Medical Rehabilitation System Research Articles

Потребность взрослого населения Хабаровского края в медицинской реабилитации

The article provides the data on the state of the medical rehabilitation system in the Khabarovsk Krai based on statistic reports data for 2019 (selected as the last profile year, since the healthcare system was re-profiled due to the Covid-19 epidemic after 2019). Proposals have been suggested to improve accessibility and quality, for the further development of medical care for medical rehabilitation to the population of the Khabarovsk Krai, in order to implement the initiative of the Government of the Russian Federation in the Khabarovsk Krai "The optimal medical rehabilitation for health recovery"

Rehabilitation Diagnosis Based on the International Functioning Classification (ICF) in Patients under Lower Limb Joint Endoprosthetics

To date, the introduction of the International Classification of Functioning, Disability and Health (ICF) into the practical work of rehabilitation institutions and units of different levels and different profiles is a key moment in the organization of the rehabilitation process in accordance with a new legislative framework and a new model of the medical rehabilitation system being created in Russia. Namely, the ICF is the basis for the rehabilitation diagnosis formulation as well as rehabilitation goals and the development of the rehabilitation strategy for each individual patient, and the practical ICF use presents the greatest difficulties for members of the multidisciplinary rehabilitation team (MDRT), since it requires to restructure their thinking stereotypes and behavior « from dysfunction – to limitation of activity», «from correction of disorders to restoration of activity». In this regard, the ICF usage issues in the process of rehabilitation of patients who underwent arthroplasty of large joints, presented in this article, are very relevant. Aim. To describe the most frequent ICF domains used in the formulation of a rehabilitation diagnosis in patients who have undergone the lower limb joints replacement. Conclusion. Identification of key problems based on ICF in patients undergoing total knee and hip arthroplasty allows a more focused and specialized approach to the rehabilitation process for this category of patients, correct formulation of rehabilitation goals and drawing up a plan of rehabilitation measures. In patients who have yet to undergo joint replacement, the use of classification allows to clarify the indications for surgical intervention.

Patient Functional Assessment in IRF: FIM vs CMS GG over the Last 4 Fiscal Years

<h3>Research Objectives</h3> For nearly 20 years CMS required Inpatient rehabilitation facilities (IRF) providing care to Medicare beneficiaries to complete the IRF-PAI on patients for reimbursement of services which include the FIM instrument for the assessment of patient function and outcomes. In Oct 2016 CMS changed the IRF-PAI tool to include CMS-derived GG items which also assessed patient functioning, however, the items were not required for reimbursement. In Oct 2019 CMS required submission of GG items for medical reimbursement. The purpose of this study was to examine the implications of the changes that have transpired over the past five years. The objective is to compare Reliability and Consistency between the items of the FIM and the new CMS Section GG Functional Abilities items included in the IRF-PAI instrument from Fiscal Year 2017 to 2020. <h3>Design</h3> A retrospective cohort study using data from the Uniform Data System for Medical Rehabilitation (UDSMR): cases discharged in the Fiscal Year 2017 - 2020. <h3>Setting</h3> IRFs located in the US subscribing to UDSMR; roughly 85% of all IRFs in the nation subscribe to UDSMR for benchmarking reporting. <h3>Participants</h3> All Medicare cases for patients admitted in IRFs which are subscribers of UDSMR from the fiscal year 2016 to 2020 <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Rehabilitation-related outcomes were compared; included were: average admission FIM® and average discharge FIM®, 16 GG self-care and mobility items plus bladder and bowel at admission and discharge which are included on CMS IRF-PAI instrument, Impairment conditions, CMG, LOS, discharge location. <h3>Results</h3> Forthcoming; patient outcomes as measured by the FIM and CMS GG items will be provided and trends examined over time The completion rates for items at admission and discharge by year will be analyzed including the reliability and validity of the items. Results may have policy implications in addition to possible impacts at the facility and patient level. <h3>Conclusions</h3> Presently the use of the following codes: -, ^, 7, 8, 9, 10, and 88 at admission or discharge is re-coded to a value of 1 for all GG functional items (except toilet transfer where a value of 2 is assigned) for reporting purposes per CMS. A value of 1 indicates the lowest level of function, in essence complete dependence, patient is unable to perform activity. CMS should reconsider assigning the value of 1 to patients with a code indicating the activity was not performed, as it is ultimately missing data and our analysis indicated the value of 1 may not be the most appropriate considering the discharge destination and the patient total length of stay in medical rehabilitation. Use of codes: -, ^, 7, 9, 10, 88 are missing values, where the patient's true level of functioning is unknown. This leads to uncertainty in the patient's true ability self-care and uncertainty regarding the most appropriate discharge setting to meet the patient's specific needs. Accuracy in assessment of patient's level of functioning is paramount in patient care and quality outcomes. CMS should consider removing the codes: -, ^, 7, 8, 9, 10 and 88 or advising clinicians to reserve use of the codes for the most atypical, rare exceptions. <h3>Author(s) Disclosures</h3> The authors declare that they have no relevant or material financial interests that relate to the research described in this poster

Cost-effectiveness Analysis of Еarly Medical Rehabilitation of Patients with Cerebral Stroke

Carrying out resuscitation procedures in the intensive care unit (ICU) aimed at maintaining and restoring the patient’s vital functions, the use of specialized resuscitation equipment and bed rest simultaneously lead to aggravation of the patient’s condition. The consequences of being in the ICU may also include the development of the post-intensive care syndrome (PIT syndrome), the prevention of which is the main goal of early rehabilitation with the participation of the multidisciplinary rehabilitation team of specialists (MDRT) led by a physical and rehabilitation medicine physician. Specialized medical rehabilitation carried out by MDRT is extremely beneficial for all neurological conditions, resulting in substantial savings in ongoing care costs, especially for ICU patients. The foreign and domestic research experience indicates a reduction in healthcare costs when introducing early rehabilitation in the ICU by reducing the duration of the patient’s stay in the expensive round-the-clock bed and lowering the patient’s home care costs or continuing rehabilitation activities at the second and third stages, as well as saving precious time for effective recovery of the developed functional deficits. It may seem that rehabilitation in the ICU with the participation of MDRT is more expensive than the work of one department doctor and a nurse. However, this article provides evidence of the economic efficiency of the MDRT work on the analysis of the results of the pilot project “Development of the Medical Rehabilitation System in the Russian Federation”, as well as the analysis of clinical cases of the Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency of Russia. So, in the absence of early rehabilitation in the ICU, the patient’s stay is delayed and the number of re-hospitalizations to the unit increases. Thus, the results of early medical rehabilitation will have a direct impact on reducing the costs associated with bed-days reducing, providing patient’s care, changing the working life of relatives, pensions of patients and their caregivers.

Functional Independence predicts patients with stroke more likely to be discharged to the community after inpatient rehabilitation

ABSTRACT Background Functional domain predictors of discharge destination following inpatient rehabilitation for stroke have not been thoroughly identified. Objectives 1) Determine the relationships between intrinsic variables (demographic; comorbidities; functional independence at admission to and at discharge from an inpatient rehabilitation facility (IRF)) and discharge to home. 2) Determine cut scores for Functional Independence Measure® (FIM) subscales and domains that predict discharge to the community. Methods This study was a secondary analysis of a large, multi-IRF dataset from the Uniform Data System for Medical Rehabilitation. Participants were adults with stroke who were discharged from an IRF in 2019 (n = 92,153). Results Correlations with discharge to the community were strongest for discharge FIM scores (r = 0.330 to 0.580), followed by admission FIM scores (r = 0.245 to 0.411), which were stronger than the demographic and comorbidity variables (r = 0.005 to 0.110). Logistic regression analysis indicated 5 of 6 FIM domains (Social Cognition, Self-care, Sphincter, Transfer, and Locomotion) scored at admission and at discharge were predictive of discharge home. Receiver operating characteristic curve analyses determined the best cut point for each domain. For each FIM measure, the area under the curve was greater when the measure was obtained at discharge than it was at admission. Conclusions Clinicians may consider the cut points presented for each domain at admission and at discharge when setting goals or making recommendations for patients with stroke who aspire to a discharge from an IRF to a community setting.

Course is a healthy country. the national innovative strategy for the reorganization and development of the system of medical and psychological rehabilitation and recovery is a means of ensuring the sustainable development of Ukrainian statehood

Course is a healthy country. the national innovative strategy for the reorganization and development of the system of medical and psychological rehabilitation and recovery is a means of ensuring the sustainable development of Ukrainian statehood

A modern system of medical rehabilitation of patients who have had a myocardial infarction in the health - resort organizations of the Ministry of Defense

A modern system of medical rehabilitation of patients who have had a myocardial infarction in the health - resort organizations of the Ministry of Defense

Somatic state assessment of the health of patients with retinoblastoma in a long-term follow-up

AIM: To comprehensively assess the incidence and nature of the chronic diseases in patients with retinoblastoma in the long-term follow-up&#x0D; MATERIAL AND METHODS: The study analyzed the long-term treatment results of 176 patients with retinoblastoma. Group 1 included 46 patients aged 18 years and Group 2 included 88 patients aged 18 and 35 years. A gynecologist and a urologist were consulted, a medical history was taken, and a physical examination with emphasis on the presence of secondary sexual characteristics and laboratory tests were performed to assess the endocrine function in surviving patients aged 18 years. Anamnestic data were used in patients aged 18 years.&#x0D; RESULTS: The somatic status data analysis of 46 surviving adolescents revealed that 29 (63%) have abnormalities. Chronic gastritis and gastroduodenitis, biliary dyskinesia, fatty hepatosis, and lactase deficiency predominate in gastrointestinal structure diseases. Respiratory diseases are represented by chronic nasopharyngeal diseases in 13.0% of children. Secondary immunodeficiency condition was diagnosed in 3 (6.5%) patients. Musculoskeletal system and connective tissue pathologies in deforming dorsopathies were identified in 10.9% of cases and bone and joint pain were identified in 8.7%. Chronic conditions were found in 42 (47.7%) of 88 patients in Group 2. Somatic disorders were found in 95.2%, hormonal disorders in 11.9%, psycho-emotional disorders in 9.5%, and combined pathology in 9.5% of cases. Endocrine pathology was detected in 14 patients (30.4%) aged 18 years.&#x0D; CONCLUSION: Retinoblastoma survivors have a high risk of somatic and endocrine disorders. The main risk factors are distance radiation therapy and alkylating agents. Regular lifelong follow-up of these patients is necessary to establish a medical rehabilitation system for children with retinoblastoma.

For-Profit and Not-for-Profit Inpatient Rehabilitation in Traumatic Brain Injury: Analysis of Demographics and Outcomes

ObjectiveTo describe differences in characteristics and outcomes of patients with traumatic brain injury by inpatient rehabilitation facility (IRF) profit status. DesignRetrospective database review using the Uniform Data System for Medical Rehabilitation. SettingIRFs. ParticipantsIndividual discharges (N=53,630) from 877 distinct rehabilitation facilities for calendar years 2016 through 2018. InterventionNot applicable. Main Outcome MeasuresPatient demographic data (age, race, primary payer source), admission and discharge FIM, FIM gain, length of stay efficiency, acute hospital readmission from for-profit and not-for-profit IRFs within 30 days, and community discharges by facility profit status. ResultsPatients at for-profit facilities were significantly older (69.69 vs 64.12 years), with lower admission FIM scores (52 vs 57), shorter lengths of stay (13 vs 15 days), and higher discharge FIM scores (88 vs 86); for-profit facilities had higher rates of community discharges (76.8% vs 74.6%) but also had higher rates of readmission (10.3% vs 9.9%). ConclusionsThe finding that for-profit facilities admit older patients who are reportedly less functional on admission and more functional on discharge, with higher rates of community discharge but higher readmission rates than not-for-profit facilities is an unexpected and potentially anomalous finding. In general, older, less functional patients who stay for shorter periods of time would not necessarily be expected to make greater functional gains. These differences should be further studied to determine if differences in patient selection, coding and/or billing, or other unreported factors underlie these differences.

Indicators of the need of disabled people for vocational rehabilitation activities

BACKGROUND: In the system of medical and social expertise and rehabilitation of disabled people, the solution of issues of employment, socialization, improvement of the level and quality of their life becomes obviously relevant.&#x0D; AIMS: To study and analyze the needs of disabled people in vocational rehabilitation, including employment and the creation of special jobs, in a comparative aspect - in St. Petersburg and the Russian Federation.&#x0D; MATERIAL AND METHODS. The materials of the study were data from Rosstat of Russia, official state statistical reporting: Forms 7-sobes "Information on medical and social expertise of persons aged 18 and older" for 20152019.&#x0D; RESULTS: The article analyzes the indicators of primary disability and the needs of disabled people in vocational rehabilitation activities based on the study of the individual rehabilitation or habilitation program (IPRA) for disabled people in Saint Petersburg and the Russian Federation in dynamics over five years (20152019). An analysis of the needs for vocational rehabilitation measures, taking into account its structure in IPRA (vocational guidance and employment) and the disability group, was carried out. Since the greatest difficulties arise in the selection and organization of jobs for people with disabilities of groups I and II, the needs of people with disabilities in creating a special workplace have been studied. The necessity of solving organizational, methodological, and financial issues when creating special jobs for the disabled is emphasized.&#x0D; CONCLUSION: The implementation of the state program "Accessible environment" and its subprograms aimed at creating models of employment of disabled people in the regions of the Russian Federation requires taking into account the territorial characteristics of the prevalence of primary disability and the specifics of the regional labor market in the employment of disabled people.

An Evaluation of Machine Learning Models to Predict Outcomes following Rehabilitation for Traumatic Brain Injury using Uniform Data System for Medical Rehabilitation data

<h3>Research Objectives</h3> To determine whether admission characteristics can accurately predict outcomes measured at discharge using machine learning methods for patients with TBI receiving inpatient rehabilitation facility (IRF) care. Secondarily, to determine which models are most accurate to aid future research <h3>Design</h3> The following models were compared: neural networks, LASSO/Ridge/Elastic Net regularization, Support Vector Machines, and Generalized Additive Models. Parameters were determined by 10-fold cross-validation. Models were evaluated on a subset of patients who were not used to develop the models using root mean-square errors (RMSE) and areas under the ROC curve (AUC). <h3>Setting</h3> Data were obtained from the Uniform Data System for Medical Rehabilitation which consists of data from 70% of IRFs in the US. <h3>Participants</h3> Adult TBI patients (N=175,358) who were admitted to a participating IRF and received a traumatic brain dysfunction Impairment Group code of 02.21 (traumatic, open injury) or 02.22 (traumatic, closed injury). <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> Discharge Functional Independence Measure; clinically significant gain in FIM (≥ 22 FIM points) between admission and discharge; and mortality. <h3>Results</h3> For the FIM score, RMSE was reduced to 14-16, depending on the model, compared to an RMSE of 24.7 using the intercept only. For clinically significant increases in FIM, AUCs for all models were between 0.71-0.80. For mortality, AUCs were between 0.8-0.89. Elastic Net regularization resulted in the most accurate models. <h3>Conclusions</h3> Machine learning models can improve rehabilitation specialists' ability to predict discharge outcomes for TBI patients receiving IRF care. Elastic Net methods were the most accurate. More complicated statistical methods (e.g. neural networks) may not be necessary. <h3>Author(s) Disclosures</h3> There are no conflicts to declare.

ANALYSIS OF THE AVAILABILITY AND EFFICIENCY OF MEDICAL CARE PROVIDED TO PATIENTS IN THE PROFILE "MEDICAL REHABILITATION" IN ASTRAKHAN REGION

The relevance of the study due to the need to pay more attention to the effective planning of health care volumes under the compulsory health insurance and the creation of an accessible system of medical rehabilitation for adults in the region. The purpose of the study is to analyze the availability and effectiveness of medical care provided to adults in the "medical rehabilitation" profile within the framework of compulsory medical insurance in the Astrakhan region. Materials and methods - on the basis of data from the Federal State Statistics Service, the territorial fund of compulsory medical insurance in the Astrakhan region, annual reporting statistical forms No. 30, 14, 14-DS, the calculation and analysis of indicators of the optimal volume of medical care for the profile of medical rehabilitation was carried out, taking into account the profile of the disease (the number of hospitalizations per one inhabitant per year, funding per unit of the volume of medical care) of adult patients aged 18 years and older. Results and discussion - the article presents the results of assessing the planned and actual indicators of the volume of medical care for medical rehabilitation for adults, taking into account the profile of diseases in the conditions of round-the-clock and day hospitals of medical organizations participating in the territorial program of state guarantees of free provision of medical care to citizens in the region in 2019. It was revealed that at the expense of the compulsory medical insurance fund, the largest proportion of treated patients in rehabilitation beds is noted among those who receive medical services for neuro- and cardiac rehabilitation. However, rehabilitation care for critically ill patients with scores on the rehabilitation routing scale of 5 and 6 points, with a high rehabilitation potential, as well as for other categories of patients with somatic diseases, remains inaccessible. Conclusion. The obtained research data can be used for further organizational and methodological work to increase the availability and efficiency of medical rehabilitation care for adults, the development of available routing schemes, selection procedures, digitalization of the management of patient flows sent to medical rehabilitation within the framework of compulsory medical insurance at the regional level.

Modern Technologies of Medical Rehabilitation of Children with Post-traumatic Neuropathies of the Upper Extremities

The proportion of injuries to the upper limbs, accompanied by nerve damage, ranges from 1.5 to 10%. Damage of the peripheralnerves of the upper limb in children is associated with fractures of the long bones in 10-12% of cases. The high incidence of damageto the peripheral nerves of the upper limb, the risk of impairment or loss of function, disability of the patient often requires not onlyactive conservative treatment, but also often surgical intervention. Aim. To analyze literature data and generalize the results of our own research to determine the optimal technologies for medical rehabilitationof children with post-traumatic neuropathies of the upper extremities. The success of both conservative and surgical treatmentof nerve injuries is largely determined by the volume and quality of the diagnostics performed. The goal of surgical or conservativetreatment of peripheral nerve damage is to restore the conduction of the nerve trunks with the highest possible functional result.Physical factors occupy one of the leading places in the system of medical rehabilitation of children with post-traumatic neuropathies.The medical rehabilitation program includes the use of apparatus physiotherapy, robotic mechanotherapy, applied kinesitherapy,massage, soft manual techniques, orthosis, and kinesiotaping. The leading technologies are the methods of motor rehabilitation. The effects of kinesitherapeutic influences are potentiated by neuromodulatory methods of hardware physiotherapy (magnetostimulation,electrical stimulation). Conclusion. Injuries to the peripheral nerves of the upper extremities in children requires long-term staged medical rehabilitation inmost cases. At the same time, to date, there are no clear recommendations for rehabilitation of children with damage to peripheralnerves in the postoperative period, there is no unified algorithm for rehabilitation measures. Motor rehabilitation technologies are keyin medical rehabilitation programs for children with post-traumatic neuropathy. The timely start of rehabilitation measures and differentiatedprescription of physical factors adjusted to the period of injury ensure the preservation of the result of surgical treatment,contribute to the early restoration of the function of the injured limb.

ОБЕСПЕЧЕННОСТЬ РЕАБИЛИТАЦИОННЫМИ МЕРОПРИЯТИЯМИ ПАЦИЕНТОВ, ПЕРЕНЕСШИХ СЕРДЕЧНО-СОСУДИСТЫЕ КАТАСТРОФЫ, В АСТРАХАНСКОЙ ОБЛАСТИ

The relevance of the study is explained by the need to increase attention to the situation with acute cardiovascular diseases and the creation of an accessible system of medical rehabilitation for patients with cardiovascular diseases in the region. The aim of the study is to analyze the provision of rehabilitation measures for patients who have suffered cardiovascular accidents in the Astrakhan region. Materials and methods - based on the data of the annual reporting statistical forms No. 12 "Information on the number of diseases registered in patients living in the service area of the medical institution" and No. 14 "Information on the activities of the hospital", the calculation and analysis of indicators of general and primary morbidity was carried out ( on appeal), hospitalized morbidity, hospital mortality, the need for rehabilitation measures and their provision of adult patients aged 18 years and older with diseases of the circulatory system, including cardiovascular accidents in the Astrakhan region. Results and discussion - the article shows the general situation with the incidence of diseases of the circulatory system of the adult population, including acute coronary syndrome and acute cerebrovascular accident in dynamics from 2014 to 2020, discloses the organizational and structural aspects of the existing system of organizing rehabilitation care in the region. The results of assessing the satisfaction of the needs of the adult population of the region in neuro- and cardiac rehabilitation by medical organizations licensed for medical activities with an indication of the work (services) for medical rehabilitation and participating in the federal and territorial program of state guarantees of free provision of medical care to citizens in the region are presented. It was revealed that less than half of those in need receive medical rehabilitation assistance at the expense of the mandatory medical insurance fund. Proposals have been formulated to increase the availability of rehabilitation care for patients who have undergone cardiovascular accidents. Conclusion. The obtained research data can be used for further organizational, methodological and coordination work to provide modern medical and rehabilitation care to patients with acute cardiovascular accidents at the regional level.

Inpatient Rehabilitation Facility Data Comparing Swallowing Status Between Primary Dysphagia and Poststroke Dysphagia: A Retrospective Study

Abstract Date Presented 04/22/21 This study was a retrospective cohort design that used data from the U.S. Uniform Data System for Medical Rehabilitation. We examined the improvement of swallowing status between patients with primary dysphagia diagnosis and those with poststroke dysphagia upon discharge from inpatient rehabilitation facilities. A main finding includes that patients with a primary dysphagia diagnosis demonstrated substantially worse swallowing status compared to those with poststroke dysphagia. Primary Author and Speaker: Kimberly Hreha Additional Authors and Speakers: Bailee Cloutier, Zana A. McNeil, Erin Pyles, and Breanna Trueblood Contributing Authors: Sharon Cosper

Индивидуальные профили функционирования с применением МКФ у лиц с инвалидностью с последствиями острого нарушения мозгового кровообращения в Киргизской Республике

Ratification of the Convention on the Rights of Persons with Disabilities in Kyrgyzstan in March 2019 has encouraged the country to explore the possibilities of multidisciplinary tools to assess the needs and strengths of an individual. The International Classification of Functioning, Disability and Health (ICF) is such a recognized tool. ICF allows to have complete information on any individual using a system for coding the level of disability. Further, this assessment of an individual's needs and strengths becomes the basis for rehabilitation programs for individuals with disabilities. The purpose of this study is to examine the relationship between the profile of individual functioning compiled according to ICF and medical rehabilitation programs for brain strokes using the 2020 data of certain medical and social expert commissions (MSEC) of the Kyrgyz Republic as an example, followed by the preparation of recommendations for the development of medical rehabilitation system for brain strokes. Each of the selected individual with disability was given an adapted profile of individual functioning with domains corresponding to brain strokes. Analysis of the profiles showed the possibility of using a single tool in the usual practice of the health system and medical and social examination for a more detailed assessment of functioning impairments and environmental conditions of an individual, which allowed to re-orient the rehabilitation goals. Authors revealed insufficient rehabilitation resources in Kyrgyzstan, including the availability of medical personnel and medicines with evidence-based effectiveness. Analysis of the findings allowed the authors to present recommendations for the development of a medical rehabilitation system for brain stroke in the Kyrgyz Republic.

Medical Internet of Things to Realize Elderly Stroke Prevention and Nursing Management.

Stroke is a major disease that seriously endangers the lives and health of middle-aged and elderly people in our country, but its implementation of secondary prevention needs to be improved urgently. The application of IoT technology in home health monitoring and telemedicine, as well as the popularization of cloud computing, contributes to the early identification of ischemic stroke and provides intelligent, humanized, and preventive medical and health services for patients at high risk of stroke. This article clarifies the networking structure and networking objects of the rehabilitation system Internet of Things, clarifies the functions of each part, and establishes an overall system architecture based on smart medical care; the design and optimization of the mechanical part of the stroke rehabilitation robot are carried out, as well as kinematics and dynamic analysis. According to the functions of different types of stroke rehabilitation robots, strategies are given for the use of lower limb rehabilitation robots; standardized codes are used to identify system objects, and RFID technology is used to automatically identify users and devices. Combined with the use of the Internet and GSM mobile communication network, construct a network database of system networking objects and, on this basis, establish information management software based on a smart medical rehabilitation system that takes care of both doctors and patients to realize the system's Internet of Things architecture. In addition, this article also gives the recovery strategy generation in the system with the design method of resource scheduling method and the theoretical algorithm of rehabilitation strategy generation is given and verified. This research summarizes the application background, advantages, and past practice of the Internet of Things in stroke medical care, develops and applies a medical collaborative cloud computing system for systematic intervention of stroke, and realizes the module functions such as information sharing, regional monitoring, and collaborative consultation within the base.

Organization of Multilevel Interdisciplinary Rehabilitation in the Netherlands

This article gives an overview of medical rehabilitation in the Netherlands. It shows that Dutch rehabilitation is based on the International Classification of Functioning, Disability and Health (ICF) and organized in three different levels: rehabilitation medicine, geriatric rehabilitation, and monodisciplinary therapy. The author describes these three levels in their distinctive scopes and numbers. Together they operate as a coherent rehabilitation service system that reflects an important characteristic of the system of health care in the Netherlands: decentralized if possible and centralized if necessary. The system is accessible for all and it is organized in a way that simple medical problems can be dealt with close to home, whereas specialized treatment is concentrated in rehabilitation centers spread over the country. The rehabilitation facilities are embedded in the general health care system: it is easy for hospitals as well as general practitioners to refer patients to rehabilitation. In conclusion, the possibilities of further improving the system of medical rehabilitation and the application of Dutch experience in other countries are considered.

A local rehabilitation service for children with hearing loss

Objectives to discuss the issues of inter-disciplinary cooperation for improvement the pediatric audiological care using modern technologies for hearing restoration.&#x0D; Material and methods. An epidemiological study of hearing impairments in 3098 children registered in the Center of Pediatric Audiology (St. Petersburg) and analysis of the city pediatric audiological services were carried out.&#x0D; Results. The introduction of the universal newborn hearing screening helped to diagnose hearing loss in children under 1 year of age in 47% of cases. Before the screening implementation, it was diagnosed in 22% of cases. The hearing screening results testify that 26% of children meet modern requirements of early diagnosis (under 3 months) of congenital hearing loss. 54% of children registered in the Audiology Center are using hearing aids or cochlear implants. The mean age of initial amplification is 3 years 8 months. 5.4% of children got amplification under 6 months of age, 20% of children - under 1 year and 58% - under 3 years. The mean interval between diagnosis and amplification was 15.7 months, only 24% of children got amplification within 3 months after being diagnosed.&#x0D; A system of family-centered medical, psychological and pedagogical rehabilitation of children with hearing impairments was developed at the Center of Pediatric Audiology.

IMPROVEMENT OF PUBLIC ADMINISTRATION OF THE MEDICAL REHABILITATION SYSTEM AS AN INTEGRAL PART OF PUBLIC HEALTH POLICY

Objective of the study: to substantiate the theoretical approaches and develop priority areas for improving public administration to ensure the system of medical rehabilitation and recreation in Ukraine.&#x0D; Material and methods. To achieve this goal, a set of interconnected and complementary general and special research methods was used, in particular, specific search methods (detection, selection, theoretical analysis, synthesis, updating, classification) were used to summarize regulatory, documentary, printed and electronic sources of information on public administration of the system of medical rehabilitation and sanatorium services.&#x0D; Results. Theoretical principles of public administration of the medical rehabilitation system are investigated. The current state of medical rehabilitation and sanatorium treatment in the health care system of Ukraine is analyzed, namely: regulatory and legal support of medical rehabilitation and sanatorium treatment in the health care system of Ukraine. The priority directions of improvement of the state administration concerning maintenance of system of medical rehabilitation and recreation in Ukraine are substantiated and the ways of improvement of the state management of system of medical rehabilitation as a component of the state policy in the field of public health services are offered.&#x0D; Findings. Support for the development of sanatorium-resort activities should be carried out using the methodology of program-targeted management, which provides for the development and adoption of comprehensive programs aimed at implementing specific measures to develop resort potential, improve quality and efficiency of sanatorium-resort services, strengthen the material and technical base of resort management at the level of the state and regions.