RU2325100C2 - Therapeutic diagnostic medical care optimization system - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: therapeutic medical care system is a set of hardware and software including the computer system with the medical and economical standards generating and editing subsystem, access facilities to the database and facilities which provide implementation of medical care. The system can contain the subsystem of hospital customer-specialist terminals of departments and services and it can be compatible with patient accounting routine and accounting software. This invention provides the data systematization of diagnosis and cure of diseases, the ability to choose the appropriate set of medical service which excludes the reasonless volume prescription of diagnosis and medical care with the cost calculation of the pathology diagnosis and treatment for the patient.

EFFECT: strength increasing of direct care with simultaneous quality increasing of performed medical care without working hours increasing of medical staff.

2 cl, 11 dwg

Description

The invention relates to medicine and can be used in outpatient and inpatient care to optimize it, improve the quality of services and to determine the actual costs of a medical institution for one scheme of care for one patient.

In medical institutions, there are lists of mandatory and additional studies and procedures, methods of physiotherapeutic treatment of patients. There are recommendations of the Ministry of Health of the Russian Federation and standards for a rational examination and drug treatment of patients of various profiles. The choice of diagnostic methods and treatment of various pathologies is made by the attending physician on the basis of the above funds and personal practical experience of the attending physician and head. branch. This leads to various labor and other types of costs for medical institutions depending on the chosen method for one scheme of care for one patient, on adjustments to the treatment regimen due to complications or associated pathology revealed during treatment, which is difficult to take into account when determining the actual the volume of staff and the quality of assistance. In addition, it is necessary to take into account the introduction of new technologies and more modern equipment, their full use, which is also important for improving the quality of the medical services provided, which accordingly leads to an increase in the actual costs of the medical institution and is not taken into account when determining the cost of treatment and staff wages.

There are known methods of calculating the cost of inpatient treatment available in inpatient medical facilities, which are based on determining the shares according to the cost items in the disease profile based on data from previous periods. But the cost of inpatient treatment of the disease profile reflects the totality of a large number of pathologies, each of which has completely different volumes of costs for all types of studies and procedures, and the available calculation methods do not allow us to estimate the real costs of healthcare institutions for treating a particular patient with his specific pathology. In addition, at present, there is no accounting for such elements of the medical diagnostic process as the labor costs of medical personnel, the cost of consumables, medical devices, wear of tools and equipment used for a certain pathology.

A known method and system for the formation and dissemination of information about products on the Internet (RF patent No. 2265246 from 09/11/03). The invention relates to a method for generating and providing access to information about the current location of a product instance. The system contains a subsystem for generating product sites and a subsystem for managing access to sites.

A known method and system for collecting and processing marketing data according to the patent of the Russian Federation No. 2216036 dated 11/18/98. The method consists in collecting information at points of retail sale of goods, communication with a point of credit authorization, storing information in a searchable database that is not related to retail selling points, s

A known method and system for the formation and dissemination of information about products on the Internet (patent No. 2265246 from 09/11/03). The method consists in assigning an identification code to the product and generating a product Web site with information on all product owners, providing for the possibility of recycling the site in case of product destruction. At the same time, each new product owner receives an access key to edit the site through the access control subsystem for the Web site.

There is a known method and system of helping a user to independently conduct medical procedures, consisting of several actions according to the patent of the Russian Federation No. 224506 dated November 30, 1999 (the closest analogue). The method includes the operation of collecting information in one or more databases of information representing the values of the diagnostic parameters of the patient’s condition, for example, diabetes mellitus, processing operations of one or more databases to provide the patient with alternative options for choosing procedures corresponding to his physiological condition. This method and system is suitable only for patients with prolonged, practically incurable chronic diseases, and does not reflect the cost of treatment, labor costs and quality of services provided by the medical institution.

The inventive method, as well as known, includes the step of collecting data, the step of calculating options for medical procedures and the evaluation step.

The inventive system, as well as known, includes a computer system.

The problem solved by the proposed group of inventions is aimed at increasing the intensity of the treatment and diagnostic process while improving the quality of medical care without increasing the labor costs of medical personnel.

The technical result of the group of inventions is to systematize the available methods for the diagnosis and treatment of various diseases, taking into account the frequency of occurrence of the nosological form, its severity, the presence of complications and concomitant pathology in patients of different age groups in order to increase the intensity of the diagnostic process. The technical result also consists in determining the labor costs of medical personnel, the cost of consumables, medical devices, wear of tools and equipment spent on a particular pathology.

The technical result consists in the possibility of choosing the optimal complex of medical services provided, excluding the unreasonable appointment of excessive types and volumes of diagnosis and treatment with the simultaneous calculation of the cost of diagnosis and treatment of a particular pathology of a particular patient. The technical result also consists in the possibility of accounting for the costs of consumables, medical devices, depreciation of equipment and tools spent on a particular pathology, and the ability to determine the actual cost of inpatient treatment for each patient. The technical result also consists in improving the operational management of the hospital and increasing the efficiency of the distribution of material and labor resources.

These results are achieved by combining nosological forms of diseases based on the similarity of diagnosis, treatment, care, manipulation of medical personnel and sanitary-hygienic treatment into medical and economic groups, form sections of medical and economic groups, generating standards containing patterns of personnel manipulation, labor costs and consumables, choose options for diagnostic and medical procedures and treatment regimens for a particular patient, taking into account the severity, presence of complications and incidents pathological pathology of a particular patient, the choice of the optimal treatment regimen is carried out taking into account several predicted values of the cost of treatment regimens for each particular patient.

Each medical and economic group may include sections of diagnostics, medical treatment, physiotherapeutic treatment, surgical treatment, anesthesiology, intensive care, medical procedures, nursing procedures, general care, nutrition, sanitary and hygienic treatment and the requirements for the results of inpatient treatment.

The technical result is achieved by the fact that the optimization system for diagnostic and treatment medical care contains a subsystem for generating and editing medical and economic groups formed on the basis of a combination of nosological forms of diseases, which are databases located on a server or one of the computers containing sections of the medical system generated in the standards -economic groups, including lists and algorithms for manipulating medical personnel with the cost of labor and supplies, odsistemu access control data bases to use and modify the database by comparing the data accumulated from previously generated database components, and means for using a program implementing the method featured in the computer and / or computer readable medium. The system may further comprise a hospital terminal subsystem. Means for implementing the method can be compatible with patient movement accounting programs and accounting programs.

The way to optimize nursing care is part of the way to optimize diagnostic and treatment care, which can be used independently to improve the quality of nursing work, increase the efficiency of remuneration, taking into account the complexity and quality of work performed, rational placement and use of personnel.

The combination at the stage of data collection of nosological forms of diseases based on the similarity of diagnosis, treatment, care, manipulations of medical personnel and sanitary-hygienic treatment into medical and economic groups in accordance with the adopted classification of diseases provides a systematization of various diseases, taking into account the frequency of occurrence of the nosological form, its severity, the presence of complications and concomitant pathology in patients of different age groups.

The formation of sections of medical and economic groups, their generation into standards containing patterns of personnel manipulation, the cost of labor and consumables ensures the systematization of staff labor and the determination of the actual complexity of the work performed, the possibility of calculating the cost of consumables, medical supplies, depreciation of equipment and tools spent on treatment of a certain pathology.

The choice of several options for diagnostic procedures eliminates the unreasonable appointment by the doctor of excessive types and volumes of diagnostics, and also increases the intensity of the treatment and diagnostic process by reducing the time for the selection process itself and, accordingly, the labor costs of personnel, allows you to combine the required minimum amount of diagnosis with an additional amount of diagnostics the need to clarify the diagnosis, the patient's condition and age characteristics of the patient.

The choice of several options for medical procedures ensures the determination of the most effective treatment regimens, their combinations, helps the patient receive an adequate amount of medical services, and also determines the preliminary cost of treatment for a particular patient, predicts his comprehensive treatment, taking into account his possible movement in the hospital departments, and thereby , improving operational management of the hospital. It also increases the intensity of the diagnostic and treatment process by reducing the time and, consequently, the labor costs of the staff to calculate treatment options and their preliminary cost.

Choosing the optimal treatment regimen taking into account several predicted values of the treatment regimen cost for each particular patient provides high-quality medical care to a particular patient, allows us to estimate the estimated costs and the actual cost of inpatient treatment for each patient and to distribute material and labor resources with high efficiency.

The implementation of the method is carried out using a system containing a computer system, a subsystem for generating and editing medical and economic groups, a subsystem for managing access to databases, and means providing the method with a program.

The inclusion in the system of the subsystem for generating and editing medical and economic groups and means of implementing the method provides an increase in the intensity of the treatment and diagnostic process while improving the quality of medical care without increasing the labor costs of medical personnel. The complex of services generated in the databases, taking into account the practical experience of all specialists of a medical institution in the quality of previously provided medical care to patients of this nosology group, ensures the appointment and provision of high-quality medical care to patients, regardless of the experience of the attending physician in treating this nosology with a specific pathology and complications.

The database access control subsystem ensures the safety of databases and excludes unauthorized access to them.

The inclusion in the system of the subsystem of hospital terminals can increase the intensity of the treatment and diagnostic process.

The compatibility of tools for implementing the method with patient movement accounting programs and accounting programs improves the operational management of the hospital and increases the efficiency of the distribution of financial, material and labor resources due to the possibility of introducing a single patient movement accounting program.

Implementation of a method for optimizing nursing care, including compiling lists of nursing manipulations, systematizing the volumes of manipulations performed by nurses for various nosological forms of diseases, generating them into standards containing lists and algorithms for manipulations, determines the estimated and actual labor costs of medical personnel, increasing the efficiency of the distribution of material and labor resources, increasing the efficiency of remuneration of their labor, given the complex osti and quality of work performed, the ability to determine the actual cost of inpatient treatment of each patient, improving the operational management of the hospital.

Algorithms of the performed nursing manipulations, made with the possibility of changing them depending on the choice of a specific diagnostic procedure and / or prescribed medication, provide an increase in the intensity of the treatment and diagnostic process while improving the quality of medical care from the nursing staff.

The analysis of the prior art by the applicant, including a search by patent and scientific and technical sources of information, did not reveal an object characterized by features identical to the totality of the essential features of the claimed invention. Therefore, the claimed invention meets the criteria of the invention of "novelty."

The search results also showed that the claimed invention does not follow explicitly for specialists from the prior art, as it allows to obtain a different result.

The method and system are illustrated using illustrations in which: FIGS. 1-5 show a structural diagram of generating a database in the form of a medical and economic group, FIG. 6 illustrates a structural diagram of sections of medical and economic groups, and FIG. 7 shows a structure service standards, Fig. 8 shows the structure of laboratory diagnostic standards, Fig. 9 shows the structural composition of the system with which the inventive method is implemented, Figs. 10-11 show exemplary lists and algorithms of nursing procedures, Fig. 12 shows the accounting scheme manipulation and labor of a particular sister for a month, on Fig.13-14 is a map of the monitoring of nursing care.

This method consists of a combination of three main stages, each of which is aimed at increasing the intensity of the diagnostic process while improving the quality of medical care without increasing the labor costs of medical personnel:

The data collection stage, during which the main work is carried out to systematize all the methods, orders and recommendations of the Ministry of Health of the Russian Federation Committee on Health in the medical institution of the Murmansk Region, the standards, norms and norms of rational examination and drug treatment of patients of various profiles. Work is underway to systematize the practical experience accumulated in the medical institution, taking into account the frequency of occurrence of a nosological form in this region, its severity, the presence of complications and concomitant pathology in patients of different age groups. Data collected according to certain templates (questionnaires, diagrams, etc.) is entered into a computer system and combined into medical and economic groups (hereinafter - MEG) using a system specially developed for these purposes. The composition of each MEG (see Fig.1-5) includes several nosological forms of diseases, organized by the principle of similar volumes and types of diagnosis, treatment, surgical aids, care and discharge criteria. Types of MEG: MEG therapeutic profile, MEG surgical profile, MEG mixed profile. Each MEG consists of three parts: general, medical and economic. The general part (see Fig. 1) includes the name of the nosological form and the code assigned to it according to the classification of ICD-10, the average duration of treatment for this group or system of organs, the service code in accordance with the approved hospital code and the name of the service.

The medical part (see Fig. 1) contains data on the number of diagnostic and therapeutic measures, nutrition, disinfection measures, staff manipulations, severity factors for patients, and the complexity factors for staff manipulations with differentiation for personnel who are in direct contact and who are not in contact with the patient. The data are given with reference to the relevant standards generated during the work of this stage. The notes provide brief information for medical staff about the features of events and manipulations. The medical unit also contains discharge criteria and the average duration of treatment.

The economic part (see FIGS. 2-5) contains quantitative data on the labor costs of personnel in arbitrary labor units (UET) and cost terms, including the salaries of direct producers of the service, general department personnel, general staff, and payroll accruals. The economic part also contains data on the cost of medicines, supplies, tools, depreciation of soft equipment and the cost of food for the patient in accordance with the approved standards.

At this stage, the MEG sections are formed, there are 11 of them for conservative treatment methods and 12 for surgical methods (see Fig. 6): laboratory and instrumental diagnostics, drug treatment, physiotherapeutic treatment, surgical treatment, anesthesiology, resuscitation, medical procedures, nursing procedures, general care, nutrition, sanitary treatment.

For each section, standards are generated (see FIG. 7), consisting of services in various combinations. Each MEG may include one or more standards and / or separately simple and complex services. For example, laboratory diagnostic standards (see Fig. 8) of therapeutic and surgical MEGs consist of simple and comprehensive medical services. Standards combine services in various combinations of the most common when diagnosing various medical and economic groups. Laboratory diagnostic standard No. 1, intended for therapeutic MEG, can be used for surgical MEG for mixed nosological forms of diseases. Laboratory Diagnostic Standard No. 2 is used only for surgical MEG. The diagnostic standard includes a list of mandatory and additional laboratory tests that must be performed on the patient with this pathology. The standard also includes the cost of consumables, labor costs of direct producers of services. High-tech and highly specialized diagnostic methods are carried out according to a special list approved by the health committee of the respective constituent entity of the Russian Federation with an appropriate license and funding volumes under cost items.

According to similar principles, other standards are generated that are not illustrated in this description due to their large volume and specific specifics for each individual medical institution. Briefly about the structure and content of the standards of other sections of the MEG.

The standard of surgical treatment includes the mandatory minimum or optimal amount of surgical treatment for this pathology. High-tech and highly specialized diagnostic methods are also carried out according to a special list approved by the public health committee of a constituent entity of the Russian Federation with an appropriate license and funding for cost items. The standard includes the cost of consumables, disinfectants, labor costs of the direct producers of the service (based on the cost at the date the information was entered into the program and may vary based on changes in producer prices, consumables, disinfectants, tools, equipment, reagents and medicines and changes in the fund formation mechanism salary).

The standards of medical and nursing manipulations include a list and manipulation algorithms that must be carried out by the medical staff for this patient with this pathology. They include types of manipulations, their number, multiplicity, cost of consumables, disinfectants, labor costs of direct producers of services. The number and frequency of medical and nursing manipulations, the cost of consumables, disinfectants, the labor costs of the direct service providers varies depending on the choice of a specific diagnostic procedure and / or the prescribed medicine

The food standards include lists of diets recommended for patients with this pathology.

The stage of calculating the options for carrying out diagnostic and medical procedures includes the intellectual costs of medical personnel, which, using the databases and systems generated at the stage of data collection, can increase the intensity of the work of specialists, regardless of their practical experience, without increasing the labor costs of medical personnel, and provide high-quality medical care for each individual patient. patient and exclude the unreasonable appointment of excessive types and volumes of diagnosis and treatment. At this stage, the most effective treatment regimens are determined, their combinations taking into account the severity, presence of complications and concomitant pathology of the patient entering the treatment by comparing with the treatment regimens previously treated with high quality treatment complexes of other patients with a similar severity and presence of pathologies.

The assessment stage includes determining the optimal range of medical services provided taking into account the predicted cost values of several treatment regimens selected at the previous stage for each specific patient. To do this, calculate the predicted values of the cost of the selected patient treatment regimens, coordinate the treatment regimens and their cost with the head of the department and the patient, and if necessary with other specialists of the institution, and select the optimal treatment regimen for the patient, taking into account both the capabilities of this medical institution and and the patient’s capabilities, providing quality medical care to this patient with his specific pathology. Predict the comprehensive treatment of an incoming patient, taking into account its possible movement in the departments of the hospital.

After a set of services, the actual cost of treatment is calculated. At the same time, the real material, labor and intellectual costs of the hospital for the treatment of a specific pathology of a particular patient are calculated. This helps to determine the remuneration of staff in accordance with the actual amount of work, taking into account the quality of medical care provided, as well as the calculation of the really necessary number of full-time posts of medical workers depending on the pathologies observed in the hospital and their number. For this, data on the minimum material unit, the optimal number of labor units for each manipulation, determined by the established method, and the working time standard for each category of personnel are entered into the computer. Intellectual costs are estimated based on the results of a reasonable correction of each specific case of treatment, taking into account the quality of the service provided. Further, the data obtained are summarized across the totality of similar pathologies and trends, which is used in the calculation of staff positions, planning of material and intellectual costs.

The optimization system for treatment and diagnostic assistance is a complex of hardware and software tools containing (see Fig. 9) a computer system 1 with a subsystem for generating and editing medical and economic groups and standards 2, an access control subsystem 3, and means for implementing method 4. Subsystem 2 allows you to create and edit databases 5, 6, 7, ... N, located on a server or one of the computers in the computer system 1. The databases are generated by automatically entering and saving data according to the pathologies actually encountered in the institution. Databases 5, 6, 7, ... N contain sections of medical and economic groups generated in standards 8, 9, 10, ... M, which include lists and algorithms for manipulating medical personnel with the cost of labor and supplies. The lists and algorithms contain comprehensive medical services 11, 12, 13, 14, ... L and simple medical services 15-22, ... n. MEG generation and editing is carried out using means 4 and access control subsystem 3, which ensures the safety of databases and eliminates unauthorized access to them. The system may contain a subsystem of hospital terminals 23, 24, 25 ... K, and their access to the databases for use in daily work is also carried out through the access control subsystem 3. Access to specialists for editing databases is carried out only with authentication of the user who has the right for editing. In one implementation of access control for simple use or for editing, the public or private key method may be used.

Editing databases (MEG and standards) is based on the generated data by comparing the components of MEG and standards. On the basis of the compiled accumulated data and the standards existing at that time, the MEG and standard correction options are proposed to specialists in the relevant sections.

If it is inexpedient to create network access to databases for use, other means are used for the practical application of this method.

The means for implementing method 4 are ROM circuits, a network connection, disks, and another medium capable of providing the computer system and individual computer terminals with the opportunity to execute a program in which the method is implemented.

The implementation of the method is possible as an independent system aimed at increasing the intensity of the medical diagnostic process while improving the quality of medical care in each department of a medical institution, and then it can be implemented using existing software, for example Mikrosoft Office.

The implementation of the method is possible with the help of a program specially created for this purpose, compatible with patient movement accounting programs and accounting programs, which is part of a single patient movement accounting program, with the integration of directories of this method and the program into which it is integrated.

Means for implementing the method can be performed in the form of databases 26 located on one of the computers, or in the form of a database block 27 on a machine-readable medium (disk, for example), or in the form of a block of general and medical parts 28 of the standards on paper and an economic block part 29 of the standards on a machine-readable medium that provides with a computer the implementation of the economic part of the method. In this case, the block of general and medical parts on paper 28 may consist of separate standards 30, 31, 32, etc.

The method of optimizing nursing care is part of the method according to claim 1, but it can be used independently for a qualitative and quantitative assessment of the activities of nursing personnel necessary for an objective assessment of the work of each sister in allocating additional or bonus funds, for recalculating staffing standards and for developing a new system remuneration for a specific amount of work. The existing system of remuneration allows you to pay only for the fact that the sisters stay in the workplace without taking into account labor costs and the quality of work performed.

The method includes compiling lists of nursing manipulations, systematizing the volumes of manipulations performed by nurses for various nosological forms of diseases, generating them into standards containing lists and algorithms of ongoing manipulations.

Figure 10 and 11 presents sample lists and algorithms of nursing manipulations.

They include the types of manipulations, their number, multiplicity, the amount of consumables, disinfectants, the time taken to complete the manipulation, categories and complexity factor of the manipulation, and epidemiological safety. The algorithms contain detailed lists of all necessary nursing procedures, which must be performed by nurses for a given patient with this pathology, which also allows in practice to improve the continuity of education and practical activities of nurses in the workplace. The lists are compiled for all types of sisterly manipulations of all MEGs and their sections.

On Fig presents a diagram of the accounting for the manipulations and labor costs of a particular sister for a month with the calculation of their cost. The algorithms of the manipulations, including the cost of disinfectants and supplies, are made with the possibility of changing them depending on the choice of a specific diagnostic procedure and / or prescribed medication. The generation, editing and use of nursing care standards is carried out using the tools described above.

On Fig-14 presents a map of the quality control of the work of a particular sister during the year. It is possible to maintain such a card during the whole work of the sister, which ensures an increase in the quality of medical care, stimulates the sisters to master manipulations of a higher complexity category, and reduces the risk of a biased approach when evaluating the activities of the sisters and their remuneration when allocating additional or bonus funds.

These method and optimization system for diagnostic and treatment medical care provide an increase in the intensity of the diagnostic and treatment process while improving the quality of medical care without increasing the labor costs of medical personnel, improving the operational management of the hospital and increasing the efficiency of the distribution of financial, material and labor resources.

Claims (2)

1. A medical care system comprising a computer system including input means to a medical database server, means of access to databases configured to control access to them, and means providing medical assistance through a program located on a computer and / or on a machine-readable medium, characterized in that the generated medical database, made with the possibility of their constant replenishment, modification and editing, are medical and economic PPPs formed on the basis of nosological forms of diseases and containing sections of medical and economic groups generated in the standards, consisting of diagrams or lists, or manipulation algorithms of medical personnel with an indication of the cost of labor, medicines and supplies, depending on the severity, presence of complications and associated patient pathology , the use of which by specialists of the institution is carried out through the subsystem of hospital computer terminals using the means built into computers in selection of options for diagnostic and treatment procedures and means of choosing the optimal treatment regimen. 2. The system according to claim 1, characterized in that the medical and economic groups (MEG) that make up the database are nosological forms of diseases combined on the basis of similarity of diagnosis, treatment and care, with each MEG comprising three parts: general, medical and economic, and consists of no more than 12 sections.

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