Order on the examination of the quality of medical care. Criteria for assessing the quality of medical care

To evaluate the work of hospitals and clinic for the reporting period (calendar year), sets of certain indicators are usually used. They characterize the activities of medical institutions. You can select multiple groups of indicators.

1. Indicators characterizing the security of the population with an outpatient polyclinic and stationary help.

3. Indicators characterizing material and technical, clinical and diagnostic and medical equipment.

4. Use of agencies and other funds.

5. Indicators characterizing the organization and quality of outpatient polyclinic and inpatient care, its effectiveness.

Evaluation of medical work on the final (concrete) result involves the dynamics of health and health indicators;

implementation of the quality standards of diagnosis and treatment, as well as quality level (y K); development of clinical and statistical groups; organization of quality control of medical care; Calculation and assessment of the achievement coefficient of results according to the model of finite results.

To evaluate the health status of the population, certain groups of indicators are also used. From a socio-hygienic point of view it is considered that the health of the population is characterized by the following main indicators:

1. Medical and demographic indicators. The health of the population is due to the condition and dynamics of demographic processes. Demographics includes data on the statics and dynamics of the population. Statics - the number, the composition of the population on the floor, age, place of residence, etc. Dynamics - fertility, mortality, infant (children's) mortality, natural increase, etc.

2. Incidence rates. The health of people is due to the level and nature of the incidence of the population, as well as disabilities, injury.

3. Indicators of physical development. The physical development of the population can be determined using anthropometric, physiometric and somatic and somatic data.

The study and comparison of this data in various socio-economic conditions allows not only to judge the level of public health of the population, but also to reveal the social conditions and the causes affecting it.

For the control system and to some extent, the quality of medical care is developed quality standards and finite results.

Quality standards (SC)

Quality standards are developed to obtain effective end results and meet the needs of the population in medical care. The SC regulates the quality of diagnosis and treatment (for completed cases) in the outpatient polyclinic institutions and hospitals, as well as the quality of dispensary observation. Thus, they reflect the adequacy of the selected medical technology, the degree of compliance, the volume of diagnostic and therapeutic measures.

Quality standards are developed for patients consisting on dispensary accounting; for stationary clinical and statistical group;

for each disease in the treatment in the clinic; For patients with acute and chronic diseases. In violation of quality standards, penalties are applied to the Contractor.

Quality standards include Three Components: Examination Standard, Treatment Standard and Patient State Standard, completed treatment.

The method of assessing the performance of quality standards in the LPU is based on the calculation of the quality level. It is determined by estimating deviations from the SC. This makes it possible to directly link the Criminal Code with the size of material incentives. Note that the level of performance of the performance of standards is among the performance indicators (AD) of the final results model. The technique includes determining the quality of the work of the work of doctors: the level of quality of treatment (UKL) and the level of quality of dispensarization (UKD).

An expert route (at the first stage of control - the head of the department) is estimated a set of measures (OHM), i.e. The volume of examination and treatment of patients taking into account the established requirements. Separately, an expert assessment of the quality (OK) is given, during which the patient's condition is determined when an input from the hospital or during the completion of the stage) clinic dispensarization.

The overall assessment of the quality and treatment level, and the dispensarization is calculated by the formula:

ONM + OK.

K. = --------

The scheme of the organization of quality control of medical care implies the definition of the level of control, solving the issue, with which structure of the LPU or the control body is created. It will be one expert or commission. The frequency of operation is determined, the amount of control (source of information), the sample size for control, evaluation parameters.

The method of controlling the quality of medical care implies the definition of medical care levels (patient doctor, structural unit of institution (separation), LPU, territorial medical association (TMO)), as well as control steps (I - head. Structural unit, II-AA - deputy . The Chief Doctor of LPU on therapeutic issues, III - Expert Commission LPU, IV - Expert Commission for the City Efforement of Health or TMO, V - Expert Commission for Health Management).

Criteria for medical care approved an order 203n.

The document revised the assessment methodology and significantly expanded the list.

How to apply the criteria in which their main goal is and what is the shortcomings of the order - we will tell in the article.

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From the article you will learn

Criteria for quality medical care

Criteria for medical care are approved by order of 203n, which expanded the scope of assessing the quality of medical assistance.

In the new version of the document, the criteria are divided into groups, their number has increased - from 50 to two thousand.

Consider on the examples some criteria for evaluation.

1. Maintaining medical records.

Criteria for medical care in 2019 includes criteria for their assessment.

Such documents include an outpatient map of the patient, a child's development map, a map of pregnant and herds, etc.

The correctness of the completion of documents is estimated according to the following indicators:

• the doctor filled with all the required card items;
• there is informed voluntary consent to medical intervention in the map.

☆ how to organize. Ready templates and comments inspectors in the Journal of Quality Management in Healthcare

Recall that the presence of the IDC in the map is a mandatory requirement of the law. In practice, many health workers ignore this requirement and do not receive consent from the patient to each service, limited to one document or forget it to arrange.

The order of 203 of the Ministry of Health allows no IDC in two cases:

• in accordance with the provisions of the Federal Law "On Health Protection", when in emergency cases, the receipt of consent is impossible;
• if as a result of force majeure circumstances, the document was destroyed.

2. Primary examination of the patient and the deadlines for medical care.

These criteria for the quality of medical care in 2019 are aimed at assessing the quality of inspection based on the recorded documentation. The indicator also reflects the anamnesis of the disease, the correctness of the recording in the patient's map, etc.

3. Making a presidential physician at primary reception.

4. Drawing up a patient examination plan on primary inspection, taking into account the preliminary diagnosis.

5. Appointment of drugs, taking into account the instructions for their use, as well as taking into account the complications of the patient, other diseases, its age, gender, etc.

If the doctor does not approach the appointment of each drug individually, it can lead to medical care defects.

6. The formulation of a clinical diagnosis on the basis of a data complex obtained during the examination, inspections, the collection of history, instrumental and laboratory diagnostics, as well as the opinions of specialist doctors.

At the same time, the doctor is guided by applicable procedures, treatment protocols and standards.

203N Order of the Ministry of Health of the Russian Federation requires how to take into account the clinical recommendations and standards of medical care, which often contradict each other in terms of requirements for the same disease.

The execution of this criterion is ensured by:

• setting the final diagnosis within 10 days from the moment of circulation to the medical insurance;
• registration of a detailed justification in the outpatient map of the patient;
• with difficulty determining the diagnosis - the appointment of the consultation of medical professionals.

Thus, according to this criteria, the diagnosis to the patient must be decorated within 10 days, in difficult cases - after the adoption of the appropriate decision by the consulium.

More severe conditions of medical quality quality criteria are installed for stationary medical care.

So, since many patients are sent to the hospital with exacerbations in serious condition, the timing of the diagnosis is significantly reduced:

• 72 hours - in the profile compartment;
• 24 hours - by emergency testimony;
• 2 hours - in resuscitation departments.

Order of the Ministry of Health 203N

The order of the Ministry of Health of the Russian Federation 203 H canceled the quality criteria for medical care, which acted earlier and generally changed the approach to the evaluation procedure.

Now the criteria are grouped according to individual states and diseases, divided under the terms of the provision of services - in hospital, outpatient conditions and day hospital.

New criteria for assessing the quality of medical care are aimed at covering as many diseases as possible and their features.

The Ministry of Health is committed to creating a unified classification of treatment methods that combine certain provisions of medical standards, orders and treatment protocols.

However, experts note that the current edition of the criteria still needs to be revisted and is not a universal assessment instrument.

For example, among the shortcomings of new criteria, the following are noted:

1. The methods of laboratory diagnostics described in the order are outdated and irrelevant.
2. Some treatment methods applied in practice are not reflected in the order, because of this, patients may suffer.
3. Some quality criteria for medical care contain those instructions that doctors themselves do not agree.
4. The criteria do not reflect some sections of medicine, for example, radiation diagnosis and dentistry.
5. Criteria are focused on an individual approach to each patient - in diagnosis, in treatment. Because of this, difficulties arise in resolving disputes with patients who are not satisfied with the results of treatment.

In addition, the current medical quality criteria are based on such a principle of medical care, as the patient's absence of predicted complications during treatment. Therefore, if such a complication occurs, this is considered as a sign of improper quality of medical care.

In this regard, the doctor must form a list of possible complications before the start of treatment and its task is to prevent their appearance.

Quality Examination: New

Changes are also expected in the order of medical examination examination. This applies to the application and interpretation of medical orders, standards, recommendations that will combine the quality criteria for medical care.

The very concept of "quality of medical assistance" will not be changed, but it is proposed to form new approaches to medical device standards and clinical guidelines.

Based on this, single standards of medical care are formed, but they should include only those drugs that are guaranteed by the state.

The procedure for adopting new standards and orders will not change - they are approved by the Ministry of Health in the form of adoption of separate orders.

Criteria for assessing the quality of medical care are formed from orders and clinical recommendations. They do not contain an indication of the appointment of specific drugs, and describe the necessary algorithm of the actions of health workers.

Federal Law "On the Fundamentals of Health Protection of Citizens in the Russian Federation" No. 323-FZ dated November 21, 2011, it establishes the possibility of conducting an examination of the quality of medical care.

Examination of the quality of medical care can be carried out in order to identify violations in the provision of medical care, including:

• estimates of the timeliness of medical care;
• evaluating the correctness of the choice of methods for prevention, diagnosis, treatment and rehabilitation;
• estimation of the degree of achievement of the planned result.

This follows from the provisions of Part 1 of Article 64 of the Federal Law No. 323-FZ of 21.11.2011.

The provisions of Part 1 of Article 64 of the Federal Law No. 323-FZ dated 11/21/2011 are consistent with the definition of the concept of "quality of medical care", which is enshrined in paragraph 2 of Art. 2 of this law.

So, according to paragraph 21 of Art. 2 of the Federal Law No. 323-FZ dated 11.21.2011. The quality of medical care is a combination of characteristics reflecting the timeliness of medical care, the correctness of the choice of methods for prevention, diagnosis, treatment and rehabilitation when providing medical care, the degree of achievement of the planned result.

Examination of the quality of medical care, established by the legislation of the Russian Federation, is an important element of legal relations in the field of life and health, and ensures the protection of the constitutional right of everyone to protect life, health and medical assistance (Article 7, 41 of the Constitution of the Russian Federation, Article. , 19 of the Federal Law No. 323-FZ dated 21.11.2011).

The examination of the quality of medical care should be distinguished by an independent assessment of the quality of service provision by medical organizations (Article 79.1 of Federal Law No. 323-FZ dated 21.11.2011).

In Article 79.1 of the Federal Law No. 323-FZ of 21.11.2011, it was said that an independent assessment of the quality of service provision by medical organizations is one of the forms of public control and is carried out in order to provide citizens with information on the quality of services with medical organizations, as well as in order to provide Improving the quality of their activities. At the same time, Part 1 of Art. 79.1 of Federal Law No. 323-FZ dated 21.11.2011 G. directly suggests that an independent assessment of the quality of service provision by medical organizations is not carried out in order to control the quality and safety of medical activities, as well as expertise and quality control of medical care.

The legislation of the Russian Federation established criteria for assessing the quality of medical care (hereinafter referred to as quality criteria).

Quality criteria, as follows from Article 64 of the Federal Law No. 323-ФЗ dated 21.11.2011, are formed in groups of diseases or conditions based on:

• medical orders of medical care;
• medical standards;
• clinical recommendations (treatment protocols) on medical care issues.

Quality criteria are approved by an authorized federal executive authority.

Currently, quality criteria are approved by order of the Ministry of Health of the Russian Federation dated July 7, 2015 No. 422an "On approval of the criteria for assessing the quality of medical care" (registered by the Ministry of Justice of the Russian Federation on August 13, 2015, Registration No. 38494).

However, from July 1, 2017, this document loses its strength, since new quality criteria, approved by the Order of the Ministry of Health of the Russian Federation No. 520n from July 15, 2016, will begin to act with the specified date. (Registered in the Ministry of Justice of the Russian Federation on August 8, 2016 Registration No. 43170)

According to order No. 520n of July 15, 2016, quality criteria are used when providing medical assistance:

• in medical organizations;
• as well as in other organizations carrying out medical activities
• licensed for medical activities obtained in the manner prescribed by the legislation of the Russian Federation.

Accordingly, the quality criteria approved by Order No. 520n of July 15, 2016 are related to medical organizations regardless of the form of ownership and the conditions for the provision of medical care (on compensated or free of charge).

The procedure for conducting examination of the quality of medical care is established by the legislation of the Russian Federation.

Currently, such an order has been developed only for medical care, which is provided within the framework of compulsory health insurance programs (hereinafter - OMS).

So, in part 3 of Art. 64 of Federal Law No. 323-FZ dated 11/21/2011 It is said that the examination of the quality of medical care provided within the framework of compulsory medical insurance programs is carried out in accordance with the legislation of the Russian Federation on compulsory health insurance.

In particular, the examination of medical care provided under the OMS is regulated:

• Federal Law No. 326-FZ dated November 29, 2010 "On compulsory medical insurance in the Russian Federation" (Art. 40 Organization of control of volumes, deadlines, quality and conditions for the provision of medical care);
• Order of the FFOMS of 01.12.2010 No. 230 (ed. Dated December 29, 2015) "On approval of the procedure for organizing and conducting control of volumes, deadlines, quality and conditions for providing medical care for compulsory health insurance" (registered in the Ministry of Justice of Russia 01/28/2011 No. 19614) .

Further, in part 4 of Art. 64 of Federal Law No. 323-FZ dated 11/21/2011 It is said that the examination of the quality of medical care, with the exception of medical care provided in accordance with the legislation of the Russian Federation on compulsory medical insurance, is carried out in the manner prescribed by an authorized federal executive authority.

Meanwhile, this order is currently only in the project.

So, with the aim of implementing Part 4 of Art. 64 of the Federal Law No. 323-FZ dated 11/21/2011, at present, the Ministry of Health of the Russian Federation has been prepared by the project (as of December 14, 2016), the procedure for the implementation of the examination of the quality of medical care, with the exception of medical care provided in accordance with the legislation of the Russian Federation On compulsory health insurance.

As indicated in the Document's Document Document, the quality examination will be carried out by checking the compliance of the medical care provisions provided to the patient criteria for assessing the quality of medical care.

Thus, at present, if medical assistance is not provided within the framework of the OMS, but on a fee basis, then the expertise of the quality of assistance can be carried out by referring to other consultants or the bureau of forensic medical examination.

Any medical organization works with information that makes up a medical secret. The information constituting the medical secret is protected by law. Therefore, regardless of the organizational and legal form, medical organization and medical workers are obliged to comply with certain regulatory requirements related to the processing of information constituting a medical secret. The protection of the information of the components of the medical secret is governed by the provisions of the following basic regulations: Federal Law No. 323-FZ dated 21.11.2011 "On the basis of the health of citizens' health in the Russian Federation" (hereinafter referred to as Federal Law No. 323-FZ dated 21.11.2011); Federal Law No. 152-FZ dated July 27, 2006 "On Personal Data" (hereinafter referred to as Federal Law No. 152-FZ dated July 27, 2006); In the process of regulation, other laws and regulations are also involved. Compliance with medical secrecy is one of the basic principles of the health of the health of citizens (paragraph 9 of Art. 4 of the Federal Law No. 323-FZ dated 21.11.2011). In accordance with sub. 7 b.5 of Art. 19 of the Federal Law No. 323-ФЗ dated 11/21/2011 The patient's right is to protect information that make up a medical secret, and one of the duties of the medical worker is to preserve the medical mystery (sub. 2, Article 73 of the Federal Law No. 323-FZ from 11/21/2011). The preservation of medical mystery also provides an oath of a doctor (Art. 71 of Federal Law No. 323-FZ dated 21.11.2011). Similar responsibilities for the preservation of information constituting a medical mystery occur at a medical organization. According to SUN 4. Part 1 of Art. 79 of Federal Law No. 323-FZ dated 21.11.2011. Medical organizations are obliged to comply with medical secret, including the confidentiality of personal data used in medical information systems. Compliance with medical mystery, both a doctor and a medical organization should be settled in local regulatory acts of a medical organization (sub. 2 Part 1 of Article 18.1 of Federal Law No. 152-FZ dated July 27, 2006). The list of local regulatory acts, their structure and content is determined by medical organizations independently. In addition to local acts in a medical organization, forms of documents (receipts) on non-disclosure of medical workers of medical mystery can be developed. Important! From patients in this case, it is necessary to refer to the consent to the processing of information constituting the medical mystery. Such agreement is issued in writing in arbitrary form, taking into account the requirements of the current legislation of the Russian Federation, for example, in the form of consent to the processing of personal data. Conditions of disclosure of medical mystery. The disclosure of medical mystery in accordance with Federal Law No. 323-FZ dated 21.11.2011 is allowed only with the written consent of the citizen (his legal representative). The disclosure of medical mystery with the written consent of the citizen is allowed: - in order to medical examination and treatment of the patient; - in order to conduct scientific research; - in order to publish in scientific publications; - in order to use in the educational process; - For other purposes. The concept of "other purposes" in the Federal Law No. 323-FZ dated 21.11.2011 was not disclosed. Cases of disclosure of medical mystery in the absence of consent. Federal Law No. 323-FZ dated 21.11.2011. Sets a whole list of cases when medical mystery may be provided without the consent of the citizen. For violation of medical secret, the legislation of the Russian Federation established: - administrative responsibility; - Criminal liability. Important! Administrative responsibility is provided for by Art. 13.14. Administrative Code "Declections of information with limited access". Responsibility comes in the form of a fine. For citizens, the penalty is provided in the amount of from 500 (five hundred) to 1,000 (one thousand) rubles. For officials - from 4,000 (four thousand) to 5,000 (five thousand) rubles. In more detail, in the material by the prepared lawyer of the company "Rosca Consulting and Audit" Kirill Bogoyavlensky. Read: https: // Website / Press / Vrachebnaya_Tayna / All the most interesting about taxes, right and accounting from the leading consulting company in Russia "Roscoe". Be aware of the latest news, look and read us where you are comfortable: the channel on YouTube - https://www.youtube.com/c/roscoconsultingaudit/ facebook - https://www.facebook.com/roscoaudit/ twitter - https://twitter.com/rosco_audit instagram - https://www.instagram.com/rosco.

Forensic examination: features in court

It is not a secret for anyone that the civil process on the quality of medical care is impossible without the involvement of a specialist with professional knowledge in the field of medicine. In this regard, both the participants in the Civil Procedure and the Court there is a need to obtain a professional assessment of the quality of medical care. The conclusion of such a specialist in the quality of the quality of medical care in turn will be one of the evidence in the case. Procedural legislation distinguishes such participants in civil proceedings as a specialist and expert. - Specialist. A specialist is a person with special knowledge. The specialist is involved in participation in the case established by law. It provides assistance in finding, consolidating and withdrawing objects and documents, the application of technical means in the study of the case file, for the formulation of the issues of the expert, as well as to clarify the parties and the court of issues included in his professional competence. The specialist gives the court a consultation in oral or writing, based on professional knowledge, without conducting special research appointed on the basis of court definition. Consultation of a specialist in writing is announced at the court session and comes to the case. Consultations and explanations of the specialist orally are entered into the minutes of the court session (Article 188 of the Civil Procedure Code of the Russian Federation). Professional experience of a specialist / specialist in various fields of medicine should not be lower than the professional experience of medical workers, the actions of which are disputed in court (in terms of education, experience, category, degree, the number of studies, operations, and pr.). - Expert. The expert is a person who has special knowledge and appointed in the manner prescribed by law for the production of forensic examination. The expert occupies a staffing post of expert at the State Bureau of Forensic Medical Examination, and conducts research in order of its official duties. The law establishes qualification requirements for the expert. The expert may be a citizen of the Russian Federation, which has a higher professional education, which has been prepared and certified by the relevant specialty, taking into account the qualification requirements (paragraph 8 of the order of the Ministry of Health and Social Development of the Russian Federation of 12.05.2010 No. 346n "On approval of the procedure for organizing and producing forensic examinations in public judicial Expert institutions of the Russian Federation "). Significant importance is the principle of independence of the expert. The expert on the law can not be in any dependence on the body or persons who have appointed forensic examination, parties and other persons interested in the outcome of the case (Article 7 of the Federal Law of 31.05.2001 No. 73-FZ "On State Forensic Expert Activity in Russian Federation"). At the same time, both an expert and a specialist cannot participate in the consideration of the case, if he was either in an official or other dependence on any of those involved in the case, their representatives (part 1 of article 18 of the Civil Procedure Code of the Russian Federation). Important! As law enforcement practice shows, the participation of a specialist in the field of medicine on the side of the plaintiff is simply necessary. Without such a specialist, it is almost impossible to competently formulate the basis of the claim and tactics of participation in the lawsuit, to competently add questions as the defendant (medical organization) and the expert of the State Bureau of Forensic Medical Examination In the event that such an examination is appointed in the case. Reference: Comprehensive Examination / Commission Examination. Complex examination is appointed by the court if the establishment of circumstances in the case requires simultaneous research using various areas of knowledge or using various scientific areas within the same area of \u200b\u200bknowledge. A comprehensive examination is entrusted to several experts (Article 82 of the Civil Procedure Code of the Russian Federation). Commissioning expertise is appointed by the court to establish the circumstances with two or more experts in the same area of \u200b\u200bknowledge. Experts meet each other and, having come to the overall conclusion, formulate it and sign the conclusion (Article 83 of the Civil Procedure Code of the Russian Federation) ..... See the material prepared by the lawyer of the company "Rosca Consulting and Audit" by Cyril Bogoyavlensky. All the most interesting about taxes, right and accounting from the leading consulting company in Russia "Roscoe". Be up to date with the latest news, see and read us where you are comfortable: the channel on YouTube - https://www.youtube.com/c/roscoconsultingaudit/ facebook - https://www.facebook.com/roscoaudit/ YandexDesen - https://zen.yandex.ru/id/5B84DF3FA459C800A93104A0 Twitter - https://twitter.com/rosco_audit instagram - https://www.instagram.com/rosco.

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The order of quality assessment has changed. Why is the order of 203 Criteria for assessing the quality of medical care causes difficulties from specialists? Let's tell us in detail how new criteria have influenced the methodology for assessing CMP specialists? What criteria are primarily important for clinics and hospital?

The order of quality assessment has changed. Why is the order of 203 Criteria for assessing the quality of medical care causes difficulties from specialists?

Let us describe in detail how new criteria influenced the methodology for assessing the CMP specialists. What criteria are primarily important for clinics and hospital?

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The main thing in the article

As an order of the Ministry of Health 203 N changed the quality criteria for medical care

Order 203 Criteria for assessing the quality of medical care, which entered into force this year, made significant changes in the activities of the staff of the medical sphere.

Consider the main directions that are relevant to any medical organization:

1. A new order to control the quality of medical care introduces new criteria for assessing medical care:
   • in the treatment of neoplasms during the provision of medical care for adults;
   • when providing specialized medical care to adult patients with behavioral disorders and mental disabilities;
   • in the treatment of diseases and states of patients in the perinatal period;
   • in the treatment of some diseases of the nervous system;
   • in the treatment of diseases of the connective tissue and the bone-muscular apparatus.
2. Order 203 Ministry of Health Criteria for the quality of medical care in individual areas expands:
   • in the treatment of diseases of digestion systems;
   • in the treatment of diseases of the eye and ear;
   • in the treatment of diseases of the urogenital system;
   • in the treatment of skin diseases;
   • when conducting patients during pregnancy, childbirth and in the postpartum period;
   • when assisting patients affected by poisoning, injuries and other difficult conditions.

Assessment of the quality of medical care in 2018: Methods

It is assumed that new Criteria for the quality of medical care of 2018 will help any expert how correctly the services were provided to a specific patient, how timely the actions of the doctors were.

In accordance with the new criteria, a technique was developed, allowing to reliably evaluate all the data on the quality of medical services in each particular case.

The process of providing medical care is considered for each existing criterion. The expert holds the basic part of the assessment in the 4th stage.

At the 5th stage, the task of the expert - to evaluate the objectively existing causes of violations made.

The opinion of the expert is reflected in the local medical institution documentation - in the journal of control, the control map, as well as in the expert's own report.

Consider these steps in more detail.

1st stage of the assessment of the CMP as part of the new order

A new order 203 Criteria for assessing the quality of medical care provides for the use of as an effective control tool. At the first stage, the expert should identify whether the place of violation of the requirements provided by the criteria was.

Depending on the availability or absence of violation, the expert notes in his report:

• if there was no violation, the control map is set "0";
• if violations were present, their number in units indicates the map.

The violations expressed in units allow you to subsequently analyze the frequency and causes of identifying these violations in dynamic form.

Criteria for the quality of medical care 2018 allow the expert to make a score of compliance with the perfect parameters.

For example, it can take a scale from 0 to 1, each step in which will be 0.1.

Thus, if the consequences of the procedure were indeed serious for the patient, the expert will appreciate its quality at a minimum level.

3rd stage of assessing the quality of medical assistance

This means that the deviations obtained by it at the 2nd stage will be compared with the threshold values \u200b\u200bof the criteria.

For example, assessing the consequences of the reception of those or other drugs expert estimated this deviation in value of 0.9. Such a value cannot be recognized as a defect, since they, in principle, could not negatively affect the patient's health.

However, the expert interprets the quality criteria for the provision of medical care and the obtained indicators are also as follows:

• if the same doctor regularly admits minor deviations in the process of providing medical services, this may affect the quality of the process as a whole;
• minor deviations should be recorded within the framework of internal control so that they are in a timely manner and in a planned manner.

Significant deviations by the expert in any case should be assessed when providing medical assistance.

Quality indicators of medical care are 0.8 and more should be regarded as the absence of a defect, less - the presence of a defect is recorded.

4th stage of assessing the quality of medical care

In particular, the value obtained at the previous stages is correlated with the next scale of the gravity of the defect:

• if the value is 0-0.1 - 4 class of danger is assigned;
• if the value is 0.2-0.3 - the 3 class of danger is assigned;
• if the value is 0.4-0.5 - 2 class of danger is assigned;
• at the values \u200b\u200bfrom 0.6 and more - the 1st class of danger is assigned.

New Quality Quality Criteria for Hospitations and Ambulatory

Consider them in more detail.

Basic quality criteria in outpatient conditions

Criteria for the quality of medical care in the conditions of outpatient polyclinic institutions are distributed over several subgroups.

1. Order 203 (criteria for assessing the quality of medical care) pays special attention to conducting medical documents. Recall that they include: med car of an outpatient patient, an individual outpatient map of a pregnant or woman who gave birth, or the history of the child's development.

What an expert evaluates:

• whether all the sections of the document are filled in the desired volume;
• does his consent on the ambulatory interference be kept in the map of the outpatient patient.

Quality of medical care is not in vain, the emphasis on the presence of the patient's consent - health workers often violate this rule and do not accept consent. It is also violated and another rule - consent is taken from the patient not for each service, as it should be, but on a range of services in one document.

Informed consent may be absent in the medapation only in two cases, which is taken into account during the quality assessment of medical care:

• the document was destroyed as a result of unforeseen circumstances (flood, fire, etc.);
• the case relates to when health workers have the right to have a medical care without receiving informed consent (for example, when entering a patient's medical institution, which is unconscious).

1. The following quality criteria for the provision of medical care of 2018, related to outpatient services are observing the provision of medical care and the initial inspection of the patient.

The fixation of the primary inspection in the patient's map in the future allows you to establish a duration of medical assistance. In addition, the state of the patient at the time of treatment of medical insurance allows you to evaluate its health in the dynamics.

The doctor who rated the gravity of the patient's health status when the first visit may immediately assign detailed diagnostics.

1. Order 203 Criteria for assessing the quality of medical care also includes the item on the appointment of drugs to patients.

It is important that the doctor in his appointments take into account, in what condition is the patient, and picked up a medicine corresponding to its sex, age and a diagnosis, accounted for possible complications.

This criterion is very important - if the expert has been proven that the individual characteristics of the patient when prescribing the medication and have complications, this will be recognized by a medical care defect.

1. Determination of the final clinical diagnosis. New Certificate of Quality Quality 2018 provides that the decision of the doctor must be based on medical standards, clinical guidelines, as well as history data and patient inspection.

Criteria for the quality of medical care in the hospital is more complex for use. This is due to the fact that patients in serious condition often fall on hospitalization, with numerous complications, etc.

Therefore, experts always act in limited time, make decisions very quickly.

Therefore, a new order to control the quality of medical care establishes a harsh time to establish a diagnosis to the patient received to the hospital:

• for 2 hours, a preliminary diagnosis of patient in intensive care and a receiving department must be preliminary;
• within 24 hours, the final diagnosis should be ruled by hospitalized for emergency testimony;
• within 72 hours, clinical diagnosis is established by all patients of the profile compartment.

In addition, the following medical care are relevant for stationary medical assistance:

1. Making a patient full information in the hospital in the hospital, indicating the recommendations of specialists regarding its further observation in the outpatient conditions.
2. Compliance with the procedure for prescribing medicines to patients. Appointments should be made to Medicat, if the decision on the appointment was made by the Doctors Commission - the protocol of such a decision is made.
3. New medical quality criteria for 2018 give experts the opportunity to evaluate the presence of a patient's examination and treatment plan.

The plan should take into account the patient's diagnosis and its current state, the presence of complications and related diseases. The treatment plan is always based on the medical standard of the corresponding profile.