Научно-практический журнал Медицинские технологии. Оценка и выбор
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Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.050-055 meta

Abstract

Introduction. Modern health care is a leader in the social sector in terms of the number of public-private partnership projects. Monitoring of the implementation of strategic projects proves that the targets on the key indicators of the road map are reached. However, experts give a negative assessment
of the availability and quality of medical care.

Methods. The article describes the experience of using the balanced scorecard as an instrument for linking the key health care indicators and performance indicators of individual health facilities. Principles underlying cohesion and balance of the separate elements of the system are justified. Methods for identifying a statistically significant causal relationship between indicators are analyzed. A general model for the assessment of the attainment of the strategic goals by taking into account the three-level healthcare system is proposed.

Results. The presented details on the structure of indicators could be used by managers of health facilities for the development of their own strategies. The article concluded that further specification on the methodology of obtaining objective information to assess the success in health care strategic management is necessary.

Keywords

strategic management; efficiency; a health facility; evaluation; factors; balanced scorecard.

For citations

Dvojnikov S.I., Arhipova S.V. To the Problem of Increased Efficiency in Health Care Strategic Management. Medical Technologies. Assessment and Choice. 2019; 1(35): 50–55.

Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.043-049 meta

Abstract

The European region WHO policy on the prevention of non-communicable diseases, and also the development of national efforts to combat non-communicable diseases in the Russian Federation, are considered in the article. The strategic directions in the evolvement of the prevention of non-communicable diseases are described from the middle of the XX century until now. The relevance of scheduled preventive activities with the population and identification of effective ways to implement the prevention strategies, to diagnose at earlier stages and to reduce the impact of behavioral risk factors for the non-communicable diseases are justified. The need for further developments in the work on the formation of a healthy lifestyle, active involvement of each individual in the process of the formation of a responsible attitude to the health are proved.

Keywords

prevention of non-communicable diseases, risk factors, health promotion, the formation of a healthy lifestyle.

For citations

Zadvornaya O.L., Borisov K.N. Development of Prevention Strategies for Non-Communicable Diseases. Medical Technologies. Assessment and Choice. 2019; 1(35): 43–49.

Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.032-042 meta

Abstract

Clinical Decision Making Support Systems (CDMSS) are becoming increasingly popular in the wake of the introduction of information technology in medicine and the development of medical information systems. The potential benefits of using the CDMSS are forcing you to look for ways to create such a system that would allow you to solve not only clinical problems, but also analytical ones, planning tasks, training medical personnel, and digging new knowledge in medicine. It has been almost 50 years since the creation of the first MYCIN CDMSS, but the developers of such systems, the systems that provide intellectual support for clinical decision-making (ICDMSS), still face the problems of imitating reflexion and building an adequate inference machine that would provide the doctor with detailed explanations regarding proposed options for further action. This article is devoted to describing the experience of developing an algorithm for the operation of the solver of ICDMSS for diagnosing angina, which using mathematical methods would allow adequately evaluating the options offered to the doctor, as well as explaining them in detail using custom user stories.

Keywords

Angina pectoris, clinical decision making support systems, CDMSS, solver algorithm.

For citations

Kiselev K.V., Noeva E.A., Vyborov O.N., Zorin A.V., Potekhina A.V., Osyaeva M.K., Martynyuk T.V., Zarubina T.V. Development of a Reasoning Solver Algorithm for Instrumental Diagnostics of Angina Pectoris in Intelligent Clinical Decision Support System. Medical Technologies. Assessment and Choice. 2019; 1(35): 32–42.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.019-024 meta

Abstract

Taking into consideration growing attention to oncological problems in Russia concerns about statistical recording of malignant neoplasms are becoming important. The main sources of information on prevalence and morbidity of malignant neoplasms are discussed in the article. They are cancer registries, forms of federal statistical monitoring and registers of medical bills of medical care provided. The exhaustiveness of the data collection for specified sources are evaluated. Assessment is done to estimate the compliance of the data collected in Russia with recommendations of the International Agency for Research on Cancer. Improvements in statistical recording of malignant neoplasms were proposed including use of modern information technologies.

Keywords

oncology, malignant neoplasms, statistical recording, morbidity, cancer registry.

For citations

Semakova E. V., Ledovskikh Y. A., Tishkina S. N., Zheleznyakova I. A., Gerasimova K. V. Statistical Recording of Malignant Neoplasms in Russian Federation: Current Situation and Main Areas for Improvement. Medical Technologies. Assessment and Choice. 2018; 4(34): 19–24.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.028-035 meta

Abstract

The paper considers the issues of funding of medical organizations rendering outpatient primary medical care, and the assessment of availability of medical care for population depending on the financial resources of medical organizations.

Keywords

performance audit, medical organization, signed population, unique patients, compulsory medical insurance, capitation fee.

For citations

Budarin S. S., Elbek Yu. V. The Analysis of the Resources Used for the Activities of Outpatient Medical Organizations at the Level of Primary Medical Care. Medical Technologies. Assessment and Choice. 2018; 3(33): 28–35.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.036-041 meta

Abstract

The article highlights the history and stages of the formation of the «maxillofacial surgery» profile in the Moscow region. The structure of the service is currently examined in detail according to the new distribution of interterritorial municipal associations. This structure includes 5 specialized highgrade profile hospitals in 8 interterritorial municipal unions. The data on the hospital fund of hospital beds are given. According to the latest statistical data, resources indicators of the doctors of medical department maxillofacial surgeons are presented in comparison with other regions of the Russian Federation. Also in the article the scheme of routing of patients from the dentist of an out-patient reception of a medical institution to the maxillofacial surgeon MONIKI is indicated. The issue of interaction between treatment and prophylactic institutions of the dental profile with in-patient hospitals in the field of maxillofacial surgery is considered. In conclusion, priority directions for the improvement of the profile service in maxillofacial surgery in the Moscow region are formulated.

Keywords

maxillofacial surgery, the medical aid organization, routing patients, the rate of availability of maxillofacial surgeons.

For citations

Sipkin A. M., Kryazhinova I. A., Lapshin V. P. Priorities for Maxillofacial Surgery Improvement in the Moscow Region. Medical Technologies. Assessment and Choice. 2018; 3(33): 36–41.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.042-048 meta

Abstract

High urgency of healthcare informatization and features of the organization of medical and diagnostic process allow searching for the ways of maintenance of medical activity information support. One of such ways is the development of clinical decision support systems based on knowledge. Among the forms of knowledge representation, a semantic network is distinguished, structurally repeating the model of graph databases that have the necessary advantages for working with knowledge.

Purpose of the study. Development of the knowledge base architecture of the clinical decision support system for the instrumental diagnosis of angina pectoris based on the ontological approach, using a graph database.

Materials and methods. Extraction of concepts related to the diagnosis of angina pectoris was carried out from clinical recommendations concerning stable ischemic heart disease. The primary accumulation of knowledge and grouping of concepts by types was carried out in MS Excel; the elaboration of the types of connections between the highlighted concepts was carried out in the ARIS Express program. To form the knowledge base, a Neo4j graph database was used.

Results. From the clinical recommendations with the help of cardiologists, 401 root concepts and 619 synonyms were extracted, which were grouped by type of diagnosis, synonym, clinical sign, diagnostic test, diagnostic sign, laboratory test, medical personnel, location of the study. The groups of concepts were linked by means of links: parent-child, synonym, concomitant pathology, clinical sign, diagnostic sign, indication for the study, place of the study, person conducting the study, person interpreting the results of the study, person taking biomaterial sampling. To indicate the characteristic values, the graph database was used to fill the attributes of nodes and links, which made it possible to reduce the dimension of the graph. The created knowledge base was twice validated for the completeness and adequacy of solutions offered to the doctor using depersonalized electronic medical records of patients. The first validation returned incomplete compliance with appointments from electronic medical records, which made it necessary to refine the filling of the database with new knowledge. New knowledge was added to the database without the need to modify its architecture, after which the re-validation returned a complete match between the proposed and the actual assignments.

Conclusion. The use of clinical decision support systems based on the ontological approach using graph databases can be promising in terms of providing speed and explaining the proposed assignments. Properly organized architecture allows you to scale the knowledge base, and graph database features allow you to reduce the dimensionality of the graph, simplifying the work with knowledge.

Keywords

angina pectoris, clinical decision support systems, CDSS, ontology, clinical recommendations.

For citations

Kiselev K. V., Noeva E. A., Vyborov O. N., Zorin A. V., Potekhina A. V., Osyaeva M. K., Shvyrev S. L., Martynyuk T. V., Chazova I. E., Zarubina T. V. Development of Knowledge Base Architecture for Clinical Decision Support System Based on Graph Database. Medical Technologies. Assessment and Choice. 2018; 3(33): 42–48.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.050-061 meta

Abstract

The article thoroughly considers the algorithm of substantiation of tariff changes for completed cases paid at the expense of obligatory health insurance by diagnostic-related groups on the level of Russian regions. The analysis is performed on the example of patients, who need fast recovery of neuromuscular conductivity after administration of muscle relaxants during abdominal surgical operations including cholecystectomy. The data from the official statistical report forms on the number of abdominal surgical interventions for 2005–2017 were used. The results on the frequency of the use of muscle relaxants were based on the data obtained from medical organizations in different regions of Russia. The analysis of the procurement of muscle relaxants was performed using the data from the analytical system for monitoring of such procurement.

Key words

diagnostic related groups, diagnostic-related subgroups, completed case, muscle relaxants.

For citations

Obukhova O. V., Laricheva I. V., Brutova A. S., Yastrebova Ye. S., Zamyatin M. N. Optimization of Costs of Inpatient Medical Care for Patients that Need Selective Antidotes to Muscle Relaxants after Abdominal Surgery. Medical Technologies. Assessment and Choice. 2018; 3(33): 50–61.

Issue № 32 | 2018 (2)

DOI: https://doi.org/10.31556/2219-0678.2018.32.2.042-047 meta

Abstract

Introduction. The innovative medical technologies are one of the main factors explaining the growth of health care expenditure in all countries. The objective of the state healthcare policy is to find the optimal balance between the availability of new treatments for the population and limited budgets, while stimulating the development of innovative medical technologies. The access to the newest and often expensive methods of treatment in Russia is provided by updating the list of specialized high-tech medical care provided free of charge under the Program of State Guarantees of Free Medical Care.

Methods. The authors examine approaches to the introduction of new medical technologies into clinical practice, including those developed within the framework of clinical approbation, as well as approaches to the formation of lists of specialized high-tech medical care based on the analysis of the current regulatory framework. They give an expert assessment of the applicability of the Order of the Ministry of Health of Russian Federation for updating the lists of high-tech medical care.

Results. The criteria for evaluating the methods of specialized medical care should be clear (without the possibility of double interpretation), measurable (have specific values) and objective (regardless of the level of the medical organization that provides the method of treatment). In order to implement a unified approach to the formation of diagnostic-related groups, a single set of parameters characterizing the methods of specialized medical care should be provided. National Nomenclature of Medical Services should be used for coding the methods. Methods of high-tech medical care included into DRG
must be clearly described in the normative documents that determine the organization of their delivery, the structure of medical care and its scope.

Keywords

clinical approbation, high-tech medical care, specialized medical care, method of treatment.

For citations

Obukhova O. V., Brutova A. S., Dergachev A. V., Bazarova I. N. Approaches to the Definition of Specialized High-Tech Medical Care.
Medical Technologies. Assessment and Choice. 2018; 2(32): 42–47. (In Russ.).

Issue № 31 | 2018 (1)

Abstract

The article highlights the problems of rendering medical care to patients with infections of the maxillofacial area. The experience of doctors of the departments of maxillofacial surgery of the Moscow region is examined, the analysis of organizational and methodical work on the profile of «maxillofacial surgery» for 2016 is conducted. Based on the analysis carried out, the effectiveness of organizational and methodological approaches to assisting patients with inflammatory diseases of the maxillofacial region is assessed.

Keywords

maxillofacial surgery, organization of medical care, inflammatory diseases of maxillofacial area.

For citation

Sipkin A. M., Davydov I. A., Akhtyamov D. V., Blagikh O. Ye. Organization of Medical Care for Patients with Infections of the Maxillofacial Area in the Moscow Region. Medical Technologies. Assessment and Choice. 2018; 1(31): 48–51.