ОРГЗДРАВ № 2 (24). 2021

Healthcare Management

News. Views. Education

The journal is published by Higher School of Healthcare Organization and Management (VSHOUZ).


Topic number
№ 2 . 2021
Content
Above all

From stagnation and crisis to the socio-economic rise of Russia

Аннотация

The periods of crises, stagnation and growth of the Russian economy have been identified in this paper, based on the analysis of the macroeconomic indicators of the Russian Federation for 2007-2020. The factors that influence the economic recovery are determined. The factors that affect the economic recovery. It is concluded that by the end of 2020, Russia is in a favorable position in comparison with other countries that more rigidly carried out self-isolation, stopped the work of entire industries, which will give Russia a chance to move faster to economic recovery.

Effective management

Consideration of telemedicine technologies in formation of development strategy of a modern medical organization (market and management aspect)

Аннотация

Telemedicine as one of emerging forms of providing medical care (services), according to researchers' forecasts, within 5 years is able to cover up to 30% of total number of treatment cases. But at the same time, like other technologies in Industry 4.0, it will not affect the content of treatment activity itself, but like other digital technologies will change forms of medical care delivery. At the same time, there will be corresponding structural sectoral changes in healthcare, due to the fact that telemedicine, as it develops, will lead to a redistribution of markets between medical organizations, strengthening some and weakening others.

In the article classification of telemedicine forms, analysis of areas and mechanisms of its use are given. New market segments are shown, for which telemedicine is more preferable (and sometimes the only advisable). Conditions and mechanisms for redistribution of medical markets between medical economic agent market participants are described. Examples of research projects' intentions for formation of "clinical terms of reference" for development of mobile applications for telemedicine are given.

Remote ultrasound examinations: expanding the functions of nursing staff

Аннотация

Background. The high informative value of ultrasound examinations as diagnostic methods is well known. They are widely used both for the diagnosis of complex diseases, and in various screening studies, preventive examinations, and medical examinations. Compact ultrasound scanners can be used when conducting visits to remote areas, which increases the availability of medical care. However, the use of ultrasound devices is possible only if the medical team includes a doctor of ultrasound diagnostics, which is often problematic. The way out of the situation may be the transfer of certain functions of the doctor to the average medical staff, which is currently not provided for by regulatory acts.

Material and methods. The method of conducting ultrasound examinations by a nurse under the remote control of a doctor was developed and tested as part of an organizational experiment. Two models were tested: in the first version, the doctor remotely monitored the progress of the study on a monitor and, if necessary, directed the actions of the secondary medical staff. In the second model, the nurse independently visualized images of internal organs, and the doctor evaluated the transmitted information, prepared and forwarded the conclusion. According to these methods, the organs of the abdominal cavity, retroperitoneal space and arteries of the lower extremities were examined.

Results. AH 186 patients who participated in the study were re-examined by a doctor using the usual method to evaluate the effectiveness of the proposed models. Timekeeping was carried out with an analysis of the time spent. The proposals for inclusion in the professional standard of the nurse of ultrasound diagnostics are presented.

Automated tool for internal audit, departmental and state control of the quality and safety of medical activities

Аннотация

Methodological, algorithmic and instrumental support for automated internal audits, self-assessment in accordance with the orders of various departments, departmental and state control of the quality and safety of medical activities using checklists (checklists), the integrated use of which ensures the completeness and quality of inspections, a sharp reduction in the time required to obtain and analyze the results of inspections and reports.

Experience of application of the concept of sustainable development in the lean ambulatory healthcare

Аннотация

Currently, health care is actively discussing issues of improving the efficiency of medical organizations for the implementation of the national project "Healthcare", while the key performance indicators are not only indicators of the quality and availability of medical care, but also the optimal resource provision, increasing the efficiency of main and auxiliary processes, timely implementation of organizational changes and achievement of strategic objectives set for a medical organization.

A significant part of outpatient clinics in our country are included in the program "Creation of a new model of a medical organization providing primary health care to the population." Using the concept of lean manufacturing, medical organizations have achieved significant results in optimizing the work of the registry, conducting preventive medical examinations and medical examinations, etc.

Analyzing the effectiveness of the implemented changes in the long term, we came to the conclusion that the effectiveness of the processes is significantly reduced for a number of reasons. To address this issue, the concept of sustainable development of a medical organization was introduced, which changed the approaches to project management, and made it possible to consolidate the results achieved.

The aim is to analyze the effectiveness of the implementation of the concept of sustainable development of a lean ambulatory healthcare.

Material and methods. The study of the effectiveness of the city ambulatory healthcare was carried out from 2018 to 2021. Research methods such as comparative analysis, organizational and functional modeling were used.

Results. In the process of introducing the concept of sustainable development in a lean polyclinic, we have combined the processes of strategic planning, process management carried out taking into account the optimization of resource provision, the introduction of changes and replication of experience. As a result, the efficiency of the organization's activities in a number of processes increased by 6.09 times; the number of patients who received the preventive medical examination service increased 3 times; in a related process, the availability of medical care by doctors by specialists for children with specialized diseases has been increased by 5 times; the number of completed cases was increased by 3 times; the satisfaction of the patients' relatives increased 10 times.

The implementation of the changes did not require additional resource support, and the new work procedure demonstrates sustainable performance indicators.

Public health

New working standards for sport medicine and therapeutic exercise

Аннотация

Aim of the research: analysis of the regulatory framework and its changes, regulating labor standards in sports medicine and physical therapy.

The materials of the research were the normative legal documents of the reference legal system "ConsultantPlus", and the research methods were analytical and statistical.

Results. The results of the study showed that the order of the Ministry of Health and Social Development of the Russian Federation of 06/09/2010 No. 613n, which for the first time established the standard provision of medical and physical dispensaries, provided ample opportunities for increasing the number of doctors in exercise therapy and sports medicine, but the order The Ministry of Health of Russia No. 134n, the peculiarity and erroneousness of which is the introduction of the union "or" into the normative record, made significant changes to the staffing standards, both of the above positions and doctors of other specialties.

Conclusion. It is shown that the revision of staff standards was carried out in conditions when the previous regulatory documents were not used, while the stages of development of staff standards were violated, before the approval of the documents, a medical and economic assessment of the possibilities of introducing standards was not carried out labor in health care practice. Thus, the orders of the Ministry of Health of Russia No. 1144n in terms of the normative number of posts and No. 134n are not acceptable for use in medical organizations, and healthcare practice does not respond to changes in the normative number of posts in medical and physical dispensaries. All this testifies to the destruction of the system of labor rationing in health care.

Expert opinion

Implications of reforms in Russian healthcare from 1990-2020. Problems and proposals

Аннотация

The aim is to analyze the main consequences of the reform of the national health care and to consider measures that would contribute to improving the organization of medical care to the population.

Material and methods. We used statistical data from the Ministry of Health of the Russian Federation, Rosstat, Federal Research Institute for Health Organization and Informatics, as well as data for the Siberian Federal District. Scientific publications on the problem under consideration have been studied.

Results. The measures taken in the country to improve the organization of medical care to the population are not effective enough, and sometimes untenable and aggravate the already difficult situation in the industry. The article presents some results of the implementation of state concepts, projects and programs that did not provide a reduction in the overall mortality of the population, including among people of working age, and an increase in the life expectancy to the planned level.

This was the result of insufficient scientific justification of the planned results and the lack of responsibility on the part of officials who did not ensure their implementation, including the implementation of the President's instructions to increase the salaries of medical workers. Special attention is paid to the activities of the industry within the framework of compulsory health insurance, as well as to the state of rural health care, which has deteriorated significantly in recent years. The authors consider a minimum of measures to preserve the public health sector, to ensure its more effective functioning and to increase the availability and quality of medical care to the population on this basis.

Conclusion. The health care reform carried out over the past three decades has not yielded the planned results, and in some areas has led to a deterioration of the situation due to insufficient scientific justification of the measures taken. The vast majority of doctors and the population believe that we should abandon compulsory health insurance and suspend the optimization of the industry. It is necessary to take measures, the implementation of which will preserve the public health sector and improve its functioning.

Our patients

Artificial intelligence algorithms for dialysis patients' therapies efficiency evaluation

Аннотация

The aim of the research is to form methodological base of medical information system development, that would be able to examine the life quality problems of dialysis patients as a whole by using machine learning algorithms.

A specific practical objective is to develop an intelligent decision support system for prescribing personalized medical therapies for patients with chronic renal failure, as well as to evaluate the efficiency of the treatment strategy in terms of the validity of prescribing for phosphorus-calcium metabolism (PCM) restoration therapy and for antianemic therapy (AAT) based on patient's profile. By patient's profile we understand the combination of socio-demographic characteristics of the patient, functional examinations, laboratory and clinical studies, monitored in dynamics, the timeline of pharmacological prescriptions in the "drug-dose-route of administration" link.

Material and methods. The model of therapies efficiency had been developed using the funnel principle: on the first stage of the model therapy classifies as "effective" one or "non-effective", then in the case of "non-effective" therapy classifies either as "insufficient" or as "excessive". In the research algorithms of gradient boosting and random forest were implemented on both stages. To balance volume of raw data recovery and to get reliable results while having a wide variety of features sampling technics as SMOTE and random oversampling were used. As features for classification models fitting were used such values as: gender and age of patient, body mass index, presence of hepatitis B, hepatitis C, HIV infection, treatment period, presence or absence of medical treatment prescription in previous periods with medicament indication, its dosage, medication frequency and route of administration, laboratory blood indicators at the moment of therapy prescription (such as hemoglobin, ferritin, potassium, sodium, hematocrit, phosphorus, iron, parathormone, calcium, percentage of transferrin iron saturation, etc.), their values at previous and pre previous months, duration of dialysis treatment, dialysis procedure efficiency indicator (monthly average KT/V ratio). The data that was used to fit models is represented by 9000 records labeled by efficiency class for both AAT and for PCM restoration therapy. Given data was divided on test and train data in 70 on 30 ratio.

Results. On test data the following quality metrics were received for therapy efficiency estimation using fitted models: for AAT efficiency - sensitivity -98.9%, specificity - 98.2%; for PCM restoration efficiency - sensitivity - 98.4%, specificity - 98.3%; for AAT insufficiency/excessiveness - sensitivity - 98.4%, specificity - 97.7%; for PCM restoration therapy insufficiency/excessiveness -sensitivity - 99.5%, specificity - 100%.

Conclusion. The implementation of the proposed algorithms efficiency estimation for AAT and PCM recovery therapy system allows to use given means for these types of therapy as efficiently as possible.

IX International congress “ORGZDRAV 2021. Effective healthcare management”

Results of the IX International Congress "Orgzdrav 2021. Effective Healthcare Management" (May 25-27, 2021, online)

Аннотация

IX International Congress "Orgzdrav 2021. Effective Healthcare Management" was held as an online event on May 25-27, 2021. The main theme of the Congress was" Pandemic: rebooting the Russian and world healthcare systems". For 3 days, 85 experts from Russia, Brazil, Great Britain, Germany, India, Italy, Canada, China, the Netherlands, USA, Turkey, France, Switzerland, South Africa discussed issues of sustainable development of healthcare systems and organization of fight against new coronavirus infection in different countries.

CHIEF EDITOR
CHIEF EDITOR
Guzel E. Ulumbekova
MD, MBA from Harvard University (Boston, USA), Head of the Graduate School of Healthcare Organization and Management (VSHOUZ), Associate Professor of the Department of Public Health and Health Care, Health Economics, Faculty of Pediatric of the Pirogov Russian National Research Medical University
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