Abstract
Background: Integrated pathways are commonly seen as the way to strengthen service delivery in many countries. Russia has traditionally had a multilevel system of care that consists of facilities varying in terms of complexity of cases treated. The recent innovation is to establish a new intermediate level of inter district specialty centers IDSC that serve the population of a few local areas and provide additional services, including preventive care and early disease identification. Integrated pathways between levels of service delivery are developed and implemented. Voronezh region is a pilot cite for this innovation in the area of urological care with the focus on the cases of benign prostate hyperplasia BPH. The objective of the research is to evaluate: 1 the scale of new BPH cases identification, 2 the change in the structure of service delivery in multilevel system, 3 the trends in total and unit cost of BPH treatment. Methods and data: The indicators of BPH cases structure, utilization and expenditure trends in Voronezh oblast for each level of service delivery are analyzed. The data relates to men older than 50 year in 2009-2013 before and after the reorganization in 2010. Results: 1- The number of identified new cases increased, while the share of surgical cases decreased. 2- The IDSCs treat the bulk of cases now, while the share of tertiary care hospitals regional and federal decreased substantially. 3- The first impact of the innovation was the growth of BPH expenditure due to early revealing the cases, but the new institutional structure together with a constant surveillance of cases has afterwards slowed down this growth. 4- The unit cost per one BPH case has a strong downward tendency – due to a decrease in tertiary care utilization. Conclusion: Multilevel system of care, based on early identification of cases and integrated pathways between the levels, can contribute to decreasing the share of complex cases requiring surgical interventions. It can also lead to decreasing the share of tertiary care utilization and lower unit cost.
Highlights
Integrated pathways are commonly seen as the way to strengthen service delivery in many countries
Russia has traditionally had a multilevel system of care that consists of facilities varying in terms of complexity of cases treated
The recent innovation is to establish a new intermediate level of inter district specialty centers IDSC that serve the population of a few local areas and provide additional services, including preventive care and early disease identification
Summary
Integrated pathways are commonly seen as the way to strengthen service delivery in many countries. Building an integrated system of urological care: the case of Russian regions 18th International Conference on Integrated Care, Utrecht, 23-25 May 2018 Igor Sheiman1 , Oleg Apolihin2, Sergey Shishkin3
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