Manager Zdravoochranenia 2020 #9

Published: 2020-08-03



    Focus of the problem
  • On the implementation of certain “medical” amendments to the constitution of the Russian Federation

    The article suggests legislative implementation of certain “medical” amendments to the Constitution of the
    Russian Federation. The authors propose to add two articles to the Federal law “on the basics of public health protection in the Russian Federation” dated 21.11.2011 N323-FZ. In one article, it is proposed to reveal and specify the
    content of the newly introduced in the Constitution of the Russian Federation concept “unified legal bases of the health
    care system”. Another proposed article reveals the forms and content of work on the coordination of health issues,
    again referred by the Constitution of the Russian Federation to the joint responsibility of the Russian Federation and the
    subjects of the Russian Federation. According to the authors, the proposed changes in legislation will allow to ensure
    in practice the proper implementation of “medical” amendments to the Constitution of the Russian Federation, which in
    turn will ensure the improvement of legal regulation of the organization and activities of health care, and strengthen its
    material and technical base.

    Authors: Piven D. V. [59] Kitsul I. S. [59] Ivanov I. V. [30]

    Tags: accessibility and quality of medical care1 coordination of health issues1 health care24 joint management1 legislation4 powers in the field of health protection1 public health protection1 quality and safety of medical activities9 unified legal framework of the health system1

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  • Management in health care
  • 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%.

    Authors: R.  S. Gadzhiev [1] L.  S. Agalarova [1]

    Tags: department head1 expert assessment2 information support1 labor organization.3 organizational experiment1 quality of medical care21

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  • 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

    Authors: A.  V. Danilov [1]

    Tags: expansion of function of quality1 measurement of satisfaction1 medical organization52

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  • 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.

    Authors: Yu. A. Ulyanov [1] E.  M. Zaripova [1] E.  N. Mingazova [1]

    Tags: 4p medicine3 client-centeredness1 development trend1 patient-centered medicine3 satisfaction with medical care3

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  • 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.

    Authors: Polyakova Yu. V. [3] Solovyova I. N. [2] Cherkasov G. E. [1] Trekova N. A [1]

    Tags: blood saving1 blood saving efficiency1 interdisciplinary problem1 surgical blood saving1 transfusion blood saving1

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  • 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.

    Authors: Koss V. V. [2] Elizarov M. V. [1] Leonov D. Yu [1]

    Tags: gerontologist’s practice1 gerontology2 neurological service1

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  • 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.

    Authors: Zhiburt E. B. [15] Kuznetsov S. I. [6] Kudinova E. V. [2]

    Tags: apheresis4 blood8 blood collection5 blood service5 blood transfusion10 covid-1928 pandemic8 platelets5 pooling4

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  • Information management
  • Distributed ledger technology in patient experience management

    Actuality. The role of “patient experience” in assessing quality of medical services is growing as a global trend to value-based healthcare. Currently, only 11% of the Russian population positively assess the quality of medical services. Federal law
    No. 256-FZ requires all public healthcare providers to conduct an independent assessment of the provision of services, but 44% of
    organizations do not have such assessment, that can be caused by methodological and organizational reasons.
    Purpose of the study to evaluate the prospects for digital improvement of measuring patient satisfaction using distributed ledger
    technology. To analyze the literature on the topic of independent assessment of the quality of services provided by medical organizations; to analyze modern approaches to assessing patient satisfaction with healthcare providers; to assess the opportunities of improving the processes and results of satisfaction assessment using distributed ledger technology.
    Materials and methods. To achieve the purpose, the authors analyzed numerous relevant Russian and foreign sources of literature. Literature review was carried out across scientific libraries as eLIBRARY, PubMed by key words. The search in open sources in
    Google and Yandex was used.
    Results. The complexity of “patient experience” measurement, biased assessment, ambiguity of the results obtained and the difficulty of correct interpretation require more transparent methods of measuring the value of healthcare. A decentralized platform based on distributed ledge technology may become one of the possible solutions to the problem of objective assessment of patients ‘ satisfaction with the quality of medical services. Such approach allows to form an objective dynamic multi-factor rating of processes and all other components of healthcare services.
    Conclusion. The existing mechanisms for independent assessment of the quality of medical services need to be improved. Confidence in the results of the patient satisfaction measurement is one of core requirement. To make managerial decision evidence-based, it is important to evaluate the processes and patient experience along with results of healthcare services. Distributed ledger technology implemented as a dynamic multi-factor rating platform can be a logical solution for improving the quality of services and could become a part of a comprehensive IT ecosystem based on value-based approach.

    Authors: Yu. А. Zuenkova [1] A.  M. Khavtorin [1]

    Tags: blockchain2 distributed ledger technology1 lean  management4 patient experience2 quality of healthcare service1 value-based healthcare3

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  • Regional medical information systems in the field of healthcare: directions of development and legal problems

    The article analyzes the development trends of regional medical information systems in the field of health care.
    The authors pay special attention to the peculiarities of the development of regional medical systems, identify individual
    and general problems of these systems, and finally draw conclusions about the ongoing development of the legal framework of the Russian Federation in the field of e-health, and as a solution to the identified problems, they propose to form
    unified rules at the federal level containing general principles and provisions on regional medical information systems,
    including the electronic health records.

    Authors: Akulin I. M. [6] Chesnokova E. A. [5] Presnyakov R. A. [5] Guryanova N. E. [6] Pryadko A. E. 3 [1] Zimina E. I. [2]

    Tags: electronic health records1 legal problems of e-health1 regional medical information systems1 unified health care system1

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  • Social aspects of health
  • Value orientations of the doctor as predictor of efficiency of activity of the medical organization

    The article presents the results of an empirical study of the value orientations of dental clinic employees. It is
    suggested that gaps in human values are factors that influence professional activities in terms of communication (in the
    production team) and ultimately the profitability of the individual in the teams. The initial data is obtained from the reports
    of the clinic’s medical information system and the Schwartz’s Value Survey (SVS) and Portrait Values Questionnaire (PVQ).
    In addition, we used a retrospective analysis and a questionnaire survey. Doctors were divided into two groups based on
    the impact of value gaps on the share of revenue plan fulfillment (type one and type two groups). Attention is drawn to the
    direction of relationships in the group of the first type, all correlations of average strength are direct, in the group of type
    2 – reverse. In the structure of the profile of value orientations, there are differences between the groups on the second
    place in importance for the respondents in the group of the first type are the value orientation (VO) “Achievement” and
    secondly, “Self-Direction”, third place in the group of the first type is “Benevolence”, whereas in the group of the second
    type of “Benevolence” in 4th place. To increase economic efficiency, managers of medical institutions need to organize
    activities to create cultural artifacts about the normative ideals of those values that affect the workflow, take into account
    the data of the employee’s value profile for optimal selection of the team composition (work shift).

    Authors: Tsaranov K. N. [11] Tarbastaev A. G. [9] Klimova E. M. [3] Akimov T. V. [1] Zvansky A. B. [1]

    Tags: effective team formation1 human resource1 personnel management4 raise of patient treatment effectiveness1

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  • Foreign experience
  • Forecasting of labor resources in the system of primary health care in Kazakhstan

    Primary health care is a highly effective and efficient way to tackle the root causes and risks of poor health
    status, and to address emerging problems that threaten future health and well-being.
    Goal: Develop a model for predicting the need for general practitioners (GPs) until 2030, taking into account various
    input data in the equations describing the movement of labor resources in the form of “flows” and “ stocks “ using the
    method of system dynamics.
    Methods: The model was built using the Any Logic program, based on information about the availability of primary
    health care doctors, demographic data and the general prevalence of diseases in the population. Three scenarios were
    considered to predict the need for general practitioners. The base year was 2018, the forecast was carried out until 2030.
    Results: All of three scenarios indicate that with the current number of graduated GPs, the shortage of primary care
    physicians will be exacerbated. In general, the shortage can reach more than two thousand.
    Conclusion: Government and medical universities need to take measures to correct the number of students in the specialty of “General Practitioner” in order to avoid a growing shortage of primary care physicians in the future until 2030.

    Authors: Son I. M. [41] Omarkulov B. K. [2] Kharin A. D. [1] Koichubekov B. K. [1]

    Tags: health care workforce2 human resources forecasting1 public health9 system dynamics1

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  • Special opinion
  • COVID-19 with fatal outcome: methodology, formulations and reasonings of quality defects

    Authors: Starchenko A. A. [34]

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  • Manager of healthcare consults
  • State measures to support the budget and budget institutions at the current stage of the spread of coronavirus infection

    Despite the fact that the main source of financial support for health care is currently the means of compulsory
    medical insurance, the importance of the Federal budget and the budget system as a whole for the functioning of the
    industry cannot be overestimated. In the context of the spread of coronavirus infection, budget legislation is undergoing major changes, with many changes being temporary and aimed at ensuring the budget process in specific conditions related to the fight against COVID‑19.

    Authors: Kadyrov F. N. [122]

    Tags: autonomous institutions1 budget7 budgetary institutions1 coronavirus  infection12 covid-1928 federal budget9

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  • Questions and answers
  • Issues of using resources purchased from other sources to provide paid medical services

    Authors: F.  N.  Kadyrov [9] Yu. V. Endovitskaya [6]

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