Manager Zdravoochranenia 2022 #2
CONTENT OF THE ISSUE
Advanced training of doctors: the main tasks today and what to do
The article presents and analyzes the main challenges that directly affect today both the qualifications of doctors and the work on the implementation of professional development programs. The author attributed the following to such challenges: the pandemic of coronavirus infection; the implementation of advanced training programs for doctors with the exclusive or preferential use of distance educational technologies; a decrease in the quality of implementation of advanced training programs for doctors; long breaks in the professional activities of doctors in the main specialty; periodic accreditation of doctors. The article proposes to focus on the development of exemplary professional development programs for doctors, taking into account the requirements of professional standards. It is necessary to ensure that the programs for improving the qualifications of doctors who develop and implement educational organizations strictly comply with the sample programs.
Features of the organization of medical care in the interests of clinical testing of methods of prevention, diagnosis, treatment, rehabilitation and registration of necessary documentation
Medical care in the interests of clinical approbation of methods of prevention, diagnosis, treatment and rehabilitation is carried out to confirm evidence of efficiency and is essential function of medical organizations. Based on the clinical approbation, the Expert Council of the Ministry of Health Care of the Russian Federation can recommend a method for inclusion in clinical guidelines (treatment protocols) to providing medical care.
The article contains an example of the assessment of 28 reports on the implementation of the clinical approbation protocols completed in Russian Scientific Center of Roentgenoradiology of the Ministry of Health of Russia at 2016–2020. In the provision of medical care during clinical approbation, improvement is arrived in 59,6%, recovery – 32,9%, no change – 7,5%, there were no bad ones. As well as the procedure for the provision of medical organization to carry out clinical approbation, which is presented to medical organization by the Expert Council of the Ministry of Health Care of the Russian Federation.
Patient-Oriented Approach in Nursing
Nursing care is aimed at achieving the best treatment results and improving the patient’s quality of life. Professional practice based on the use of a patient-centered approach in nursing care contributes to health promotion, healing, disease prevention, provides not only physical, but also psychosocial comfort for the patient, including the ability to adapt to his condition, cope with illness or disability.
Rationale for optimizing the organization of providing coloproctological assistance to the population by assessing the quality of different approaches of its providing
In this article, in order to justify the optimization of the organization of providing coloproctological care to the population, the results of assessing the quality of various approaches to its provision are presented.
Materials and methods. A comparative analysis of the coefficients of medical efficiency for the traditional coloproctological profile service system and the proposed system is carried out. The quality of coloproctological care was assessed using efficiency coefficients and an integrated quality indicator.
Results. As a result, a higher level of medical, social and economic efficiency is shown in the conditions of the developed
system. The data are reliable, differences are noted both for individual coloproctological pathologies and in general. An integral quantitative assessment of the quality of coloproctological care also showed a higher efficiency of the developed system (p<0.05), which reflects its medical, social and economic effectiveness.
Conclusions. The creation of regional coloproctology centers combining inpatient treatment and outpatient care; provided with highly qualified personnel with sufficient experience in this specialty; equipped with modern equipment, including video endoscopic equipment for performing diagnostic procedures; introducing new high-tech operations, will further improve the timely diagnosis of coloproctological diseases and provide highly qualified specialized care to patients.
A research of the impact of the call routing strategy on the call-centre work efficiency as a medical organisation providing primary hospital health care
The article provides an estimation of the efficiency of a call-centre work when using two different strategies of targeting incoming calls. The authors clearly demonstrate a reduction in the waiting time for communication with the operator and the frequency of call cancellations, an increase in the number of processed requests and an increase in the level of service when using the strategy of interactive navigation of incoming calls, which generally creates favorable conditions for increasing the availability of medical care to the population.
The purpose of the study is to study the effect of routing incoming calls on the efficiency of a medical call center in order to improve its operation.
Materials and methods. The comparison of the effectiveness of the polyclinic call center was carried out according to the indicators according to GOST R 55540-2013 under the conditions of using the scheme of random and interactive navigation of incoming calls.
The target values of quality indicators are established empirically, taking into account the accepted industrial standards. The analysis of statistical information was carried out using special software “Asternic call center stats”. A total of 72 statistical indicators were studied in both cases within the same seasonal period.
Results. It was found that the organization of the scheme of interactive guidance of incoming calls helps to increase the productivity of a medical call center by optimizing the processing of calls without increasing the number of operators. The average waiting time for a patient to communicate with an operator has decreased by 2 times, the frequency of call cancellations has decreased by 3 times, the processing time for patient calls has decreased by 15.6%, the level of service has increased by 1.6 times. The practical significance of the proposed scheme for navigating incoming calls is due not only to the effective increase in the functionality of the medical call center, but also to the ease of scaling due to the unified IP telephony architecture in medical call centers.
Conclusions. Thus, as a result of the study, a call routing strategy has been identified, which makes it possible to improve the performance indicators of the medical CC, to service more calls faster without attracting additional personnel, and to create conditions for increasing the availability of medical care to the population.
Estimation of the impact of trans-regional routing of patients with ST-segment elevation acute coronary syndrome on acute myocardial infarction mortality reduction based on the digital twin of Kurgan region
Reduction of the time required for medical evacuation to the regional vascular center in order to carry out percutaneous coronary intervention in case of ST-segment elevation acute coronary syndrome is an essential factor directly affecting the mortality rate of this condition. The concept of territorial attribution in rendering emergency medical services militates against the effective use of such emergency medical services aimed to promptly deliver patients to the hospital.
Research objective. The research objective is to study the efficiency of trans-regional communication in reducing the time required to deliver patients with ST-segment elevation acute coronary syndrome to hospitals in order to carry out percutaneous coronary intervention and its impact on acute myocardial infarction mortality rate basing on the digital twin of Kurgan region.
Materials and methods. the digital twin of the Kurgan region represents the time required to evacuate patients with ST-segment elevation acute coronary syndrome to regional vascular centers by ambulance crews in pursuance with an applicable order, compared with patient routing in case of trans-regional cooperation with vascular centers of neighboring regions.
Results: due to the implementation of trans-regional cooperation, mean patient evacuation time within the region had been reduced by 21,3 ± 9,84 minutes, and mean time on routes from the localities wherefrom it was faster to deliver patients to vascular centers in neighboring regions had been reduced by 55±25,73 minutes. The estimated myocardial infarction mortality rate on average for the Kurgan region caused by medical evacuation time reduction in case of implementing trans-regional cooperation had been reduced by 5,32%.
Conclusions: the use of resources of neighboring regions when working out regional orders on routing the patients with acute coronary syndrome in a number of instances contributes to the provision of two-hour availability of percutaneous coronary intervention and serves as a significant reserve for acute myocardial infarction mortality reduction.
Adaptation and initial reliability testing of the Russian-language version of the safety attitudes questionnaire for medical organizations
The article presents the results of adaptation and initial reliability testing of the Russian version of the safety attitudes questionnaire (SAQ) for medical organizations. The reliability of using the questionnaire has been proven: all scales have high internal consistency and correlate with original factors. Using exploratory and confirmatory factor analysis, the features of the seven-factor structure of the Russian version of the questionnaire are shown: 1. teamwork climate; 2. safety climate; 3. job satisfaction; 4. stress recognition; 5. perceptions of management (department level); 6. perceptions of management (hospital level); 7. working conditions.
Telerehabilitation of post-stroke patients: current trends in the Russian healthcare system
With age, the risk of stroke increases significantly, but at the same time, there are tendencies for an increase in its prevalence in young and middle-aged people, which determines the urgency of the problem of rehabilitation treatment after stroke both in the world and in Russia. The use of digital technologies in neurorehabilitation can be very multifaceted and extensive. Telerehabilitation as an innovative direction of telemedicine is an important aspect within the framework of the national project «Healthcare» and the program «Digital Economy of the Russian Federation».
P u r p o s e of the study is to analysis of the Russian experience of organizing and conducting telerehabilitation of post-stroke period in the context of the digital transformation of the healthcare system in Russia.
M a t e r i a l s a n d m e t h o d s . The article used technologies for searching and selecting information using search engines (www. google.ru, www.yandex.ru), specialized and bibliographic databases (PubMed, eLIBRARY.RU), methods of analysis and synthesis, analytical data processing.
R e s u l t s . The study showed that telerehabilitation has a high clinical value of adherence to the treatment of patients of post-stroke period and is not a separate type of medical activity, but an innovative therapeutic and prophylactic method that expands the possibilities of therapy and improves the process of interaction in the «doctor-patient» and «doctor-doctor» communication systems.
This technology of restorative telemedicine makes it possible to increase the level of scientific knowledge, skills and abilities of healthcare organizers and medical workers in order to strengthen the national healthcare system of Russia, as well as to rationally use the scientific and practical potential of digital solutions in interdisciplinary interaction of specialists dealing with medical neurorehabilitation, significantly expanding the coverage of the population telerehabilitation services after a stroke.
F i n d i n g s . Despite the positive experience of some medical organizations in Russia in the use of telerehabilitation, this direction is still in its infancy and is likely to develop in the coming years for the rehabilitation of many stroke patients, which will help healthcare organizers, doctors and patients and other interdisciplinary specialists effectively and interact seamlessly in the digital health ecosystem in the context of the development of patient-centered medicine.
Predicting the development of hypertension using machine learning models in the remote cardiomonitoring subsystem
One of the tasks of personalized medicine is to build a new organizational model for providing medical care to patients, based on the selection of individual medical, diagnostic and preventive agents that are optimally suitable for the peculiarities of the body.
Modern artificial intelligence methods allow you to solve problems of this type.
Purpose. The aim of the study is to construct and apply predictive logistic regression models and decision tree using machine learning techniques to identify patients at high risk of hypertension without the need for invasive clinical procedures.
Materials and methods. A formed data set consisting of 395 patient records of Voronezh City Clinical Clinic No. 1 is used. Each record contains patient parameters: patient sex; patient age; body mass index; waist circumference; hip circumference; tobacco smoking status; alcohol use status; systolic pressure; diastolic pressure. Machine learning methods are used to build prognostic models.
Results. Two models for predicting the development of hypertension are constructed, characterized by high indicators of classification accuracy: a logistic regression model designed to calculate the patient’s individual risk (accuracy 96%), and a decision tree model designed to predict the patient’s possible disease with hypertension and explain the reasons why this disease can occur (accuracy 94%).
Findings. The expediency of using machine learning methods in constructing prognostic models for assessing the state of patients is shown, the possibility of creating a recommendation block based on the obtained models in the remote cardiomonitoring subsystem is indicated.
Network facilities of internal communication of a medical organization.
For the effective work of employees, it is necessary to competently establish internal communication. To date, dozens of companies provide various network means of internal communication, but not all of them are suitable for a medical organization.
P u r p o s e of the study is to study the network means of internal communication in a medical organization.
M a t e r i a l s a n d m e t h o d s . Network facilities of internal communication, their advantages and disadvantages were analyzed and systematized in the article. The definitions, types of communication networks and communication management are presented. The rules for the security of personal data when using network communication tools are described. A survey of employees was carried out to identify the main facilities of internal communication used, as well as satisfaction from them on the basis of the State Autonomous Healthcare Institution “City Polyclinic No. 21”. A SWOT based on the survey results analysis was carried out.
R e s u l t s . 85 employees participated in the study. It showed that the main facilities of electronic internal communication used are the WhatsApp messenger and the electronic document management system. WhatsApp isn’t convenient for a significant part of employees to use, also there are too many working chats and messages in this messenger. Employees don’t often use the electronic document management system and there is a significant part of users who don’t like using it.
F i n d i n g s . One of the most convenient facilities of internal network communication is a corporate social network, which, however, is difficult to implement and expensive in terms of costs. A more accessible means of internal communication is the Telegram messenger.
Issues of healthcare informatization
The proposed material presents an analysis of changes in the requirements for a unified state information system in the field of healthcare in connection with the adoption of a new decree of the Government of the Russian Federation regulating this area. The analysis of the causes and consequences of the most significant changes in the regulation of health informatization is carried out.
Focus of problem
Marketing in health care
Sociology of healthcare
Questions and answers