scholarly journals Assessment of the quality of medical care provided to patients in a psychiatric hospital

2020 ◽  
Vol 15 (4) ◽  
pp. 274-282
Author(s):  
Irina Shikina ◽  
◽  
David Davidov ◽  
Keyword(s):  
Quality Control ◽  
Medical Care ◽  
Psychiatric Hospital ◽  
Care Quality ◽  
Internal Quality ◽  
Diagnostic Process ◽  
Medical Diagnostic ◽  
Quality Coefficient ◽  
Quality Of Medical Care

Monitoring and evaluation of the quality of medical care provided to patients is essential in any medical specialty, but especially in relation to specialized care in mental health hospitals. The aim of our work is to assess the quality of specialized medical care provided to patients in the psychiatric hospital. We have examined 270 medical records and internal quality control cards of patients hospitalized from 2015 to 2019 in the Psychiatric Clinical Hospital No. 4 of the Moscow Healthcare Department (hereinafter referred to as “PCH No. 4” of MHD). The quality control of the provided medical care was carried out twice with the assessment of each studied section in the range from 0 to 1 point. Thus, it was possible to calculate the overall medical care quality coefficient with a description of the defects found in the provision of medical services. After the first control, quality coefficient appeared to be 0.86 (0.79; 0.91), and after the second one 0.95 (0.92; 0.96). During the second control, which was conducted in 2019, the medical care quality was significantly higher (p = 0.011) compared to the results of 2015–2018. The total share of detected defects in the medical-diagnostic process in a psychiatric hospital was 40.7 % (and was captured in 110 out of 270 cases). The results of our study demonstrate the necessity of medical care internal quality monitoring in a psychiatric hospital, since it contributes not only to the improvement of overall quality of medical treatment, but also to timely detection and reduction of the number of defects in the medical-diagnostic process.

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 role of thematic expertise of medical care quality in improvement of results of its performance in cases of acute pancreatitis

2020 ◽  
Vol 22 (1) ◽  
pp. 105-112
Author(s):  
O N Scryabin ◽  
K N Movchan ◽  
V V Tatarkin ◽  
O A Klitsenko ◽  
Yu M Morozov ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Medical Care ◽  
Care Quality ◽  
Diagnostic Process ◽  
Abdominal Organs ◽  
Treatment Measures ◽  
Medical Diagnostic ◽  
Surgical Teams ◽  
Operational Activity

The parameters of assessing the quality of medical care provided in 2014 to 416 patients with acute pancreatitis in 9 hospitals in St. Petersburg were expertly studied. All medical institutions were licensed in the format of providing services for the examination and treatment of patients suffering from acute surgical diseases of the abdominal organs. According to the results of the data analysis, a correlation was observed between the consequences of defects in the medical diagnostic process in medical organizations with insufficient regulation and activity in clinical expert work on the profile of “abdominal surgery”. The facts of overdiagnosis of cases of acute pancreatitis in mild variants of the severity of the disease have been established. Preservation of low operational activity indicators in the treatment of patients with acute pancreatitis without a tendency to use (when indicated) modern (primarily, endovideo surgical) technologies has been observed. It was noted that with a positive (in general) trend in the development of emergency pancreatology, in cases of assessing the particular results of the activities of specialists of specific surgical teams involved in providing medical care to patients with acute pancreatitis, compliance with systemic clinical and expert approaches with timely management decisions should be a priority in quality management of diagnostic and treatment measures. It is substantiated that the calculation of the volume of medical care for residents of a metropolis with acute pancreatitis should be based on the quality of the examination and treatment of patients with this disease on the basis of a thematic examination of assessing the conformity of the diagnostic process to the level of modern ideas about the theory of development and course of this disease.

The significance of theme expertise of the quality of medical care in achieving successful results in treating patients with acute gastrointestinal bleeding

2020 ◽  
Vol 22 (3) ◽  
pp. 56-60
Author(s):  
O. N. Skryabin ◽  
K. N. Movchan ◽  
D. A. Tvorogov ◽  
V. V. Tatarkin ◽  
Yu. M. Morozov ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Medical Care ◽  
Diagnostic Process ◽  
Negative Consequences ◽  
Acute Gastrointestinal Bleeding ◽  
Abdominal Organs ◽  
Medical Institutions ◽  
Medical Diagnostic ◽  
Quality Of Medical Care

Abstract. This piece of work has evaluated the quality of medical care provided in 2015 to 1,158 patients with acute gastrointestinal bleeding in 11 medical institutions of Saint Petersburg that are licensed to provide in-patient examination and treatment for people with acute surgical diseases abdominal organs. The data on the possible correlative relationship of negative consequences for the implementation of the medical treatment and diagnostic process in cases of insufficient activity in terms of conducting clinical expert work on the profile of emergency abdominal surgery have been analysed in particular. It has been shown that providing medical care to patients with gastrointestinal bleeding is associated with defects in the medical diagnostic process in almost every second case. In the structure of inaccuracies, there prevailed cases of improper examination and treatment of patients (48 and 36%, respectively). Defects in making diagnosis and providing continuity comprise 13 and 3% respectively. The most significant drawback in providing medical care to patients with gastrointestinal bleeding was the use of low-effective anti-ulcer drug therapy schemes (16% of observation cases) and attempts to perform hemostasis by using outdated technologies of intraluminal endoscopy (16% of cases). It is noted that in cases of providing medical care to patients with acute gastrointestinal bleeding, a differentiated principle should be observed. It is proved that the proper quality of medical care for patients with acute gastrointestinal bleeding can be achieved by consistent, programmed provision of it with coordinated activities not only of surgeons directly involved in the treatment and diagnostic process, but also with their purposeful interaction with specialists of other medical fields.

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.

scholarly journals Optimization of internal quality control system of health care for children needing rehabilitation after neuroinfections

2018 ◽  
Vol 20 (3) ◽  
pp. 196-198
Author(s):  
I G Samoylova
Keyword(s):  
Quality Control ◽  
Control System ◽  
Medical Care ◽  
Internal Control ◽  
Medical Documentation ◽  
Internal Quality ◽  
Tier System ◽  
Internal Control System ◽  
Quality Of Medical Care

The results of the implementation of a three-tier system of internal quality control of medical care for children in need of rehabilitation after neuroinfections are presented. In 2015, a three-tier internal control system was developed at the clinic of the Children’s Research and Clinical Center for Infectious Diseases. The importance of introducing a new approach was determined by the severity of the patients at this clinic. The severity of the condition of children is due to the effects of neuroinfections. In addition, the quality of medical care is an essential element of improving the health care system in modern conditions. After the introduction of this system, the number of examinations carried out at the first level (heads of clinical departments) increased, at the second level (deputy chief physician for medical work and quality of medical care) decreased. The number of detected defects increased, but the quality factor of medical care turned out to be quite high and fell into the group of «insignificant deviations». The main defects are defects in filling in medical documentation and redundancy in laboratory and instrumental research. The leading position in the structure of defects is occupied by defects in filling in medical documentation with a specific weight of 32,4%. With the introduction of a new quality control system, the average length of stay of a patient in the rehabilitation department came close to the one prescribed in medical and economic standards. Revealed quite a large percentage of diagnostic studies that are not included in the medical and economic standards, that is, additional. This fact indicates the need to revise the medical and economic standards in the direction of expansion, taking into account the need. The third level of the internal control system is designed to assess the corrective actions taken as a result of audits at the first two levels of the internal control system. In general, the three-tier system has certainly improved the quality of care.

Quality control as a fundamental institute of medical activities (review of literary sources)

2021 ◽  
pp. 39-48
Author(s):  
Larisa Arkadyevna Karaseva ◽  
Tatyana Vladimirovna Bessonova
Keyword(s):  
Quality Of Life ◽  
Quality Control ◽  
Medical Care ◽  
Internal Quality Control ◽  
Internal Quality ◽  
Quality And Safety ◽  
Professional Activities ◽  
Literary Sources ◽  
High Level

The aim of the study, analyze and evaluate the quality control and safety of medical activities carried out in medical organizations. Results: the essence of the concept of quality control in the field of medical care was determined, criteria for assessing the quality of medical activities were identified, the main aspects of developing a program for internal quality control and safety of medical activities were characterized, key risks existing in medical activities were identified, directions for improving the quality and safety of professional activities of medical workers. Conclusion: modern approaches to the organization of quality control and safety of medical activities make it possible to ensure a high level of medical care provided to the population and improve the quality of life of the population as a whole.

scholarly journals Methological aspets of assessing the quality of medical care

2021 ◽  
Vol 1 (8) ◽  
pp. 44-52
Author(s):  
A. V. Kolokolov
Keyword(s):  
Medical Care ◽  
Negative Impact ◽  
Economic Conditions ◽  
Diagnostic Process ◽  
High Quality ◽  
Smart System ◽  
New Approach ◽  
Quality Of Medical Care ◽  
Methodological Aspects

One of the most urgent areas of Russian health care is the organization of medical care in the new socio-economic conditions, aimed at providing affordable high-quality and safe medical care to the population, therefore, a new approach to the formation of control over both the quality of medical care and its safety is of particular interest. At all stages of the treatment and diagnostic process, serious mistakes can be made that can have a negative impact on the life and health of patients.The article discusses the methodological aspects of assessing the quality of medical care at all stages of the treatment and diagnostic process. Requirements for the formation of an expert opinion, which is prepared based on the results of the examination of the quality of medical care, have been formulated. In order to effectively manage the quality of medical care, the author proposes the creation of a digital “smart” system for monitoring defects in medical care.

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 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.

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