The quality of medical care should be based on the provision of high-tech medical care, preventive measures, accurate diagnosis, conscientious treatment using modern technologies and productive comfortable rehabilitation.
Common components and characteristics of the ILC
In the literature you can find more than one definition of this concept. In many countries, the WHO definition is followed, which states that the quality of medical care is the optimal medical care for the patient's he alth in accordance with the current level of medical science, the patient's diagnosis, age, and response to treatment. It is important that the minimum funds are used, the risk of injury and complications is minimized, the patient must be satisfied with the result of the assistance provided.
Definition of the Central Research Institutehe alth care of the Ministry of He alth of the Russian Federation is simpler and more understandable. It states that the quality of medical care is the totality of all characteristics that confirm the compliance of medical care with the necessary needs of the population, modern technologies, medical science, and patient expectations.
A medical care standard is a document that contains a specific list of manipulations necessary to perform when treating a specific disease or condition.
Characteristics of care
KMP characteristics include:
- Professional competence.
- Performance.
- Availability.
- Interpersonal relationship between patient and doctor.
- Continuity.
- Efficiency.
- Convenience.
- Safety.
- Satisfaction.
Professional competence is understood as the presence of skills and knowledge of he alth workers, as well as auxiliary staff, the ability to use them in work, in accordance with standards, clinical guidelines, protocols. Poor professional competence is expressed not only in small deviations from the standards, but also in gross errors that can reduce the effectiveness of treatment, which can endanger human he alth and even life.
Under the accessibility of medical care is understood that it should not depend in any way on criteria such as social status, culture, organization.
The quality of medical care will depend on the effectiveness and efficiency of the appliedtechnologies in the field of medicine. To evaluate the effectiveness, you need to answer 2 questions:
- Will the treatment prescribed by the doctor lead to the desired result?
- Will the result be the best in the specific conditions, if the therapy prescribed by the doctor is used?
Interpersonal relationships are understood as the relationship between a he alth worker and a patient, medical staff and management, the he alth system as a whole and the people.
Efficiency is defined as the ratio of resources spent to the result obtained. It is always a relative concept, so it is used to compare alternative solutions.
Continuity means that the patient can receive all the necessary medical care without delays, interruptions, unreasonable repetitions.
Quality control of medical care provides such a characteristic as safety. It is understood as the reduction of all possible risks from a side effect to a minimum during treatment, during diagnosis.
Convenience means cleanliness, comfort, confidentiality in medical facilities. The concept of patient satisfaction includes the fact that the he alth care system must meet the requirements of he alth workers, the needs and expectations of the patient.
Review of legislation
Regulatory acts that regulate the standard of quality of medical care include:
- Federal law, which is called "On the basics of the protection of citizens in the Russian Federation" No. 323.
- Federallaw en titled "On Compulsory Medical Insurance in the Russian Federation" No. 326.
- Order of the Ministry of He alth (“On approval of evaluation criteria”) No. 520n.
Federal Law No. 323 contains characteristics of the timeliness of medical care, the correctness in choosing the necessary method of treatment, the result of the achieved result of treatment. Also, this law contains information on the examination of the quality of medical care.
Federal Law No. 326 is intended to regulate the process of control of the ILC in medical institutions. There are clear rules, forms, conditions and terms for the provision of medical care. The law applies only to public clinics where the patient receives treatment under the CHI program. In private clinics, the relationship between the institution and the patient is based on an individual agreement concluded between them.
Order of the Ministry of He alth is a normative act that defines the standards and criteria that are used in assessing the quality of medical care.
Medical care: quality and evaluation
This issue is regulated by the Federal Law en titled "On Compulsory Medical Insurance in the Russian Federation" No. 326. According to him, to evaluate the ILC, they use expertise, which is divided into planned and targeted.
Targeted examination is carried out in cases:
- Complaints from a patient.
- Complications of the course of the disease.
- Unpredictable death.
- In some individual cases, when a patient returns with the same diagnosis.
As for the scheduled examination, it is held according to the previously planned schedule, which is made up by interested organizations - CHI funds. This type of assessment should be subject to at least 5% of cases of medical care for the entire reporting period.
Examination of the quality of medical care is only required to be carried out by funds and insurance organizations of compulsory medical insurance. Speaking on their behalf, the examination is carried out by experts who meet the professional requirements that are regulated by law:
- Experience at least 10 years.
- Higher education.
- Accreditation of an expert doctor.
- The position of a doctor in a specific required area.
The doctor-expert evaluates the literacy of the medical documentation, its compliance with the requirements of the law and the possible impact on the patient's condition. They consider the correctness of the diagnosis, the timing of the treatment and the final result.
Office of the ILC
In order to competently organize the work of the he althcare system, there are special organizations that provide medical care based on meeting the necessary needs of patients. These organizations exist on the basis of the state program guaranteeing the provision of free medical care to all citizens of the Russian Federation.
The quality control system of medical care is based on the principles:
- Continuity of governance.
- Using evidence-based medicine.
- Conducting examinations based on developed medicalstandards.
- Unity in approaches to examinations.
- Using legal and economic methods.
- Monitoring of the ILC control system.
- Analysis of cost effectiveness, ratio of costs with the optimal level of ILC.
- Studying the opinion of the population on the quality of medical care.
Levels of responsibility
The quality of medical care is the safety of medical activities and control. Now there are 3 levels of control over the activities of medical institutions:
- State.
- Internal (in the medical facility itself).
- Departmental.
Such a system was created not to duplicate checks, but to establish a clear framework for responsibility for the proper provision of medical services.
State control is mainly aimed at licensing the activities of medical organizations and conducting various inspections of human rights in the he althcare sector.
CMP in surgery
This issue is regulated by the order of the Ministry of He alth of Russia No. 922n. The specific procedure for the provision of medical care in the field of surgery applies to all medical institutions. It appears in the following forms:
- Primary he alth care phase.
- Specialized ambulance.
Medical care is provided on an outpatient basis (conditions that do not provide for treatment and observation by doctors around the clock), on a dayin a hospital (treatment and observation only during the daytime), in a hospital (observation and treatment by medical staff around the clock).
In primary he alth care, measures are taken to prevent, diagnose, treat surgical diseases, as well as medical rehabilitation, and the formation of a he althy lifestyle. It includes:
- First medical primary he alth care.
- Physician primary he alth care.
- Specialized primary he alth care.
Primary he alth care refers to a form of he alth care in which specialists treat in a day hospital or outpatient setting. The duties of pre-medical primary he alth care are performed by a he alth worker whose education must be at least secondary.
As for medical care, it is performed by general practitioners (district) or a family doctor. If, during the examination by these specialists, there are indications for contacting a surgeon, they give a referral to him.
In primary he alth care of a specialized nature, the surgeon examines the patient and prescribes treatment. If this is not enough, then he refers the patient to a medical organization that specializes in a surgical profile.
An ambulance is needed when urgent surgery is required. It is staffed by paramedical and medical teams on the basis of an orderMinistry of He alth and Social Development No. 179 dated November 1, 2004
If it becomes necessary to evacuate a patient during examination by ambulance specialists, they perform it in an urgent emergency form. An ambulance team delivers a person with a life-threatening condition to a round-the-clock department of anesthesiology, resuscitation or surgery. After the patient's life-threatening factors are eliminated, he is transferred to the surgical department for further medical care. If necessary, the surgeon involves other specialists to provide adequate treatment.
The procedure for providing medical care in the field of surgery should be based on accurate diagnosis, conscientious treatment using advanced technologies and productive comfortable rehabilitation.
Elective care in surgery
Such medical assistance should be provided in cases of preventive measures. They are carried out only for simple diseases that do not require emergency care at the moment and do not pose a threat to the he alth and life of the patient.
In order to improve the quality of medical care, patients who have an atypical course of the disease, there is no positive result in treatment, there is no final diagnosis, are sent to more high-tech medical organizations.
Also, patients who have specific medical indications are sent for rehabilitation to sanatorium-resort complexes.
Protection of rightspatient
In the he althcare sector, unfortunately, there are still cases of imposition of paid services, unscrupulous doctors, financial losses or harm to he alth. Here, the law "On the Protection of the Rights of Consumers of Medical Services" No. 2300-1 takes the side of the patient. In Art. 31 of this law states that a period of 10 days is allotted for taking action on a claim, and the countdown begins from the date the complaint is received. In Art. 16 it is written that the provisions of the contract that violate the rights of the patient are recognized as invalid.
The quality of medical care is the adequate provision of conscientious, satisfying the population of medical services. The patient is en titled to:
- Receipt of medical quality care in full and on time.
- Familiarization with full information about the contractor and upcoming services.
- Providing him with comprehensive information that affects the quality of medical services provided.
It is important to note that there is no difference on what basis (paid or free) services are provided. Consumer protection implies high-quality and full service. The state controls the quality of medical care.
The rights of the patient in case of dishonest provision of medical services
In case of illiterate performance of services that do not comply with the concluded contract or state regulations, the consumer has the right to demand a reduction in the cost of treatment, to eliminate existing shortcomings byfollow-up care, reimbursement, termination of the contract with damages, and re-delivery of services.
A person who has received medical treatment in violation of the law can write an appeal to Roszdravnadzor and Rospotrebnadzor. These bodies are responsible for compliance with the criteria for the quality of care. They are required to conduct an inspection in the medical institution against which the complaint was received.
