Научно-практический журнал Медицинские технологии. Оценка и выбор
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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 № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.062-074 meta

Abstract

Enzalutamide, abiraterone plus prednisone and cabazitaxel plus prednisone (hereafter referred to as abiraterone and cabazitaxel, respectively) are approved for the post-chemotherapy treatment of metastatic castration-resistant prostate cancer (mCRPC) in Russia. Currently, none of these treatments are
included in the Government Drug Reimbursement Program (GDRP).

The aim of this pharmacoeconomic evaluation is to comapre enzalutamide, abiraterone and cabazitaxel used after chemotherapy in patients with mCRPC from the Russian healthcare system perspective.

Materials and methods. Based on data from clinical trials – AFFIRM (enzalutamide), COU-AA-301 (abiraterone) and TROPIC (cabazitaxel) – and indirect comparisons of considered drugs, we proposed an mCRPC Markov chain model and calculated medical costs associated with three options. We used the 5-year time horizon as proposed by the national guidelines for pharmacoeconomic research. Budget impact, cost-effectiveness and cost-utility analyses were conducted.

Results: Use of enzalutamide, abiraterone and cabazitaxel resulted in 1.04, 0.94 and 0.96 quality-adjusted life years, respectively. Monthly medication costs for enzalutamide were 183 550,71 RUB per patient, 15% less than for abiraterone and 49% less than for cabazitaxel. Five-year total medical costs were 3 330 982 RUB, 3 331 998 RUB and 4 434 624 RUB per patient for enzalutamide, abiraterone and cabazitaxel, respectively. The smaller difference in total medical costs resulted from longer progression-free survival on enzalutamide compared to abiraterone or cabazitaxel. If included in GDRP, enzalutamide results in the lowest budget impact: 6 524,6 RUB million, compared to 6 526,6 RUB million for abiraterone and 8 688,4 RUB million for cabazitaxel.

Conclusions: Enzalutamide is more effective compared to abiraterone and cabazitaxel and requires the same or less additional budget expenditure in Russia.

Key words

prostate cancer, enzalutamide, abiraterone, cabazitaxel, pharmacoeconomic evaluation, cost-effectiveness analysis, cost-utility analysis, budget impact.

For citations

Avxentyev N. A., Derkach E. V., Makarov A. S. Pharmacoeconomic Evaluation of Enzalutamide, Abiraterone and Cabazitaxel for the Treatment of Post-Chemotherapy Patients with Metastatic Castration-Resistant Prostate Cancer. Medical Technologies. Assessment and Choice. 2018; 3(33): 62–74.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.075-088 meta

Abstract

The article presents the results of pharmacoeconomic study of umeclidinium bromide/vilanterol compared with tiotropium bromide/olodaterol and glycopyrronium bromide/vilanterol for the treatment of patients with chronic obstructive pulmonary disease (COPD). It was found that the use of umeclidinium bromide/vilanterol reduces the cost of therapy (26 and 29% respectively) and direct medical costs (23 and 25% respectively), and also increases the
effectiveness in respect of the criteria that characterise external respiration in patients with obstructive pulmonary diseases based on the measurement of
volume that has been exhaled at the end of the first second of forced expiration (FEV1). It is also the most convenient and simple in use and maintenance.

Key words

umeclidinium bromide/vilanterol, tiotropium bromide/olodaterol, glycopyrronium bromide/vilanterol, pharmacoeconomic analysis, pharmacoeconomic study, budget impact analysis, cost-effectiveness analysis.

For citations

Tolkushin A. G., Pogudin N. L. Pharmacoeconomic Analysis of Drug Therapy of Chronic Obstructive Pulmonary Disease: Umeclidinium Bromide/Vilanterol Compared with other Combinations of Long-Acting β-Antagonists and Anticholinergics. Medical Technologies. Assessment and
Choice. 2018; 2(32): 75–88.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.089-094 meta

Abstract

The paper is dedicated to the discovery of mechanisms of circulation and the circulatory system, which was one of the greatest achievements in medicine and physiology. Without this discovery, many medical methods and technologies would have never entered our lives. In 1628, a book Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus by William Harvey was published in Frankfurt. It was a breakthrough in scientific understanding of the functioning of heart in those days. Its author went down the history of science.

Key words

blood, heart, arteries, veins, pulmonary circulation, systemic circulation, Servetus, Harvey.

For citations

Opimakh I. V. Mysteries of the Heart. Medical Technologies. Assessment and Choice. 2018; 2(32): 89–94.

Issue № 32 | 2018 (2)

DOI: https://doi.org/10.31556/2219-0678.2018.32.2.008-022 meta

Abstract

The article explains the prerequisites, principles and steps of the developing in 2018 new diagnostic related groups (DRG) for inpatient cancer pharmacotherapy in Russian healthcare. New DRGs were developed in 5 steps: 1) most prevalent malignant tumors were revealed based on statistical data on the cancer incidence rate in 2016; 2) all recommended schemes of drug therapy for the most prevalent tumors were extracted from clinical guidelines made by Russian Oncology Association; 3) standards of medical care were created for the cases of hospital treatment with the use of each scheme of drug therapy; 4) the costs of hospital treatment with the use of each scheme were calculated; 5) cases with similar costs were combined into DRGs. 10 DRGs were formed for inpatient treatment and 8 – for treatment in the day hospitals. The cost-based relative weights were determined for each DRG. The system for coding drug regimens was developed for computerized assignment of cases to the DRGs in the Russian regions. The new DRGs are more homogeneous than previous ones in terms of clinical and economic characteristics, thus the main principle of DRG development is followed to a greater extent than before. Authors underline the necessity to monitor the results of the new DRGs implementation at the regions for minimizing the risks of imbalance in the payment system.

Keywords

provider-payment method in healthcare; diagnostic related group (DRG), cancer; standard of medical care; clinical guideline.

For citations

Avxentyeva M. V., Omelyanovskiy V. V., Petrovskiy A. V. et al. New Approaches to the Development of Diagnostic Related Groups for Cancer Pharmacotherapy in Russian Federation. Medical Technologies. Assessment and Choice. 2018; 2(32): 8–22.

Issue № 32 | 2018 (2)

DOI: https://doi.org/10.31556/2219-0678.2018.32.2.024-033 meta

Abstract

The classification algorithm is one of the key elements of the provider-payment system based on diagnostic related groups (DRG). Current version of the algorithm in Russian DRG system is described in a manual approved by the Federal Fund of Compulsory Medical Insurance. The algorithm determines the steps of computerized assignment of each hospital case to the DRG. Each region of Russia creates its own information system for classification of cases based on the approved algorithm. The article provides a brief analysis of the case-mix classification criteria and the classification algorithms in the Russian DRG model. The problems of the current algorithm are underlined and illustrated by the examples. Finally, the authors propose the ways for improving the algorithm.

Keywords

provider-payment methods in healthcare, diagnostic related groups (DRG), classification algorithm.

For citations

Fedyaev D. V., Akimov O. V., Zuev A. V. Algorithm of Hospital Cases Classification in the Russian Model of Diagnostic Related Groups: Need for Improvement. Medical Technologies. Assessment and Choice. 2018; 2(32): 24–33.

Issue № 32 | 2018 (2)

DOI: https://doi.org/10.31556/2219-0678.2018.32.2.034-041 meta

Abstract

The article discusses the health technology assessment (HTA) in Scotland. The HTA is provided by the Scottish Medicines Consortium (SMC), that gives recommendations on the use of new registered drugs in the National Health Service of Scotland. New forms of release and new indications for the use of already existing drugs are assessed as well. The SMC assesses only new prescription drugs but not vaccines, generic drugs or blood products. The assessment procedures are strictly regulated. The experts use the specially designed checklists. The assessment is carried out on the basis of the data submitted by the applicant and filled in accordance with the established form (dossier). Clinical efficacy, safety, clinical and economic advantages of the drug in question are assessed. The file review takes about 18 weeks. Based on the assessment results, the SMC makes a conclusion on the possibility of financing the drug at the expense of the state budget. The SMC ‘s conclusions are recommendations only, the final decisions on the state financing of the drug are taken at the meetings of the country’s territorial health councils.

Keywords

health technology assessment, the Scottish Medicines Consortium, clinical checklist, economics checklist.

For citations

Teptsova N. S., Lemeshko V. A. Health Technology Assessment in Scotland. Medical Technologies. Assessment and Choice. 2018; 2(32): 34–41