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Manager Zdravoochranenia 2022 #9
Published: 2022-09-18
614
CONTENT OF THE ISSUE
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The evaluation of the provision of specialized medical care to patients with COVID‑19 in the conditions of the central district hospital
Planning and managing the activities of a medical organization in the context of a biological challenge associated with the spread of a new coronavirus infection (COVID‑19) is an urgent task for the healthcare system, determining the possibilities of its functioning in the conditions of transformation and re-profiling of the bed fund, mobilization of human, material and technical resources. Based on the results of assessing the parameters of the activities of a medical organization, it is possible to systematize and streamline the work of its structural divisions.
P u r p o s e of the study is to determine the optimal burden on medical workers, to establish factors that affect the duration of hospitalization and determining the outcomes of the disease among patients with COVID‑19.
M a t e r i a l s a n d m e t h o d s . The retrospective continuous study of hospitalizations of 7576 patients was planned and conducted with an analysis of the duration of hospitalization, the dependence of the results of hospitalization on gender and age, as well as the impact on this indicator of the severity of the disease (using Pearson’s linear correlation coefficient (r-Pearson)) and analysis of survival by evaluating Kaplan-Meier.
R e s u l t s . The results of the analysis showed that the average number of patients per doctor per month was 28,23 ± 13,27 patients [IQR: 16,93; 41,25]. The dependence of the duration of hospitalization on sex and age showed the absence of statistical significance between these indicators (r-Pearson = 0,079; p < 0,001). The dependence of the duration of hospitalization on the severity of the course of the disease showed no statistical significance between these indicators (r-Pearson = 0,04; p < 0,001). The risk of death was increased with the length of hospitalization.
C o n c l u s i o n . The results of study are relevant for public health specialists who plan the resources of medical organizations and assess the possibilities of using the bed fund. -
Features of national account of donor platelets collection
Based on the analysis of the practice of collection and the volume of units of donor red blood cells, plasma and cryoprecipitate in 13 Russian blood service organizations, it was established:
- volumes of units of 9 received types of erythrocytes differ significantly: H-test of Kruskal-Wallis – 32,071 with a critical value of 15,507 (p < 0,001);
- the volume of red blood cells suspension exceeds the volume of red blood cells suspension mass by 28,8% (p = 0,004);
- removal of the buffy-coat reduces the volume of red blood cells suspension suspension – by 14,8% (p = 0,002);
- leukodepletion does not reduce the volume of red blood cells suspension and mass;
- the volume of washed red blood cells is the most variable (median absolute deviation = 33), since it is determined by an arbitrary amount of saline added to the final product;
- pathogen inactivation does not affect the plasma volume, which allows us to recommend the production of pathogen-reduced cryoprecipitate;
- there is no unequivocal qualification of cryosupernatant plasma as a therapeutic product or a vastage in cryoprecipitate production (out of 12 organizations collected cryoprecipitate, 5 indicated the preparation of cryosupernatant plasma);
- 3 out of 13 participants in the study have already implemented the production of pooled cryoprecipitate – a technology that significantly reduces labor costs and 92% – unproductive consumption of the medical product (p < 0,001);
- the current system for accounting for the volume of red blood cells and plasma collection does not allow estimating the number of prepared therapeutic units;
- it is proposed to account donor red blood cells, plasma for transfusion and cryoprecipitate in units, and plasma for the production of medicines – in liters. -
Identification of directions for improving the quality of medical services using SERVQUAL and IPA techniques
Assessing patients’ expectations and perceptions of health care delivery is challenging. To understand the quality of health care delivery, a study was conducted related to how patients assess the expected and perceived quality of health care delivery in a district hospital. Modern methods of measuring patient satisfaction and its interpretation using statistical analysis methods allow solving problems of this type.
P u r p o s e : development of approach to improvement of quality of medical services provision using results of measurement of satisfaction with quality of medical services provided to patients in inpatient conditions of regional level, using SERVQUAL technique; substantiation on built regression model of influence of certain aspects of patients’ perception of quality satisfaction.
M a t e r i a l s a n d m e t h o d s . The materials of the study are presented in the form of the results of a medical and sociological study of 418 patients who received medical services in one of the medical organizations at the regional level. Methods of statistical analysis of patient questionnaire results, factor, regression analysis, Importance-Performance Analysis (IPA) were used.
R e s u l t s . An analysis of the data showed that 54.3% of patients were quite satisfied with the services. A regression equation is constructed to calculate the degree of patient satisfaction depending on a number of aspects of health care delivery. According to the IPA method, a schedule of four-quadrant distributions of patient assessments has been drawn up, on the basis of which it is possible to form measures to increase patient satisfaction with medical services.
F i n d i n g s . The use of the SERVQUAL technique allows you to measure satisfaction with the quality of medical services, and the use of the IPA technique allows you to interpret it and obtain useful information regarding the quality of medical services as an element of patient feedback in the quality management system of a medical organization -
The role of naming in healthcare. From a psychiatric hospital to a mental health center.
An urgent issue today is to increase the confidence of citizens in the healthcare system. Moreover, the issue of trust is of particular importance in the provision of psychiatric care, due to the high level of stigmatization of this area of medicine.
The purpose of the study was to assess the significance for patients of the names of medical organizations in the profile of «psychiatry».
Materials and methods. In 2021 Kirov Regional Clinical Psychiatric Hospital named after Academician V.M. Bekhterev changed its name and became the Center for Psychiatry and Mental Health Academician V.M. Bekhterev. A survey was conducted of 216 patients who applied or are undergoing treatment at the Center of Psychiatry and Mental Health named after Academician V.M.
Bekhterev, using a specially designed questionnaire consisting of 24 questions. The results obtained were statistically processed.
Results. A large proportion of the respondents had one or another mental disorder, and more than half are worried because of this, to one degree or another. One-fifth of the respondents indicate that their rights were violated due to their mental disorders.
All this points to the problems that exist to this day associated with the stigmatization of patients with mental disorders, as well as the stigmatization of the psychiatric service itself. 43% of respondents noted that the name of a medical organization has an impact on their trust in a medical organization. The patients surveyed gave the highest rating to the name «Mental Health Center».
Conclusions. Thus, the name of a medical organization directly affects the trust of patients in it. In addition, the name also affects the subjective assessment of the quality of medical care provided in a medical organization. -
Intentional potential of scientific and clinical heads as a strategic resource of a healthcare organization
R e l e v a n c e . The healthcare management system requires high-quality and rational use of the organization’s workforce, i. e. the skills of employees. The intentional potential of an employee is a set of needs, motives, etc., the «core» of the personality driving it to achieve a meaningful goal. The N. V. Sklifosovsky Research Institute for Emergency Medicine is a leading multidisciplinary medical institution with an established multi-level system and management culture, the quantitative assessment of the intentional potential of which is of great interest.
P u r p o s e : to study the intentional potential of the heads of clinical and scientific departments.
M e t h o d s . An anonymous survey was conducted among the heads of the scientific and clinical departments of the N. V. Sklifosovsky
Research Institute for Emergency Medicine (2021), including two methods of S. Schwartz: assessment by the level of normative ideals (SVS) and by individual priorities (PVQ). The procedures of centering and ranking by the average values of each valuemotivational type were carried out. Next, the value-intentional consistency (VIC) and the coefficient of value oppositions (Cvo) were investigated.
F i n d i n g s . No statistically significant differences in the VIC at the SVS and PVQ levels, as well as no differences in the Cvo at the SVS level in the groups of heads of clinical and scientific departments were revealed. Intrapersonal contradictions between the value oppositions «Security» and «Stimulation» at the PVQ level (p<0.05) were revealed, they are less pronounced in the group of heads of scientific departments. There were also no statistically significant differences in the other oppositions of value orientations of the PVQ level.
C o n c l u s i o n s . The presented results can be used as additional factors in the planning and implementation of measures of sociopsychological management of scientific and clinical departments. In the professional selection for the relevant positions, the Cvo indicator is more informative. Differences between the groups of scientific and clinical heads in the «Security – Stimulation» Cvo were shown, the distribution of this indicator tends to be more pronounced among the group of scientific heads. -
Methodological foundations of forecasting the spread of diseases in the world (review)
In modern conditions, the prediction of the morbidity of the population is becoming one of the most urgent tasks of public health worldwide. For state and international health services, with the help of forecasting the possible incidence and prevalence of various diseases in the general population, it becomes necessary to improve the system of providing specialized care due to the possibility of an updated calculation of the necessary resources.
Purpose of the study is to analyze the methodological basis for predicting the morbidity of the population based on the study and generalization of literary sources.
Materials and methods. The materials for the analysis were scientific publications on the issues of forecasting and modeling of morbidity in various subgroups of the population and territories of the Russian Federation and other countries. In the course of the research, such methods as comparative analysis, study and generalization of experience, bibliographic were used.
Results. Currently, there are a number of studies devoted to disease prediction, and the number of methodological approaches to predicting possible changes in the epidemiological situation in various territories is growing. The study provides an overview of existing methodological approaches to predicting the morbidity of the population in Russia and in the world community.
Findings. Thus, the analysis of the experience of predicting morbidity made it possible to determine the features of the use of certain mixed methods of forecasting different classes, groups and types of diseases, especially when identifying new viruses and infectious diseases. -
Health related quality of life as a predictor of the transfer of patients with COVID‑19 to the intensive care unit
Understanding the results of self-assessment of health-related quality of life in patients with COVID‑19 is an important part of the full and objective picture of the medical condition on the first day of hospitalization when making decisions to start early intensive care in the resuscitation and intensive care unit.
H y p o t h e s i s : the values of health-related quality of life indicators in patients with COVID‑19 on the first day of hospitalization are interrelated with the fact of their stay in the resuscitation and intensive care unit.
P u r p o s e : a retrospective study of the relationship of health-related quality of life in patients with COVID‑19 on the first day of hospitalization and the necessity of treatment in the resuscitation and intensive care unit.
M a t e r i a l s a n d m e t h o d s . The study was conducted on the basis of the “Kommunarka” Moscow Multidisciplinary Clinical Center of the Moscow City Health Department from March 2021 to April 2022. Data collection was carried out using a paper- and-pencil Russian version of the EQ‑5D‑5L questionnaire (Tracking Number: 41183). Additional patient data was extracted from electronic medical records. Two types of EQ‑5D‑5L questionnaire results were evaluated: the EQ index and the visual-analogEQ scale. All calculations of the regression model were carried out using the language R4.2.1 in the software environment RStudio 2022.02.3 Build 492.
F i n d i n g s . This study is the first work where health-related quality of life indicators measured during the first 24 hours of hospitalization in order to predict the transfer of patients with COVID‑19 to the intensive care unit. The best results of self-assessment of their medical condition in the course of hospitalization were revealed in those patients who did not require further treatment in the intensive care unit. The worst results of self-assessment of their medical condition were revealed in lethal patients hospitalized in the intensive care unit on the first day. Two logistic regression models demonstrated a significant relationship of the EQ Index and the Mobility domain with the probability of transferring patients to the intensive care unit. The results obtained prove that subjective indicators of health-related quality of life reflecting the perception of one’s illness “here and now” along with objective clinical indicators are independent predictors of the transfer of patients with COVID‑19 to the resuscitation and intensive care unit.
C o n c l u s i o n . Health-related quality of life indicators (EQ Index and MO) can be used to predict the early use of preventive measures to prevent the deterioration of patients’ condition and reduce the load on the intensive care unit -
The role of risk factors in childhood on the formation of chronic obstructive pulmonary disease
An analysis of literature on COPD in children has shown that COPD arises from an accelerated decline in lung function, an inability to achieve normal lung function after childhood, or a combination of the two. Risk factors for the development of COPD are considered negative environmental influences; maternal smoking, intrauterine development disorders, prematurity, low birth weight, bronchopulmonary dysplasia, as well as frequent or severe respiratory infections in childhood (especially respiratory syncytial virus and rhinovirus) that prevent the full growth and development of the lungs; asthma in childhood; early allergic sensitization and/or a rare genetic disorder (alpha‑1 antitrypsin deficiency), childhood chronic cough, parental history of respiratory disease, and low educational attainment. Particularly vulnerable are children from socio-economically low strata of the population, in particular,
from among the indigenous population of multi-ethnic countries. In low- and middle-income countries, diagnosing COPD is difficult, and the disease may go undiagnosed. Bronchial asthma in childhood can be considered as an independent risk factor for COPD in adulthood. At the same time, the asthma-COPD overlap syndrome is widespread, the risk of which is especially high among individuals with persistent and severe childhood asthma, which is highly dependent on genetics. Targeted programs are needed to reduce the risk of adverse pulmonary outcomes in disadvantaged children, as well as the integration of specialized outreach services into primary health care. The WHO COPD core package includes protocols for assessing, diagnosing and managing COPD, as well as modules on healthy lifestyles, including smoking cessation and self-help, and development of rehabilitation services. -
About some methodological approaches to the assessment of the salary level of medical workers.
The article deals with methodological issues of assessing the level of salaries of medical workers by official statistics bodies (Rosstat) and within the framework of surveys of medical workers themselves.
The main methodological differences are shown in the methods of calculating the indicators characterizing wages used by statistical authorities and survey organizers. The main reasons leading to the discrepancy between the results of such assessments are shown. Among them, first of all, it is necessary to name different approaches to accounting for personal income tax, restrictions in the sample, etc.
In addition, official statistics take into account not only wages, but also some other expenses in favor of employees. At the same time, the concept of "average number" is used, which is not taken into account in the framework of the conducted surveys.
At the same time, the salaries of medical workers in order to assess the achievement of the targets set by the May Presidential
Decrees should be correlated not with the average salary for the subject of the Russian Federation, but with the average monthly income from work.
Such methodological differences create an objective basis for the discrepancy between the survey results and official statistical data and should be taken into account when interpreting the data obtained. -
Issues related to the powers of state (municipal) healthcare institutions in the field of labor rationing
The presented material concerns the rights and obligations of state (municipal) healthcare institutions in matters of labor rationing. It examines the scope of authority of the heads of these institutions as employers for the organization of rationing.
With reference to the Labor Code of the Russian Federation and other normative legal acts devoted to this topic, various aspects of labor rationing are analyzed. In particular, the degree of completeness of the coverage of labor standards of all employees of medical organizations, the identity of load indicators and labor standards, etc.
