Interregional Centers of High-Tech Children’s Surgery – Mortgage of Accessibility and Quality of Medical Care for Russian Children

Rozinov, V. M.; Morozov, D. A.; Rumyantsev, S. A.; Ваганов, Н. Н.; Azovskiy, D. R.; Afaunov, N. V.

doi:10.30946/2219-4061-2018-8-3-6-17

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…В соответствии с согласованной технологией эксперты федерального уровня, обосновывая дислокацию и количество межрегиональных центров, ориентировались на число детей в зоне ответственности МРЦ, плотность детского населения территорий, транспортную доступность, критически оценивали потенциал медицинских организаций, которые в сравнительном аспекте рассматривались в качестве потенциальных баз МРЦ [3,4].…”

Section: материалы и методы исследованияunclassified

“…Перспектива минимизации рисков ограничения доступности и снижения качества медицинской помощи детям с хирургическими заболеваниями и травмами обусловлена в российских реалиях организацией профильных межрегиональных центров (МРЦ) специализированной, в том числе высокотехнологичной, медицинской помощи [4,5].…”

Section: Introductionunclassified

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The rationale for dislocation of interregional specialized surgical care centers for children in the Russian Federation

Rozinov

Михайлович²,

Morozov

et al. 2020

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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Introduction. In Russia, there is a need to reorganize the system of providing specialized surgical care to children, primarily in emergency and urgent care and in remote, sparsely populated, and hard-to-reach areas. This need is evidenced by the significant persisting disparities in the mortality rate in the countrys various regions. Purpose of the study. This study aims to provide multifactorial substantiation of the expediency, profile, and location of specialized (surgical) interregional centers (MRC), including high-tech, medical care for children, by the priority profiles of activity, about medical organizations of the federal districts (FD) of Russia. Materials and methods. The study design included a two-level (regional and federal) system of professional expertise and justification in terms of the profile, location, and area of responsibility of the MRC in the federal district of the country. At the regional level, Delphi technology was implemented with a mathematical and statistical analysis of 103 expert opinions from 85 constituent entities of Russia, the result of which activities priority profiles were substantiated (newborn surgery, neurosurgery, thoracic surgery, oncology, combustiology) and patient routing preferences. At the second stage of the work, with the involvement of federal experts, the SWOT analysis technology was implemented as a universal method of strategic planning, with the justification of the location and number of MRCs in individual FD of the country, about specific medical organizations where they are based. For an objective (quantitative) assessment of the provision of the Federal District of Russia with the MRC of specialized medical care for children according to the established profiles of activity, we have proposed a calculated indicator the regional contingency coefficient (CRC), representing the ratio of two uniformly calculated values the number of MRCs and regions in a particular Federal District, or the country as a whole. Results. The consolidated position of federal experts regarding the location of the MRC was formulated according to the established profiles of activity about FD and specific medical organizations in the Russian Federation constituent entities. The cattle in the profile of the activity of neonatal surgery was 0.14, and about neurosurgery, thoracic surgery, and oncology, respectively, 0.12, 0.11, and 0.11 for Russia as a whole. The lowest (0.09) cattle in the country characterized the situation with the combustiology profile. In the overwhelming majority (76.0%), the location of the MRC is tied to the administrative centers of the Federal District or cities of federal significance. Among the 50 MRCs of all priority profiles, 43 (86%) were potentially designated by experts based on multidisciplinary pediatric medical organizations. Discussion. The effectiveness of the MRC functioning is due to the organization of medical and evacuation support for children with diseases and injuries. The development of consultative and resuscitation centers in the primary hospital structure is promising. Its functionality, along with remote counseling, treatment, and evacuation activities, includes monitoring the condition of sick and affected children at the place of primary hospitalization. An alternative is a presence on the clinical base of the MRC of a structural unit or a branch of the regional center for emergency medical care and disaster medicine. Conclusion. Overcoming the inequality in the availability and quality of medical care for children in certain FD and regions of Russia is necessary to reorganize the current system of staged medical care. Optimal logistics of medical and evacuation support for specialized patients and injured people include the MRC as a collector for children in need of specialized care, including high-tech medical care, with the implementation of the predominant principle of evacuation of oneself.

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Section: материалы и методы исследованияunclassified

Section: Introductionunclassified

The rationale for dislocation of interregional specialized surgical care centers for children in the Russian Federation

Rozinov

Михайлович²,

Morozov

et al. 2020

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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Business game “High-tech Pediatric Surgery”: Modeling of management decisions in children’s health protection in the Far Eastern Federal District

Morozov,

Rozinov,

Suvorov

et al. 2023

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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BACKGROUND: The difference in the levels of total infant mortality in certain administrative territorial entities of the country is an acute medical and social problem of domestic healthcare, which indicates the absence of a single standard of accessibility and quality of medical care. This indicator in the Far Eastern Federal District significantly exceeds the corresponding indicators in the Central and Northwestern districts. AIM: This study aimed to identify unresolved problems and identify ways to improve the availability and quality of surgical care for children by modeling the process of making administrative and clinical decisions by employees of medical organizations and heads of healthcare in the Far Eastern Federal District in the interests of children in need of specialized, including high-tech, medical care, including medical evacuation. MATERIALS AND METHODS: A “business game” with simultaneous implementation of the simulation process in 11 regions of the Far Eastern Federal District was conducted using distributed communication channels and technical capabilities of audiovisual fixation of the opinions of the study participants. A series of five business games on the following profiles were implemented: neonatal surgery, thoracic surgery, neurosurgery, oncology, and combustiology. The scenarios of the games were prepared by the organizers of the study: “Russian Association of Pediatric Surgeons” (LLC) and “Agency for Strategic Initiatives to promote new projects” (ANO). The moderators of the games were leading specialists from specialized federal medical organizations. The game participants were regional teams of the subjects of the Far Eastern Federal District. The observers of the games were representatives of federal legislative and executive authorities and healthcare experts. RESULTS: In this study, 9–11 regions of the Far Eastern Federal District participated in a series of five games. The total number of participants in business games ranged from 126 to 151, and the number of connection points was 42–66. The identified problematic issues included organizational (9), personnel (8), transport (7), equipment (7), and financial (6) aspects. CONCLUSIONS: The ideology of the interregional centers of specialized surgical care for children corresponds to the vision of representatives of the professional community and organizers of territorial healthcare as a promising way to increase the availability and quality of medical care to the pediatric population.

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Interregional Centers for Specialized Pediatric Surgical Aid in Russia – Profile and Dislocation

Rozinov¹,

Morozov²,

Румянцев³

et al. 2019

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Introduction. Russia needs to reform the stepwise model for delivering medical aid to children with surgical diseases and traumas mobilizing patients and those injured at specialized Interregional Centers (IRC). Purpose. To substantiate profiles and dislocation of IRC providing surgical aid to children in Russia. Material and methods. 103 specialists from 85 territorial entities of the Russian Federation presented their expert reviews concerning profiles and dislocation of IRC that provide surgical aid to children in accordance with the nomenclature of professions and administrative structure of the country. The expert reviews were analyzed using the methods of descriptive statistics to rate IRC profiles, their territorial dislocation, and focus on interaction of those surveyed with certain medical organizations. Consistency of expert opinions was estimated using Kendall’s coefficient of concordance. Results. Experts indicated 14 activity profiles of IRC providing surgical aid to children. According to rating results, more than a half of positive estimates belonged to five priority profiles including surgery of neonates, neurosurgery, oncology, thoracic surgery and combustiolgy. As far as IRC dislocation is concerned, experts mainly considered medical organizations within a federal district of territorial entities of the Russian Federation. Total number (287) of references (by priority profiles) to hospitals within territorial entities of Russia was 4 times more than the respective estimate (66) for federally governed healthcare providers. Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology that served as a base for potential IRC (oncology) was the most in-demand (19 requests) federal structure. Conclusion. Community of professionals has come to a consolidated opinion according to which buildup of IRC providing care in neonatal surgery, neurosurgery, oncology, thoracic surgery, and combustiology at children’s hospitals in territorial entities of the Russian Federation and 13 federally governed clinical research centers is a significant factor of providing affordable and qualitative medical aid.

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Interregional Centers of High-Tech Children’s Surgery – Mortgage of Accessibility and Quality of Medical Care for Russian Children

Cited by 3 publications

References 29 publications

The rationale for dislocation of interregional specialized surgical care centers for children in the Russian Federation

The rationale for dislocation of interregional specialized surgical care centers for children in the Russian Federation

Business game “High-tech Pediatric Surgery”: Modeling of management decisions in children’s health protection in the Far Eastern Federal District

Interregional Centers for Specialized Pediatric Surgical Aid in Russia – Profile and Dislocation

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