The article presents materials of studying of such important problem of health care as standardization of specialized medical care provided in conditions of hospital and modernization of regional health care. The issues of standardization of specialized medical care are considered in medical, economic and social aspects. The implementation of medical standards was determined as one of main tasks of the regional program of modernization of health care. The program was developed with direct involvement of the authors of article. The comparative analysis of classes of diseases and nosologic forms on main indices of hospitalized morbidity and lethality was used for substantiation of priority of implementing medical standards in the region. The questionnaire survey was carried out on sampling of 510 patients of hospitals. The sociological questionnaire survey was applied to sampling of 8732 patients comprised by system of mandatory medical insurance. Such an approach determined reliability of derived results. The expertise of medical standards was implemented by 124 experienced and competent physicians participating in implementation of medical standards. The results of expertise confirmed expediency of implementation of medical standards. Kepy following shortcomings were established: inadequate financing; lacking of modern equipment and analysis techniques in hospitals, etc. The article presents evidences of effectiveness of process of standardization of specialized of medical care provided in hospital conditions. The basis of such an assumption was reliable increasing of level of satisfaction of quality of its organization and achievement of planned indices of "road map" in the section of increasing of salary of medical workers and decreasing of mortality of population because of controllable causes.
The public health care systems in the Nordic countries provide high quality care almost free of charge to all citizens. However, social inequalities in health persist. Previous research has, for example, documented substantial educational inequalities in cancer survival. We investigate to what extent this may be driven by differential access to and utilization of high quality treatment options. Quasi-experimental evidence based on the establishment of regional cancer wards indicates that (i) highly educated individuals utilized centralized specialized treatment to a greater extent than less educated patients and (ii) the use of such treatment improved these patients' survival.
Antibiotic use at a pediatric teaching hospital was reviewed for a month. A total of 188 courses of therapy were evaluated with respect to choice of antibiotic, dosage and necessity of treatment. Errors in therapy were noted in 30% of the medical orders and 63% of the surgical orders. The most frequent error, unnecessary therapy, was found in 13% and 45% of the medical and surgical orders respectively. Error rates were highest for the most frequently ordered antibiotics, notably the penicillins. The magnitude of the problem appeared to be similar to that previously reported from general ana adult hospitals. The difficulties with solutions such as educational programs and compulsory consultation are discussed.
CONTEXT: Many countries have adopted the CanMEDS roles. However, there is limited information on how these apply in an international context and in different specialties. OBJECTIVES: To survey trainee and specialist ratings of the importance of the CanMEDS roles and perceived ability to perform tasks within the roles. METHODS: We surveyed 8749 doctors within a defined region (eastern Denmark) via a single-issue, mailed questionnaire. Each of the 7 roles was represented by 3 questionnaire items to be rated for perceived importance and confidence in ability to perform the role. RESULTS: Responses were received from 3476 doctors (42.8%), including 190 interns, 201 doctors in the introductory year of specialist training, 529 residents and 2152 specialists. The overall mean rating of importance (on a scale of 1-5) of the aspects of competence described in the CanMEDS roles was 4.2 (standard deviation 0.6) and did not differ between trainee groups and specialists. Mean ratings of confidence were lower than ratings of importance and increased across the groups from interns to specialists. Differences between specialty groups were evident in both importance and confidence for many of the roles. For laboratory, technical and, to a lesser extent, cognitive specialties, the role of Health Advocate scored the lowest in importance. For general medicine specialties, the roles of Medical Expert, Collaborator, Manager and Scholar all scored lower for importance and confidence. CONCLUSIONS: This study provides a sketch of the content and construct validity of the CanMEDS roles in a non-Canadian setting. More research is needed in how these aspects of competence can be best taught and applied across specialties in different jurisdictions.
ReprintIn: Ugeskr Laeger. 2007 Jun 11;169(24):2329-3217594852
A comparative analysis of effectiveness of medical care service for patients with stroke in neurological and a specialized departments for the treatment of patients with stroke has been carried out in the regional hospital. The specialized department had an intensive therapy block that made it possible to conduct twenty-four-hour monitoring of main parameters of vital functions and oxygenotherapy. Patients who were in need of artificial lung ventilation were placed to a department of general reanimation. In the end of the acute period, the level of disability significantly decreased in patients with ischemic stroke. The significant decrease of disability level was found in patients with ischemic as well as with hemorrhagic stroke after 3 months. The results suggest the higher effectiveness of therapy conducted in specialized departments.
Previous studies suggest that patients with heart failure (HF) treated by cardiologists have improved outcomes compared with patients treated by other physicians. It remains unclear whether these findings reflect differences in patient characteristics, processes of care, practice setting, or a combination of these factors.
We examined physician specialty-related differences in processes of care and clinical outcomes for 7,634 patients newly hospitalized for HF in Ontario, Canada, who were included in the EFFECT study between April 2004 and March 2005. Patients were categorized according to whether they received cardiologist, generalist (e.g., internist or family doctor), or generalist care with cardiology consultation.
Multivariable hierarchical modeling demonstrated that patients treated by generalists alone had higher risk of 30-day (odds ratio [OR] 1.50, 95% CI 1.18-1.91) and 1-year mortality (OR 1.29, 95% CI 1.10-1.50), as well as the 1-year composite outcome of death and readmission, compared with patients treated by cardiologists. These differences were significantly attenuated if patients who had "do not resuscitate" orders were excluded. Patients who had a cardiologist involved in their care were more likely to undergo diagnostic procedures, such as echocardiography, and had higher rates of certain evidence-based pharmacologic therapy such as ß-blockers.
Physician specialty-related differences in HF outcomes appear to reflect a combination of both case-mix differences and differences in the use of certain heart failure processes of care. These findings suggest that it may be possible to improve HF outcomes in patients receiving care from generalist physicians.