Management in health care
  • 2021 № 5 Organization of medical care for patients with cancer on the basis of lean production in the interests of developing organizational health-saving technologies during the pandemic

    The article presents the results of the application of lean manufacturing (LM) technologies for the successful implementation of the state task of a clinical medical organization to provide high-tech medical care during the restrictions caused by the COVID19 pandemic. The highest degree of implementation of LM values and technologies was achieved in the section of respect for the person and corporate culture – 89%, compliance with specialized standards – 86%, satisfaction with quality and safety, as well as quick response to changes‑85% for each,
    which allows implementing organizational health-saving technologies. The most accessible and widespread health-saving technology can be considered specialized information on the prevention of non-communicable diseases posted on the website of a medical organization in a special section and attracting the attention of patients in a voluntary informed consent. The organizational and methodological department can become the organizing structural unit of a medical organization for testing the introduction of lean production technologies and testing organizational health-saving technologies, whose specialists should be engaged in improving the level of professional training of doctors,
    specialists in clinical profile and secondary medical personnel on health-saving issues, conducting communication campaigns aimed at increasing the responsibility of patients who come for examination and treatment for their health, their relatives and relatives, awareness of the value of human life and health, the formation of a culture of health in various age and social groups.

    Authors: Gurov A. N. [15] Kruglov S. E. [2] Solodkiy V. A. [2]

    Tags: covid-19 pandemic6 medical care for patients1 oncological diseases3 organizational health-saving technologies1 “lean manufacturing”3

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  • Management in healthcare
  • 2017 № 7 Pharmacoeconomic analysis of breast cancer prevention in women with BRCA1/2 mutation

    The article deals the problems of using preventive surgical interventions (preventive mastectomy, preventive adnexectomy) in patients carrying BRCA mutations. The article presents and justifies economic efficiency of methods of surgical prevention compared to the observational method estimation. The most preferable tactics of management these patients offer, according to pharmacoeconomic analysis. Five models (decision trees) were developed to assess the cost of every tactics of patient management. The following health statuses were considered: no disease, primary disease, remission, and death. Based on the results of these models, pharmacoeconomic analysis was conducted to compare preventive surgical interventions with the observational method. Life years saved was the measure of effectiveness. The cost assessment was conducted for a medical facility. The modelling horizon was the age of 25–70 years. Preventive surgical interventions enabled to save 9–88 additional years of life in the cohort of 100 women with BRCA1/2 mutation compared to the observational method. Bilateral prophylactic mastectomy and preventive adnexectomy performed in the whole cohort of 50 year-old women instead of observation resulted in additional cost of 70 323 RUB for one saved year of life. Other considered approaches connected with the preventive surgical interventions were found to be more economically effective than observation. According to pharmacoeconomic analysis, the most preferable tactics of management is bilateral prophylactic mastectomy and preventive adnexectomy in the age of 40, which allow achieving greater results with fewer costs by 70 years old.

    Authors: Solodkiy V. A. [2] Khodorovich O. S. [1] Derkach Ye. V. [1]

    Tags: brca1/2 mutations1 life years saved1 pharmacoeconomic analysis1 preventive adnexectomy1 prophylactic mastectomy1

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