2022 № 6 Experience and prospects of digital twins application in public healthcare
Digitalization of healthcare opens up opportunities for applying new approaches to the organization of medical care, improving its quality, optimizing the use of healthcare resources. Digital twin is one of the new approaches, a virtual model of a physical object with dynamic bidirectional connections between a physical object and its corresponding twin in a digital environment.
Digital twins allow to study, create and test new hypotheses, conduct experiments and research in silico. T h e a i m o f t h e s t u d y is to describe the existing Russian and foreign experience in the practical application of digital twins in the field of healthcare.
M a t e r i a l s a n d m e t h o d s . The literature review was conducted in Pubmed and Elibrary databases. Publications describing ethical and regulatory aspects, industrial, engineering or logistics applications were excluded. The articles have passed two rounds of peer review. R e s u l t s . Digital twins are used in clinical medicine to test new methods of treatment and the body’s response to them, to simulate the work of organs and tissues. The application of the technology for the development of precision therapy in cardiology, oncology, endocrinology, gastroenterology, orthodontic treatment, rehabilitation, intensive care is described. The digital twin can be used by health authorities to model patient behavior, predict the spread of the infectious process, the work of a medical institution and its structural units in order to optimize resources. C o n c l u s i o n s . The article provides an overview of technology and the main areas of application of digital twins for personalized medicine, public health and smart healthy cities. The prospects for using digital twins lie in the field of creating smart “healthy” cities and regions.
2022 № 5 Application of the VALS and the laddering techniques at shared decision-making
Patients values are fundamental in the process of health decision-making. The use of PROMs is often difficult in routine clinical practice, which requires the search for simpler methods of determining the patients values, where psychographic segmentation and laddering are one of those.
The aim of the study was to improve the process of shared-decision-making in patients with non-melanoma skin cancer using the VALS segmentation and the laddering technique.
Materials and methods. An inclusive, incomparable, prospective, long-term multicenter cohort study of the use of the laddering technique and the VALS technique was conducted in 158 patients (154 (97%) with basal cell skin cancer, 4 (3%) squamous cell skin cancer; 129 (82%) patients with stage I–II diseases, 17 (11%), with IV – 12 (7%); 56 (35%) – men, 102 (65%) – women.
The results of psychographic segmentation showed: the clinical result of the procedure is important for 96% (n=152), the safety of treatment and adverse reactions – for 91% (n=143), the cosmetic result – for 46% (n=73), convenience and flexibility of the treatment schedule – for 36% (n=57), the painlessness of the treatment procedure – for 34% (n=54), the ability to lead a habitual lifestyle during treatment – for 23% (n=36), the comfort of the treatment procedure – for 14% (n=22), the financial costs associated with treatment – for 9% (n=14), preservation of organ function after treatment – for 3% (n=5).
Conclusions. The method of psychographic segmentation can be adapted to the tasks of communication between the doctor and the patient. The scope of application of the VALS methodology and the laddering technique can be considered situations when a doctor is unable to use validated quality of life questionnaires due to limited resources or the absence of such questionnaires.
2022 № 4 Patient support program as a part of value-based healthcare implementation
Patient support programs as a new institutional phenomenon take over part of the functions of the Institute of Healthcare in drug provision, diagnostics, clinicians and patients education, infrastructure support.
Purpose: to evaluate the role of patient support programs (PPMS) by describing the mechanisms of their implementation.
Materials and methods. On the basis of open sources of information and scientific literature data, the initiatives to launch PPP in Russia of medicines and medical devices were analyzed.
Results. The most common programs are that combine financial and information mechanisms. The key principle of the development of the PPP is orientation to the patient’s pathway. Typical tools for the implementation of PPP include the following: hotline, SMS-informing, patronage service, online monitoring, patient training, insurance. The effectiveness of the PPP is assessed by four groups of indicators: patient adherence, quality of life and patient experience, clinical outcome indicators, cost savings.
Conclusions. Health authorities and medical professionals should be aware of the possibilities of programs to achieve the goals of improving the quality and accessibility of medical care, and can also help to systematically assess the effectiveness of such programs from the perspective of public health.
2021 № 9 Current issues of evidence-based management of state and municipal health care.
The topic of evidence-based management is relevant due to a significant increase of managerial innovations in medicine, healthcare commercialization, changes in approaches to the use of evidence sources in healthcare and high commercial, investment, social and reputational risks of poorly evidence-based decisions. The article deals with awareness and practical use of the evidence-based management approach among the executives of budgetary medical cites. The results of the first Russian study of evidence-based management among health care managers are presented, in particular, their awareness of the evidence-based approach, attitude to evidence-based management practice, and the sources of information used by them are studied.
The purpose of the study is to investigate the existing practice of applying evidence-based approaches in the management, awareness of the approach, it’s application in practice, drawing conclusions about the factors influencing managerial decisionmaking, and making recommendations for their improvement.
Materials and methods. The study of the management practice of heads of medical organizations was conducted using an online survey. The general part of the questionnaire included questions about the demography of respondents, their management experience, education, and the size of the organization. The special part assessed: respondents ‘ awareness of the approach; their attitude to the evidence-based management practice; sources of information when making decisions. Their opinion on the role of corporate culture in the formation of evidence-based management practice was clarified.
Results. Only 17% of managers use an evidence-based approach in practice, and only 5% use at least six sources of information for this purpose. The popularity rating of information sources is presented as follows: own experience 81%, consultations with external experts 60,3%, internal data of the organization 56,9%, scientific data 38%, the opinion of colleagues 36,2%. Most managers consider the use of data in practice to be the most difficult in making managerial decisions. Only 31% of healthcare managers regularly summarize their managerial experience. The majority of respondents, 75.8%, recognize the important role of corporate culture in forming the habit of making decisions on an evidence-based basis, but also assess the organization’s resources for making informed management decisions as insufficient. Only 20,7% of respondents rated the degree of the organization’s learning ability and its readiness for changes as high.
Conclusions. Further improvement of the practice of making managerial decisions on an evidence-based basis is possible due to the informatization of healthcare and the development of the corporate culture of municipal medical organizations. Evidence-based management practices should be integrated into the trajectory of continuing medical education of healthcare managers in order to improve the efficiency of the industry.