Quality Management Of Medical Care In State Medical Institutions

Abstract

The reorganization and reforming of medical care in a difficult socio-economic situation is beyond the competence of health management bodies. The new reality dictates extremely high qualification requirements for health care organizers and medical personnel of medical organizations. The purpose of the study is to comprehensively study the main issues of the examination of temporary disability. It is necessary to identify the problematic aspects of the examination of temporary disability. The methodological basis of the study is a system of various methods, logical techniques and means of scientific knowledge. The article emphasizes the relevance of the examination of temporary disability as a component of the examination of the quality of medical care. The issues of organization of this examination are highlighted, the main problems during the examination of temporary disability are identified and ways to solve these problems are proposed. It is necessary to increase the responsibility of the head of the medical organization for the organization of the examination; to determine in each health organization the person responsible for the examination of temporary disability; to analyze individual cases of violations of order of carrying out examination of temporary disability and the periods of temporary incapacity on monthly medical conferences.

Keywords: Examination of temporary disabilityhealth care organizationproblems of conducting an examination of temporary disabilityquality of medical care

Introduction

The priority national tasks in the field of health and social development at the present stage are to strengthen the health of the population, strengthen the prevention of morbidity and disability, develop rehabilitation, and introduce modern health-saving technologies. The reorganization and reforming of medical care in a difficult socio-economic situation is beyond the competence of health management bodies. The new reality dictates extremely high qualification requirements for health care organizers and medical personnel of medical organizations. One of the main goals of reforming health care and social protection of the population is to reduce the losses of society due to morbidity with temporary disability and disablement of the population.

One of the most common types of medical examination is the examination of temporary disability. Examination of temporary disability of citizens in connection with diseases, injuries, poisonings and other conditions connected with time disability, the aftercare in sanatorium-resort organizations, when needed to care for a sick family member in connection with quarantine at the time of prosthetics in stationary conditions, in connection with pregnancy and childbirth, for child adoption is conducted for the purpose of determining the employee's ability to work, the need and timing of temporary or permanent transfer of an employee for health reasons to another job, and deciding on the direction of the citizen on medical and social examination (Memetov & Sharkunov, 2019).

Unfortunately, until recently, the procedure for conducting an examination of temporary disability was not defined in our country, there were no requirements for its conducting. The examination of temporary disability was carried out in various medical organizations mainly taking into account the established traditions and often depended on the level of knowledge and training of specialists working in this medical organization, which in turn created certain problems during various inspections to control the organization and conducting the examination of temporary disability in various medical organizations.

Problem Statement

The examination of temporary disability is an integral part of the activities to ensure the quality of medical care and is carried out in medical organizations when providing medical care to working citizens, as well as when it is necessary to address social protection issues in relation to certain categories of citizens. Examination of temporary disability is both a field of scientific knowledge and a system of practical activities that have their own methodology. The examination of temporary disability functions in the health care, social insurance and social protection. Having a legislative and scientific base, it performs important state tasks for the preservation of health, prevention of disability and mortality of people.

Research Questions

In the study, a number of issues were considered:

1. To study the concept of temporary disability examination.

2. To study the organization of the examination of temporary disability.

3. To study the legal regulation of the examination of temporary disability.

4. To study the types of medical examinations in Russia.

5. To study the problems of examination of temporary disability.

6. To suggest ways to solve problems in the field of conducting an examination of temporary disability.

Research questions:

- what is a medical examination?

- what is the examination of temporary disability?

- what are the types of medical examinations?

- what are the main regulatory and legal documents regulate the examination of temporary disability?

- how is the registration of primary medical documentation is carried out?

- what problems of examination of temporary disability exist at the moment?

- what ways can be proposed to solve problems in the field of conducting an examination of temporary disability?

Purpose of the Study

The purpose of the study is to comprehensively study the main issues of the examination of temporary disability. It is necessary to identify the problematic aspects of the examination of temporary disability. Then, to try and suggest ways to solve these problems. To achieve this goal, the author of this article has formed the main tasks of the work, which will help in achieving the intended goal. In addition, research questions were put forward, to which the author of this work should receive answers at the end of the study. To achieve this goal, it is necessary to form methods that will be used when writing the work. Finding out possible ways to solve the problems will minimize the controversial issues that arise during this examination.

Research Methods

The methodological basis of the study is a system of various methods, logical techniques and means of scientific knowledge. Within the framework of the theory, both general scientific and private scientific research methods were used: formal-logical, formal-legal, the method of scientific deduction, normative-legal and comparative-legal analysis. Also, the following research methods: analytical, expert assessments, organizational modeling.

With the help of the analytical method, theoretical questions on a given topic were studied. Using the method of expert assessments, future results were studied based on the forecasts of specialists. The method of organizational modeling was used in the preparation of possible solutions to existing problems.

Medical expertise is a study conducted in accordance with the established procedure, aimed at establishing the state of health of a citizen in order to determine his ability to carry out labor or other activities, as well as establishing a causal relationship between the impact of any events, factors and the state of health.

In accordance with paragraph 2 of Article 58 of the Federal Law of the Russian Federation No. 323 of 21.11. 2011 "On the basics of health protection of citizens of the Russian Federation", the following types of medical examinations are carried out in the Russian Federation:

- examination of temporary disability;

- medical and social expertise;

- military medical examination;

- forensic medical and forensic psychiatric examination;

- examination of professional suitability and examination of the connection of the disease with the profession;

- examination of the quality of medical care (Galanova, 2019).

Findings

To organize work in this direction, the Ministry of Health of the Russian Federation has developed the Order, which was approved by Order of Ministry of Health of the Russian Federation from 23.08.2016, No. 625n "On approval of procedure for examination of temporary disability" (Registered in the Ministry of justice 20.02.2017, No. 45704).

It should be noted that this procedure did not make any significant changes to the examination of temporary disability. At the same time, it clarifies some positions concerning registration of primary medical documentation, including changes in registration of the protocol of the meeting of the medical commission when solving issues of temporary disability.

In particular, the algorithm of actions of the attending physician (paramedic, dentist) during the examination of temporary disability is established:

-based on the examination, collection of anamnesis and analysis, the diagnosis of the disease and the degree of functional disorders of organs and systems are established;

-determines the treatment regime, recommends treatment, diagnostic and rehabilitation measures, prescribes research and consultations of specialist doctors;

-defines the terms of temporary disability.

An important point is the requirement for registration of medical documentation, in particular, it should necessarily reflect information about the state of health of a citizen with the justification for the need for temporary release from work, information about the nature and conditions of work, social factors, as well as the justification for closing the disability certificate when restoring working capacity. It is mandatory to indicate information about the issued disability certificate (number, date, duration, dates of regular appearances to a doctor's appointment, etc.) (Lazareva & Minaev, 2020).

This procedure requires the attending physician to analyze the causes of morbidity with temporary disability and primary disability, with participation in the development and implementation of measures to reduce them, which, in our opinion, will be very problematic to implement in practice due to the workload of attending physicians.

If necessary, extension of sick leave over the period specified by applicable law, the citizen to solve the issue of temporary disability is sent to medical commission of the medical organization.

The medical commission of the medical organization during the examination of temporary disability carries out the following activities:

-assesses the effectiveness of preventive, diagnostic, therapeutic and rehabilitation measures prescribed by the attending physician (paramedic, dentist);

-if there are indications, gives permission to extend the terms of temporary disability in accordance with the current legislation;

-the adopted decision is formalized by a protocol, which should necessarily contain information about the state of health of the citizen and the justification for the decision (Lazareva & Vaníčková, 2020).

It should be noted that the requirements for the registration of the protocol meeting of the medical commission are determined by the Ministry of Health of the Russian Federation from May 5, 2012 N 502n "On approval of the procedure for the establishment and operation of the medical commission of a medical organization".

In particular, in accordance with these requirements, the protocol of the medical commission contains the following information:

-dates of the meeting of the medical commission;

- list of members of the medical commission who were present at the meeting;

-list of issues discussed;

-the decision of the medical commission and its justification (Sizikova et al., 2020).

The order of carrying out examination of temporary incapacity, requires medical commission in addition to the above-mentioned requirements, to evaluate the effectiveness of prescribed, treatment and rehabilitation measures, and also to specify information about the health of the citizen under the examination of temporary disability.

Therefore, in our opinion, it is necessary to amend the Order of the Ministry of Health and Social Development of the Russian Federation of May 5, 2012. N 502n "About the approval of the order of creation and activity of the medical commission of the medical organization" in the part concerning requirements to registration of the protocol of the medical commission, having added it with two points:

1. Effectiveness of prescribed preventive, diagnostic, therapeutic and rehabilitation measures;

2. The state of health of a citizen at the time of the examination of temporary disability.

It is important to emphasize that in accordance with the current regulatory framework, the decision on the referral of a patient for medical and social examination is the exclusive competence of the medical commission of a medical organization.

It should also be noted that the patient has the right to refuse to undergo a medical and social examination. In this case, the medical organization does not extend the disability certificate from the date of refusal to send it for medical and social examination, information about this is indicated in the disability certificate and in the medical card of the outpatient.

If it is necessary to extend the disability certificate over the period established by the current legislation, a citizen is sent to the medical commission of a medical organization to resolve the issue of temporary disability. The medical commission, in turn, during the examination of temporary disability, conducts the following activities:

-assesses the effectiveness of preventive, diagnostic, therapeutic and rehabilitation measures prescribed by the attending physician;

-if there are indications, gives permission to extend the terms of temporary disability in accordance with the current legislation;

-the decision made by the medical commission of the medical organization is drawn up in a protocol, which should necessarily contain information about the state of health of the citizen and the justification for the decision made.

It should be noted that an important component of the examination of temporary disability is its quality and effectiveness, which, first of all, depend on the qualification and professionalism of the specialist, on the interaction of its levels within the medical organization, on the purposeful interaction of all subjects and participants in this process. Examination of temporary disability is carried out in medical organizations that have the right to carry out medical activities in accordance with the license, included in the register of medical organizations and have a license for the examination of temporary disability. At the same time, it is not necessary to speak about the quality of the examination of temporary disability without the implementation of appropriate control. Control of the examination of temporary disability is carried out within the framework of quality control and safety of medical activities in the following forms: state control, departmental control, internal control.

State control of the examination of temporary disability is carried out by state control bodies in accordance with their powers by conducting inspections of compliance by medical organizations with the procedures for conducting medical examinations and organizing the implementation of departmental and internal control of the quality and safety of medical activities.

In accordance with the Order of Roszdravnadzor dated 20.12.2017 No. 10 450, the checklist for the procedures for conducting medical examinations contains the following requirements:

-availability of a license to carry out medical activities for the examination of temporary disability;

-compliance with the requirement due to which the members of the medical commission have training on the examination of temporary disability;

-compliance with the terms and procedure for registration of a referral for medical and social expertise;

-compliance with the terms of the examination of temporary disability;

-compliance with the procedure for conducting an examination of temporary disability by the attending physician (paramedic, dentist);

-compliance with the procedure for conducting an examination of temporary disability by the medical commission of a medical organization (Suslin et al., 2018).

None of the above-mentioned points allows to assess the quality of the examination of temporary disability and, consequently, the validity of the period of temporary disability.

In the order of departmental control of quality and safety of medical activity, approved by the Order of the Ministry of Health of the Russian Federation No. 1340 of 21.12.2012, the organization and conducting of the examination of temporary disability is not listed as the subject of verification.

The procedure for conducting internal control of the quality and safety of medical activities today still remains the exclusive sphere of activity of a medical organization and is established by the head of the medical organization, since there are no regulations approved by the Ministry of Health of the Russian Federation for the uniform implementation of internal control, as provided for in the new version of Article 90 of Federal Law No. 323-FZ.

As for the powers of the Federal Social Insurance Fund in terms of monitoring the examination of temporary disability, they are limited only to monitoring the procedure for issuing, extending and filling out a temporary disability leave. That is, the issues of the validity of the issuance of a temporary disability leave, the quality of the examination of temporary disability, the timing of temporary disability remain outside the field of activity of supervisory authorities (Lazareva et al., 2020).

While one of the main tasks of health care reforming is to reduce the losses of society in terms of medical and biological aspects, where the incidence of temporary disability does not occupy a leading position, but its level remains quite high, and the society suffers significant losses of labor potential.

Conclusion

A medical examination is a study conducted in accordance with the established procedure, aimed at establishing the state of health of a citizen in order to determine his ability to carry out labor or other activities, as well as establishing a causal relationship between the impact of any events, factors and the state of health. It is necessary to amend the order of the Ministry of Health and Social Development of the Russian Federation dated May 5, 2012. N 502n "About the approval of the order of creation and activity of the medical commission of the medical organization" in the part concerning requirements to registration of the protocol of the medical commission, having added it with two points:

1. Effectiveness of prescribed preventive, diagnostic, therapeutic and rehabilitation measures.

2. The state of health of a citizen at the time of the examination of temporary disability.

Then, it is necessary to increase the responsibility of the head of the medical organization for organizing the examination of temporary disability and monitoring the timing of temporary disability.

It is necessary to identify in each medical organization a person responsible for the examination of temporary disability, with the authority to monitor the organization and conducting of the examination of temporary disability.

It is advisable to examine individual cases of violation of the procedure for conducting an examination of temporary disability and the terms of temporary disability on a monthly basis at medical conferences.

References

1. Federal Law of the Russian Federation No. 323 of 21.11.2011 "On the basics of health protection of citizens of the Russian Federation". http://www.consultant.ru/document/cons_doc_LAW_121895/
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