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 № 7 Hospital replacement technologies in dermatovenereology
The Program of State Guarantees provided for a decrease of almost 20% in the volume of inpatient care due to the development of hospital-substituting forms. The efficiency of day hospitals is higher than hospitals by 1.5–3 times, which is associated with work in 2 shifts. The economic effect of the activity of DS according to the results of research works of a number of authors reaches 70%.
At the same time, the rate of introduction of day hospitals (DS) remains unreasonably low, and core day hospitals are not sufficiently developed, including in dermatology.
The disadvantage of the healthcare system in Russia and dermatovenerologic care in particular is the lack of economic incentives in favor of choosing less expensive technologies, their parameters are shifted towards hospital provision. Over the past decade, the numberof research papers on the activities of CPs has significantly decreased, an economic financing mechanismhas not been developed that stimulates the development of these forms of work.
2019 № 6 Perfection of organizational forms of work in dermatovenerology in conditions of “lean production”
An important part of the activity in dermatovenerological care in the conditions of “lean production” is the improvement of organizational forms of work of medical organizations (MO), providing medical care to patients with dermatovenerological pathology at all stages of its provision.The survey was conducted at the Samara oblast, the dermatovenerologic dispensary (SACVD). Based on the diagnosis of “zones of inefficiency” in the provision of medical care to patients with dermatovenerological pathology, the reorganization of dermatovenerological care was carried out, including: restructuring of the MO network, the creation of mo areas of responsibility for the provision of dermatovenerological care; the organization of an interdistrict center; the reorganization of three city CVD departments; the opening of CVC; the development of regulations for intradepartmental interaction of dermatovenerologists with doctors of other specialties; the organization on the basis of THE; information support of participants of interaction; increase of professional level of medical personnel. The economic effect due to the elimination of duplication of laboratory and diagnostic studies in the medical examination of patients with dermatovenerological pathology was in 2015 1190266,7 rubles. Sociological surveys of patients who applied to the CSQ, showed that the majority of respondents were satisfied with the medical care, positively assessed its availability (90,3%) and quality (96,1%).