Work Of Medical Organizations Research Articles

Организация оказания медицинской помощи на дому пациентам с новой коронавирусной инфекцией (COVID-19) в Российской Федерации

The aim. To study the organization of home-based medical care for patients with a coronavirus infection (COVID-19) in the Russian Federation. Material and methods. A review of regulatory documents on the organization of medical care at home for patients with a coronavirus infection (COVID-19) adopted by the Ministry of Health of the Russian Federation in 2020-2022 was carried out. Based on publications, the provision of medical care at home to patients with a coronavirus infection (COVID-19) in some regions of the Russian Federation was analyzed. Since 2019, in the statistical reporting form № 14ds "Information on the activities of day hospitals of medical organizations", combined data on the work of day hospitals of medical organizations providing assistance on an outpatient basis and hospitals at home have been filled in. In 2021, a special study conducted made it possible to collect information on the work of hospitals at home treating patients with a coronavirus infection (COVID-19) in the Russian Federation and its constituent entities. The methods used were: content analysis, analytical, statistical. Results and discussion. In Russia the activities of medical organizations providing outpatient medical care to patients with a coronavirus infection (COVID-19) is regulated by the Ministry of Health of the Russian Federation, defining the basic principles for such care. The work of medical organizations in the constituent entities of Russia providing home-based care to patients with a coronavirus infection (COVID-19) was regulated by the order of the Ministry of Health of the Russian Federation of May 19, 2020 № 198n. The scientific publications on the organization of home-based medical care for patients with a coronavirus infection (COVID-19) were studied. An analysis was made of the performance indicators of hospitals at home for the treatment of patients with a coronavirus infection (COVID-19) in the Russian Federation and its constituent entities in 2021 (number of patients treated, average duration of treatment). Patients with coronavirus infection (COVID-19) were treated in hospitals at home in 19 subjects across the country. The number of patients treated was 0,3 per 1000 population. The highest proportion of patients treated with COVID-19 at home per 1000 people was observed in the Republic of Adygea, in the Sverdlovsk, Voronezh regions, in the Primorsky Territory, in the Tyumen Region. The average duration of treatment is 11,3 days. Conclusions. In the constituent entities of the Russian Federation, provision of medical care on an outpatient basis has been organized for patients with a coronavirus infection (COVID-19) in accordance with the algorithms. One of the forms of providing are hospitals at home, in which 43,9 thousand patients with a coronavirus infection (COVID-19) or 14,7% of all those treated in hospitals at home were treated in 2021. In the city of St. Petersburg, in the Sverdlovsk region and the Republic of Adygea, hospitals at home were mainly deployed to treat patients with a coronavirus infection (COVID-19).

New ways to prevent nosocomial infection (literature review)

The problem of prevention of nosocomial infection is one of the central in the work of medical organizations, and interest in it from clinicians remains high. Nosocomial infection is one of the main causes of death in a hospital setting and significantly increases the risk of death. Nosocomial infections lengthen the time spent in the hospital and increase the material costs of diagnosing and treating the underlying disease. Due to the high prevalence, more and more new methods of prevention of nosocomial infections appear and the existing ones are being improved. The basis of all methods is the observance of the rules of asepsis and antisepsis, but the importance of the socio-economic aspect of the policy of medical organizations and institutions is not excluded. Currently, examples of successful preventive measures are hand hygiene, sterilization and disinfection of medical equipment, prevention of environmental pollution, timely disposal of waste, compliance with precautions for isolation and continuous monitoring of data on the spread of nosocomial infections. However, despite significant progress in the study and application of preventive measures in practice, the problem of nosocomial infection remains unresolved. Difficulty for the development of a trend towards a decrease in the incidence of nosocomial infections is the specificity of pathogens and an increase in their resistance. Research and the search for effective, convenient and cost-effective methods and means of prevention of nosocomial infection must continue, as the implementation of programs for prevention and control of infections in the future can reduce the length of hospital stay and avoid other additional costs.

Изменения в порядке проведения контрольных мероприятий в системе обязательного медицинского страхования в 2022 году

One of the most important innovations in the system of compulsory medical insurance in 2021 was the change in the order of control measures. At the same time, both the participants of the MHI system, who have the authority to conduct control measures, and the procedure for conducting control have changed. This paper analyzes the next, rather voluminous changes in the system of control measures that occurred already in 2022. An assessment of the impact of these changes on the effectiveness of control and on the work of medical organizations is given.

Analysis of failed receptions in the profile of “pediatric surgery” in polyclinics of the NEAO of Moscow in 2021

Introduction. The availability of medical care is one of the indicators of the quality of medical care. Every day, during the work of doctors, there is a non-appearance of patients for appointments without canceling the appointment. This plays a significant role in limiting the availability of medical care. Purpose. To analyze the indicators of failed appointments with a pediatric surgeon during 2021 in polyclinics of the North-Eastern Administrative District of Moscow. Methods and materials. The evaluation of records to a pediatric surgeon during 2021 was carried out in four children's polyclinics of the north-eastern district of Moscow. Failed receptions were divided into groups depending on the time of recording, the age of the patient, the sex of the child and the method of recording, a retrospective analysis of these groups was carried out. Results. The total share of failed appointments in the field of “pediatric surgery” in the North-Eastern Administrative District of Moscow was determined. Males were more often registered with the surgeon – out of 84 459 in 48 718 cases (57.4 %), females – in 35 741 cases (42.6 %). The proportion of no-shows was 18 % and 17 %, respectively, but the differences are not significant (p=0.25). When analyzing absenteeism in relation to the age of patients, it was noted that children from 0 to 3 years of age have the minimum part of absenteeism – 13.4 %, and children aged 6–13 years old – in 21 % of cases (significant differences p=0.001). It was also found that the maximum share of non-attendance at appointments relative to the recording time falls on 16–20 hours – 20 %, and the minimum – from 8 to 12 hours, which is 15 % of cases (p=0.001). Conclusion. Informing about the possibility of canceling an appointment with a doctor should be carried out more intensively in a group of parents of schoolchildren. The introduction of a rule to clarify with legal representatives about attendance at an appointment by phone, when making an appointment in the evening, may result in a decrease in the proportion of absences. The important contribution of patients and their legal representatives to the formation of such an important indicator in the work of medical organizations as accessibility was noted.

Mathematical modeling of the calculation of economic efficiency of implementing the project results in the workof medical organizations

Mathematical modeling of the calculation of economic efficiency of implementing the project results in the workof medical organizations

Математические модели расчета экономической эффективности внедрения результатов проектной деятельности в работу медицинских организаций и органов управления здравоохранением

The article provides specific mathematical models for calculating economic efficiency implementation of the results of project activities in the work of medical organizations and management bodies healthcare. The overall economic effect is determined on the basis of an innovative result with a financial effect, prevented economic damage, medical effect and economic effect from cost savings, based on an assessment of the quality of life related to health, social, managerial, medical and environmental, educational, advertising and scientific and technical effects. After correlating the effect with costs, the economic efficiency of the implementation of the results of project activities is calculated into the practice of health care.

Методические подходы к оценке эффективности внедрения результатов проектной деятель- ности в работу медицинских организаций и органов управления здравоохранением

The article presents methodological approaches to assessing the effectiveness of implementing the results of project activities in the work of medical organizations and health management bodies. The evaluation methodology has been developed. Its objects, criteria of implementation efficiency are defined: medical, economic, social, etc. The characteristic of two approaches to the integral assessment of the effectiveness of the implementation of the results of project activities – multicriteria and monocriteria- is presented. Along with a quantitative assessment showing the degree of achievement of the standard result in fractions of a unit or percent, a qualitative assessment of the effectiveness of the implementation of the results of project activities in the system of work of health authorities by the level of reliability is proposed.

Current approaches to comprehensive assessment of child and adolescent health in hygiene and clinical practice

The relevance of improving the quality of preventive medical surveillance of children and adolescents is undeniable, which provides the basis for the search for methodologically sound approaches to an integrated assessment of the health of the child population. The purpose of the study was to develop and create the software product «Computer Program «Comprehensive Assessment of the Health of Children and Adolescents». For realization of the purpose, patent search, compilation of a technical specification on the basis of criteria of assessment of children’s health and assignment to a particular group of health, writing of a software product using modern programming libraries, as well as preparation of accompanying documents for registration of an intellectual property object were performed. The result of the work was the «Computer Program «Comprehensive Assessment of the Health of Children and Adolescents», designed for the integrated assessment of the state of health of children and adolescents during screening and preventive examinations. After filling in all fields, the program processes the received data and displays the final result — assessment of the child’s health status with the definition of the health group. Information about the examined patient is sent to the program database. The built-in database allows you to systematize the data obtained, analyze the health indicators of the surveyed contingents both in one-step and in longitudinal studies. This program product can be used in the work of medical organizations, higher educational institutions of a medical profile, physical education organizations and institutions of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in the Russian Federation.

Some results of the implementation of the priority project «creating a new model of a medical organization that provides primary health care»: problems and prospects

Optimization of the activities of medical organizations providing primary health care requires the development of new organizational and functional models. The introduction of new approaches to organizing the activities of medical organizations is primarily a step towards patients. The new model is a patient-oriented medical organization, the management of which is based on the use of a process-oriented approach and «lean» technologies. Since 2019, within the framework of the federal project «Development of a primary health care system,» a project has been launched to introduce the «New Model of a Medical Organization Providing Primary Health Care». The implementation of the project is scheduled for 2019-2024 inclusive. The creation and replication of the «new model» is planned for the participation of all subjects of the Russian Federation. The introduction of lean technology methods in the work of medical organizations has reduced the waiting time for doctors, optimized the burden on doctors, reduced the time for obtaining research results, streamlining the process of moving a patient within a medical organization. The creation of an effective quality management system in medical organizations is achieved through the phased implementation of lean-technology.

Medical and Sociological Study of the Opinion of the Population as Justification for the Implementation of the Principles of Lean Production in the Work of Medical Organizations of the Nizhniy Novgorod Region

The article is devoted to the need of implementation of lean healthcare technologies in the activities of medical organizations. The article gives a brief overview of the concept of lean technologies, stages of their implementation, prospects. The article presents the experience of the participation of the territorial fund of compulsory medical insurance of the Nizhniy Novgorod region and insurance medical organizations in assessing the effectiveness of measures to implement the principles of lean production in the work of medical organizations that provide primary health care to the population of the region. The authors analyzed the survey of the population about their interest in improving the organization of medical care and the social effectiveness of the implementation of lean healthcare technologies in the work of a large number of hospitals and clinics of the region. The pivotal conclusion from the experience of implementing lean technologies in healthcare is the need to search for and widespread use of innovative communication technologies.

The conflict of interests and organizational structures in conditions of health care commercialization

The article based on the analysis of foreign experience of commercialization of health care and introducing management methods typical for business into the work of medical organizations, shows the difficult conflict of interests within the medical community itself, as well as the clash of organizational cultures of doctors and managers. As a result, the population suffers as it either cut of from medical care or pays for imposed medical services. And the doctors suffer because of the pursuit of their leadership for economic efficiency and productivity without taking into account the specifics of the medical profession, and this leads to overwork, stress and early professional burnout. Based on a survey of Russian experts, the authors show that while in the West they come to a conclusion about the need for a management revolution that returns doctors to their priority role and prioritizes not patient's profits, but patient interests, Russia is rapidly moving along the path of unrestrained health care commercialization and fetishization indicators in the medical industry. The article describes a system of economic and organizational-legal factors that provoke a conflict of interest that arise management and staff, and also reveals the absence of mechanisms that are designed to contain its negative consequences and to some extent operate in countries whose approaches to organization Russia is rapidly adopting in health care. In addition, the opinions and arguments of the experts are given in relation to the new question for Russia as to whether the head of the medical organization should be a clinician or a manager.

Информационные системы в практике медицинской организации

Modern approaches in the provision of medical services, the need to comply with the procedures and standards of medical care imply the use of effective methods of managing the resources of the medical organization. It is these requirements that make it imperative to use automation systems in the work of medical organizations. In this study we proposed the experience of integrated use of information technologies in the activities of a medical organization and the assessment of obtained medical and socio-economic effects. Materials and methods.We used economic methods of evaluating the use of medical information systems in the medical organization. Results. The evaluation of the use of medical information systems in the medical organization showed medical and socio-economic effects in the form of an opportunity for employees to make optimal use of working hours, using unified directories developed by templates, automatically filling in model medical protocols; obtain statistical information on the number of provided services; a comprehensive approach to the write-off of consumable medical supplies; create standard documents with minimal time; prepare statements, conclusions, form a record in the outpatient card and, if necessary, an electronic prescription in the pharmacy. The duration of the doctor's appointment decreased by 50 % (from 30 minutes to 15-20 minutes), which made it possible to increase the number of served patients. Conclusion. The use of medical information systems ensures the medical organization and application of patients with the necessary social (in the form of ensuring the accessibility of medical services to more patients), medical (achieving high efficiency of medical services) and economic (cost reduction) effects.

Creating an effective system of quality management in health care organizations through the implementation of technology lean production

In the conditions of changing management paradigm in the public sphere, strengthening political, economic, social and technological risks on the part of stakeholders of medical organizations, there is a need to create an effective quality management system based on the technology of lean production. This system is aimed at increasing the satisfaction of consumers of medical services, reducing the labor losses of medical personnel, improving the quality and productivity of labor in medical organizations. The use of lin-production in the framework of pilot projects implemented in Russia for the last three years shows significant advantages in the work of medical organizations in comparison with traditional approaches in the organization of the provision of services by polyclinics. In the article, step-by-step organization of the work on creating a thrifty polyclinic is considered.