The beginning of the standardization of medical care in Russia can be considered the order of the Ministry of Health of the RSFSR dated 10/16/1992 No. 277, which approved the "Temporary Regulations on Medical Standards (Regulations) of the Ministry of Health Russian Federation».

Currently in force the federal law dated November 21, 2011 No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens of the Russian Federation”, according to which “medical care is provided in accordance with the procedures for the provision of medical care, mandatory for all medical organizations in the Russian Federation, as well as on the basis of medical care standards. ..” (clause 1, article 37).

The concept of " standard of care”, which should not be confused with the concept of “procedure for the provision of medical care”.

The procedure for providing medical care(hereinafter - the order) - this is a sequence of actions, justified by clinical recommendations and treatment protocols, for effective therapeutic and diagnostic measures.

Medico-economic standard of medical care is a set with a fixed cost medical services, medicines and medical materials necessary for effective treatment and diagnostic measures for a patient with an established diagnosis.

The development of a system of standards for the provision of medical care is included in the Concept for the Development of Health Care in the Russian Federation until 2020: “One of the main factors in creating a system of high-quality and affordable medical care is the … standards providing medical care for the most common and socially significant diseases and pathological conditions.

Compliance with the standards of medical care must be guaranteed to citizens throughout the Russian Federation.

The creation of medical care standards will make it possible to calculate the real cost of medical services in each constituent entity of the Russian Federation, determine the costs of implementing state and territorial medical care programs for the population, calculate the necessary drug supply for these programs (a list of vital and essential medicines), justify per capita funding standards and optimize options for restructuring the network of health care institutions.

Delivery standards certain types medical care are the basis of the program of state guarantees for the provision of free medical care to citizens, relevant state of the art development of medicine and binding.

One of the main elements of quality assurance should be considered the development by professional communities (associations) of clinical recommendations (guidelines) containing information on the prevention, diagnosis, treatment of specific diseases and syndromes, which will serve as the basis for the development of standards of medical care, indicators of the quality of the treatment and diagnostic process.

In countries recognized as advanced in the field of healthcare organization, among which Australia is considered the leader, at present, standards of care are understood as patient management plans (critical paths, clinical guidelines, maps, protocols - more than 30 different terms are found in the literature) based on clinical recommendations of national and world professional organizations (Standard treatment guidelines, Clinical guidelines, Practice guidelines).

The closest analogue of standards are clinical paths (Clinical Pathways), developed and published by national and international medical associations and adapted by specific medical institutions for their own use. In particular, the existence of documented clinical pathways is prerequisite international commission for the accreditation of a medical institution Joint Commission International (JCI). Clinical pathways are not used for economic planning.

The main objective of these documents is to ensure compliance with unified approaches to the treatment of diseases, improve treatment outcomes and, of course, control the quality of medical care.

In other words, these "standards" are used only to determine the medical components of the diagnostic and treatment process. For economic analysis(calculation of budgetary indicators of health care and control of its adequacy modern conditions, payment for medical services), the Diagnostic Related Groups (DRG) system is usually used.

In accordance with the Concept for the Development of Healthcare in the Russian Federation until 2020, Russia plans to switch to a single-channel financing system, which, of course, will require the introduction of the above system in our country (in Russia - clinical statistical groups, CSG).

The main problem of the implementation of this system in the Russian Federation is that in order to use the DRG (DRG), the current data must be constantly collected and analyzed. medical statistics on cases of diseases (treated patients), medical services provided during their treatment, as well as detailed and objective information on the costs of medical institutions for the treatment of these diseases.

Information currently available (statistical coupons and maps, statistical reports medical and preventive institutions (HCIs), accounting reports, etc.), possibly, and meets some needs of the authorities government controlled, but cannot be used to adapt the DRG to the conditions of the Russian Federation, especially in the absence of unified reference books for medical, in particular diagnostic, services.

The general principle of the structure of most foreign directories is a clear and simple service search system. In addition, special attention is paid to the elimination of duplication of services, since these directories are used, among other things, for financial calculations, in which accuracy and unambiguity are very important.

In the United States, the American Medical Association (non-governmental professional organization) developed and maintained a service guide, Current Procedural Terminology (CPT), with input from physicians and billing staff, which is used by:

To control and pay bills for services rendered;

Collection and analysis of data on the costs of providing services by doctors and medical institutions, which, in turn, provides information to justify prices for services.

The CPT guide uses clear classification principles that depend on the content of the section and the workflow of the relevant specialists. For example, surgical procedures are grouped according to the anatomical principle, radiological diagnostics are grouped according to the types of equipment used (ultrasound (ultrasound), X-ray, computed tomography, etc.), and laboratory diagnostics are grouped according to the types of examinations.

It explains in great detail in which cases which services need to be used, there are ample opportunities for searching on several grounds (even in the paper version of the guide, you can search both by sections and alphabetically). The presence of a system of modifiers (additional codes) makes it possible to take into account the features of the services provided, which is especially in demand for surgical interventions.

Australia's statutory health insurance (CHI) system, called Medicare, uses single directory services and prices for Medicare Benefits Schedule (MBS), which is maintained and updated monthly by the Health Insurance Commission (HIC), an analogue of the Russian Compulsory Medical Insurance Fund. All information contained in the handbook is available on the Internet for both doctors and patients.

In domestic health care, the situation is as follows. In 2001, by orders of the Ministry of Health of Russia dated April 10, 2001 No. 113 and dated July 16, 2001 No. 268, the industry classifiers "Simple medical services" and "Complex and complex medical services" were put into effect, and on July 12, 2004, on the basis of these classifiers formally (signed by the Deputy Minister of Health and social development) approved the Federal Nomenclature of Works and Services in Healthcare (hereinafter referred to as the Nomenclature), which is used today in most regions of the country, including when creating standards.

The part of the document related to the medical services themselves includes the sections "Simple medical services" and "Complex and complex medical services". To build the Nomenclature, the so-called ICPM (International Classification of Procedures in Medicine) was chosen, which was offered by the World Health Organization (WHO) to its members in 1978, but “by 1989, work on the development of this reference book was practically stopped due to its inadequacy to the rapid development of medical technologies ”(quote from the WHO website).

The nomenclature includes both a list (reference book) of services and a classifier (that is, a combination of services into logically related groups). The advantages of the Nomenclature include, first of all, a unified system of classification. Of the main shortcomings of the Nomenclature, first of all, it should be noted the inconvenience of its use due to the following reasons.

First, there is no clear definition of the difference between simple and complex services. For example, it is not clear why the appointments and consultations of doctors are classified in the section of complex medical services, and operations (even very complex ones that can be divided into elements contrary to the definition given in the Nomenclature) - in the section of simple ones. At the same time, for many positions there are many intersections between the classifiers of simple, complex and complex services - in fact, these are two directories, with a different structure, in which the same terms are used.

Secondly, in many cases the established practice is sacrificed for the unity of the structure. So, for example, the presence of anatomical classification in all sections leads to unexpected results in laboratory studies, where anatomy does not play a role, but the type of study plays a role. Thus, the established and widely used principle of classification is ignored. laboratory research by types such as hematology, biochemistry, serology, etc.

Thirdly, there is an uneven allocation of services: for example, the elementary actions carried out by any doctor during any examination - the collection of complaints, palpation, percussion, etc. pathology of the immune system organs" and "general therapeutic palpation" in the examination of an allergist).

Fourth, overly abstract names are used, such as "Registration of sound signals emitted or reflected by organs or tissues" instead of "Ultrasound services".

The scope of services of the Nomenclature does not meet the requirements today, since there is no system for its maintenance and updating, including in electronic form.

Developed on the basis of the order of the Committee of Health of Moscow and the Moscow City Federal Medical Insurance Fund dated 07.04.1999 No. 152/57 “On sectoral city classifiers of the unified information space of the health care system of Moscow”, the Moscow City Register of Medical Services in the Compulsory Medical Insurance System (hereinafter referred to as the Register) is used for settlements between Health care facilities and insurance companies within the framework of compulsory medical insurance in Moscow.

The names of services in the Register are familiar and understandable to Russian doctors and health care providers. An indication for each service of its labor intensity in conventional units of labor costs (UUT) makes it possible to justify the price. The registry is maintained centrally and is available to all interested organizations in the form of a database on the site www.sonsi.ru.

At the same time, the lack of a clear classification system, too detailed division of services (by methodology, place of provision, by types of analyzers, etc.) and their duplication create significant problems when using this guide.

One of the main conditions for the possibility of calculating the planned cost of the standard is to determine the cost of the elements of filling the standard, which, in turn, requires the presence of a subject directory that includes services, drugs and consumables. Each subject reference book requires a price list, which indicates the price of the corresponding element of filling the standard in a given period of time. The subject guide and its associated price list may be maintained by various people or organizations.

What is meant by "service" as the main concept of any directory? A service is any medical or other assistance provided to a patient. The provision of a service implies the receipt of a certain result and the expenditure of resources. The directory includes all services that can be provided to patients when they receive medical care.

More than 400 services of appointments and consultations of specialists are registered in the Register with a detailed division according to the specialization of the doctor (therapist, surgeon, gastroenterologist, etc.), type of appointment (primary, repeated, preventive, dispensary, etc.), place of admission (at at home, in a CDC, in a hospital, etc.). At the same time, for most of them, the labor costs are the same, measured in LLL, and, in terms of resource use, there is practically no difference between these services.

In the American CPT directory, appointments and consultations of specialists are not separated by the specialty of the doctor and the place of medical care. The only criterion for difference is the time spent by the doctor on the appointment. In the "Patient Appointments and Consultations" section of this guide, only four services are listed: code 9912 - appointment up to 10 minutes, code 9913 - from 10 to 15 minutes, code 9914 - from 15 to 25 minutes, code 9915 - more than 25 minutes.

Another example from the same area is the application of the principle of separation of services according to the method of their provision. The same result can be obtained using different methods. So, a general blood test can be performed manually or on one or another automatic analyzer. The Registry contains different methods for performing a hematological examination and its components on various analyzers, different ways considered different services. In total, the directory lists more than 20 services related to this analysis.

In comparison, the Australian MBS directory contains only three services related to complete blood count. They differ in a set of indicators (i.e. result): a short formula (3 indicators), a detailed formula and a separate service for counting reticulocytes. At the same time, it is emphasized that the definition of indicators can be performed by any method.

We believe that the division of services in the guide according to the methodology for their provision is inappropriate, since this leads to:

To an unjustified increase in the number of services;

Problems in the preparation of standards (if the standard provides for the performance of a general blood test, then which of the twenty available services should be indicated?);

Creation of prerequisites for the distortion of statistical and financial indicators due to the fact that health facilities that perform, for example, analyzer studies, have the opportunity to include in the bill services for measuring individual indicators, allegedly performed by manual calculation, since in this case the total cost is higher .

Objective indicators of the possibility of providing services are the availability of qualified personnel, equipment, premises and the fulfillment of other conditions that are mandatory for the provision of the declared types of medical care.

It is possible to assess the compliance of a health facility with the established requirements if there is a described and approved technology for the provision of a service (technological map) with the obligatory indication of the key elements of the methodology, including its timing. The Technology Directory can be integral part(one of the sections) of the directory of services.

It is advisable to divide services according to the result of the service, with a description of the expected result, as well as indicating the mandatory requirements for the provision of each service, which can later be used for accreditation of health facilities.

Collection of medical statistics and statistical analysis performance of certain services in the provision of medical care allow not only to determine the current state of the industry, but also to plan the need for material and human resources.

A correctly compiled service directory that does not allow for ambiguous interpretation of the terms used in it makes it possible to organize the collection of statistical data, including using information systems.

The classification system of services implies the grouping of services into sections according to the principle of the presence or absence of any signs. For the same directory, several alternative classification systems may exist and be supported, however, most directories use a single system. This is probably due to the high labor costs for maintaining alternative systems.

The following classification principles are most commonly used:

Organs and systems (anatomical). As a rule, it is used for surgical operations, studies of radiation diagnostics, anesthesia;

Research types. This classification has historically developed for laboratory research (hematology, biochemistry, serology, etc.) and continues to evolve as new laboratory methods appear;

The type of equipment used. It is used for radiation diagnostic methods, including ultrasound, computed tomography, magnetic resonance imaging, etc.;

Degrees of invasiveness (for surgical interventions).

The directory should provide for the possibility of adding service properties.

The principles of constructing a directory of laboratory equipment should be largely similar to those applied to a directory of medicines, but it is necessary to take into account the following features medical devices and their classification:

For some types of medical devices (such as dressings) there are many specific names. The use of specific names and prices for such medical devices in the standard is inappropriate. It is more productive to indicate in the standard the type of medical device and the price of the type of medical device;

Some products belonging to the same type (for example, hematology analyzers) may differ significantly in consumer properties and, thus, only one or several products of a certain type can be used to provide a service. In this case, it is necessary to provide for the possibility of specifying in the standard a specific medical device or several alternative medical devices;

The technology standard should include the following sections:

General provisions;

technology requirements;

Graphical, schematic representation of technology (if necessary);

Formulas, calculations, nomograms, forms and other documentation (if necessary);

Technology monitoring.

The Technology Requirements section includes the following subsections:

Requirements for specialists and support staff;

Requirements for ensuring the safety of medical personnel;

Conditions for performing a simple medical service;

Functional purpose of a simple medical service;

Material resources necessary to perform a simple medical service;

Characteristics of methods for performing a simple medical service;

additional information about the features of performing a simple medical service;

Achieved results, quality indicators, parameters for assessing and monitoring the quality of a simple medical service;

Requirements for the regime of work, rest, treatment or rehabilitation, dietary prescriptions and restrictions, preparation of the patient in the process of performing a simple medical service (if necessary);

Features of the patient's voluntary informed consent when performing a simple medical service and additional information for the patient and his family members;

Cost characteristics technologies for performing a simple medical service.

Technology requirements are developed separately for each method of performing a medical service. For each simple medical service, there may be several methods for its implementation. Developers in the process of developing a technology standard must decide on the number of methods included in the developed technology standard.

5.1 General

The "General Provisions" section provides information about the developers of the technology standard, indicating their names, positions, addresses, the goals and objectives of developing and implementing the technology standard, its concept and a short list of the main literature used to develop the technology and substantiate the evidence.

The section also provides an extended definition of a simple medical service, a list of techniques, data from clinical epidemiology, and substantiates the medical and social significance of the development of this technology standard.

5.2 Requirements for specialists and support staff

The subsection indicates the list of medical specialties in accordance with which this technology can be performed.

The subsection also indicates additional or special requirements for specialists and support staff to work on a specific methodology for performing a simple medical service, requirements for their education, knowledge, skills, work experience.

5.3 Requirements for ensuring the safety of medical personnel

Labor safety requirements for the performance of a simple medical service should contain references to the relevant regulatory documents or a descriptive description of the safety of the conditions for performing a specific methodology for a simple medical service.

5.4 Conditions for performing a simple medical service

The subsection indicates the conditions for performing a simple medical service in accordance with Appendix B. For one technology, several conditions for performing a simple medical service can be specified.

5.5 Functional purpose of a simple medical service

The subsection indicates the functional purpose of a simple medical service in accordance with Appendix B. For one technology, several types of functional purpose of a simple medical service can be indicated.

5.6 Material resources required to perform a simple medical service

The subsection indicates material resources (fixed assets - instruments and tools; consumables - reagents, medicines, immunobiological substances, blood products, dressings, other consumables, etc.) necessary to perform a specific simple medical service.

5.6.1 Devices, instruments, medical products

This paragraph indicates medical devices, medical devices, instruments, optics, chemical glassware registered in the Russian Federation in the prescribed manner, indicating the brands of devices and devices used to perform a particular technique.

They also indicate the name of the device, instrument, medical equipment product with reference to the registration normative document, the number or limits in which the number of medical devices, instruments, medical products required to perform a specific technique may be located.

5.6.2 Reagents

The paragraph indicates reagents registered in the Russian Federation in the prescribed manner, including dyes, fluorescents, radioisotope reagents and substances, radiopaque substances, etc., necessary to perform a specific simple medical service.

The name of the reagent is also indicated with reference to the document regulating its use, the amount of the reagent or the limits within which the amount of the reagent may be required to perform a simple medical service, the terms and features of its storage, destruction, disinfection, etc.

5.6.3 Immunobiological preparations and reagents

The paragraph indicates the name of the immunobiological preparation or reagent, the registration data of immunobiological preparations and reagents, their quantity required to perform a specific simple medical service, additional information about the features of storage, use, destruction and disinfection, ensuring the safety of personnel and patients when working with immunobiological preparations and reagents.

5.6.4 Blood components

The paragraph indicates blood components registered in the Russian Federation in the prescribed manner, used in the performance of a simple medical service, their dosage and the average amount required to perform a specific technique.

5.6.5 Medicines

When compiling lists of medicines (see. picture 1) indicate:

- Name pharmacotherapeutic group in accordance with the pharmacotherapeutic classification of drugs;

- Name anatomical therapeutic chemical (ATC) subgroup in accordance with the anatomical therapeutic chemical classification. As part of one pharmacotherapeutic group, several ATC subgroups can be represented;

┌──────────┬───────────┬───────────┬────────┬─────────────┬─────────────┐

│ Pharmaco- │ ATC │Non-patent- │Frequency │Indicative-│Equivalent│

│therapeutic-│ subgroup │ bathroom │appointed-│ daily │course dose│

│ academic │ │ names │ │ dose (ODD) │ (ECD) │

│ group │ │ nie │ │ │ │

├──────────┴───────────┴───────────┼────────┼─────────────┼─────────────┤

│Name │ │ │ │

│pharmacotherapeutic group │ │ │ │

├──────────┬───────────────────────┼────────┼─────────────┼─────────────┤

│ │Name ATX│ │ │ │

│ │ subgroups │ │ │ │

├──────────┼───────────┬───────────┼────────┼─────────────┼─────────────┤

│ │ │ Namenova- │ │ │ │

│ │ │nie │ │ │ │

│ │ │ drugs │ │ │ │

└──────────┴───────────┴───────────┴────────┴─────────────┴─────────────┘

Figure 1. The form of the list of medicines (diagnostic, therapeutic, preventive, rehabilitation stages of medical care)

IN column"Generic name" - an international generic name or a substitute name for a medicinal product, approved in the prescribed manner. As part of one ATC subgroup, several names of medicines can be represented;

IN column"Destination Frequency": vs. graphs"Name of the pharmacotherapeutic group" - the frequency of prescription of the pharmacotherapeutic group; against graphs"Name of ATC subgroup" - the frequency of prescribing ATC subgroup within the pharmacotherapeutic group; against graphs"Generic name" - the frequency of prescription of the generic name of the medicinal product within the ATC subgroup.

Prescribing frequency reflects the likelihood of using a pharmacotherapeutic group, ATC subgroup, or generic drug name and can be from 0 to 1. Prescribing frequency 1 for a pharmacotherapeutic group means that all patients should use this pharmacotherapeutic group. A prescribing frequency of 1 for the ATC subgroup means that the ATC subgroup within the pharmacotherapeutic group is assigned to all patients with this pathology. A prescribing frequency of 1 for a generic name means that in the ATC subgroup, the drug will be used in all patients. Frequency of prescribing less than 1 for pharmacotherapeutic group, ATC subgroup, generic drug name means that they should not be used in all patients, but only if indicated;

IN column"Estimated daily dose" (ODD) - vs. graphs"Generic name" - the average daily dose of the drug;

IN column"Equivalent course dose" (ECD) - against graphs"Generic name" - a dose of a medicinal product equal to the number of days of administration of the medicinal product, multiplied by the estimated daily dose.

5.6.6 Other consumables

The item indicates the need for soft equipment (napkins, diapers, special clothes, etc.), household equipment (storage containers, etc.), disinfectants, etc., indicating their number (number) necessary to perform simple medical service.

(developed by the Department of Standardization in Healthcare of the Research Institute of Public Health and Healthcare Management of the Moscow Medical Academy named after I.M. Sechenov under the guidance of Prof. P.A. Vorobyov)

1. INTRODUCTION

1.1. The standard of medical care is a regulatory document that defines the requirements for the provision of medical care to a patient with a specific disease, with a specific syndrome, or in a specific clinical situation.

The purpose of the development of standards is the normative support of the quality management system of medical care.

Standards are developed to solve the following problems:

• 
  selection of optimal technologies for prevention, diagnosis, treatment and rehabilitation for a particular patient;
• 
  protection of the rights of the patient and the doctor in resolving controversial and conflict issues.
• 
  conducting an examination and assessment of the quality of medical care for patients with a specific disease, syndrome or in a specific clinical situation, and planning measures to improve it;
• 
  planning the volume of medical care;
• 
  calculation of the necessary costs for the provision of medical care;
• 
  substantiation of the program of state guarantees for the provision of medical care to the population;

1.3. National standards - patient management protocols and standards of medical care of the Ministry of Health and Social Development of Russia are the basis for creating standards for the subject of the Federation / medical organization. National standards - patient management protocols - and the standards of medical care of the Ministry of Health and Social Development of Russia define the general requirements for the process of providing medical care to a patient with a specific disease (syndrome, clinical situation) at all stages (diagnosis, treatment, rehabilitation and prevention) and for all conditions (sanatorium- resort, outpatient, inpatient, including specialized and high-tech care, emergency medical care).

National standards - patient management protocols - and the standards of medical care of the Ministry of Health and Social Development of Russia are aimed at ensuring the integrity of the diagnostic and treatment process, continuity and interconnection in the provision of medical care in various medical organizations and do not take into account the specific features of individual subjects of the Federation and medical organizations (material and specifications, established organizational and technological approaches to the provision of medical care, etc.), which determine the ways of implementing the established requirements.

1.4. On the basis of the protocols for managing patients and the standards of the Ministry of Health and Social Development of Russia, clinical and economic standards are being developed in the subjects of the Federation, and then, on the basis of clinical and economic standards, the standards of a medical organization are being developed. Thus, a 3-level system of normative documents (national / federal, regional levels and the level of a medical organization) is being formed that regulates the volume and quality of medical care.

1.5. To ensure compliance with the established requirements, the clinical and economic standards of the subject of the Federation and the standards of medical organizations should contain standard operating procedures (SOPs) - documented instructions for the implementation of operating procedures that ensure compliance with the requirements of the standard (providing the medical services provided for by the standard, prescribing medicines, ensuring continuity and stages in the provision of medical care; quality management of medical care using the standard).

1.6. The subject of the Federation and the medical organization can initiate the development of their own standards on a topic on which there are no national / federal regulations. At the same time, the principles and procedure for developing standards of medical care set out in this document are observed.

^ 2. ORDER OF DEVELOPMENT OF STANDARDS OF MEDICAL CARE AT THE LEVEL OF THE SUBJECT OF THE FEDERATION AND MEDICAL ORGANIZATION

the Russian Federation Order of the Ministry of Health and Medical Industry of the Russian Federation

On the introduction of the industry standard "Technologies for performing simple medical services. General requirements"

set a bookmark

set a bookmark

1. Enact from 09/01/2000 the industry standard "Technologies for performing simple medical services. General requirements (hereinafter OST TPMU N 91500.01.0004-2000) (Appendix) .

2. The Department of Organization of Medical Assistance to the Population and the Prevention of Non-communicable Diseases (Karpeev A.A.), the Department of Research Medical Institutions (Tkachenko S.B.) and the Department of Medical Problems of Motherhood and Childhood (Korsunsky A.A.) to ensure the development of implementation technologies simple medical services in accordance with the requirements of OST TPMU N 91500.01.0004-2000.

3. The Moscow Medical Academy named after I.M. Sechenov of the Ministry of Health of the Russian Federation (Paltsev M.A.) from 01.09.2000 maintains OST TPMU N 91500.01.0004-2000 and coordinates the development of technologies for simple medical services.

4. To impose control over the implementation of this order on the First Deputy Minister of Health of the Russian Federation Volkov A.I.

Appendix

APPROVED
by order
Ministry of Health
Russian Federation
dated 31.07.2000 N 299

STANDARDIZATION SYSTEM IN HEALTH CARE
RUSSIAN FEDERATION

INDUSTRY STANDARD

TECHNOLOGIES OF PERFORMANCE
SIMPLE MEDICAL SERVICES,
GENERAL REQUIREMENTS

91500.01.0004-2000

Foreword

INTRODUCED FOR THE FIRST TIME

This industry standard "Technologies for performing simple medical services. General requirements" cannot be fully or partially reproduced, replicated and distributed as an official publication without the permission of the Ministry of Health of the Russian Federation.

Industry standard

TECHNOLOGIES OF PERFORMANCE
SIMPLE MEDICAL SERVICES,
GENERAL REQUIREMENTS.

Introduction date 2000-09-01

01 INTRODUCTION

Industry standard 91500.01.0004-2000 "Technologies for performing simple medical services. General requirements" (hereinafter referred to as OST TPMU) was developed at the Laboratory for Standardization Problems in Healthcare (Head Professor P.A. Vorobyov) of the I.M. Sechenov Moscow Medical Academy of the Ministry of Health Russian Federation.

The basis for the development of OST TPMU is the Decree of the Government of the Russian Federation dated 05.11.97 N 1387 "On measures to stabilize and develop health care and medical science in the Russian Federation" and "Program of work on the creation and development of a standardization system in health care" dated July 21, 1998, order of the Ministry of Health of the Russian Federation of December 22, 1998 N 374 "On the introduction of the classifier" Simple medical services ".

OST TPMU is developed taking into account the principles, rules and requirements established in the standards State system standardization of the Russian Federation (GOST R 1.0-92 - GOST R 1.5-92), decisions of the boards of the Ministry of Health of the Russian Federation, the State Committee of the Russian Federation for Standardization, Metrology and Certification, the Council executive directors territorial funds of compulsory medical insurance dated 03.12.97 N 14/43/6-11 "On the main provisions of standardization in health care", order of the Ministry of Health of the Russian Federation and the Federal Fund for Compulsory Medical Insurance N 12/2 dated 19.01.98 "On the organization of work on standardization in health care", Order of the Ministry of Health of the Russian Federation dated 08.12.98 N 354 "On the procedure for reviewing and approving draft regulatory documents on standardization in health care" and practical experience of domestic and international standardization in the field of technologies for performing simple medical services.

OST TPMU according to the "Basic provisions of standardization in health care" refers to group 01 - "Basic provisions".

The scope of OST TPMU is the system of standardization in health care, the regulatory document is the base for the development of industry standards for technologies for performing certain simple medical services.

01.02 Goals and objectives

OST TPMU was created for the purpose of regulatory support and unification of the process of development, adoption, implementation of industry standards for technologies for performing simple medical services and assessing the quality of their performance.

01.03 Definitions and abbreviations

In this OST TPMU, terms are used in the interpretation, making them unambiguous for perception. For the purposes of this normative document the following terms and definitions are used:

01.04 General principles building
OST TPMU

The industry standard code is decoded as follows:

OST TPMU is a systematized set of rules that determine the procedure and sequence for the formation of standards for the technology of performing simple medical services, the structure of the regulatory document, and uniform requirements for the implementation and evaluation of the results of the application of the GTMU. OST TPMU is an open system, the elements of which can be adjusted and supplemented.

01.04.01 Order of copying industry

OST TPMU provides for a six-step hierarchical classification of technology standards for performing simple medical services. At each stage, coding is carried out according to significant classification features.

Each technology standard for performing a simple medical service has a common (constant) part of the code: 91500.11. This constant part reflects the belonging of the regulatory document (the technology standard for performing a simple medical service) to the "Healthcare" industry (91500) according to OKONH and, according to the "Basic Provisions of Standardization in Healthcare", to the group of regulatory documents 11 - "Requirements for the provision of medical services".

At three steps of the variable part of the code, a three-step PMU code is placed, according to OK PMU. The year of approval of the technology standard for performing a simple medical service and its new revision is located at the end of the variable part of the code.

Thus, each technology standard for performing a simple medical service is located in a group that has a 19-digit digital code of the following structure:

Standards of work of the medical organization. “Standard of medical reception. Customer-Oriented Service"

It is no secret that most doctors of medical organizations are part-time workers, i.e. Doctors come to booked clients during their business hours.

All these doctors are already working somewhere, and most of them work in medical and health-improving institutions of the state budgetary medicine. Each doctor has his own understanding of how to work with a patient, his own experience in conducting a medical appointment. Often in such a situation, the doctors of the commercial medical center where they came, in their understanding, for a part-time job, do not even know each other. Not to mention the uniform methods and technologies for conducting medical appointments, the process of providing medical services in a particular medical center.

But the most important thing is that many doctors who have come to private medicine do not understand the difference in approaches to working with a patient in public and commercial medicine. There is no culture of customer-oriented service in their work. Therefore, the head of the medical center, the chief physician, needs to work painstakingly and systematically with each doctor to form this culture so that the clients of a commercial medical center feel the difference in the provision of medical services in a private medical center and a budgetary clinic and come to you again and again.

For such work with doctors of a commercial medical center/clinic, the “Standard for Conducting a Medical Appointment” is required, which describes in detail, as a specific guide to interaction with a patient, all elements of a client-oriented service.

It is equally important to develop a unified approach to the provision of medical services and patient management for the entire medical center / clinic.

Unfortunately, in most private medical centers, there is no such approach, and if it is in the understanding of the head of the medical center and its leading specialists, then it is not formalized, everything is in words, which means it is not obvious that all medical staff have such an understanding medical center/clinic. All this leads to the loss of customers, the loss of profits of the medical center.

I will describe the standard approach to the provision of medical services for many private medical centers.

So, in a certain medical center there is a set of medical services for which a medical license has been obtained. Doctors are invited under this set of services. Then the doctors conduct the reception and treatment, as they are used to doing in their other jobs. At the appointed time, the patient comes to the doctor, he had a consultative appointment, was prescribed treatment within the framework of his nosology. And that's it! Further, the doctor does not remember about his patient until he makes an appointment with him. There is no patient management system and systemic treatment process specific to this particular medical center. To correct this situation, again, you need to develop your own corporate "Standard for conducting medical appointments", which establishes your specific technologies and requirements.

In order for such a standard to appear, it is necessary, first of all, to develop a concept for the treatment process for your medical center / clinic. For example, within the framework of such a concept, an integrated approach in the treatment of a patient can be adopted, within which certain situations interdisciplinary medical consultations. Such consultations make it possible to develop an individual treatment program for the patient and significantly increase the efficiency of the treatment process and bring additional profit to the medical center.

After the accepted concept, the document "Standard for conducting a medical appointment" is developed. According to this standard, briefings are held with each doctor of the medical center. To control the requirements established in this standard, there should also be a special procedure for monitoring the quality of medical services, also described as the standard of your medical center, for example, the standard “Monitoring and assessing the quality of medical reception and treatment process”. For this procedure to be carried out in your medical center/clinic, a specialist, such as a quality control expert or a chief medical officer, should be assigned.

The introduction of technologies such as the standard into the work of the medical center / clinic will significantly increase the satisfaction of your medical center / clinic with your patients who will come to you again and again, i.e. the number of repeated appointments will at least double, which means that the profit of the medical center will double.

Get acquainted with the detailed content of the client-oriented service standard for doctors - "Standard for conducting medical appointments" and other standards of the medical organization in the "Catalogue of standards for the work of a medical organization"