2023 № 5 New rules for the provision of paid medical services: review and evaluation of the main innovations
The article discusses the change in the regulatory framework for the provision of paid medical services in connection with the adoption of the decree of the Government of the Russian Federation, which approved new rules for the provision of paid medical services. The reason for the adoption of the new rules is analyzed, as well as the content of its individual provisions. An assessment is given of how the new legal framework for the provision of paid medical services will affect the activities of medical organizations and how they will affect the interests of patients.
Special attention is paid to the emergence of a new – remote form of contract conclusion.
2023 № 6 Payment methods for primary health care, specialized (including high-tech) medical care in the compulsory health insurance system: the logic of the most urgent changes in the tariff policy of 2023.
The article discusses new methodological approaches to the methods of paying for medical care in the compulsory medical insurance system for 2023, including those approved by recently issued regulatory legal acts, as well as joint recommendations of the Ministry of Health of Russia and the Federal Compulsory Medical Insurance Fund (FOMS).
The article analyzes the main reasons for changes in the tariff policy and their expected consequences in terms of increasing the motivation of medical organizations.
It is noted that there is a need to revise the remuneration systems of employees of medical organizations (primarily state and municipal) in order to more closely link incentive payments with performance indicators used in determining the amount of payment for medical care, which is intended to become an important motivation tool for improving the availability and quality of primary health care and, as a consequence, reducing the need for specialized medical care.
An overview of innovations in the payment of high-tech medical care is given.
2022 № 1 Portrait of regional health authority manager
Competent management is crucial condition for the development and functioning and requires qualified managers. In the Russian Federation over the past few years Federation there were many rotations in management of regional health authorities. These changes will be followed by lack of continuity in management decision-making, high degree of uncertainty and a low level of population and professional community trust.
T h e a i m o f t h e s t u d y was to give a detailed information about regional health authorities managers in Russian Federation.
M a t e r i a l s a n d m e t h o d s . This research was designed as observational study with the use of questionnaire which included the characteristics of the age and gender of the respondents, the level of their basic and additional education, additional competencies, occupational background in leadership position.
R e s u l t s . We achieved a response from 81 respondents. We founded that rotation of managers and extremely short occupation period had significant impact on managers’ qualifications. The culture of purposeful formation of the professional skills by the respondents was poor. Only 7% of managers paid attention to their education. About 40% did not have professional retraining for management in healthcare.
C o n c l u s i o n s . It is necessary to develop a standard set of Russian region health managers competencies and responsibilities.
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.
2023 № 3 Portrait of regional health authority manager – 2022
The heads of regional executive authorities in the sphere of health protection are key figures in the realization of the Russian Federation’s healthcare development strategy. Without qualified managers, it is difficult to achieve national goals and objectives of federal projects. The study of the qualifications, professional experience, and skills of the high leaders of regional health systems allows the evaluation of top personnel’s human potential and the successful implementation of steps to increase the efficiency of its administration.
T h e a i m o f t h e s t u d y was to give a detailed information about regional health authorities managers in Russian Federation.
M a t e r i a l s a n d m e t h o d s . A single-stage, continuous sociological study was planned and carried out using a specially developed questionnaire, which included a characterization of the accounting characteristics of participants’ age and demographic characteristic, level of basic and additional education, availability of professional competencies, and work experience in managerial positions.
R e s u l t s . We achieved a response from 85 respondents. It was found that, as compared to 2021, there was a slowdown inside the process of rotation of regional ministers’ personnel and an increase in the degree of professional qualifications of managers in 2022.
These trends were reflected in the increase in the average length of service in the position of regional minister (2021 2,1±1,9 years; 2022 2,6±2,5 years), the doubling of the number of managers with work experience of up to one year (2021 n = 42; 2022 n = 21), and the decrease in the number of managers with work experience of up to one year (2021 n = 42; 2022 n = 21).
C o n c l u s i o n . The research allows for an assessment of the dynamics of changes in regional health care systems in terms of managerial human resources from 2021 to 2022. Positive declining trends in 2022 have been identified. The pace of rotation of regional ministers’ staff adds to the development of leaders’ professional abilities and experience and, eventually, will be the key to accomplishing strategic goals in health care.
2022 № 5 Review of lean practices in clinical laboratories
The main role of clinical laboratory diagnostics is to obtain reliable, reproducible and timely results that help to make the right clinical decisions. As the literature review shows, there are a number of common problems for many clinical laboratories, such as: long turnaround times, high laboratory costs for consumables, insufficient level of satisfaction with quality of services received by patients and high number of complaints. The use of lean manufacturing can be one way of solving these problems.
Purpose of the study is to summarize and analyze the literature regarding the application of lean manufacturing in clinical laboratories.
Materials and methods. A literature review was performed using the following abstract databases: Web of Science, Scopus, PubMed, ScienceDirect, Mendeley, and NCBI. The depth of the search according to the time parameter had no limitations. The following keywords were used as search markers: “lean management”, “lean thinking”, “lean six sigma”, “lean tools”, “healthcare”, “health services”, “clinical laboratory”. More than 100 publications were analyzed, from which 28 most representative studies were selected.
Results. The implementation of lean production methods provides a reduction in turnaround time, costs and errors in the clinical laboratory, reduces the contamination of biological material at the preanalytical stage and reduces waiting time for services and, as a consequence, reduces the number of patient complaints.
Conclusion. The above results indicate that lean production methods can be used in laboratories to solve frequently occurring problems and demonstrate the effectiveness of their application in clinical laboratories.
2021 № 1 Applying lean manufacturing technologies to optimize ambulance operations amid the spread of COVID‑19
The pandemic of new coronavirus infection COVID‑19 has become a serious challenge for the national health
systems, including Russia, setting ambitious goals aimed at preventing the spread of infection and maintaining the availability of medical care in environment of increasing pressure. The aim of the study was to develop, based on the principles of lean production, a set of measures to increase the availability of emergency medical services for patients diagnosed with or suspected of a new coronavirus infection COVID‑19 in the Tomsk Region. Standard tools of lean manufacturing are applied to the work process of the admission department of the respiratory center in RSBHI «Medical sanitary station № 2». As a result of implementation of target state map, which provides for the optimization of process of transferring a patient diagnosed or suspected of a new coronavirus infection COVID‑19 to admission department, a positive dynamics of local (5.4 times increase in the proportion of calls completed within 15 minutes after the patient was delivered to the admission department) and system (an increase of 1.3 times in the proportion of calls with the time the ambulance team reaches the patient within 20 minutes) indicators of the ambulance service was achieved. The study confirms the effectiveness of lean manufacturing tools for optimizing the work of ambulance and allows us to recommend them for use in a pandemic and other risks of emergency.
2019 № 9 Application of lean management in medical examination of children in Tomsk region
The object of the study is the process of preventive medical examination of children of the first year of life, which can be improved on the basis of the principles of lean production. As part of a joint project of the Ministry of health of Russia and Rosatom state Corporation “Lean clinic”, which is designed to improve the efficiency of medical organizations and the availability of their assistance by introducing elements of lean production in public health institutions on a systematic basis, in the Tomsk region on the basis of a pilot medical organization – children’s clinic – a project was implemented to introduce lean technologies in the process of preventive examination of children of the first year of life, in order to minimize the loss of time when receiving medical services by the patient. The main directions of optimization: improving the productivity of the process using the mapping method; increasing the productivity of a single workplace using the 5C technique; increasing the productivity of the movement of medical staff using the Spaghetti diagram. During the project, the logistics scheme of patients and staff movement was significantly improved, and a route map was developed, which was issued to the parents of patients in the registry of the medical organization. In addition, in order to assess the effectiveness of the developed measures before the project and after its implementation, a sociological survey was conducted among the parents of children undergoing pre¬ventive medical examination, which allowed to assess the level of their satisfaction with the assistance provided. As a result of the implementation of the project on the introduction of lean technologies, it was possible to achieve the goals, in particular, to reduce by almost 3.5 times the time spent by patients on the passage of a full cycle of preventive examination, to reduce to 2 number of visits to the clinic, as well as to increase comfort of staying in the institution of patients and their parents.
2018 № 2 Development and implementation of a standard for the organization of work of registries medical organizations: the project «Entrance group»
Regional project “Front-office” was set up and implemented in Tomsk oblast (Siberia, Russia). The aim of the project was launch a front-office of out-patients departments standard for improvement patients satisfaction in medical institutes. There are five directions in the project: providing affordable telephone service, front-office infrastructure, staff training, medical documents logistic, corporative style creation. Using of holistic project approach has led to significant improvement of availability and quality of health care in Tomsk oblast
2021 № 5 New system of control measures in relation to medical organizations within the framework of compulsory health insurance
One of the most serious innovations in the system of compulsory health insurance is the change in the procedure for conducting control measures. In accordance with the new version of Federal Law No. 326-FZ (in accordance with the provisions of the Federal Law of December 8, 2020 № 430-FZ On Amendments to the Federal Law "On Compulsory Medical Insurance in the Russian Federation"), the procedure for monitoring the volume, timing, quality and conditions of providing medical care for compulsory medical insurance to insured persons, as well as its financial support, is now established not by the Federal Fund for Compulsory Medical Insurance, but by the Ministry of Health of the Russian Federation. At the same time, both the participants of the CMI system who have the authority to conduct control measures, and the procedure for conducting control, are changing.
2021 № 4 NEW SYSTEM OF CONTRACTS WITHIN THE FRAMEWORK OF COMPULSORY HEALTH INSURANCE
The system of compulsory health insurance is regulated by a large number of regulatory legal acts. Nevertheless, many issues related to the relationship between the participants of the MHI system, and above all – financial, are determined by the content of the contracts concluded between them. This article analyzes the new system of contracts that has developed in the system of compulsory medical insurance in connection with the adoption of Federal Law No. 430-FZ of December 8, 2020 “On Amendments to the Federal Law “On Compulsory Medical Insurance in the Russian Federation”, as well as other related regulatory legal acts. There have been changes not only in the content of the contracts, but also in the composition of their participants. In addition, there is a new, previously absent type of contract. The purpose of the work is to analyze changes in contracts in the MHI system and their possible consequences.
2022 № 9 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
2022 № 8 Prediction of disease outcomes in patients with COVID-19 based on the EQ 5D 5L questionnaire
In order to provide effective medical care to patients with COVID-19 in hospitals, the disease outcome prognosis is of
considerable importance. The authors of the study suggested a relationship between health-related quality of life indicators and the outcomes of the disease of patients hospitalized because of COVID-19.
P u r p o s e . Retrospective study of the relationship between health-related quality of life in patients with COVID-19 on the first day of hospitalization with the outcomes of the disease in a hospital and at the stages of rehabilitation up to 180 days following the discharge to predict outcomes at the early stages of the disease.
M a t e r i a l s a n d m e t h o d s . The study was conducted at 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), on the first day of admission of patients to the hospital. Additional patient data was extracted from electronic health records. Two types of EQ-5D-5L questionnaire results were evaluated: Index EQ and the Visual Analog scale (VAS) EQ. All calculations of the regression model were carried out using the R 4.2.1 language in the RStudio 2022.02.3 Build 492 software environment.
F i n d i n g s . In the obtained logistic regression model, the extremely high statistical significance of the variable “Index EQ” (p<0.01) was demonstrated, the greater the value of the variable “Index EQ” is, the less the probability of a fatal outcome is.
At the same time, there is no statistically significant relationship between the variable VAS EQ under study and the probability of a fatal outcome.
C o n c l u s i o n s . An extremely significant relationship between the calculated health-related quality of life index, Index EQ, and outcomes of COVID-19 when patients were admitted to the hospital was revealed, which makes it possible to use it as a predictor of disease outcomes at early stages. No significant relationship between the VAS EQ and the outcomes of the disease in patients with COVID-19 on the first day of hospitalization was revealed, which makes it impossible to use it as a predictor of disease outcomes at the early stages. Application of the health-related quality of life index, Index EQ can be used to make medical decisions in order to early predict tactics of patient management in hospital treatment and rehabilitation.
2021 № 4 PROFESSIONAL BURNOUT OF NURSES: FEATURES OF GENERATIONS
Professional burnout among nurses is an urgent public health problem, which negatively affects the quality of medical care. A specialist’s belonging to a certain generation determines its own characteristics of the response to stress factors and the development of professional burnout.
Purpose of the study is to determine the main patterns of occurrence of professional burnout among nurses depending on the generation for development and implementation of targeted prevention methods.
Materials and methods. A one-stage comparative study was planned and conducted using a specially designed questionnaire, including a burnout questionnaire MBI (Maslach Burnout Inventory) and questions assessing professional performance and socioeconomic status to determine the factors of professional burnout. All nurses were stratified into three generational groups.
Results. The study involved 2486 nurses. It was found that respondents of all generations were prone to professional burnout, with a high and extremely high degree. At the same time, the third generation was most susceptible to the development of professional burnout, the first was the least. The main predictors of the development of professional burnout in the third generation were: lack of sleep and rest, low salary and large loan payments, excessive work load; in the first – the presence of chronic diseases. The second generation had a smaller percentage of respondents with an extremely high degree of professional burnout, because they were characterized by lower labor intensity, lack of sleep deficit and the highest salary.
Findings. Thus, prevention measures can be individual for each generation, with considering the differences in predictive and protective factors. While, it is necessary to focus on the youngest, third generation, reinforcing factors preventing the development of professional burnout.
2019 № 1 An integrated approach to determining the need for medical personnel on the model of the Tomsk region
The recent history of modernization of the national health care system is characterized by the improvement of the health care system, including in the staff aspect. However, the opinion of the population and experts shows that it was not possible to completely solve the problem of shortage of doctors. This article presents the experience of the Tomsk region in terms of approaches to determining the deficit and imbalance of medical staff. This analysis formed the basis for further actions on staff policy in the health care system of the region.
2020 № 8 Satisfaction of patients as an indicator of the effectiveness of organizational models of providing medical care in the outpatient sector
The object of the study is patient satisfaction with the medical care provided as a potential tool for evaluating the effectiveness of organizational changes in the outpatient unit. The patient-oriented approach is becoming more and more widespread in the world and domestic health care, so it is also necessary to take into account the opinion of the recipients of medical care in order to evaluate the ongoing changes. The purpose of the study was to test the developed online patient satisfaction assessment service TesMed in the implementation of systemic organizational changes in the outpatient section of the Tomsk region (united in one document – the Standard for organizing outpatient care in the Tomsk region). Patients were able to use the smartphone functionality to identify the medical organization and put a rating on a five-point scale. If the patient scored less than five points, the app asked them to select a reason for dissatisfaction from the list. The data of 2898 forms were analyzed. By the time of the beginning of noticeable
changes for visitors of polyclinics (changing the format of the reception area, staff jobs, registry, formation of corporate culture), the share of visitors who rated the work of a medical organization by five points was 57.78%. After a month of project implementation, this parameter increased to 85.79% and did not fall below 72% until the end of 2019. The analysis of factors affecting negative ratings showed that the structure of reasons for their decline has not changed significantly. The study showed that the use of assessment methods used in the provision of medical care organizational models based on the opinion of patients, along with standard performance indicators, contributes to improving the effectiveness of interaction between medical organizations and patients.