Organization Of Specialized Care Research Articles

Incidence of the musculoskeletal system diseases in children and the organization of specialized care in Saint Petersburg

BACKGROUND: The high prevalence of musculoskeletal system and connective tissue diseases, effects on the quality of life of children, and disability level are among the main medical and social problems.
 AIM: To assess the morbidity rates and provision of medical care to St. Petersburg children with musculoskeletal diseases between 2017 and 2021.
 MATERIALS AND METHODS: Data on the incidence of musculoskeletal diseases in children of St. Petersburg were analyzed based on the Federal statistical observation forms submitted by the St. Petersburg State Budgetary Institution Medical Center for Information and Analysis, collections of N.N. Priorov National Medical Research Center for Traumatology and Orthopedics of the Ministry of Health of the Russian Federation “Trauma, orthopedic morbidity, the state of trauma and orthopedic care for the population,” edited by Acad. S.P. Mironov, RAS, and data from the Federal State Statistics Service.
 RESULTS: In Saint Petersburg, the morbidity rate of musculoskeletal and connective tissue diseases from 2017 to 2021 was 13%, excluding 2020, which was most likely due to the introduction of measures aimed at counteracting the spread of COVID-19 and the suspension of planned outpatient specialized care. The number of orthopedic beds for children decreased by 58, whereas the availability of beds for children remained at the same level and amounted to 4.3 beds per 10,000 children, which exceeded the indicator for the Russian Federation (1.0). The number of children with these disabilities increased 1.4-fold. Deaths of children due to musculoskeletal and connective tissue diseases were recorded in 2019 and 2020.
 CONCLUSIONS: The results of the 5-year observation period of musculoskeletal and connective tissue diseases in children in St. Petersburg revealed increasing incidence because of the increase in the number of children newly diagnosed with these diseases.

Mistakes in the Organization of Specialized Care for Patients with Traumatic Amputation of Hand Segments

The aim of the study appears to focus on identifying and analyzing errors or inadequacies within the organization of specialized care for patients who have experienced traumatic amputation of hand segments. The specific goals might include understanding the flaws in the existing care structures, improving patient outcomes, and developing recommendations to enhance the quality of specialized care provided to patients who have suffered hand segment amputations.Methods. 2020 to 2022 to the clinic of the National Scientific Center for Surgery named after Syzganov, 165 patients with acute injuries of limb segments were urgently hospitalized to provide specialized surgical care, leading to decompensation of blood circulation in the hand or fingers. Results. Due to incorrect actions in 24 patients, it was not possible to replant the delivered segments (33 segments). These patients underwent stump formation.At the same time, 50-75% still allow diagnostic, technical and tactical errors in the treatment of this category of patients. The possibility of replantation and revascularization, as well as their outcome, largely depended on the timeliness and quality of first aid, compliance with the conditions for preserving the cut-off segment, the speed of transportation and other organizational factors. Conclusions. The use of modern methods of microsurgical restorative interventions with the reconstruction of injured vessels can significantly expand the possibilities of preserving and restoring completely and partially torn segments of the hand and fingers. The improvement of the results of treatment of patients with traumatic amputations and injuries of the neurovascular bundles of limb segments was significantly affected by the provision of timely specialized microsurgical care

Organization of specialized care for the adult population with diseases of the ears, throat and nose in the agricultural region

Organization of specialized care for the adult population with diseases of the ears, throat and nose in the agricultural region

National Development and Regional Differences in eHealth Maturity in Finnish Public Health Care: Survey Study.

BackgroundeHealth increasingly affects the delivery of health care around the world and the quest for more efficient health systems. In Finland, the development of eHealth maturity has been systematically studied since 2003, through surveys conducted every 3 years. It has also been monitored in several international studies. The indicators used in these studies examined the availability of the electronic patient record, picture archiving and communication system, health information exchange, and other key eHealth functionalities.ObjectiveThe first aim is to study the national development in the maturity level of eHealth in primary health care and specialized care between 2011 and 2020 in Finland. The second aim is to clarify the regional differences in the maturity level of eHealth among Finnish hospital districts in 2020.MethodsData for this study were collected in 2011, 2014, 2017, and 2020, using web-based questionnaires from the Use of information and communication technology surveys in Finnish health care project. In total, 16 indicators were selected to describe the status of eHealth, and they were based on international eHealth studies and Finnish eHealth surveys in 3 areas: applications, regional integration, and data security and information and communications technology skills. The indicators remain the same in all the study years; therefore, the results are comparable.ResultsAll the specialized care organizations (21/21, 100%) in 2011, 2014, 2017, and 2020 participated in the study. The response rate among primary health care organizations was 86.3% (139/161) in 2011, 88.2% (135/153) in 2014, 85.8% (121/141) in 2017, and 95.6% (130/136) in 2020. At the national level, the biggest developments in eHealth maturity occurred between 2011 and 2014. The development has since continued, and some indicators have been saturated. Primary health care lags behind specialized care organizations, as measured by all the indicators and throughout the period under review. Regionally, there are differences among different types of organizations.ConclusionseHealth maturity has steadily progressed in Finland nationally, and its implementation has also been promoted through various national strategies and legislative changes. Some eHealth indicators have already been saturated and achieved an intensity of use rate of 100%. However, the scope for development remains, especially in primary health care. As Finland has long been a pioneer in the digitalization of health care, the results of this study show that the functionalities of eHealth will be adopted in stages, and deployment will take time; therefore, national eHealth strategies and legislative changes need to be implemented in a timely manner. The comprehensive sample size used in this study allows a regional comparison in the country, compared with previous country-specific international studies.

Orthopedic morbidity and organization of specialized care for children in Saint Petersburg

Demographic indices, structure and dynamics of orthopaedic morbidity in children and adolescents of St. Petersburg are presented. During 10 years (from 1991) total number and the number of primary visits in connection with osseous-muscular diseases increased 2,5-3 times. In children the rate of orthopaedic pathology among total morbidity increased from 0.7 to 2.1% and in adolescents from 8,2 to 16%o. The problems of organization of specilaized outpatient care as well as hospital and rehabilitation care for the children with loco-motor system pathology were considered.

The analysis of impact of medical social and economic factors on regional coloproctological morbidity of adult population

Actually, there is constant increase of number of patients with coloproctological diseases, including corresponding malignant neoplasms. At that, issues of improving organization of specialized care of patients of this kind still remain unresolved in many positions. The retrospective analysis of regional coloproctological morbidity of adult population was carried out as exemplified by the Perm Kray. To forecast onset of colorectal cancer multiple logistic regression analysis was applied. To assess relationship of particular factors and morbidity, the Spearman rank correlation method was implemented. The ROC-analysis was applied using MedCalc software. The study established strong relationship between the presence of colorectal cancer and colon polyps (87.2%, Somers' D = 0.868). According to ROC analysis data, colon polyps are risk factor of development of colorectal cancer in 93.4% of cases. The pronounced relationship is demonstrated for presence of colon polyps and colorectal cancer detectability (OR 225.85, CI 61.5 - 829.15, p <0.0001). The results of analysis of regional coloproctological morbidity of adult population in 45 municipalities of the Perm Kray testify significant variability of territorial features. The study revealed that level of coloproctological morbidity in municipalities depends on such indices as provision of physicians and hospital beds and average salary. The study results testify necessity to consider territorial characteristics of Perm Kray in planning complex coloproctological care of population. The identified interrelationships of population morbidity, activities and resource support are to be taken into account in planning organizational measures to modernize treatment and preventive care of coloproctological patients, including early diagnosis of coloproctological cancer in combination with other measures to reduce overall level of coloproctological morbidity on territory of Perm Kray and to improve quality of life of patients.

View of relatives on quality of care: narratives on the care for people with visual and intellectual disabilities

In the care for people with intellectual disabilities in the Netherlands there is a growing emphasis on the relationship with relatives. The aim of this study is to explore the views of relatives regarding the quality of care and support for people with visual and intellectual disabilities. In this qualitative study twelve semi-structured interviews were conducted with relatives of people with visual and intellectual disabilities having experience with multiple group-homes of specialized care organizations. Analysis revealed seven overarching themes: 1) Be partners in care; 2) ‘Know’ the person with the disability; 3) Provide care from the heart; 4) Provide safety; 5) Provide opportunities for development; 6) Provide continuity in care; 7) Provide a ‘home’. We conclude that the attitudes of care professionals are very important to provide good care and support, as seen from the perspective of relatives. For relatives, it is important to be acknowledged by the care professionals. Points of interest This article is about the viewpoint of relatives concerning the question: what is your understanding of good care and support for people with a visual and intellectual disability living in a group-home? Relatives wish to be involved in the care that the person with disabilities needs and receives. They would like to be seen as partners of care professionals in providing care and support and wish to be contacted if choices or decisions are made. It is important for people with a disability living in a group-home to be respected as a person by care professionals, to be able to learn new things, to receive structured care by familiar carers and to feel safe and at home in the group-home. The findings from this study may serve as recommendations for care organizations and professionals.

Эпидемиология и структура травматических повреждений уха в Карачаево-Черкесской республике

The growth of emergencies, increased traffic and overall technological progress led to an increase in the number of traumatic injuries, including the organ of hearing. The lack of information on the structure and prevalence of traumatic injuries of the organ of hearing makes it difficult to plan and increase the effectiveness of the organization of specialized care for such victims. To study the prevalence and structure of traumatic injuries of the hearing organ in the Karachay-Cherkess Republic, the medical records of patients with various ear injuries who were treated in the departments of the Karachay-Cherkess Republican Clinical Hospital over the past three years were analyzed. The prevalence of traumatic injuries of the organ of hearing and its structure was determined according to the data of hospitals of the republican hospital. There was a tendency toward an increase in patients with ear injuries in all age groups. Maintaining the predominance of mechanical trauma, with an increase in the number of victims with baro- and acoustic trauma. The features of damage to the structures of the organ of hearing are examined and it is emphasized that the mechanism of trauma determines the tactics of the victim. The scale of hearing injuries and their consequences require a more in-depth study of their regional characteristics, risk factors to develop all possible preventive measures.

Regionalized networks and guarantee of specialized health care: the experience of Ceará, Brazil.

This paper analyzes policies and management tools aimed at the regional organization of specialized care in Ceará. A case study was developed in a health region based on 18 interviews with regional and municipal managers and health professionals and visits to services. Several factors enabled advances in the organization of specialized care: the preponderant role of the State Health Secretariat in the regional health coordination of actions and services, providing infrastructure, financing with redistribution of resources and technical support to municipalities; implantation of regional Polyclinic and Specialized Dental Care Centers through the Public Health Consortium; and logistics support of transport system. The institutional framework of Municipal Health Secretaries Council and the participatory functioning of the Regional Interagency Committee provided adequate space for the regional governance. Challenges remain for the integration of the network, qualification of care regulation, and provision of hospital care in the region. The results reinforce the importance of public and universal arrangements for the provision of comprehensive health care that can reduce inequities.

Geographical variations in access to expert centers for multiple sclerosis in France

Abstract Background Multiple sclerosis (MS) is a chronic neurological disease affecting about 100,000 persons in France. Disease management is mainly supervised by the neurologist, supported by the general practitioner (GP). The complexity of the disease, due to the variety of symptoms as well as the recent changes in the therapeutic arsenal, requires both a high level of expertise and coordination between the different health care providers. To face this challenge, integrated and coordinated network of services “MS expert centers” have been progressively set up from 2000 onwards. Our objectives are to describe referrals to MS expert centers over the 2010-2015 period, to look for geographic variations and if any, to identify potential determinants of access. Methods The analysis is performed on the French health insurance database which covers 97% of the French population. Geographic variations of access are explored, as well as association with the following parameters: demographics (age, sex), socio-economic characteristics (social deprivation index at residence, degree of urbanization), and density of health care services (GPs, neurologists, hospital beds). Results Overall, 112,415 people with MS (70% women, mean age 46 years) were included. Initial results show that over the study period, 98% of patient had at least one visit to GP, 87% to neurologist, and 36% in a CRC SEP. Conclusions The present study will assess to what extent MS patients have been able to take full advantage of an innovative organization of specialized care which was recently deployed in France. This model of care has been generalized by the French Ministry of Health in 2016 and 23 ‘competence and resource centers’ for MS (CRC SEP) are now covering the whole national territory. Further research will be performed to identify whether and how this has modified access to specialized coordinated MS care.

Improving inter-organizational care-cure designs: specialization versus integration

PurposeThe purpose of this paper is to investigate inter-organizational designs for care–cure conditions in which low-risk patients are cared for in specialized care organizations and high-risk patients are cared for in specialized cure organizations. Performance impacts of increasing levels of integration between these organizations are analyzed.Design/methodology/approachMixed methods were used in Dutch perinatal care: analysis of archival data, clinical research and system dynamics simulation modeling.FindingsInter-organizational design has an effect on inter-organizational dynamics such as collaboration and trust, and also on the operational aspects such as patient flows through the system. Solutions are found in integrating care and cure organizations. However, not all levels of integrated designs perform better than a design based on organizational separation of care and cure.Practical implicationsA clear split between midwifery practices (care) and obstetric departments (cure) will not work since all pregnant women need both care and cure. Having midwifery practices only works well when there are high levels of collaboration and trust with obstetric departments in hospitals. Integrated care designs are likely to exhibit superior performance. However, these designs will have an adverse effect on organizations that are not part of this integration, since integrating only a subset of organizations will feed distrust, low collaboration and hence low performance.Originality/valueThe originality of this research is derived from its multi-method approach. Archival data and clinical research revealed the dynamic relations between organizations. The caveat of some integrated care models was found through simulation.

Coopetition in health care: A multi-level analysis of its individual and organizational determinants

Cooperative inter-organizational relations are salient to healthcare delivery. However, they do not match with the pro-competitive healthcare reforms implemented in several countries. Healthcare organizations thus need to balance competition and cooperation in a situation of ‘coopetition’. In this paper we study the individual and organizational determinants of coopetition versus those of cooperation in the price-competitive specialized care sector of the Netherlands. We use shared medical specialists as a proxy of collaboration between healthcare organizations. Based on a sample of 15,431 medical specialists and 371 specialized care organizations from March 2016, one logistic multi-level model is used to predict medical specialists' likelihood to be shared and another to predict their likelihood to be shared to a competitor. We find that different organizations share different specialists to competitors and non-competitors. Cooperation and coopetition are hence distinct organizational strategies in health care. Cooperation manifests through spin-off formation. Coopetition occurs most among organizations in the price-competitive market segment but in alternative geographical markets. Hence, coopetition in health care does not appear to be particularly anti-competitive. However, healthcare organizations seem reluctant to share their most specialized human resources, limiting the knowledge-sharing effects of this type of relation. Therefore, it remains unclear whether coopetition in health care is beneficial to patients.

Organization of specialized care for children with cardiovascular diseases at the republican heart center in Republic of Bashkortostan

The organization of cardiologic and cardio surgical care for children and adolescents in Republican Heart Center of Republic of Bashkortostan is characterized. The hospital has a united block for providing specialized medical care. Departments of cardio surgery, pediatric cardiology and intensive care unit №1 are based on the same floor. The advantages of staged approach and continuity of care for children and adolescents with cardiovascular diseases is emphasized. Registers for prenatal diagnosis of congenital heart diseases (includes 7894 children and adolescents by December 31, 2012), for pulmonary hypertension are developed and used in the Republican Heart Center for timely cardio surgery in patients with congenital heart diseases. The main directions of medical care for children with cardiovascular diseases in Republic heart center are cardiac surgery of congenital heart diseases, pediatric cardiology, radiosurgery of congenital heart diseases, emergency cardiology and cardiac surgery, and neonatal cardiac surgery. 4500 cardiovascular surgeries are performed annually, including 398 on children aged 0-17 years, among them 224 on assisted circulation. Department of cardio surgery annually performs about 100 surgeries on infant patients with «critical» congenital heart diseases, contributing up to 35% of all children who underwent surgery, including 30 surgeries per year on newborns. The outpatient clinics examines over 15 thousand children per year. The basis of the successful maintaining the public health is good teamwork of highly specialized professionals in the atmosphere of a clear motivation, enthusiasm and high morals.

Distribution of Specialized Care Centers in the United States

As a recommended strategy for optimally managing critical illness, regionalization of care involves matching the needs of the target population with available hospital resources. The national supply and characteristics of hospitals providing specialized critical care services is currently unknown. We seek to characterize the current distribution of specialized care centers in the United States. Using public data linked with the American Hospital Association directory and US Census, we identified US general acute hospitals providing specialized care for ST-segment elevation myocardial infarction (STEMI) (≥40 annual primary percutaneous coronary interventions reported in Medicare Hospital Compare), stroke (The Joint Commission certified stroke centers), trauma (American College of Surgeons or state-designated, adult or pediatric, level I or II), and pediatric critical care (presence of a pediatric ICU) services. We determined the characteristics and state-level distribution and density of specialized care centers (centers per state and centers per state population). Among 4,931 acute care hospitals in the United States, 1,325 (26.9%) provided one of the 4 defined specialized care services, including 574 STEMI, 763 stroke, 508 trauma, and 457 pediatric critical care centers. Approximately half of the 1,325 hospitals provided 2 or more specialized services, and one fifth provided 3 or 4 specialized services. There was variation in the number of each type of specialized care center in each state: STEMI median 7 interquartile range (IQR 2 to 14), stroke 8 (IQR 3 to 17), trauma 6 (IQR 3 to 11), pediatric specialized care 6 (IQR 3 to 11). Similarly, there was variation in the number of each type of specialized care center per population: STEMI median 1 center per 585,135 persons (IQR 418,729 to 696,143), stroke 1 center per 412,188 persons (IQR 321,604 to 572,387), trauma 1 center per 610,589 persons (IQR 406,192 to 917,588), and pediatric critical care 1 center per 665,282 persons (IQR 441,525 to 942,254). The national distribution patterns differed for each type of specialized care center. The distribution of specialized care centers varies across the United States. These observations highlight unanswered questions about the regional organization of specialized care in the United States.

Zabolevaemost' zlokachestvennymi gliomami golovnogo mozga v Volgogradskoy oblasti

The paper presents data on the incidence of malignant brain gliomas (MBG) at the populational level in the Volgograd Region in 2001-2006. The quantitative and qualitative parameters of morbidity are analyzed by gender and age in detail. The higher incidence of MBG in the Volgograd Region is due to its rise in the able-bodied male contingents and in the female population in the age group older than the able-bodied age. Further study of the organization of specialized care to patients to MBG is possible only when information available in the population-based cancer registers of the subjects of the Russian Federation as a constituent of the State Cancer register is collected and analyzed.

Optimal technologies in the diagnosis and treatment of orthopedic pathology in children and adolescents, errors and complications. Symposium of pediatric traumatologists-orthopedists of Russia (September 17-19, 2003, Volgograd)

The symposium was attended by 212 pediatric orthopedic traumatologists from 53 administrative territories of Russia. The program of the symposium included the following questions:1. injuries and morbidity of the musculoskeletal system in children and adolescents, organization of specialized care;2. optimal technologies for the treatment of injuries and their consequences, congenital and acquired diseases of the musculoskeletal system, benign bone tumors. Errors in diagnosis and treatment, ways to overcome the complications that have arisen;3. new technologies for diagnosis, treatment and rehabilitation.