Организация здравоохранения
OBSERVATION OF PATIENTS AFTER HIP REPLACEMENT: CLINICAL– EPIDEMIOLOGICAL AND ECONOMIC PREREQUISITES FOR THE CREATION OF NEW CLINICAL AND STATISTICAL GROUPS
A.M. Chililov1,3,1,2, A.O. Denisov3, O.V. Zelenova1,2, S.A. Sterlikov2, S.I. Abramov2
1. FGBU “NMIC of Surgery named after A.V. Vishnevsky” Ministry of Health of Russia
2. FGBU "Central Research Institute of Organization and Informatization of Healthcare" of the Ministry of Health of Russia, Moscow
3. FGBU "R.R. Vreden National Medical Research Center of Traumatology and Orthopedics" of the Ministry of Health of the Russian Federation
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Summary:
Relevance. With the increase in the number of primary endoprosthesis operations, the absolute number of revision interventions is also increasing. The main problem of repeated interventions is periprosthetic infection, which develops in the first months after primary prosthetics after the patient is discharged from a specialized clinic under the supervision of a surgeon on an outpatient basis at the place of residence, which leads to an untimely diagnosis of PPI. Taking into account the specifics of financing primary health care (on a per capita basis in outpatient settings) the surgeon should be able to refer the patient to a day hospital for further examination, for which it is necessary to develop a patient model and calculate a clinical and statistical group for the dynamic management of patients after hip replacement.
The purpose of the study. To create a CSG to monitor the patient after the initial endoprosthesis, which will allow the surgeon to refer the patient to a day hospital for further examination, for which it is necessary to develop a patient model and calculate the tariff based on the methodological recommendations of the FFOMS.
Materials and methods. The analysis of the depersonalized database of patients of the Russian Ministry of Health from 2010 to 2020 was carried out. The number of records of 31137 patients. Based on the analysis of the database, the main trends in the epidemiology of the development of PPI have been identified. The tariffs for medical services for the diagnosis of the disease and condition within 3 days are calculated, such as admission, examination, consultation of a specialist doctor, laboratory research methods, instrumental research methods, register maintenance, other research methods and medicines. The calculation of overhead costs was carried out.
Results: A patient model has been created to calculate a clinical and statistical group for monitoring a patient after primary hip replacement in a day hospital and using telemedicine technologies. The clinical and statistical group was created on the basis of the Methodological Recommendations of the FFOMS from 2021 on the Creation and updating of the CSG within the framework of the program of state guarantees for the provision of free medical care to citizens of the Russian Federation. A tariff has been formed for CSG for monitoring a patient in a day hospital for 3 days, which can amount to 23 783.31 rubles, taking into account overhead costs.
Conclusions: The analysis of the database for 10 years has shown that patients who require repeated interventions associated with PPI account for 4.8% of all operated patients, and about 3% of all operated in Russia. In order to prevent periprosthetic infection and repeated interventions on the joints, careful monitoring of the patient with the possibility of periodic comprehensive examination using the necessary laboratory and instrumental diagnostic methods, as well as remote (telemedicine) consultations with specialists in case of difficulties in interpreting the data of X-rays, computer and MR tomograms. To solve this problem, a patient model was formed and calculations were carried out for a new clinical and statistical group "Observation and examination of a patient after hip transplantation in a day hospital for 3 days", This CSG can be used no earlier than 3 months after joint surgery, but also no later than 1 year to avoid asymptomatic the course of PPI and have the possibility of early correction by therapeutic methods.
Keywords endoprosthetics, hip joint, CSG, dynamic observation, periprosthetic infection, patient model, telemedicine consultation.
Bibliographic reference:
A.M. Chililov1,3,, A.O. Denisov, O.V. Zelenova, S.A. Sterlikov, S.I. Abramov, OBSERVATION OF PATIENTS AFTER HIP REPLACEMENT: CLINICAL– EPIDEMIOLOGICAL AND ECONOMIC PREREQUISITES FOR THE CREATION OF NEW CLINICAL AND STATISTICAL GROUPS // Scientific journal «Current problems of health care and medical statistics». - 2022. - №5;
URL: http://healthproblem.ru/magazines?textEn=958 (date of access: 21.11.2024).
URL: http://healthproblem.ru/magazines?textEn=958 (date of access: 21.11.2024).
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