New approaches to formation of diagnosis-related groups for payment for radiotherapy and chemoradiotherapy based on clinical guidelines with the use of standardized modules of healthcare

The article presents a methodology and results of developing diagnosis related groups (DRGs) for the cases of healthcare provided with the use of radiotherapy and chemoradiotherapy for malignant neoplasms in Russian Federation. A key element of the methodology is the standardized module of healthcare (SM) which allows calculating the tariffs for medical care in accordance with clinical guidelines. As a result of the application of the new methodology, in 2019, changes were made to the DRG model in terms of payment for radiotherapy and chemoradiotherapy. The changes included developing 10 DRGs for in-patient radiotherapy and 10 DRGs in day hospital; 7 DRGs for in-patient chemoradiotherapy and 5 DRGs in day hospital. New classification criteria have been introduced into the DRG model for attributing the case to a certain DRG, in addition to the medical service used before. The number of fractions became a new criterion for radiotherapy, the number of fractions and the international non-proprietary name of the drug were proposed for chemoradiotherapy. A wider range of DRG’s weight coefficients was calculated, which allows more differentiated reimbursement of the costs of medical care provided by medical organizations depending on the method and the regimen used.

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Medical Care for Children with Cancer in the Donetsk People’s Republic: Results of an Ecological Study in 2014–2017

Oncopediatrics ◽

10.15690/onco.v5i3.1932 ◽

2018 ◽

Vol 5 (3) ◽

pp. 145-154

Author(s):

M. Yu. Rykov ◽

I. N. Inozemtsev ◽

S. A. Kolomenskaya

Keyword(s):

Medical Care ◽

Pediatric Patient ◽

Ecological Study ◽

Medical Service ◽

Care Delivery ◽

Benign Tumors ◽

High Tech ◽

Malignant Neoplasms ◽

Children With Cancer ◽

Patient Capacity

Background.Analysis of medical care delivery for children with cancer in armed conflict is highly important because the high-tech treatment in this context is extraordinary difficult and challenging task. Objective. Our aim was to analyze the morbidity and mortality rates in children with malignant tumors, to assess the pediatric patient capacity and medical service density in the Donetsk People’s Republic.Methods.The ecological study was conducted where the units of analysis were represented by the aggregated data of the Republican Cancer Registry on the number of primary and secondary patients with malignant and benign tumors, the deceased patients in the DNR in 2014–2017, pediatric patient capacity, and medical service density.Results.The number of pediatric patient capacity for children with cancer was 10 (0.27 per 10,000 children aged 0–17), pediatric patient capacity for children with hematological disorders — 40 (1.37 per 10,000 children aged 0–17). The treatment of children with cancer was performed by 5 healthcare providers: 1 pediatric oncologist (0.02 per 10,000 children aged 0–17), 3 hematologists (0.08 per 10,000 pediatric population aged 0–17), and 1 practitioner who did not have a specialist certificate in oncology. Morbidity rate for malignant neoplasms from 2014 to 2017 decreased by 25% (in 2014 — 9.6 per 10,000 children aged 0–17; in 2017 — 7.2). In the morbidity structure, the incidence proportion of hemoblastoses was 68.4%, brain tumors — 2.6%, other solid tumors — 29%. The death rate due to malignant neoplasms decreased by 37% (in 2014 — 2.7; in 2017 — 1.7).Conclusion.Low levels of the incidence rate and pattern of morbidity indicate defects in the identification and recording of patients. This explains the performance of the bed: low average bed occupancy per year and low turnover. For a reliable analysis of mortality statistical data is not available: in 2014–2015 only the number of in-hospital deceased patients is presented. Limited data is due to the lack of reliable patient catamnesis which is explained by the high rate of population migration.

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Forecasting and optimization of the kilovoltage X-ray therapy office within the framework of clinical guidelines of the Association of oncologists of Russia (AOR) of the Ministry of health of the Russian Federation

Research n Practical Medicine Journal ◽

10.17709/2409-2231-2020-7-3-10 ◽

2020 ◽

Vol 7 (3) ◽

pp. 99-107

Author(s):

L. N. Izurov ◽

J. A. Zuenkova

Keyword(s):

Mathematical Model ◽

Skin Cancer ◽

Medical Care ◽

Clinical Guidelines ◽

Day Hospital ◽

Actual Performance ◽

X Ray ◽

Non Melanoma Skin Cancer ◽

Therapy Room ◽

Melanoma Skin

One of the elements of the quality of medical care is its accessibility, which depends on the material and technical base of the institution, as well as on the availability of stuff and work management. Implementation of the new clinical guidelines of the Association of Oncologists of Russia (AOR) for the treatment of non-melanoma skin cancer (NRC), revealed the problem of increasing the load on stuff and equipment. Purpose of the study. To investigate and forecast the load of the kilovoltage X-ray therapy unit taking into account the updated clinical guidelines for the treatment of patients with non-melanoma skin cancer using radiotherapy. Determine the clinical and organizational changes in the technology of x-ray therapy for non-melanoma skin cancer within the day-hospital department for the skin cancer size more than 2 cm after implementation of new clinical guidelines and fraction regimes in compare with previously used schemes; derive a mathematical model of the work of the kilovoltage x-ray therapy room. Materials and methods. Data from the kilovoltage X-ray therapy office of radiotherapy unit No. 2 of the Sverdlovsk Regional Oncology Dispensary (SROD) were used. The average duration of radiotherapy sessions per patient was estimated and calculated using timekeeping. The results were evaluated using correlation analysis. In order to forecast the use of material and human resources, an economic method of mathematical modeling was used. Results. The analysis of the kilovoltage X-ray therapy unit of radiotherapy department No. 2 of the SROD for 3 years showed an increase from 10.4 to 17.3 in the average number of therapeutic fractions per patient after the implementation of the updated clinical guidelines. An increase in the average number of radiotherapy sessions leads to a doubling of the average bed-day of the patient's stay in the day-hospital. The formula was proposed for predicting the work of the unit. There is a clear correlation between the duration of treatment, the dynamics of hospitalization and the number of treated patients. The calculated results obtained using a mathematical model fully correspond to the actual performance of the radiotherapy room. Conclusion. To ensure optimal availability of medical care, it is necessary to match treatment technologies with available resources of the organization. The introduction of new treatment programs may require both the expansion of staff (medical, nursing), and an increase in the number of units of medical equipment. The obtained mathematical model of the kilovoltage X-ray therapy room allows to predict the optimal mode of work of employees while maintaining the quality and accessability of medical care.

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Oncology calculator as a tool for optimizing drug provision for patients with malignant neoplasms in the subjects of the Russian Federation

Health Care of the Russian Federation ◽

10.47470/0044-197x-2021-65-5-418-424 ◽

2021 ◽

Vol 65 (5) ◽

pp. 418-424

Author(s):

Sergey A. Linnik ◽

Elena E. Tumenko

Keyword(s):

Medical Care ◽

Russian Federation ◽

Clinical Guidelines ◽

Federal Budget ◽

Federal State ◽

Malignant Neoplasms ◽

Constituent Entity ◽

Patients With Cancer ◽

Number Of Patients ◽

The Russian Federation

Introduction. The increase in financial resources on the part of the state for the procurement of medicines for treating patients with malignant neoplasms makes the issue of calculation the need in medicinal preparations (MP) actual. The aim of the work is to develop a special tool (oncology calculator) that standardizes the method for determining the need for drugs and can calculate the need for medications for the treatment of malignant neoplasms in a particular constituent entity of the Russian Federation. Material and methods. To develop an oncology calculator, we analyzed the need for the drugs for the treatment of patients with the most common malignant neoplasms was analyzed based on current clinical guidelines approved and published on the Ministry of the Russian Federation website. The number of patients at each stage of a specific cancer was calculated. The frequency of application of a particular treatment regimen was calculated based on the approved standards of medical care for patients with cancer or from a project. The number of patients was calculated on the official statistics presented in the P.A. Hertsen Moscow Oncological Research Institute - branch of the Federal State Budgetary Institution “National Medical Research Center of Radiology” by the Ministry of Health of Russia. Results. We have developed a tool called the “Oncology calculator” that standardizes the methodology for determining the need of a constituent entity of the Russian Federation or a medical institution for drugs based on clinical guidelines, as well as facilitating the planning of the volume of medical care in the conditions of round-the-clock and day hospitals, and in the provision of medical care to patients with malignant neoplasms in outpatient settings. Conclusion. The existing approaches to calculating the need for drugs for the treatment of patients with cancer in the constituent entities of the Russian Federation are scattered, which leads to the ineffective use of funds from the federal budget, compulsory medical insurance funds, budgets of the constituent entities of the Russian Federation. A uniform approach to calculating the need for drugs to treat malignant neoplasms should be based on clinical guidelines containing drug regimens for treating patients.

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Diagnosis-related groups and payments for the treatment of malignant neoplasms in the model of 2019

PHARMACOECONOMICS Modern pharmacoeconomics and pharmacoepidemiology ◽

10.17749/2070-4909.2019.12.3.169-177 ◽

2019 ◽

Vol 12 (3) ◽

pp. 169-177

Author(s):

D. V. Fedyaev  ◽

V. V. Omelyanovskiy  ◽

M. L. Lazareva  ◽

Yu. V. Seryapina ◽

Yu. A. Ledovskikh

Keyword(s):

Medical Care ◽

Healthcare System ◽

Cancer Care ◽

Diagnosis Related Groups ◽

Medical Insurance ◽

Malignant Neoplasms ◽

Coding System ◽

Clinical Recommendations ◽

Regulation Changes ◽

Made In

The article addresses the model of diagnosis-related groups (DRG) updated according to the new tariffs in the compulsory medical insurance. Especially emphasized are changes made in the DRG model of 2019, which resulted from the previous work on the development and revision of the clinical recommendations in oncology, as well as the regulation changes in the healthcare system. In addition, the article describes the functioning of the DRG model in 2018 and the payment for cancer care and also provides examples from the practice of chemotherapy. The modifications made in the 2019 model are carefully discussed in terms of: expanding the list of oncological diagnoses, creating and characterizing new DRG groups, updating the coding system and the structure of reference books, changing the Guidebook recommendations and the Instruction related to oncological groups. Clarifications are given regarding frequently asked questions on payments for the medical care in oncology within the current DRG model.

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Medical Care for a Mass Gathering: The Suwa Onbashira Festival

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00005161 ◽

2007 ◽

Vol 22 (5) ◽

pp. 431-435 ◽

Cited By ~ 18

Author(s):

Kazuyuki Yazawa ◽

Yukihiro Kamijo ◽

Ryuichi Sakai ◽

Masahiko Ohashi ◽

Mafumi Owa

Keyword(s):

Medical Care ◽

Medical Records ◽

Medical Service ◽

Medical Problems ◽

Medical Care System ◽

Mass Gatherings ◽

Emergency Medical ◽

Cervical Spine Fractures ◽

First Time ◽

Care System

AbstractIntroduction:The Suwa Onbashira Festival is held every six years and draws approximately one million spectators from across Japan. Men ride the Onbashira pillars (logs) down steep slopes.At each festival, several people are crushed under the heavy log. During the 2004 festival, for the first time, a medical care system that coordinated a medical team, an emergency medical service, related agencies, and local hospitals was constructed.Objective:The aims of this study were to characterize the spectrum of injuries and illness and to evaluate the medical care system of this festival.Methods:The festival was held 02 April–10 May 2004. The medical records of all of the patients who presented to an on-site medical tent or who were treated at the scene and transported to hospitals over a 12-day period were reviewed.The following items were evaluated: (1) the emergency medical system at the festival; (2) the environmental circumstances; and (3) patient data.Results:All medical usage rates are reported as patients per 10,000 attendees (PPTT). A total 1.8 million spectators attended the festival during the 12-day study period; a total of 237 patients presented to the medical tent (1.32 PPTT), and 63 (27%) were transferred to hospitals (0.35 PPTT). Of the total, 135 (57%) suffered from trauma—two were severely injured with pelvic and cervical spine fractures; and 102 (43%) had medical problems including heat-related illness.Conclusions:Comprehensive medical care is essential for similar mass gatherings. The appropriate triage of patients can lead to efficient medical coverage.

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Mixed Adenocarcinomas of the Lung: Place in New Proposals in Classification, Mandatory for Target Therapy

Archives of Pathology & Laboratory Medicine ◽

10.5858/134.1.55 ◽

2010 ◽

Vol 134 (1) ◽

pp. 55-65 ◽

Cited By ~ 3

Author(s):

Marco Chilosi ◽

Bruno Murer

Keyword(s):

Lung Cancer ◽

Lung Adenocarcinoma ◽

World Health Organization ◽

Cell Biology ◽

Small Cell ◽

World Health ◽

Malignant Neoplasms ◽

New Classification ◽

Therapeutic Decisions ◽

Health Organization

Abstract Context.—Lung cancer is one of the most frequent and lethal malignant neoplasms, but knowledge regarding the molecular basis of its pathogenesis is far from complete due to the striking diversity of different forms. The current lung cancer classification (World Health Organization 2004) can efficiently distinguish clinically relevant major subtypes (small cell and non–small cell carcinomas), but its results are partly inadequate when facing prognostic and therapeutic decisions for non–small cell carcinomas, especially for the group of tumors classified as adenocarcinoma. Lung adenocarcinoma comprises a heterogeneous group of tumors characterized by diverse morphologic features and molecular pathogenesis. The category of mixed adenocarcinomas includes most adenocarcinomas (approximately 80%) and, according to World Health Organization criteria, is defined by the occurrence of a mixed array of different patterns (acinar, papillary, bronchioloalveolar, solid with mucin). The histologic recognition of mixed adenocarcinoma is subjective and cannot consistently discriminate between responders and nonresponders to new targeted therapies (eg, tyrosine kinase inhibitors). Diagnostic problems are mainly related to the poor reproducibility of histologic criteria, especially when applied in small biopsies and cytology, and to the difficulty in assigning each form to a precisely defined entity, as needed by updated therapeutic approaches. In this evolving scenario, pathologists face new challenging diagnostic roles that include not only the precise morphologic definition of carcinoma subtypes but also their molecular characterization. Objective.—To use a comprehensive critical analysis reconciling the overwhelming variety of biologic, morphologic, molecular, and clinical data to define new classification schemes for lung adenocarcinoma. Data Sources.—Scientific literature and personal data were used. Conclusions.—A new classification approach should redefine lung adenocarcinoma heterogeneity reconciling classic morphology, immunophenotypic and molecular features of neoplastic cells, and also relevant information provided by stem cell biology. This approach, which has been already successfully applied in World Health Organization classification of other tumors, could improve the recognition of new reproducible profiles for adenocarcinomas, more closely and reproducibly related to clinical features and response to specific therapies, limiting the use of “wastebasket” categories such as mixed adenocarcinoma.

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Organization of immunobiological therapy for severe bronchial asthma in the Sverdlovsk region

Rossiiskii Allergologicheskii ZHurnal ◽

10.36691/rja1414 ◽

2021 ◽

Author(s):

Evgeny K. Beltyukov ◽

Valery A. Shelyakin ◽

Veronika V. Naumova ◽

Alexander V. Vinogradov ◽

Olga G. Smolenskaya

Keyword(s):

Differential Diagnosis ◽

Targeted Therapy ◽

Medical Care ◽

Clinical Guidelines ◽

Medical Insurance ◽

Continuation Therapy ◽

Insurance Program ◽

Routine Medical Care ◽

Insurance Funds ◽

Stay Hospital

Background: Biologicals use in severe asthma (SA) is associated with problem of targeted therapy (TT) availability. Ensuring availability of biologicals can be resolved within the territorial compulsory medical insurance program (TCMIP) in day-stay or round-the-clock hospital. Aims: development and implementation of program for introduction of immunobiological therapy (IBT) for SA in Sverdlovsk Region (SR). Materials and methods: Program for introduction of IBT for SA was developed in SR in 2018 to provide patients with expensive biologicals within the TCMIP. Program includes: SA prevalence study in SR; practitioners training in differential diagnosis of SA; organization of affordable therapy for patients with SA; register of SA patients сreation and maintenance; patients selection and management of patients with SA in accordance with federal clinical guidelines. Results: Atopic phenotype in SA was detected in 5%, eosinophilic - in 2.3% of all analyzed cases of asthma (n=216). Practitioners of SR were trained in differential diagnosis of SA. The orders of the Ministry of Health of SR were issued, regulating the procedure for referring patients with SA to IBT, a list of municipal medical organizations providing IBT in a day-stay or round-the-clock hospital; approved regional register form of SA patients requiring biologicals use; ungrouping of clinical and statistical groups of day-stay hospital was carried out depending on INN and dose of biologicals; patients with SA are selected for TT and included in the regional register. Initiating of TT in round-the-clock hospital and continuation therapy in day-stay hospital provides a significant savings in compulsory medical insurance funds. Conclusions: introduction of IBT for SA in SR is carried out within framework of developed program. Principle of decentralization brings highly specialized types of medical care closer to patients and makes it possible to provide routine medical care in allergology-immunology profile in context of restrictions caused by COVID-19 pandemic.

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How Much does Improved Medical Service Affect Infant Mortality?

PEDIATRICS ◽

10.1542/peds.49.4.638 ◽

1972 ◽

Vol 49 (4) ◽

pp. 638-638

Author(s):

Arnold Gilbert

Keyword(s):

Infant Mortality ◽

Medical Care ◽

Community Health ◽

Medical Service ◽

Health Programs ◽

Community Health Programs ◽

Delivery Of Medical Care

The meaning of the article by Dr. Chabot in Pediatrics, June 1971 concerning improved infant mortality between 1964 and 1968 in Denver puzzled me. I wonder whether there is any relation between the improved community health programs described and the happy results presented. Surely, many factors other than medical care affect infant mortality. For example, I wonder whether the author would suggest that the startling (to me) rise in infant mortality noted in Table II for Boston, Buffalo, Phoenix, Pittsburgh and Seattle, resulted from poorer delivery of medical care.

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