QUALITY OF MEDICAL AIDElena A. AbumuslimovaPh.D., Assistant Professor

Department of Public Health and Health Care,Northern-West State Medical University named after I.I. Mechnikov, Sant-Petersberg

The Quality of medical aid is:- a degree of conformity (adequate) of

medical technologies to exact criteria and standards;

- a group of the characteristics that determine conformity of expected medical aid to modern level of medical science and technology, available to requirements of the patient.

•Medical technology – is the set of treatment, prophylaxis and diagnostic measures, needed for concrete goals achievement.

•Standards – are requirements, demands that are made of above measures.

The criterion of quality of health care according WHO

Degree of risk reduction:• Occurrence of possible disease;• Progress of existing disease;• Development of complications, as a

result of both diseases and treatment.

Quality of medical aid is a maintenance of interaction of the doctor and the patient, based on qualification of the professional, his ability to reduce risk of progressing of disease available at the patient and occurrence of new pathological process.

The directions for Quality of medical aid (QMA) improving (according WHO):

• To promote the professional responsibility increasing of medical workers for QMA improving – the assessment/estimation of QMA by internal medical workers (themselves)

• To initiate the estimation of QMA by external medical workers

• The creation of strategy indicators of QMA• The information spreading and best

practices popularization – conferences, seminars, etc.

• The science researches for QMA improving

Main goals for QMA improving:

•The doctor qualification•The recourses of medical service•The remuneration of labor (salary)

QMA components or approaches for QMA estimation•Structural – the assessment/valuing of

recourses, material-technical base•Procession – the quality of

technologies – the assessment of quality of medical help giving process

•Resulting – the results assessment

The structure of health care

•Material and technical base (research-and-development plant)

•Finance supplying•Staff

The conditions of medical help•Accreditation•Licensing•Staff attestation

Accreditation and licensing allow defining the recourses of medical establishments.

The insurance medical organizations implement the accreditation and licensing based on standards.

The stages of accreditation and licensing•Self-estimation•Expertise estimation (the control of

correct giving process of medical aid)•Decision making by licensing-

certifying commission

The procession of health care•The main criteria of medical aid is

medical mistake - wrong action (or inactivity) of the doctor, having in the basis imperfection of a modern science, objective conditions of work, ignorance or inability to use available knowledge in practice.

Medical mistakes

Objective SubjectiveImperfection of a modern science and technical equipment

Absence at the doctor of necessary knowledge and skills

Complexity and atypical currents of disease

Disability of doctors to put into practice their knowledge

Absence at the doctor of necessary means and conditions for carrying out medical-diagnostic actions

The subjective reasons of medical mistakes considerably prevail above objective

According to the stages of medical process there are such medical mistakes:

• gathering of the information,• the diagnosis, • treatment, • maintenance of continuity.

Mistakes of gathering of the information can become the reason of diagnostic mistakes and treatment. Diagnostic mistakes, in turn, can become the reason of occurrence of treatment and continuity mistakes.

Resulting approach

•It is a degree of goal approaching and finishing result of medical establishment activity

The resulting indices

For in-patient hospitals:• clinical-laboratories• instrumental• morphological-

functional• Structure of outcomes

(recovering, aggravation, complication)

• Diagnosis discrepancies, etc.

For out-patient establishments:• Dynamic of primary invalidity•Complete and partial recovering•Rate of hospitalization•Death rate•Rate of dispancery observation excluding•Rate of temporary disability•Structure of outcomes

Satisfaction of patient

•It is the main index of estimation of quality of health care.

•Medical help of high quality - is a help that leads to improving of quality of life and life longevity.

Quality of life

• Quality of life – is an integral subjective characteristic of physical, mental, emotional and social functioning of human.

• The method – is interview.

• Topics – the organizational structure of medical help, interrelation between doctor and patient.

From a position of the consumer of medical services quality of medical aid is characterized by four properties:

• - Availability of medical aid;• - Safety of medical aid;• - Satisfaction of patients medical aid;• - An optimality of medical aid (as conformity

to professional medical standards and norms of ethics).

The methods of QMA estimation

•Comparing of medical activity with standards

•Expertise method

In the development countries the estimation of quality of medical aid is carried out on the basis of a triad:

• - standards on resources – • - standards on processes (activity) – • - standards on results.

•The concept of development of public health services and medical science in the Russian Federation as one of priority directions of perfection of medical aid provides maintenance of its quality and safety by carrying out of a complex of works on standardization, licensing and certification.

Types of medical standarts

• resource standards• organizational standards• technological standards• medical-economic standards• standards of programs of medical aid• complex standards

Resource standard

•It contains requirements to a skill level of the medical workers and material equipment of this treatment-and-prophylactic establishment, caused by the kinds of medical activity declared on licensing.

Organizational standard

•It contains requirements to the organization of a control system by the medical institution providing effective and safe use of personnel and material resources at rendering of medical aid of the declared kind of medical activity.

Technological standard

• It regulates carrying out of procedure of rendering of medical aid of the resolved kind of medical activity, that is performance of diagnostic researches, medical, rehabilitation, preventive and improving actions in volume of the allowed kinds of medical activity.

Medical-economic standard

• It determine the guaranteed volume and quality of medical-diagnostic inspections and medical actions, requirements to results of treatment of patients at corresponding diseases and expenses for their performance, naturally, in view of real opportunities of medical institution.

The structure of medical-economy standard (1)

• Clinical-laboratory indices, necessary for doctor observation implemention

• Patient’ s condition characteristics, based on - obligatory methods of clinical-

laboratory investigation - obligatory consulting - obligatory special method of diagnosis - additional methods of investigation according to various disease course

The structure of medical-economy standard (2)

• The algorithm/scheme and method of therapy with medicines indication

• Expected effectiveness of therapy and its terms/duration. Therapy course exchanging in case of necessity/ Complications. Outcome.

• The indications for doctor observation stopping

• The duration of doctor observation (days)• Treatment cost

Cost standard

•It is economical characteristic of case of medical help that evaluate normative cost and impressed in money units or indices, which is characterized the QMA mediately.

The method of expert estimation

• Expertise method of QMA assessment – execute on base of doctor activity results. The comparison of “in fact” actual/factual activity of doctor with experts opinion of what it should be

The base of expertise method

•Standards• Methodical recommendations•Modern data•Subjective opinion based on work

experience

The expertise method allows to determine

• The reasons of inappropriate QMA effectiveness

• Exposure of defects of medical help giving with negative results

• Resources optimal using• The reasons of dissatisfaction of

patient/consumer with QMA

The objects of expertise

• Therapy-diagnostic process• The doctors activity in any set of clinical

cases• The medical characteristics –

effectiveness, point of action, complication etc.

• The quality level and safety of treatment• The quality of medical standards and

other normative documents• The qualification level of medical workers

Organizational structure of expertise

• departmental expertise committee on health care organization

• non-departmental expertise – insurance medical organizations, medical associations, accreditation-licensing commissions

• independent – centers without of administrative subordination

The features of expert of QMA

• High qualified• The work experience in exact specialty• Objective opinion• Administrative cadre of medical

establishment• The specialists of health care service

(could execute after specialization courses)

• Science researchers

The Center of independent expertise

•Planned and non-planned expertise•The augured cases•The consumer rights protection

The information should be reported universally to management of health care organization

The conception of persistent QMA improvement (1)

•The organization of service of health care quality management

•Assistance in development of standardization, licensing, certification

•The federal and target programs realization on QMA improvement

•The forming of universal approaches and methods of QMA estimation

The conception of persistent QMA improvement (2)

•The development of integral parameters of QMA for various health care establishments and services

•The general informational data base and monitoring of results of QMA

•The forming of motivation and development of economical mechanisms of activity stimulation of various health care establishments and services

•The study of population satisfaction with QMA