Quality of medical care for children with cancer in Ural Federal District

Abstract

Objective. Analysis of main indicators of the quality of medical care for children with cancer in Ural Federal District.Materials and methods. The study analyzed operational reports for 2017 obtained from the public health care executive authorities of the 6 Russian Federation Subjects constituting Ural Federal District: Kurgan Oblast, Tyumen Oblast, Sverdlovsk Oblast, Chelyabinsk Oblast, Khanty‑Mansi Autonomous Okrug, and Yamal‑Nenets Autonomous Okrug.Results. There were 3 paediatric oncology departments. No paediatric oncology departments were available in 3 Subjects (50 %), one Subject (20 %) had no paediatric oncology hospital beds. There were 192 paediatric oncology hospital beds in total (0.7 per 10,000 children aged 0‑17 years). No paediatric oncology hospital beds were available in one Subject (20 %) (Yamal‑Nenets Autonomous Okrug). The average hospital bed occupancy was 343 days a year. The number of physicians providing medical care for children with cancer was 59, and 35 of them (59.3 %, 0.1 per 10,000 children aged 0‑17 years) had a paediatric oncologist certificate. No paediatric oncologists or paediatric oncology hospital beds were available in one Subject (20 %) (Yamal‑Nenets Autonomous Okrug). The 2017 incidence rate in Ural Federal District was 14, the prevalence rate was 147.2 (per 100,000 patients aged 0‑17 years). The mortality rate was 2.5 per 100,000 patients aged 0‑17 years, the one‑year mortality rate was 5 %. There were 46 patients diagnosed through active case finding (12.1 %). A total of 94 patients (24.8 %) were referred to medical centres of Federal subordination. Four primary patients (1 %) left the Russian Federation for treatment.Conclusion. Apparent registration flaws (low incidence) and the lack of reliable follow‑up data (mortality assessment is difficult) can be overcome by the introduction of electronic registries. Audit of medical records is necessary for reliable assessment of how the general demand in paediatric oncology hospital beds is met and of the percentage of patients referred for treatment to medical centres of Federal subordination. The long‑standing problems of lack of paediatric oncologists and low percentage of patients diagnosed through active case finding should be tackled through reform of the medical education system.