Medical Service Providers Research Articles

Influence of Blood Sampling Service Process Reengineering on Medical Services Supply: Quasi-Experimental Study.

Tertiary hospitals in China are confronted with significant challenges due to limited spatial capacity and workforce constraints, leading to saturated allocation of medical resources and restricted growth in medical service provision. The incorporation of digital health into medical service process reengineering (MSPR) marks a pivotal transformation and restructuring of conventional health service delivery models. Specifically, the application of MSPR to blood sampling services processes reengineering (BSSPR) holds promise for substantially enhancing the efficiency and quality of medical services through streamlining and optimizing these procedures. However, the comprehensive impact of BSSPR has been infrequently quantified in existing research. This study aims to investigate the influence of BSSPR on the efficiency and quality of medical services and to elucidate the key informative technological support points underpinning BSSPR. Data were collected from both the new and old laboratory information systems from August 1, 2019, to December 31, 2021. A combination of statistical description, chi-square test, and t test was used to compare check-in time and waiting time of outpatients before and after the implementation of BSSPR. An interrupted time-series design was used to analyze the impact of BSSPR on medical service efficiency and quality, enabling the control of confounding variables, including changes in medical human resources and both long- and short-term temporal trends. BSSPR had an impact on the efficiency and quality of medical services. Notably, there was a significant increase in the number of patients receiving blood sampling services, with a daily service volume increase of ~150 individuals (P=.04). The average waiting time for patients decreased substantially from 29 (SD 36) to 11 (SD 11) minutes, indicating a marked improvement in patient experience. During the peak period, the number of patients receiving blood sampling services per working hour statistically increased from 9.56 to 16.77 (P<.001). The interrupted time-series model results demonstrated a reduction in patients' waiting time by an average of 26.1 (SD 3.8; 95% CI -33.64 to -18.57) minutes. Although there was an initial decline in the number of outpatients admitted following BSSPR implementation, an upward trend was observed over time (β=1.13, 95% CI 0.91-1.36). BSSPR implementation for outpatients not only reduced waiting time and improved patients' experience but also augmented the hospital's capacity to provide medical services. This study's findings offer valuable insights into the potential advantages of BSSPR and underscore the significance of harnessing digital technologies to optimize medical service processes. This research serves as a foundational basis and provides scientific support for the promotion and application of BSSPR in other health care contexts. By continuing to explore and refine the integration of digital technologies in health care, we can further enhance patient outcomes and elevate the overall quality of medical services.

Empowering health: exploring the vital role of facilitator organisations in supporting chronic disease patients in Assam, India

BackgroundThe research centers on an underrated type of mediator organization namely facilitator organizations (FO) that work in the health care setting. These organizations are mediators that bridge the gap between patients (healthcare customers) and medical services. The facilitator organizations considered for the study are non-governmental organizations situated in Assam that works in align to chronic diseases, particularly cancer.MethodsThe data collection was done through organizational referrals for the study making it a snowball sampling, progressively incorporating additional contemporary entities. The study's respondents were facilitator organizations (i.e.Non-Government Organizations) actively involved in addressing chronic disease. Data were gathered from these facilitator organizations situated in Assam, India, supporting healthcare customers specifically those with cancer. Key informant interviews and semi-structured questionnaires were used for data collection, the responses were documented using a field diary and the Lovelock service model was used as a reference for the construction of the questionnaire and developing the research framework.ResultsThe analysis of data shows that facilitator organisations maintain continuity in relationships, which enhances health management and outcomes for customers. The shift in cancer care towards a patient-centred approach and the crucial role of FOs in providing comprehensive and individualized care, addressing diverse patient needs thereby addressing the holistic development of the health care customer is vital. In addition, effective patient-centred communication, incorporating trust, compassion, respect and comprehensive support including mental health therapy, occupational therapy, and rehabilitation plays a crucial role in leading a normal life. `ConclusionThe facilitator organizations dealing with Cancer have to meet a broad range of services outside the core medical service providers for their healthcare customers. These efforts contribute to the overall recovery of both the healthcare customer with cancer and their family.

Comparison of direct and indirect admission to a cardiac arrest centre for intubated out-of-hospital cardiac arrest patients in the Northwest England: an audit

Abstract Background Despite concerted global efforts to enhance cardio-pulmonary resuscitation (CPR) and post-resuscitation care, out-of-hospital cardiac arrest (OHCA) remains a significant cause of mortality. Current guidelines promote the concept of Cardiac Arrest Center (CAC), offering advanced post-resuscitation management with the aim of improving survival rates. However, it remains uncertain whether directly transporting OHCA patients from the scene to these centers would enhance their prognosis. Purpose This study aimed to assess whether direct transport of intubated OHCA patients to a higher-level cardiac arrest center in the Northwest of England yielded better outcomes compared to initial resuscitation in smaller local emergency departments followed by transfer. Methods Conducted as a retrospective analysis, the audit examined OHCA patients presenting at a single cardiac arrest center between October 2018 and April 2022. Only intubated patients were included. The study compared two groups based on the route of admission: direct admission to the cardiac arrest center from the field by emergency medical service providers versus indirect admission via inter-hospital transfer to the center. The primary outcomes assessed were inpatient survival and 30-day survival. Statistical analysis employed Student's T-test and Chi-square test for clinical significance. Results The audit included 214 patients, with 112 (52.34%) in the direct group and 102 (47.66%) in the indirect group. Baseline characteristics between the groups were similar, including age, gender, downtime, bystander CPR, haemodynamic status, initial presenting rhythm (VT/VF), post-arrest ECG (STEMI), comorbidities, and procedural outcomes (Table 1). However, the direct group exhibited significantly shorter average arrival times at the cardiac arrest center (72 minutes vs. 190 minutes, p=0.017), along with improved in-hospital survival (52.68% vs. 41.18%, p=0.009) and 30-day survival rates (52.68% vs. 37.25%, p=0.002). Conclusion The direct admission of intubated OHCA patients to a cardiac arrest center, as observed in this audit, was associated with improved outcomes attributed to expedited admission times. The study’s design limitations, including its non-randomized nature and single-center approach, underscore the need for further research.

Mobile computed tomography at the Munich Oktoberfest : From idea to implementation.

The Munich Oktoberfest, the largest folk festival in the world, attracts around 6.2million visitors over 16-18days. Some of the visitors exhibit certain risky behaviors, leading to asignificantly increased number of medical emergencies during the festival. During Oktoberfest, the prehospital and clinical emergency services of the city are heavily strained, as one-third more ambulances are needed, and over 7000 patients must be treated on-site each year. Until 2022, there was no option for guideline-compliant radiological assessment on-site for patients with head or facial trauma and suspected serious trauma-related injuries. This required alarge number of emergency service admissions to hospitals, mostly for outpatient assessments. To relieve the overburdened medical system, amobile computed tomography (CT) scanner was set up on the Oktoberfest grounds in 2022 for the first time. Amobile CT scanner at the Munich Oktoberfest was utilized for diagnosing injuries to the face, cranium, and cervical spine. For an indication of cranial CT, we used acombination of the Canadian CT Head Rule and NEXUS criteria. Despite the complex structural conditions, this integration seamlessly fit into the structured processes of the on-site medical service. Since this deployment was, to our knowledge, the first of its kind globally, we had to develop and implement new clinical concepts and procedures tailored to the unique conditions of afolk festival. We demonstrated that aCT scanner could be effectively integrated into the preclinical processes of amedical service without direct hospital connection. On-site CT diagnostics proved to be ahighly effective means of avoiding unnecessary transportation to the hospital. Consequently, areduction in emergency medical service provision and stabilization of clinical emergency medicine during the Oktoberfest became feasible. From the authors' perspective, establishing amobile CT scanner at events with high or very high demands on preclinical and clinical emergency medicine is feasible and provides significant relief for the system. The primary goal of stabilizing prehospital and clinical emergency structures, as well as improving the detection and treatment of potentially life-threatening patients on-site, was successfully achieved. Careful integration into the overall process flow is essential.

PUBLIC ADMINISTRATION POLICY IN THE HEALTHCARE SECTOR UNDER MARTIAL LAW

The article analyzes the main directions of public administration in the field of health care of Ukraine during martial law. The main focus is on the adaptation of the legislative framework and the modernization of management approaches, which allow to ensure the effective functioning of the health care system in crisis situations. The issue of creating mobile medical teams and hospitals, which are the main tool for providing medical care in front-line and de-occupied areas, was considered. The contribution of international organizations to the support of the Ukrainian medical system in terms of supplying medical equipment, medicines and providing financial assistance is analyzed. The key normative legal acts, which were adopted from 2022 and contributed to the adaptation of the medical system to new challenges, were studied. Features of the functioning of the Resolution of the Cabinet of Ministers No. 302, No. 683, No. 1078 and others are given. Particular attention is paid to the digitization of health care, the implementation of electronic medical records in order to ensure the prompt provision of medical services. The problems of medical institutions in the front-line zones, including the destruction of more than 700 hospitals, and ways to solve the logistical problems of the supply of medicines were considered. A conclusion was made regarding the further development of public administration in the field of health care based on the integration of international and national resources, improvement of digital technologies and modernization of medical infrastructure. Ensuring adequate funding of the health care system, which includes the health insurance program, emergency and specialized medical care, is revealed, which is a priority in the 2023 budget. The article examines the influence of international humanitarian organizations on the support of the Ukrainian health care system in the conditions of military operations. The basis for the development of long-term strategies for the recovery of medical facilities after destruction and their equipment with modern technologies is proposed. Aspects of integration of digital solutions to ensure the continuity of medical services in the most difficult conditions have been studied.

Exploring ethical issues in the Chinese translation of medical terms: The convergence of translation ethics and medical ethics

This article explores the ethical aspects of translating medical terminology into English, with a particular emphasis on the joint influence of medical ethics and translation ethics. This study identified four key issues in current translation practice through the analysis of various cases from the perspective of Chestermans five kinds of translation ethics, including representation ethics, service ethics, communication ethics, norm-based ethics, and commitment ethics. The four issues involve discrimination, superstition, contempt, and overgeneralization. These issues may hinder the provision of appropriate medical services and social acceptance by fueling social stigma, public misunderstandings, and negative perceptions of diseases. This study suggests that medical translation is not only about language conversion, but also involves considerations of cultural, ethical, and social factors. This article attempts to provide practical advice for medical translators and healthcare workers by combining medical ethics with translation ethics. It suggests that future research should prioritize interdisciplinary collaboration to improve ethical standards in medical translation and promote more accurate and respectful descriptions of diseases in different cultures.

Подходы в совершенствовании нормативной базы в отношении применения мультифокальных интраокулярных линз при хирургическом лечении катаракты

Ultrasound phacoemulsification with intraocular lens (IOL) implantation is the “gold standard” for cataract treatment. Considering the existing requirements for the quality of vision after surgery, there is an increasing demand from patients for IOL implantation, which provides comfortable vision not only at a long distance, but also at a short one without the use of reading glasses (IOL with multifocal properties). The analysis of the existing regulatory framework regarding the possibility and obligation of using this medical product in the provision of specialized medical care – surgical treatment of cataract within the framework of the state guarantee program shows the possibility of using this consumable material without the obligation of the medical organization to consider the wishes of the patient. The change in the structure of the payment tariff for medical care for patients with cataract in 2023, the reduction in the tariff for providing specialized medical care to patients with uncomplicated forms affected the availability of multifocal IOL for patients without specifying the way to obtain this type of service, which makes it relevant to analyze approaches to improving the regulatory framework regarding the use of multifocal intraocular lenses in cataract surgical treatment. There are unsettled clinical, organizational, and economic issues regarding the use of multifocal intraocular lenses (artificial lenses) in the surgical treatment of cataract. There are various approaches (clinical-organizational, economic, legal, information) to improving the regulatory framework, but the approach of decision makers should be complex based on a comprehensive assessment of the economic, clinical, and technological components. Approaches are only a means to achieve a goal: the development of a multifunctional system of state guarantees in the provision of medical services, rational use of available resources.

Resilience Capacity of Pre-hospital Emergency Medical Service (EMS) Providers and the Future Agenda for Sustainable Development of A Resilient EMS System in Thailand

In the current scenario, demand for emergency care is rising due to the shift in disease pattern all around the world, from growing burden of non-communicable diseases to the pre-existing communicable diseases. The principle aim of an emergency medical service (EMS) system is to prevent premature mortality, reduce pain and prevent long term disability. EMS workers serve on the front lines of emergency medical care, which is one of the most important components in an EMS system of any country. Since the latest pandemic has caused increased burn out and stress among the service providers with long term mental and physical effect which is yet to be researched in Thailand, and no study in particular have addressed to evaluate the resilience capacities of the front-line EMS workforce and identify components that influence their performance and response to emergencies. This study aims to measure the resilience capacity of pre-hospital EMS providers of Thailand along with providing recommendations to policy makers regarding EMS service provider future agendas and standard methods for proper workforce development in order to tackle future public health emergency situations. The respondents were EMTs, ENPs, paramedics, frontline rescuers working in the provinces as an EMS service provider under the ministry of public health (MOPH), National Institute of Emergency Medicine (NIEM), Thailand. Total 500 participated in the survey from 32 different provinces. Resilience capacity was divided into high, moderate and low; Components and factors were developed through literature review and grouping was done. With total 41 questions: Safety, Competencies, Wellness and Behavioral Health. Open ended questions reflected the perception and experiences of the EMS service providers regarding the strength and improvement areas of the EMS system in Thailand. The result from the survey shows that the EMS service providers have moderate resilience in terms of Behavioral Health which is related to their psychometric properties and main components to measure the resiliency scales. Similarly, in terms of Safety, Wellness and Competencies components the EMS services have shown moderate level of resilience capacity as a front-line worker in the emergency medical service system to prepare for the future public health emergencies. The findings of the research present the perception and opinions of various EMS providers working in different provinces of Thailand. This study explores the present status/situation of front-line workers of the EMS system in Thailand. The findings provide crucial recommendations to health policy makers for developing resilient EMS system and their workforce in Thailand focusing on pre-hospital care setting. This research suggests measurement tools and plans focusing on the EMS future agenda 2050.

Informatization of the processes of administration of the quality of medical services in surgical hospitals

Among the various forms of quality control of the provision of medical care, self-control and internal control of the quality of medical services are the most effective and significant. Currently, there is no comprehensive information technology and algorithm for recording data on the provision of medical services and determining their quality. The goal is to develop and analyze the effectiveness of business processes and an algorithm for quality control of the performance of medical services in a surgical health care institution by establishing their daily accounting in the information system, control of indicators characterizing the safety and quality of their performance, as well as an opportunity to assess the dynamics changes in indicators for making management decisions. In the study, an analysis of literary sources was carried out, business processes were formulated, and on the materials of a retrospective analysis algorithms for the use of information technologies were developed based on the methods of generalization, comparison, content analysis, system-analytical and logical analysis, a graphic analysis was performed to increase the clarity of the presentation of the material. The research was approved by the Biomedical Ethics Committee. For the first time, as a result of the work of the internal quality commission, daily and summarized forms of reports on the work of the medical center, which have five sections are obtained. The statistical indicators of the operation of the surgical unit for any period are fixed, formed in an automated mode and analyzed. Clinical data characterizing all prescribed procedures applied are subject to analysis, and the results provide an opportunity to isolate from the records the disorders and complications reflected in the reports. The quality control of the use of antibiotics, the frequency of their use for preventive and therapeutic purposes is also carried out. The section that contains multivariate epidemiological control of the work of the treatment facility, as well as the section that shows the quality of medical record keeping and patient care is important. Together with the inpatient chart, e-mails of medical appointments are analyzed, patient falls are recorded, appointments and monitoring of patient care, pain assessment after surgery, allergic reactions are recorded, as well as a retrospective audit of the charts regarding the justification of the appointment of antimicrobial therapy. Control of patient safety and the quality of the provided medical services requires constant verification of their implementation and paying attention to be up to standards, the occurrence of deviations and complications. The application of a specially developed algorithm based on information technologies, aimed at daily accounting of medical services and obtaining data on deviations in their application, makes it possible to make urgent management decisions and influence the improvement of the qualifications of personnel who provide such services.

MODERN VIEWS OF USE OF TELEREHABILITATION IN URINARY TRACT DYSFUNCTION IN PATIENTS WITH MULTIPLE SCLEROSIS

Multiple sclerosis is a chronic disease of the nervous system that often leads to various disorders, including urinary tract dysfunction. This significantly affects the quality of life of patients, causing physical and psychological complications. The term "bladder rehabilitation" summarizes treatment options aimed at restoring its function in patients with neurourological symptoms. A strong contraction of the sphincter of the urethra and/or pelvic floor, as well as anal dilatation, manipulation of the genital area, and physical activity reflexly inhibit urination. A comprehensive physical therapy program for patients with pelvic disoders includes pelvic floor vibration massage, training in proper breathing patterns, pelvic floor muscle relaxation and stabilization exercises and should last several months, during which the patient regularly visits the doctor. The pandemic and war have created barriers that affect almost every aspect of life, treatment and rehabilitation, especially for people with chronic neurological conditions. Traditional rehabilitation methods used to correct urinary tract dysfunction have their limitations, including difficulties in accessing specialists, especially in remote areas. This stimulates the development and implementation of telerehabilitation as an alternative approach. Telerehabilitation involves the use of digital technologies for the remote provision of medical services and patient monitoring. It allows doctors to monitor the condition of patients, provide recommendations and adjust treatment without the need for personal visits. Considering the existing data and our own clinical experience, we consider it appropriate to use telerehabilitation for the correction of disorders of the lower urinary tract, especially in the conditions of war, when access to rehabilitation centers may be difficult. In the department of medical rehabilitation of the University Clinic of the Kharkiv National Medical University, we successfully conducted telerehabilitation using Google Meet video conferencing for 10 patients with urinary incontinence on the background of multiple sclerosis, whose EDSS was no more than 4.0. When conducting online classes under the guidance of a physical therapist, patients noted a desire to strictly follow the recommendations and perform regular exercises. All patients kept a urination diary, according to which the frequency of urination was reduced by an average of 20-25%, which had a positive effect on their quality of life. Although our observations are not representative, in combination with existing studies, we consider telerehabilitation to be a promising direction in complex therapy and rehabilitation of this pathology. Conclusion The use of telerehabilitation for urinary tract dysfunction in patients with multiple sclerosis is a promising direction that requires further research. This approach can significantly improve the quality of life of patients, reduce the burden on the health care system and provide a more affordable and convenient treatment. A multidisciplinary team should be involved, including a neurologist, a urologist, a gynecologist, and a physical therapist to select the optimal tactics of drug treatment and physical therapy. A promising direction of further research is the development of standard protocols for conducting telerehabilitation for patients with lower urinary tract dysfunction against the background of multiple sclerosis and other pathologies.

Legal aspects of civil liability of healthcare professionals for violation of patients’ rights in the course of provision of medical services: current challenges and prospects for improvement of legislation

In today’s world, where the quality of medical services and patients’ rights are becoming increasingly important, the issue of civil liability of medical professionals is becoming extremely relevant. The article is devoted to a comprehensive study of the legal aspects of civil liability of healthcare professionals for violation of patients’ rights in the course of providing medical services in the context of current challenges and prospects for improving Ukrainian legislation. The article examines theoretical and practical issues related to the peculiarities of civil liability in the medical field. The legal basis for such liability, its forms and consequences are analysed. Particular attention is paid to the specifics of proof in medical cases and the problems faced by patients in defending their violated rights. The article analyses the judicial practice of consideration of cases involving violation of patients’ rights, identifies the main trends and problems of law enforcement. On the basis of this analysis, the author formulates proposals for improving the mechanisms of civil liability in the medical field. Special attention is paid to the new challenges facing the healthcare system in the context of technological progress and globalisation. The author examines the issues of liability in the use of telemedicine, artificial intelligence in diagnosis and treatment, as well as the problems of protecting patients’ personal data. Based on the study, the author proposes specific ways to improve Ukrainian legislation in the area of civil liability of medical professionals. In particular, the author considers the possibilities of introducing specialised rules on medical liability into the Civil Code of Ukraine, creating an effective system of pre-trial settlement of disputes in the medical field, and strengthening guarantees for the protection of patients’ rights. The article contains substantiated conclusions regarding the need for a systematic approach to reforming legislation in the area of civil liability of medical professionals. The author emphasises the importance of a balance between protection of patients’ rights and creation of favourable conditions for professional activity of healthcare professionals.

The Moderating Role of Proposed External Incentives on COVID-19 Vaccination Intentions in an Emerging Economy Context

The COVID-19 pandemic has highlighted the critical need for widespread vaccination to combat the spread of the virus and protect public health. This study aims to investigate the factors that influence COVID-19 vaccination intentions and examine the moderating role of proposed external incentives in an emerging economy context. Specifically, the study explores the impact of attitude, subjective norms (SN) and perceived behavioural (PB) control on vaccination intentions and examines how external incentives interact with these factors to strengthen vaccination intentions. Data was collected through 318 structured self-report questionnaires administered to individuals. The collected data underwent statistical analysis using partial least squares structural equation modelling (PLS-SEM) with SmartPLS 3.0. The analysis fulfilled all the necessary assumptions and criteria for data quality and model robustness. The findings indicate that attitude, SN and PB control significantly influence individuals’ intentions to get vaccinated against COVID-19. However, the main contribution of this study lies in its revelation that proposed external incentives positively impact the relationship between attitude and vaccination intentions. This suggests that external factors, such as monetary and non-monetary incentives, play a crucial role in attracting individuals towards preventive vaccination. The findings hold practical implications for policymakers and medical service providers, as they highlight the importance of external incentives in positively influencing vaccination intentions. These insights can aid in designing effective strategies to encourage vaccine uptake and reduce the likelihood of future pandemics.

Alzheimer's dementia in people with Down syndrome : Results of guideline-assisted expert interviews on healthcare deficits in the diagnostics and treatment as well as solution approaches

People with Down syndrome have agenetically increased risk of developing early onset Alzheimer's dementia. An interview study with healthcare providers, patient representatives and employees in residential and work facilities was conducted to identify deficits in the healthcare process and approaches to overcoming them. In this study 14 semi-structured interviews were conducted and analyzed using qualitative content analysis. Alack of knowledge and experience on the part of medical service providers in dealing with and providing medical care for people with Down syndrome was identified as akey challenge. In addition, the diagnosis of dementia in people with Down syndrome is difficult for various reasons (including lack of appropriate diagnostic tools in standard care and lack of time or financial resources). Doubts were expressed about the efficacy of antidementia medications and the reasons for the increased use of sedatives were discussed. Attentive observation of behavior and involvement of caregivers, regular review and reduction of polypharmacy and the use of alternative behavior modification techniques were mentioned as possible solutions. The identified deficits in the medical care of the target population and the approaches to solving them will be incorporated into the development of health policy recommendations in order to optimize the care situation of those affected in the long term.

Wpływ nieosiągnięcia rezultatu na ocenę wykonania umowy o świadczenie usług medycznych

Contractual liability related to the provision of health services arises in the event of damage resulting from non-performance or improper performance by a doctor or dentist of obligations arising from a contract for the provision of medical services (treatment contract). A contract for the provision of medical services to which (under Article 750 of the Civil Code) the provisions on mandate apply (Article 734 ff. of the Civil Code) is considered a contract of diligent action, which means that the doctor’s obligation is not to achieve the designated therapeutic goal (in particular the patient’s recovery) but pursuing this goal with due diligence. However, there are views expressed in the literature that in some factual situations (in particular in the field of dentistry and aesthetic medicine), a doctor’s obligations should be classified as a result of obligation with the result that contractual liability also covers achieving the intended therapeutic result. The article is an attempt to assess the impact of failure to achieve a therapeutic result on the assessment of the performance of the medical services provision agreement.

Doctor interaction behavior, patient participation in value co-creation and patient satisfaction: cross-sectional survey in a tertiary-level hospital from Guangzhou, China

Value co-creation can be defined as the joint benefit that is created by patients and medical service providers through the integration of their respective resources. Participation and interaction between doctors and patients can generate an outcome that benefits both sides. Relevant studies of value co-creation in the healthcare field are limited. This study established hypotheses to explore the association between doctor interaction behavior, patient participation in value co-creation, and patient satisfaction. A cross-sectional survey was conducted with 637 patients (outpatients and inpatients) at a tertiary-level hospital in Guangzhou, China. The analysis result indicated that doctor interaction behavior could stimulate patient participation in value co-creation then increase patient satisfaction. The standardized total effect, direct effect, and indirect effect were 0.641 (95%CI: 0.055 ~ 0.067), 0.546 (95%CI: 0.044 ~ 0.059), and 0.095 (95%CI: 0.032 ~ 0.166), respectively. Patient participation in value co-creation mediated the relationship between doctor interaction behavior and patient satisfaction. Among the different dimensions of doctor interaction behavior, access, risk assessment and transparency dimensions were associated with positive patient participation in value co-creation. During the treatment process, doctor interaction and patient participation can get satisfying results.

Experience of integrating lean technologies into the quality management system of a medical organization providing primary medical and sanitary care

Objective. To evaluate the effectiveness of implementation of lean production methods into the practical activity of primary health care on the example of the State Institution of Health Care «Saratov City Polycli nic № 2». Materials and methods. The study was divided into three stages: data collection through anonymous sociological surveys using phones or tablets, timing and improvement of the process, and a follow-up questioning of participants to assess their satisfaction. 296 residents of Saratov receiving primary health care at the polyclinic took part in the survey. The survey was conducted using a specially developed electronic questionnaire via Google Form. For mathematical processing, the results of the study were initially transferred into an electronic database; the results of the study were analyzed using the descriptive statistics method. Results. According to the survey, the majority of respondents are satisfied with the quality of outpatient medical care. This shows that organization of the medical care is focused on the patients` needs and desire to meet their demands. The organization of the front office and the premises of the polyclinic in accordance with the requirements for the new model of the organization providing primary medical care made it possible to achieve a high evaluation of the information stands and the waiting area. The study showed that ineffective organization of the registry office contributed significantly to the patients` low assessment. In our opinion, in order to solve the problem, it is necessary to optimize the work of the registry office by introducing modern technologies and equal distribution of duties among the employees. Conclusions. In order to improve the quality and accessibility of medical services, it is necessary to make certain changes in the organization of medical care. The level of patient satisfaction with the work of medical institutions may depend on various factors, such as waiting time for a doctor, the timing of medical services provision after the appointment, the availability of necessary diagnostic tests and specialists.

THE ROLE OF MEDICAL INSURANCE IN THE FIELD OF HEALTH CARE AND LEGAL ISSUES OF ITS IMPLEMENTATION

It is important to make medical services acceptable in all respects, high-quality and financially feasible for the population in the preservation of human health. In the provision of medical services, the organization of mutual relations between the medical institution, the doctor and the patient, and the creation of necessary conditions for the treatment of patients in the medical institution are organized in different ways. Medical insurance is considered the most effective of such methods in today's modern medicine. Through medical insurance, the insurance organization takes all organizational (placement of the patient in a medical institution, highly qualified doctors) financial measures related to the treatment of the insured person (patient) in the event of an insured event, and as a result the insured person will have the opportunity to receive qualified and quality medical services. Today, there are no clear approaches to the role of medical insurance in legal regulations and areas of jurisprudence, which branch of insurance it belongs to: life insurance and general insurance. At the same time, this creates a number of problems and gaps in the legal regulation in the interpretation of the essence of the medical insurance contract and its application. Therefore, it is important to determine the nature of medical insurance, its content and peculiarities as a legal relationship, and thereby create the legal basis of medical insurance.

Aspects of application of digital solutions in primary health care

All over the world, with regard to digitalization in the provision of primary health care, issues of the principles of the cost-effective resource system for the provision of medical services covering all residents (any category of the population), ways to achieve other goals set for the health system at the territorial or regional level are being discussed. Depending on the main goals and principles set out in national legislation, including legislation in the field of health protection, approaches to achieving the Sustainable Development Goals and, accordingly, approaches to organizing the digitalization of medical care differ in different States. The issues of automating the processes of a medical organization and generating relevant information relate to the ways of using artificial intelligence to free up time for doctors, reduce the administrative burden on medical service providers. The level of digital medical literacy, combined with modern possibilities of remote interaction in the patient-medical worker format, can be decisive at the first stage of seeking medical help - with remote patient triage, which is an indispensable tool for determining both the need for assistance and the urgency of providing assistance. The experience of remote triage of patients by non-medical staff provided by the NHS Pathways clinical decision support system, used by the National Health Service of England, has freed up general practitioners (doctors and nurses) to provide other forms of medical care. In 2005, nurses and, to a lesser extent, general practitioners in England accounted for 100% of the staff handling telephone calls in the similar NHS Direct remote consultation system. The foreign experience of patient teletriage in our country will be limited by the legislation of the Russian Federation in the field of health protection, however, some existing restrictions, taking into account the assessment of risks to patients brought by innovative development, may be revised during the implementation of the «Program of experimental legal regime in the field of digital innovations in the field of medical activity, including the use of telemedicine technologies and technologies for collecting and processing information about the state of health and diagnoses of citizens», which will expire on 08/01/2026.

Inequalities changes in health services utilization among middle-aged and older adult disabled people in China: based on CHARLS 2011-2018.

Multiple intersections, including socioeconomic inequalities, influence health equity for disabled people and sub-populations. However, this association has not been sufficiently analyzed among Chinese-impaired persons. This study aimed to investigate the health services utilization and inequalities in middle and older adult persons with disabilities and subgroups. The China Health and Retirement Longitudinal Study (CHARLS) database in 2011, 2013, 2015, and 2018 were used. Health services utilization was measured by outpatient, inpatient, and self-treatment service utilization. Types of disabilities were classified into six categories. The pooled cross-section regression, concentration index, horizontal inequity index, and concentration index decomposition were used to evaluate inequalities and explore their main contributing factor. The utilization and non-utilization of healthcare services showed variations across years (p < 0.05). The CIs and HIs for inpatient health service utilization were positive for all years and disability types. The total CIs of inpatient utilization were the highest (0.248). The highest disparities in utilization of inpatient services were for physical disabilities (0.4515 for CI in 2011), and the highest in self-treatment services were for intellectual disability (0.1538 for CI in 2011). The expenditure factor was the main contributor to inequalities. Chronic disease, educational level, and health insurance factors also contribute to the utilization inequalities. Policies should promote medical insurance and assistance for disabled people with serious impairment and poor. It is crucial to improve the provision of basic medical services, including meeting the demand for varied disabilities and the accessibility of facilities and equipment to enhance the access and well-being of people with disabilities.

Perceptions and Use of Automated Hospital Outcome Data by EMS Providers: A Pilot Study

Background: Our primary objective evaluated the perception of emergency medical service (EMS) providers’ review of automated hospital outcome data. Secondarily, we assessed participation in outcome review as a means of microlearning to obtain continuing education (CE). Methods: From October–December 2023, three high-volume EMS systems participated in a three-part intervention with results evaluated using a mixed-methods approach. First, EMS providers (emergency medical technicians and paramedics) were invited, via their electronic health record (EHR), to complete a presurvey evaluating their perceptions of reviewing outcomes. Then, EMS providers were notified about the opportunity to earn CE via a microlearning intervention, offering Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE)-approved CE hours for completion of outcome reviews and associated learning modules. Finally, EMS providers were invited to complete a post-survey mirroring the pre-survey. Qualitative analyses identified themes among open-ended responses. Quantitative analyses examined perceptions between pre- and post- surveys. Results: Of 843 providers contacted, 217 responded to the pre-survey (25.7%). The most endorsed rationale for reviewing outcomes included improving clinical knowledge (95%), improving patient care (94%), and knowing whether care made a difference (93%). Nearly all (91%) reported being more likely to review outcomes if CE were awarded. Among the 67 who completed the open-ended items, the three dominant themes included enhance personal confidence and competence (43%); acquire personal knowledge (39%); and operations (21%). Of 211 providers who participated in the intervention, 56 (27%) were awarded CE. A total of 152 providers responded to the post-survey, and the percentage who agreed that reviewing outcomes improves job satisfaction rose from 89% to 95% between pre- and post-surveys (P = 0.05). Conclusion: EMS providers supported the personal and professional development and patient care improvement of reviewing patients’ outcomes with associated CE. Further study is warranted to evaluate the generalizability of these findings and the best user experience.