scholarly journals THE MEDICAL AND LEGAL ASPECTS OF EFFECTIVENESS EVALUATIONOF THE EXAMINATION AND TREATMENT OF COMPLICATED FORMS OF DIABETICFOOT IN PATIENTS DISSATISFIED WITH THE QUALITY OF MEDICAL CARE PROVIDED

2017 ◽  
Vol 9 (3) ◽  
pp. 121-126
Author(s):  
K N Movchan ◽  
R B Iskhakov ◽  
A V Kovalenko ◽  
K I Rusakevich
Keyword(s):  
Diabetes Mellitus ◽  
Medical Care ◽  
Quality Assessment ◽  
Diabetic Foot ◽  
Healthcare Providers ◽  
Legal Aspects ◽  
Care Quality ◽  
Patient Cooperation ◽  
Quality Of Medical Care

Medical care quality assessment in patients suffering from ulcerous-necrotic forms of diabetic foot is a rather problematic question, especially in cases of negative disease outcome. Patients fighting against diabetes mellitus and its complications for saving their lives occasionally not only criticize the healthcare organization without a good cause but use civil law procedures, bringing in an indictment accusing healthcare practitioners of unsuitable medical care. The article discusses deonto- logical aspects of providing medical care to patients with diabetic foot dissatisfied with the quality of examination and treatment in healthcare providing institutions. It also demonstrates the medical and legal conflict which arose due to medical care quality assessment in a patient with complicated form of diabetic foot who regularly was consulted and was under the care of different health care practitioners as an in-patient so as an out-patient. The article illustrates that important factors in successful treat- ment of patient with diabetes mellitus are professional engagement and interaction between healthcare providers of specialized centres and healthcare practitioners at the out-patient stage as well as case follow-up with suitable and well-timed correction of glucemia. Special attention should be given to doctor-patient cooperation. Only a multidisciplinatory approach offers the possibility to improve the quality of medical care provided to patients with complicated forms of diabetic foot and to reduce the frequency of complaints to different medical, social and politico-administrative authoritative bodies.

Evaluation of medical care for Diabetic and Hypertensive patients in primary care in Mexico: Observational retrospective study (Preprint)

2020 ◽  
Author(s):  
Agustin Lara-Esqueda ◽  
Sergio A Zaizar-Fregoso ◽  
Violeta M Madrigal-Perez ◽  
Mario Ramirez-Flores ◽  
Daniel A Montes-Galindo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Medical Care ◽  
Serum Lipids ◽  
Quality Care ◽  
Premature Death ◽  
Current Standard ◽  
Anonymized Data ◽  
Quality Of Medical Care

BACKGROUND Diabetes Mellitus is a worldwide health problem and the leading cause of premature death with increasing prevalence over time. Usually, along with it, Hypertension presents and acts as another risk factor that increases mortality risk. Both diseases impact the country's health while also producing an economic burden for society, causing billions of dollars to be invested in their management. OBJECTIVE The present study evaluated the quality of medical care for patients diagnosed with diabetes mellitus (DM), hypertension (HBP), and both pathologies (DM+HBP) within a public health system in Mexico, according to the official Mexican standard for each pathology. METHODS 45,498 patients were included from 2012 to 2015. All information was taken from the electronic medical records database, exported as anonymized data for research purposes. Each patient record was compared against the standard to test the quality of medical care. RESULTS Glycemia with hypertension goals reached 29.6% in DM+HBP, 48.6% in DM, and 53.2% in HBP. The goals of serum lipids were reached by 3% in DM+HBP, 5% in DM, and 0.2% in HBP. Glycemia, hypertension, and LDL cholesterol reached 0.04%. 15% of patients had an undiagnosed disease of diabetes or hypertension. Clinical follow-up examinations reached 20% for foot examination and clinical eye examination in the whole population. Specialty referral reached 1% in angiology or cardiology in the whole population. CONCLUSIONS Goals for glycemic and hypertension reached 50% in the overall population, while serum lipids, clinical follow-up examinations, and referral to a specialist were deficient. Patients who had both diseases had more consultations, better control for hypertension and lipids, but inferior glycemic control. Overall, quality care for DM and/or HBP has not been met according to the standards. While patients with DM and HBP do not have a current standard to evaluate their own needs.

scholarly journals The development of criteria, indices and indicators and of medical care quality for patients with syndrome of diabetic foot in out-patient practice

2019 ◽  
Vol 60 (3) ◽  
pp. 138-142
Author(s):  
Oleg V. Udovichenko ◽  
E. A. Berseneva ◽  
D. O. Meshkov
Keyword(s):  
Data Collection ◽  
Medical Care ◽  
Diabetic Foot ◽  
Care Quality ◽  
Practice Analysis ◽  
Results Of Treatment ◽  
Quality Of Structure ◽  
Chronic Course

The special techniques of evaluation of every single disease are required for assessing quality and effectiveness of treatment in out-patient practice. The purpose of study was development of criteria, indices and indicators of evaluation of quality of out-patient medical care of patients with syndrome of diabetic foot. The technique of literary searching and practice analysis were applied to develop criteria, indices and indicators for evaluating structure, processes and results of treatment. The evaluation of quality of result requires more complicated techniques of data collection as opposed to indices of quality of structure and processes. The developed indices can be also applied in evaluating effectiveness of treatment of other diseases with chronic course though curable in the main.

scholarly journals ALGORITHM FOR MEDICAL EXAMINATION OF ENDODONTIC TREATMENT

2020 ◽  
Vol 5 (4) ◽  
pp. 20-25
Author(s):  
A. К. Iordanishvili ◽  
E. K. Barinov ◽  
I. B. Salmanov
Keyword(s):  
Quality Control ◽  
Medical Care ◽  
Dental Treatment ◽  
Care Quality ◽  
Endodontic Treatment ◽  
Internal Quality ◽  
Dental Clinics ◽  
Quality Of Medical Care ◽  
Te Material

Evaluation (including within the framework of medico-legal examination) of the quality and efectiveness of endodontic dental treatment is a matter of current interest in the clinical dentistry.Obiectives. Te aim of the work was to develop an algorithm of medico-legal examination in case of endodontic treatment, to test this algorithm in the work of the commissions of medical care quality control in the departments of therapeutic dentistry of outpatient dental clinics.Material and methods.Te material of the study was the reports of daily activities of dental clinics of various forms of ownership (municipal, departmental, private) in 3 regions of Russia (Moscow, St. Petersburg, Rostov-on-Don), including periodic reports and reference reports, ofcial statistical reports of the activities of the examined clinics, including registration books of the work of the commissions of the quality of medical care. Tese materials were used as a source of primary statistical information. Afer grouping of the information contained in them, the main data characterizing organization, condition and quality of endodontic care were recovered taking into account nosological entities: pulpitis and periodontitis. Taking into account the medical, statistical and analytical nature of the study, the main conclusions and recommendations were formulated on the basis of a retrospective study of these materials.Results. Based on the studies carried out and recommendations of the European Endodontic Association on provision of the standard of endodontic treatment, an algorithm for medico-legal examination of endodontic treatment was proposed. Tis algorithm allows to assess the quality and efectiveness of endodontic treatment of pulpitis and periodontitis in diferent terms (immediately afer treatment, remote period)Conclusion. Te use of the developed algorithm in clinical practice in internal quality control of endodontic care has shown its efectiveness. A large number of clinical cases of insufcient quality of endodontic treatment and its low efectiveness in the remote period indicate persistence of the potential for claims from patients. 

scholarly journals THE LEGISLATIVE FOUNDATION OF EXPERTISE OF MEDICAL CARE QUALITY ACCORDING CASES OF LETHAL OUTCOMES

2019 ◽  
Vol 62 (2) ◽  
pp. 95-102
Author(s):  
Konstantin V. Polyakov ◽  
N. M. Gayfullin ◽  
Zh. A. Akopyan ◽  
P. G. Mal'kov
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Quality Evaluation ◽  
Evaluation Criteria ◽  
Care Quality ◽  
Icd 10 ◽  
Quality Of Medical Care ◽  
The Russian Federation ◽  
Care Support

The article presents analysis of national and foreign legislative documents concerning issues of expertise of quality of medical care according cases of lethal outcomes (Universal Declaration of Human Rights, the Constitution of the Russian Federation, ICD-10, Federal laws and sectoral orders). It is established that key elements of system of medical care quality control (levels of control, authorized authority, forms of control, sources of development of criteria of quality evaluation, criteria of quality evaluation) are determined legislatively and reflect main requirements of international documents. The criteria of medical care quality evaluation are developed by groups of diseases of conditions on the basis of corresponding of medical care support Procedures, medical care Standards, Rules of implementation of laboratory, instrumental, pathologico-anatomic and other forms diagnostic analysis and Clinical Recommendations (records of treatment) related to issues of medical care support. The shortcoming of the Russian Federation legislation is an inadequate reflection of sources of development of criteria of medical care quality evaluation and relevant incompleteness of the very criteria of medical care quality evaluation. Therefore, their application by experts to issues of evaluation of medical care quality is complicated that effects formation of expert conclusion and negatively affects detection and prevention of possible violations during medical care support. The outdated normative regulation of clinical pathologic anatomic conference is noted as an important form of control of medical care support according cases of lethal outcomes. The necessity of alterations and additions in particular currently in force documents concerning issues of expertise of medical care quality, including according cases of lethal outcomes.

scholarly journals Treatment of patients with acute coronary syndrome in 2019 (data from federal registry of acute coronary syndrome)

2020 ◽  
pp. 37-45
Author(s):  
О.В. Сагайдак ◽  
Е.В. Ощепкова ◽  
Ю.В. Попова ◽  
О.М. Посненкова ◽  
А.Р. Киселев ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Medical Care ◽  
Median Time ◽  
Myocardial Revascularization ◽  
Care Quality ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Quality Of Medical Care

Введение. Проблема качества оказания медицинской помощи больным с острым коронарным синдромом (ОКС) является одной из наиболее актуальных для нашей страны, так как летальность, особенно при ОКС с подъемом сегмента ST (ОКСсST) остается на высоком уровне. Федеральный регистр больных с ОКС (далее – Регистр) дает возможность выявлять недостатки и разрабатывать подходы к улучшению оказания медицинской помощи больным в реальной клинической практике. Цель исследования: анализ качества оказания медицинской помощи больным с ОКС, прошедших лечение в 2019 году. Материалы и методы. За период с 01.01.2019 по 31.12.2019 в Регистр были внесены данные 27929 больных с ОКС из 138 медицинских организаций 32 субъектов Российской Федерации (средний возраст 65,3±11,7 лет, 62,7% мужчин). Результаты: Из 20757 у 65,9% (n= 13399) диагноз при выписке – острый и повторный инфаркт миокарда, у 32,6% – нестабильная стенокардия. 44,7% (n=9287) составили больные с ОКС с подъемом сегмента ST (ОКСсST), 55,3% (n=11470) – c ОКС без подъема сегмента ST(ОКСбST). Из 9287 больных с ОКСсST75,8% (n=7044) была выполнена реваскуляризация миокарда. Из них у 21,7% (n=1532) использовался фармакоинвазивный подход, у 61,1% (n=4304) больных выполнено только ЧКВ, у 17,0% больных проводили только тромболитичсекую терапию без ЧКВ. Остальным больным реваскуляризация не была проведена и выбрана консервативная тактика лечения. Из 11470 больных с ОКСбST реваскуляризация выполнена лишь у 31,5% (n=3621). У больных с ОКСсSTмедиана времени от момента госпитализации до начала ЧКВ составило 55 [34;106] мин. Медиана времени от начала симптомов заболевания до начала ЧКВ составила 320 [180;807] мин. Среди больных с ОКСбST медиана времени от момента госпитализации до начала ЧКВ составила 195 [75;1025] мин. От начала симптомов заболевания до начала ЧКВ составила 945 [370;2620] мин. Заключение При анализе соответствия клиническим рекомендациям, отмечается, что оказание медицинской помощи больным с ОКС оказывается не в полном объеме, что наиболее выраженно в подгруппе больных с ОКС без подъема сегмента ST. Introduction. The problem of the quality of medical care for patients with acute coronary syndrome (ACS) is one of the most relevant for our country, since mortality, especially for patients with ACS with ST segment elevation (ACSwST) remains high. The Federal Registry of Patients with ACS (hereinafter referred to as the Register) makes it possible to identify gaps in medical care quality and develop approaches for its improvement. Objective: to analyze the quality of medical care for patients with ACS who underwent treatment in 2019. Materials and methods. For the period from January 1, 2019 to December 31, 2019, data from 27029 patients with ACS from 138 medical organizations in 32 regions of the Russian Federation was included in the Registry (average age 65.3 ± 11.7 years, 62.7% of men). Results: Out of 20757, 65.9% (n = 13399) had an acute and repeated myocardial infarction diagnosis at discharge, and 32.6% had unstable angina pectoris. 44.7% (n = 9287) were patients with ACS with ST segment elevation (ACSwST), 55.3% (n = 11470) - with ACS without ST segment elevation (ACSnST). Of 9287 patients with ACSwST, 75.8% (n = 7044) underwent myocardial revascularization. Of these, in 21.7% (n = 1532) the pharmacoinvasive approach was used, in 61.1% (n = 4304) of patients only PCI was performed, in 17.0% of patients only thrombolytic therapy without PCI was performed. The remaining patients did not undergo revascularization and conservative treatment was chosen. Of 11470 patients with ACSnST, revascularization was performed only in 31.5% (n = 3621). In patients with ACSwST, the median time from hospitalization to the onset of PCI was 55 [34; 106] min. The median time from the onset of symptoms to the onset of PCI was 320 [180; 807] min. Among patients with ACSnST, the median time from the time of hospitalization to the onset of PCI was 195 [75; 1025] min. From the onset of symptoms to the onset of PCI, it was 945 [370; 2620] min. Conclusion Analyzing the quality of ACS patients medical care we concluded that ssufficient part of patients with ACS are provided with non-optimal treatment due to clinical guidelines, and the medical care is the it was noted that the provision of medical care to patients with ACS is not in full, which is most pronounced in the subgroup of patients with ACS without raising the ST segment.

scholarly journals Diabetologic Training Program for endocrinologists of Moscow devoted to type II diabetes mellitus

1995 ◽  
Vol 41 (6) ◽  
pp. 47-48
Author(s):  
M. B. Antsiferov ◽  
M. Ryabchun
Keyword(s):  
Diabetes Mellitus ◽  
Medical Care ◽  
Type Ii Diabetes ◽  
Diabetes Education ◽  
Type Ii Diabetes Mellitus ◽  
Type Ii ◽  
Care Level ◽  
Primary Care Level ◽  
Quality Of Medical Care

In April 1995, the Diabetes Education Program was opened for endocrinologists on type II diabetes mellitus. The emergence of this initiative is due to the need to significantly improve the quality of medical care for patients with type II diabetes mellitus at the primary care level of specialized medical care.

scholarly journals RESULTS OF MEDICAL-SOCIAL RESEARCH ON MEDICAL CARE QUALITY FOR PATIENTS WITH COVID-19 OF INPATIENT HOSPITAL DEPARTMENTS IN SUMY REGION

2021 ◽  
Vol 74 (5) ◽  
pp. 1057-1060
Author(s):  
Natalia O. Dryha ◽  
Alla V. Stepanenko ◽  
Lesia A. Rudenko ◽  
Daria O. Zhaldak ◽  
Svitlana M. Piven ◽  
...  
Keyword(s):  
Medical Care ◽  
Social Research ◽  
Care Quality ◽  
Viral Infectious Disease ◽  
Working Age ◽  
Quality Of Medical Care ◽  
Bed Days ◽  
Health Institutions ◽  
The Relationship

The aim: The aim of the study is to assess the quality of medical care and determine the relationship between treatment outcomes of patients and acute respiratory viral infectious disease caused by SARS-CoV-2,depending on patients` age, the time from onset of symptoms to hospitalization, and the presence of comorbidity. Materials and methods: According to the specially designed form, a retrospective analysis of primary accounting documents was carried out (f. No. 103/o) in 158 patients with COVID-19. The research was carried out in specialized inpatient infectious diseases wards of health institutions of the Sumy region during the period from April to September 2020. The study used a systemic approach, bibliosemantic, comparative and statistical analyses, logical generalization methods. Results: Among the study group of patients, namely 158 people, a bigger number of women (56.33±3.95%) than men (43.67±3.95%) were recorded. Patients of working age (from 18 to 64 years old) took 70.89±3.61% of all patients, and people aged 65 years and older – 29.11±3.61%. The time from the beginning of symptoms to hospitalization in each second patient (49.37±3.98%) lasted 5-7 days. In most cases, the patient’s stay in the hospital equaled 13-15 bed-days – 32.28±3.72%. The index of patients with severe and critical state was 20.89±3.23% (33 patients). In 8.23±2.19% (13 people) of treated cases of hospital stay ended in death. A large index of patients with a severe course of the disease, the treatment of which ended in discharge, were in hospital for more than 13 bed days – 12.03±2.59% (19 people). All of these patients were older, had CNCDs (chronic non-communicable diseases), half of them were hospitalized on day 7 and later from the onset of symptoms. Conclusions: In older people, the disease progresses faster and complications are developing more often. Also, the severity of the SARS-CoV-2 pattern and the length of staying in the hospital are affected by the time starting the onset of symptoms till hospitalization and the presence of CNCDs. The hereinafter data allows to increase knowledge about spreading of COVID-19, to improve the quality of organizational and preventive events in the provision of medical care, and reducing mortality.

scholarly journals Diabetes Health Services in Sri Lanka: Development of a Quality Index

2019 ◽  
Vol 11 (4) ◽  
pp. 41
Author(s):  
Nethmini VJ Thenuwara ◽  
Christopher M Reid ◽  
Pushpa Fonseka ◽  
Baki Billah ◽  
Champika Wickramasinghe ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Sri Lanka ◽  
Service Quality ◽  
Quality Assessment ◽  
Internal Consistency ◽  
Care Quality ◽  
Quality Of Services ◽  
Tertiary Level ◽  
Scaling Analysis

BACKGROUND: Diabetes mellitus is a major public health issue in Sri Lanka and across the globe. Patients with diabetes mellitus (DM) need long term comprehensive care. Quality of care for DM varies in different settings. Service quality assessment leads to identifying service areas that may benefit from appropriate intervention in order to achieve better health outcomes. The aim of this study was to develop and validate an instrument to measure the quality of services provided for patients with DM attending medical and diabetic clinics in state hospitals of Sri Lanka. METHODS: A ‘Care for DM Quality of services’ (CD QS) instrument comprised of 8 subscales: routine services, glycaemic control, Blood Pressure and lipid control, weight control, annual screening, patient empowerment, recording of information and functional aspects was developed and validated. Trained research assistants collected data from 100 volunteer patients attending four diabetic clinics two each at secondary and tertiary level hospitals. Construct validity was established by multi-trait scaling analysis and known group comparisons. Internal consistency was assessed by item-total correlations and Cronbach’s alpha. Cut off levels to classify the hospital clinic as ‘good’, ‘moderate’ or ‘poor’ performance were determined by the average score in each subscale being above mean + SD (good), between mean + SD (moderate), and below the mean –SD (poor) respectively. RESULTS: Multi-trait scaling analysis of items showed highest correlation with its own subscale compared to the other subscales. Significantly higher mean scores (p<0.05) for all the subscales were observed in tertiary level clinics compared to the secondary level. Internal consistency of ‘CD QS’ was good with Cronbach’s alpha of 0.9. Intra Class Correlation Coefficients were over 0.9 for all subscales with confidence intervals ranging from 0.8 to 2.9 suggestive of good inter-rater reliability. CONCLUSIONS: ‘CD QS’ is a valid and reliable tool to assess both functional and technical quality of follow up care provided for patients with DM. This facilitates regular quality assessment of DM care thus identifying the gaps and improving the service quality. Further implementation and testing for clinical usefulness and acceptability will determine the tools application in the healthcare setting.

scholarly journals WORK EXPERIENCE OF THE MULTI-PROFILE HOSPITAL ON AUTOMATION OF EXPERT ACTIVITIES IN THE HEALTH CARE QUALITY MANAGEMENT SYSTEM

2018 ◽  
Vol 25 (3) ◽  
pp. 88-96
Author(s):  
O. T. ODNOVOLOV ◽  
N. A. ARSHINOVA ◽  
V. V. PONOMAREV ◽  
YA. O. TRUSOVA
Keyword(s):  
Quality Management ◽  
Medical Care ◽  
Management System ◽  
Health Care Quality ◽  
Quality Management System ◽  
Care Quality ◽  
Internal Quality ◽  
Regulatory Documents ◽  
Quality Of Medical Care

Aim. Improvement of the quality of medical services provided due to a precise organization of the health care quality management system, based on the implementation of the requirements of existing regulatory documents determining expert work and its subsequent automation.Materials and methods. The quality management system in the institution is based on an active multifunctional organizational structure able to respond quickly to the detection of defects in providing medical care through the use of computerization of all areas of its activities. The automated control system of the diagnostic and treatment process proposed by us allows moving from the formal compliance with requirements established by the current regulatory documents to full management of the quality of medical care in the institution through comprehensive automation of the structure of internal quality control of medical care that ensures monitoring of all directions of the institution with the formation of automated accounting and reporting forms.Results. The introduction into the practical work of an automated quality management system for providing medical care made it possible to reduce by 5 times the time for obtaining of operative medical information, to reduce defects caused by poor registration of medical documentation by 46%, to reduce the unjustified delay of patients in the hospital by 10%, to reduce the number of cases of repeated hospitalization , due to inadequate inpatient medical care by 11%, to minimize delays at medical sub-commission for the extension of sick leave almost to zero cases.Conclusion. The automated control system of the diagnostic and treatment process proposed by us, in contrast to the existing ones at the present time, allows us to move from formal compliance with requirements established by the current normative documents to full-fledged management of the quality of medical care in the institution through comprehensive automation of the internal quality control structure of medical care providing monitoring of all activities of the institution and achievement of the recommended regulatory documents criteria of quality of medical care.

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