of Health of the Russian Federation, Chelyabinsk, Russia)
The article examines the differences in the approaches to their assessment of morbidity, mortality and disability caused by diseases of the circulatory system (SBR). On mortality from BSK affect coding errors and selecting the cause of death, the lowest frequency of autopsies on the background of high mortality outside hospitals. Indicators of overall morbidity due to peculiarities of the collection of statistical information is significantly more than the population , while the actual number of sick people is unknown. On disability rates have a significant impact not only and not so much the degree of violation of physical state as psychological characteristics and evaluation of subjective perception of disease by patients and physicians; social factors, regulatory documents. These factors lead to the problems of comparing mortality, morbidity and disability between the Russian Federation and other countries, and between regions of the Russian Federation, the complexity of the information support for management decision-making in health and health care organization.
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2014 № 6 Special aspects of national nomenclature of medical devices (FSFI <VNIIIMT> Federal Compliance Service the sphere of healthcare, Moscow, Russia)
In the article there are considered main core definitions of nomenclature and principals of its development, as well as its nationalpeculiarities. There has been evaluated the practicability of Russia's participation in the project of World Nomenclature Medical Devices Agency GMDN and in the project on creating a system of devices unique identification (Unique Device Identifier).
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2014 № 6 Measures to prevent the entry of substandard and counterfeit medicines in medical organizations (Center for Quality Assurance and Certification of drugs <Trans-Baikal Territory, Chita, Russia; Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)
The article presents practical approaches to implementation of individual measures on the safety of medicines in the medical organization. Shows the organizational technology to prevent receipt of substandard and counterfeit medicines in medical organization.
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2014 № 6 Voluntary informed consent to medical intervention (Novosibirsk College of Medicine, Novosibirsk, Russia)
Article is devoted to the problem of obtaining voluntary informed consent to medical intervention, especially obtaining consent to medical interventions in medical emergencies.
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2014 № 4 Comparison of mortality indexes in subjects of Russian Federation: role of population's age structure (State scientific-research center of preventive medicine of Ministry of health care of Russia, Moscow, Russia)
Significant geographical discrepancies in mortality indexes are stipulated by many factors (social-economical, climate, efficiency of functioning and amount of health care system funding, sex-age structure of population). In this article there is studied the role and significance of age structure of population in regards of regional mortality indexes. There is presented a hypothesis that neither factual nor standardized mortality indexes do not represent solid criteria for monitoring and valuating the health care efficiency programs.
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2014 № 4 Current rules and law regulations for the labor of ophthalmologist (Federal research institute for health organization and informatics of ministry of health of the Russian Federation, Moscow, Russia)
Existing normative base does not correspond with modern requirements on providing specialized medical aid and is in need of re-consideration. One of the main instruments for achieving this objective in the process of health care modernization is objectivation of physician's work norms and of the middle-level medical staff with the regards of changed social life conditions of the society and epidemiological situation, as well as significant improvement of material-technical base of medical organizations and new requirements towards organization of aid-diagnostics process. Modernization of medical organizations, implementing innovative methods of diagnostics, suggesting high qualification of specialists along with understaffing of personnel set, and the growth of pressure on physician, require re-consideration of existing normatives.
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2014 № 4 Several questions of normative regulation of organizing intensive care in medical institutions (Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)
The review presents options for organization of chambers of resuscitation and intensive therapy in advanced profile orders of rendering medical assistance to adult population.
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2014 № 2 Corruption in a medical organization: mechanisms to counter (Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)
In article are considered questions of the organization of work in counteraction to corruption in a medical organization. The authors analyze the existing difficulties in solving this problem and suggest ways to overcome them. The article stressed that anti-corruption measures in medical organizations must not only be independent direction in the work of its leadership, but also the most important component of the internal control system of quality and safety of medical activity.
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2014 № 2 Methodical aspects of the analysis of medical workers' labor productivity (SBEI HVT «Altay State Medical University» of the Ministry of Health of Russian Federation, Barnaul, Russia)
Annotation: The theoretical ideas and methodological approaches to substantiation labor productivity indicators have been reviewed, developing the system of labor productivity indicators in public health services. The technique of the analysis of labor productivity in public health services is offered.
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2014 № 1 Some methodological approaches to organization of medical care in municipal medical institutions in the Compulsory Health Insurance system (Samara State Medical University, Samara, Russia; Ryazan State I.V. Pavlov Medical University, Ryazan, Russia).
Аnnotation. Organization of medical care in health care facilities in rural municipalities require special approaches to the implementation of medical standards, exploit opportunities of inter-municipal centers and optimization of payment methods of medical care.
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2014 № 1 Improving the process of documentary support of hospitalization via emergency medical care (Federal Research Institute for Health Care Organization and Information of the Ministry of Health and Social Development of Russian Federation, Moscow, Russia)
Annotation. Proposes to amend the current form number 114/y «An accompanying sheet of Emergency Ambulance Station» and abandon coupon of. Exchange of information to monitor quality of medical care is offered to produce using a new form of notification about identified defects medical care before hospitalization.
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2014 № 1 The problem targeted use of funds CHI (Ltd. CDC «The Dobryi Doctor», Altayskiy State Medical University; ANO «Medicine and Law» NP «Medstandart», Barnaul, Russia; Federal Research Institute for Health Care Organization and Information of the Ministry of Health and Social Development of Russian Federation, Moscow, Russia)
Annotation. Transition to a single channel funding, a variety of legal forms of medical organizations involved in the delivery of medical care within the compulsory health insurance, expanding the powers of state ( municipal) institutions, etc. raise the question of the need to reform the rights of medical organizations independent of funds. The article examines the legality of preserving the concept of «improper use of funds» in the current conditions and appropriate sanctions.
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2013 № 12 Some problems of implementation of the Federal law of the Russian Federation dated November 21, 2011 № 323-FZ «On fundamentals of protection of the health of citizens in the Russian Federation » (Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)
Annotation. The article proves the necessity to introduce amendments to the Federal law of the Russian Federation dated November 21, 2011 № 323-FZ «On fundamentals of protection of the health of citizens in the Russian Federation». These amendments relate both to clarify used in the law of the conceptual apparatus and concretization of the mechanisms for the implementation of patients rights in receiving medical care.
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2013 № 12 Social-demographic processes and health care (Federal state budgetary establishment of a science Institute for socio-economic studies population RAS, (ISESP RAS), Moscow, Russia)
Questions of a social inequality concerning health are considered. The importance of problems of maintenance in the Russian Federation validity of a financial payment on public health services is discussed. It is offered to fix legislatively principles of formation of a ratio of the basic parameters of the State expenditure on public health services depending on public revenues at federal, regional levels.
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2013 № 12 New criteria of Birth: medical and demographical outcomes and organizational problems of obstetric services (Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia)
Annotation. The paper defines the characteristics of the obstetric services organization in modern conditions. In April 2012, Russia introduced new birth criteria — birth weight 500 grams and 22 weeks of gestation. According to this criteria termination of pregnancy at 22–27 weeks of gestation that used to be termed as «late abortion» before 2011 should be considered and registered as extremely premature birth starting April 2012. This reform has been accompanied by reorganization of outcomes of registered pregnancies — births and abortions as well as the number of births and deaths by body weight.
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2013 № 12 The analysis of regional features of mortality from diseases of system of blood circulation for an assessment of efficiency of programs of health care (Research Institute for Complex Problems of Cardiovascular Diseases, SB RAMS, Kemerovo, Russia)
Annotation. Analysis results of mortality of the population of the Kemerovo region are given in article from diseases of system of blood circulation and its two main forms: coronary heart disease and cerebrovascular diseases in the period of 2000–2011. For the purpose of separation of regional features the assessment of probability of death by calculation of the odds ratio and creation of their trends was carried out. Results of research testify that implementation of regional and federal programs on lowering of mortality from diseases of system of blood circulation allowed to achieve certain successes in improving of a demographic situation in Kuzbass. It concerns first of rates of mortality from diseases of system of blood circulation as a whole and from coronary heart disease.
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2013 № 12 Pecularities of National Rules of blood transfusion (National medical and surgical center after N.I.Pirogov, Moscow, Russia)
There has been evaluated a correspondance of Rules on usage of donor blood in clinic needs and/or its components with International standards, experience of other developed countries and Russian health care practice. It has been shown that Rules lack information on reaching national consensus opinion, the data on level of conclusiveness of several Rules with indication of publication source (as it is conducted in other developed countries). There has been noted a necessity in completing a serious correction of the Rules.
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2013 № 12 Input normal of execution of state (municipal) assignment as an instrument of financial effectiveness rise (Krasnoyarsk City Administration, Russia).
In the corresponding budget of the Russian Federation budget system there provided appropriation for execution of the assignment. The appropriation are allocated to institution as a subsidy for compensation of normative inputs connected with providing of state (municipal) services (caring out work) and maintenance of property. To determine proper value of subsidy for the fiscal year in turn it is necessary to rate the normals. In the article there considered the methods for determination of normative inputs of providing of state (municipal) services (caring out work) and normative inputs of property maintenance, there given practical examples.
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2013 № 11 Effective ways to pay for health care of the government guarantee program (Federal Public Health Institute for Health Care Organization and Information of the Ministry of Public Health of Russian Federation, Moscow, Russia)
Annotation: The question which discussed in this article are evidence-based selection impeding effective ways to pay for health care provided by health care organizations within the regional programs of state guarantees of free medical care under different conditions of its provision. Recommendations on the use of existing materials for development of a methodology for calculating tariffs on effective methods of payment for medical care, resultoriented activities of the medical organization are given.
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2013 № 11 Efficiency of centralization of city medical institutions laboratories based on clinical diagnostic laboratory of large multi-discipline hospital (Kazan State Medical University, Kazan, Russia; GAUZ RT «Hospital of first medical aid» NaberejniyChelni, Russia)
There is processed a statistics-economic analysis of consequences of centralizing laboratory services. In order to complete it, there was finalized an analysis study of clinic-diagnostics laboratory work flow in the period of 2010–2013 years. It was proven a financial efficiency of laboratory services centralization.
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2013 № 11 Methodology of calculating industrial registration indicators, diagnostics and efficiency of medical treatment for patients suffering from tuberculosis (Federal Public Health Institute for Health Care Organization and Information of the Ministry of Public Health of Russian Federation, Moscow, Russia)
There are announced the principal mechanisms affecting the size of registration indicators, diagnostics and treatment efficiency for patients suffering from tuberculosis. There are presented the consequences of a number of management solutions.
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2013 № 10 Demand of Russian Federation in medical human resources (Ministry of health care of Russian Federation, Moscow, Russia; Federal Research Institute for Health Organization and Informatics of Ministry of Health Development of the Russian Federation, Moscow, Russia)
Annotation: In the article there are presented results of defining demands of Russian Federation in medical human resources. Base for calculating the number of specialists was volumes of aid set in each subject of Russian Federation while realizing territorial program of state guarantees on provision of medical aid with consideration of age-specific indicators of analogue state guarantees federal program, regional specifics and level of population's morbidity in subjects of Russian Federation. Besides that, methodology called «Calculation of demands of Russian Federation in medical human resources», developed in Federal State Entity of «Central SRI of Organization and Informatization of Health Care», considered territorial specifics of subjects of Russian Federation, — location of the subject in Far North areas and equivalent to the, density of population, proportion of the rural population. With that there were used reducing the pressure coefficients on physicians positions. In the article there is a comparison of actual number of main professions in 2012 year and revised regulatory normative of physicians numbers in 2013–2014 years (per 10 thousand capita), as well as there is described а deviationof normative number of physicians from its actual number (deficit/surplus of physicians) for the main professions.
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2013 № 10 Regarding the right of a patient or his official legal representatives to demand a consultation of physicians-specialists (Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia).
Annotation. Authors refer the right of a patient or his official legal representatives to demand a consultation of physicians-specialists to the group of hardest to establish rights in the health care system of Russian Federation. In the article there is given a detailed description of problems, related to implementing this right. As a proposal directed on complying the appointed law, there is suggested a mandatory development of internal document in every medical entity, regulating the procedure of processing patient's consultations. There are given concrete recommendations on what content has to be reflected in the regulation of the procedure of organizing and conducting consultations in medical organizations.
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2013 № 10 Modeling outcomes in the management of health care quality (Самарский государственный медицинский университет, г. Самара, Россия)
Outcome model as a method of assessing the quality management system of care includes indicators of performance, regulatory parameters and values of the scale for assessing performance. Creating a system of evaluation of health care institutions on the basis of the formation of the final results of models used for the analysis of all the organizations, including outpatient and inpatient. Using the principle of constructing a model of the final results of the activities of the hospital, in many settings in the Samara region developed system of quality assessment of each employee, the results of which are used for a differentiated approach to remuneration.
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2013 № 10 Aspects of organizing medical aid services for rehabilitation in practical health care (Federal Research Institute for Health Organization and Informaticsof Ministry of Health Development of the Russian Federation, Moscow, Russia)
Annotation. In the article there is an analysis of objectives, main streams and events directed onto developing medical rehabilitation in the system of health care of Russian Federation. There is considered a number of actual questions regarding organization of medical rehabilitation, its stage-by-stage approach, specifics and opportunities of rehabilitation tactics in conditions of outpatient and hospital health care entities.
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2013 № 10 The analysis of indicators of activity of establishments of social service of citizens of advanced age in the Russian Federation (Federal Research Institute for Health Organization and Informatics of Ministry of Health Development of the Russian Federation, Moscow, Russia)
The demographic situation in Russia is characterized by a dynamic increase in the proportion of elderly, which requires the improvement of integrated health and social care with more active participation of the social sector and to attract non-state institutions. Social care the elderly, the disabled, is an activity to meet the needs of social services. Social service includes the collection of social services provided to citizens and the disabled elderly at home or in social service institutions, regardless of ownership. In article the analysis of the basic indicators of activity of establishments of the state (municipal) system of social service of citizens of advanced age and invalids in the Russian Federation for last 13 years (stationary establishments of social service, branch of social service at home, the centers of social service), the standard documents regulating their work is presented.
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2013 № 9 Regarding several problems with evaluating salary income of medical employees (Samara State Medical University, Samara, Russia; TFOMS of Ryazan region, Ryazan, Russia)
In 2013 it is planned to significantly increase amount of salary pays for medical employees. At the same time, there are a number of questions which are not resolved yet which relate to analysis of labor compensation in medical entities, as well as formation of payroll funds and salaries.
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2013 № 9 Investment strategy to economic efficacy assessment of medical intervention (coronary artery bypass graft surgery) (Almazov Federal Heart, Blood and Endocrinology Centre, Saint-Petersburg State University of Service and Economics, Saint-Petersburg, Russia)
The studies of investment strategy as one of the methods of economic efficacy assessment of high-tech medical care (coronary artery bypass surgery, CABG), when medical care is considered to be an investment project (capital investment — is a high-tech medical care at the cost of R — into patient quality of life improvement) made possible future treatment cost reduction. The research has shown, that CABG is not only high clinical, but also cost effective economic medical intervention. Parameters of investment project efficacy were used to assess medical care cost-effectiveness. The result correlates with medical care value and patient life expectancy.
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2013 № 9 From the principle of pay for the result-oriented work to the effective contract with MONIKI (Moscow Regional Clinical and Research Institute n.a. M.F. Vladimirsky (MONIKI), Moscow, Russia)
An unceasing work is being carried out in MONIKI on studying different principles of pay for work depending on the qualitative and quantitative parameters of working results which are reflected in the labor (effective) contract of the employee. The closest direct connection between the basic and stimulating salaries of the hospital physicians and sisters was established using index which characterizes satisfaction of patients with treatment process, introduction of contemporary diagnostic and therapeutic methods into medical practice, and operative activity of surgeons. The strongest feed-back was revealed between medical staff salaries and postoperative complications, patients' complaints, penalty sanctions, and the mean duration of hospital treatment.
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2013 № 9 National and regional assessment of the use of diagnostic resources in the Russian Federation (Moscow, Russia)
The article examines the use of magnetic resonance imaging, nuclear diagnostic, endoscopic and functional diagnostics in public healthcare in Russia. Differences in availability of MRI diagnostic equipment, PET, gastroscopy, colonoscopy, Holter monitoring of ECG and blood pressure equipment among Russian region are discussed. Differences in the number of diagnostic tests performed (including difference in per capita numbers), and a significant difference in operating efficiency are observed and discussed.
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2013 № 8 Dynamics of morbidity with a temporary disability in Russian Federation in 2007–2011 years (Federal Research Institute for Health Organization and Informatics of Ministry of Health Development of the Russian Federation, Moscow
Annotation: In the article there is presented an analysis of cases when there is obtained a disability in different categories of diseases within the past 5 year old period dated from 2007 till 2011 years among men and women. Study of dynamics of this indicator has revealed that there has been noticed an increase of disease cases among men obtaining disability and with women the number of cases when disability was obtained remained almost the same. There is presented a structure of diseases causing temporary disability and analysis of indicator dynamics in all classes and particular groups of diseases in the sex cut. There is evidence of importance of studying diseases causing temporary disability, especially taking in account predicted temporary decrease of number of cases and days of temporary disability in 2018 and 2019 years (compared to 2017 year) due to the unfavorable demographic situation forecast.
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2013 № 8 Regional differences in the utilization of CT in the goverment health care sector of Russia (Moscow, Russia)
Investigated availability and utilization of CT services in the public healthcare system in Russia. Presented differences in availability of diagnostic equipment in Russian regions. Identified inequality among regions in the volumes of carried CT exams, CT exams per 10000 population as well as a significant difference in technical efficiency of equipment utilization. Presented differences in key performance indicators of CT service between Russia and OECD countries.
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2013 № 8 Features of the national remuneration for blood donation (Pirogov National Medical Surgical Center, Moscow, Russia)
Order of the Ministry of Health of Russia from 17.12.2012 № 1069n «About approval of the cases in which the possibility of putting blood and (or) its components for a fee, and the amount of such fee» requires to create the paid blood donors group based on the extended red blood cell phenotyping and to identify evidencebased clinical use of the regulated phenotypes blood. Необходимо to provide for the expenses in the budget of the blood service and to amend the technical regulation on blood safety, the instructions for use of blood components, standards of medical care, standard for the labelling of blood and exemplary staff of the organization.
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2013 № 8 Method of defining demands of adult population in medical rehabilitation (FSHM «Russian scientific center of medical rehabilitation and spa treatment» Ministry of Health Care of Russian Federation, Moscow, Russia; Federal Research Institute for Health Organization and Informatics of Ministry of Health Development of the Russian Federation, Moscow)
Annotation: Method of defining demands of adult population in medical rehabilitation is based on data concerning population's morbidity, generally in accordance to diseases classes as well as on few particular diseases. The basis of defining method for demand in medical rehabilitation was formed by indications and contraindications to its processing in outpatient and inpatient conditions. The development of medical organizations network, which provides aid for medical rehabilitation has to correspond with the real demand of the population. The following methodical recommendations permit to make a judgment regarding demands of concrete region in medical rehabilitation after processing the described calculations.
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2013 № 8 Development of related services while organizing sanatorium — resort aid to population (on the basis of OJSC «Sanatorium of Russia») (Altay State Medical University, Barnaul, Russia; «Sanatorium Russia», Belokuriha, Russia)
Annotation: In the article there are considered questions related to demand of population in sanatorium resort services due to problems of «men's health». There is developed a complex of medical services directed towards solving this problem.
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2013 № 7 Will the raker fly past? Across-the-board standard medical examination: declaration and reality (Samara State Medical University, Samara, Russia; TFOMS Ryazan region, Ryazan, Russia).
In 2013 there has been started a across-the-board standard medical examination of population of Russian Federation which forced to solve a number of problems, part of which existed in other previous campaigns, therefore, it is important to consider their experience and results. First of all, it is necessary to avoid quantitate evaluation of the standard medical examination, and pay more attention towards long-term research on impact of standard medical examination on the health state of population. At the same time, the standard medical examination shouldn't affect the affordability of medical aid for ill people, applying to medical organizations.
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2013 № 7 The problems of realization of the patient rights for the choice of doctor and the ways of its solution in the medical organization (Saint-Petersburg, Irkutsk, Russia)
The article considers the issues related to the implementation of the rights of the patient to choose a doctor. The authors emphasize that the need for compliance with the law in the medical organization requires the development and adoption of the relevant internal document regulating the procedure of choice of doctor it is in this medical organization. The article provides specific recommendations as to what should be reflected in the procedure of choice of doctor in the medical organization.
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2013 № 6 The medical insurance organizations control of the inpatient health care conditions for the insured persons in Saint-Petersburg (The Regional medical insurance fund of Saint-Petersburg, Saint-Petersburg, Russia)
The article presents the results of analysis of current health legislation, which establishes the control obligations for medical insurance organizations.
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2013 № 6 The problems of payment for medical care provided to the citizens of the Republic of Belarus, temporarily residing in the Russian Federation (The Regional medical insurance fund of Saint-Petersburg, Saint-Petersburg, Russia)
Delivery and payment of medical assistance to the citizens of the Republic of Belarus in the framework of the Agreement between the Russian Federation and the Republic of Belarus «On equal rights of citizens» is important for Russia. The paper examines existing at the moment the problem and suggests ways to address them in accordance with applicable law and the authority of government.
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2013 № 6 Results of expert activities of insurance medical organizations in Saint-petersburg in 2012 (The Regional medical insurance fund of Saint-Petersburg, Saint-Petersburg, Russia)
This article presents the analysis of the activities of medical insurance companies for medico-economic expertise and expertise of the quality of medical care, including data on detection of medical care's defects and application of financial sanctions on the results of 2012 year, compared with 2011.
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2013 № 6 Models of the optimal distribution of the planned volume of financial means in the sphere of compulsory health insurance of Saint-Petersburg (The territorial compulsory health insurance fund of Saint-Petersburg, Saint-Petersburg, Russia)
The article deals with the mathematic modeling of distribution of the planned volume of financial means in the compulsory health insurance and the results of modeling.
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2013 № 6 Regarding experience of organizing issue of obligatory health insurance policies in multifunctional centers of public services of Saint-Petersburg (The Regional medical insurance fund of Saint-Petersburg, Saint-Petersburg, Russia)
In this article we discussed the experience of organization of issue policies of compulsory health insurance in the multifunctional centers of public services of Saint-Petersburg. Considered are the main organizational activities carried out to ensure the possibility of obtaining the policies of compulsory health insurance in multifunctional centers.
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2013 № 6 Creation of conditions of optimization of the economic accessibility of medical care in the obligatory medical insurance system in St. Petersburg 2012 (The Regional medical insurance fund of Saint-Petersburg, Saint-Petersburg, Russia)
One of the most important problems of obligatory health insurance system is the restriction of availability of medical assistance. The article presents ways of the decision of this problem in Saint-Petersburg.
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2013 № 3 Efficient contract in health care: opportunities and risks (Central Research Institute for Health Organization and Informatization, Ministry of Healthcare, Moscow, Russia)
Article is dedicated to problems of implementing efficient contract into health care. Currently, there are created descent conditions for implementing efficient contract into health care, what provides circumstances for its future successful realization. But, on the other hand, there is required a flexible policy not only towards terms, included in labor contracts with employees but towards the process of implementing efficient contract itself. Especially, when health care is characterized by great diversity: not everywhere the same approaches for stimulation are acceptable and reasonable. In the article there is given an analysis of opportunities and threats, related to implementing efficient contract, there are suggested measures countering these threats.
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2013 № 3 Fundholding: overview in a quarter of century (Samara State Medical University, Russia; TFOMS Ryazan region, Russia)
Reforming the system of mandatory medical assurance in Russia is impossible without implementing modern methods of medical services expenses coverage. Herewith it is important to consider all positive and negative aspects of various methods with regards of concrete situation examples. In the article there is investigated the introduction of per capita funding with elements of fundholding in Samara region together with the analysis of existing risks from the historic angle.
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2013 № 3 Calculation of expenses for performance of medical service on the basis of resource model (Medical centre for information and analysis of Russian academy of medical sciences, Moscow, Russia; I.M. Sechenov First Moscow state medical university, Moscow, Russia)
The design procedure of standard expenses for performance of the medical service, developed according to new rules of obligatory medical insurance is described. Basic formulas of calculation of expenses on the basis of resource model of medical service are resulted. The basic problems connected with identification and classification of resources are listed.
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2013 № 3 Improving of organizational and economic management mechanism of blood transfusion services (Moscow State University M.V. Lomonosov, Russia)
The article discusses the organizational and economic mechanism of management in blood transfusion services in Russia and abroad, problems of national blood services are highlighted, in particular the problem of donor movement and production of blood products, and recommendations for improving the effectiveness of the service are given.
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2013 № 3 The theoretical aspects of the sanitary-epidemiological expertise (Federal State Unitary Enterprise «Scientific-Research Institute of Hygiene, Occupational Pathology and Human Ecology» Federal Medical-Biological Agency, Sankt-Peterburg, Russia; State Educational Establishment for High Professional Training «North-West state medical University named after I.I. Mechnikov» of Ministry for Public Health of the Russian Federation, Sankt-Peterburg, Russia)
In this paper, a philological, semantic and legal analysis of terminology is performed forming the basis of sanitary-epidemiological expertise. The influence of linguistic and semantic content of texts on the rules of professional conduct is considered. The definitions of object of sanitary-epidemiological examination survey are presented, the meaning of terms: opinion, judgment, evaluation, inference, conclusion are considered. The action algorithm of sanitary-epidemiological expertise expert is considered.
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2013 № 2 Transformation problems of existing labor payment system in aim of implementing efficient contract into the health care (Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia)
The article is dedicated to problems of implementing efficient contract into the health care. Despite the presence of definite normative base, all necessary conditions for implementing efficient contract are not yet created. Moreover, approved and planned for approval normative acts do not consider a number of important issues, related to efficiency of material stimulation measures in such specific field as health care. Therefore, this article is dedicated to its analysis, as well as proposals for increase of productivity while implementing efficient contract in the field.
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2013 № 2 А new system of control of quality and safety of medical care in public health system of the Russian Federation (Sankt-Peterburg, Russia; Irkutsk, Russia)
The questions relating to the formation of a new system of quality and safety of medical care in the context of the provisions of the Federal Law. The authors note that it needs further legislative drop-ment term safety of medical practice. Offers strategic and operational scenario of gradual formation of quality control and safety of medical care. Specific recommendations managers of medical organization to develop internal documents of the internal control quality and safety of medical care.
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2013 № 2 Defining the need in hospital beds in Ryazan region (TFOMS Ryazan region, Ryazan; Russia, Samara State University, Samara, Russia)
Annotation. Modernization of health care on regional level provides deployment of optimal amount of hospital beds, corresponding to real needs of population. With the help of differentiated normatives on provision of hospital beds (V.I. Starodubov and co-authors, 2011) there is calculated a need in 24/hour stationary beds in Ryazan region.
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2013 № 2 State assignments on providing high-technological medical care: sectoral and regional aspects (Non-State Entity of Health care «Medical-health department», Astrahan, Russia)
Annotation. In the article there is presented data received while processing statistic analysis of state assignments for providing high-technological medical care in Russia. Structure indicators are counted for federal medical entities, taking part in fulfillment of state assignments as well as for various of its groups. There are distinguished main trends in the structure of state assignments. It is shown that analysis should be processed in territory aspect, according to types of medical entities and to cost level.
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2013 № 2 Evaluation of the economic efficiency of building workforce disabled after coronary bypass surgery (based approach «cost-benefit of loss») («Chelyabinsk State Medical Academy» of Federal Agency for Healthcare and Social Development the Russian Federation, Chelyabinsk, Russia)
The research is based on the analysis of the register of patients operated on for CHD in the period 2000–2009 in Chelyabinsk interregional cardiac center on the basis of the Chelyabinsk Regional Clinical Hospital. The present article is concerned with estimation of the potential loss of employment due to disability of patients after coronary bypass surgery. Purpose — the calculation of economic damage from the underproduction of the gross regional product of the Chelyabinsk region in case of disability of the patients with coronary artery disease after coronary bypass surgery. These results allowed us to estimate lost profits for the disabled after coronary artery bypass grafting in total economic loss.
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2013 № 1 To a question of rehabilitation system model creation in the Volga Federal District (Nizhegorodskaya medical academy, Nizhniy Novgorod, Russia)
Annotation: In this article the concept of rehabilitation system model creation in the Volga Federal District is stated. Results of calculation of requirement for the stationary rehabilitation help, the analysis of possibilities of the existing PFO rehabilitation institutions are given, options of real creation of system of rehabilitation in the Volga Federal District are considered. For ensuring development of rehabilitation establishments of the region expediency of formation of the centralized investment fund is defined. The optimum form of government investment fund, according to the author, is the management company. The scheme of functioning of management company is offered at creation of system of rehabilitation in PFO. Advantages of a new control system are analyzed by rehabilitation establishments. Important advantage of the Project is its representativeness.
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2013 № 1 Utilitarian analysis of the health care effectiveness in the group of patients with disabilities after coronary bypass surgery («Chelyabinsk State Medical Academy» of Federal Agency for Healthcare and Social Development the Russian Federation, Chelyabinsk, Russia)
Summary. The research is based on the analysis of the register of patients operated on for CHD in the period 2000–2009 in Chelyabinsk interregional cardiac center on the basis of the Chelyabinsk Regional Clinical Hospital. Utilitarian analysis of cardiac surgery may play a crucial role in making organizational, clinical and financial decisions. The purpose — to carry out clinical and economic analysis with the use of the utility index («utility») DALY's (disability adjusted life years) in patients with coronary artery disease after coronary bypass surgery. The result — the values obtained allowed to conclude that a decrease in the degree of disability potentially duration of the life quality increases.
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2013 № 1 Regarding the question of informational volunteer agreement in circumstances of kids infection hospital (SCBOE VPO VolgGMU, SGBEH «Volgograd regional Children's Clinic Infection Hospital», Volgograd, Russia)
In the article there is investigated the current state of question concerning informational agreement on diagnostics and treatment manipulations among minor children affected by infectious diseases. There is presented a reading of this question from the point of last edition of Russian law dated from 21st of November 2011 № 323-FL «Regarding basics of health care protection of citizens of Russian Federation», there are considered discrepancies, appearing while practical implementation in the clinic of children's infectious diseases. There are presented approach examples on resolving questions about informational agreement among minor children in several developed foreign countries.