Научно-практический журнал Медицинские технологии. Оценка и выбор
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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.

Issue № 31 | 2018 (1)

Abstract

The article discusses the proposals for the inclusion of the results of the expert activities of insurance companies and funds of obligatory medical insurance in the system of estimation of efficiency activities of medical organizations, providing medical assistance in programs of obligatory medical insurance.

Keywords

expert activities, medical organization, evaluation criteria, OMS, performance audit, quality standard resource management.

For citations

Budarin S. S., Smirnova E. V. Using the Results of Expert Activities in Assessing the Quality of Resource Management in a Medical Organization. Medical Technologies. Assessment and Choice. 2018; 1(31): 40–47.

Issue № 30 | 2017 (4)

Abstract

The review article examines the issues of delegating the possibilities of diagnosis and treatment of depressive and anxiety disorders to primary care physicians. The foreign experience of rendering medical care to this contingent of patients in an outpatient medical network is described. The possibilities of providing primary care facilities in Russian institutions for the treatment of anxiety and depressive disorders are analyzed. Problems are noted related to the contradictions in the legislative framework in the fi eld of mental health, the specifi cs of fi nancing the provision of psychiatric care in the context of primary care, and the need for training specialists. Possible models of the organization of the medical-diagnostic process in the framework of primary health care and specialized psychiatric and psychotherapeutic care for people with anxiety-depressive disorders are discussed, and proposals for resolving the indicated problems are expressed.

Keywords

depression, anxiety disorders, organization of primary psychiatric care.

For citations

Kostyuk G. P., Masyakin A. V., Starinskaya M. А. On the Prospects of Diagnosis and Treatment of Depressive and Anxiety Disorders in the General Medical Network. Medical Technologies. Assessment and Choice. 2017; 4(30): 70–75.

Issue № 30 | 2017 (4)

Abstract

The system of internal quality control and safety of medical activities is an element of the quality management system. It is necessary to improve the quality and effectiveness of medical care, reduce the economic risks of a medical organization. The introduction of quality indicators (approved by Order No. 203n of the Ministry of Health of the Russian Federation on May 10, 2017 «On Approval of Criteria for Evaluating the Quality of Medical Care») is an important step in improving the quality assurance of medical care and the development of a quality management system in medical organizations. The article presents an implementation algorithm for implementing indicators into the system of internal quality control and safety of medical activities of medical organizations. It is based on the results of the conducted analysis of the organization of the system of internal quality control and safety of medical activities of medical organizations in the Moscow Region.

Keywords

internal quality control and safety of medical activities, quality indicators, quality management system, Order of the Ministry of Health of Russia № 203n

For citations

Sukhorukikh O. A., Galeyeva Zh. A., Lukyantseva D. V., Shubina L. S., Pashkina A. A., Zhuravlyov N. I., Kravtsov A. A., Tishkina S. N. An Algorithm of Introduction of the Healthcare Quality Assessment Criteria. Medical Technologies. Assessment and Choice. 2017; 4(30): 62–69.