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Number of operations performed

Surgical activity rate (%) = patients leaving the hospital* 100

Number of patients used

Indicators of surgical activity are presented in Table 11 and Fig. 8:

Table 11. Indicators of surgical activity

Rice. Fig. 9. Structure of discharged patients according to Fig. 10. Structure of discharged patients according to

treatment results for 2005 treatment results for 2006

Comparative analysis of indicators for 2005-2006:

1. The staffing level of nursing staff is below standard indicators: in the city by 8.2% in 2005-06, in the republic by 10% in 2005-06.

2 . The average annual bed occupancy in 2006 increased by 6% (32.6 days) compared to 2005. The average annual bed occupancy indicators decreased compared to planned by 21.3% (61.3 days) in 2005, 9.4 % (26.7 days) in 2006

3 . The average duration of treatment for a patient in the department in 2006 increased by 13.7% (0.52 days) compared to 2005. This figure remains below the target by 34% (1.7 days) in 2005 and 15% ( 0.67 days) in 2006

4 . The bed turnover remained the same, but in comparison with planned indicators it was lower in 2005. by 13.2% (9.03 days) and by 12% (8.2 days) in 2006.

5. According to the structure of morbidity in 2005, the prevailing pathologies were: respiratory organs, PRK, gastrointestinal organs, pathology of the skin and subcutaneous tissue, and developmental defects. In 2006, pathology predominated: o. mesadenitis, the number of inguinal hernias increased (since the department of planned surgery was closed for 1 month), the number of genital diseases, poisonings, burns increased, the number of congenital pathologies decreased. The number of other diseases also increased - 14.7%, with the indicators of regulatory documents - no more than 10.5%.

6. The timeliness of delivery for emergency surgical care was found in 2006. lower than in 2005 by 2.3%. In the structure of discharged patients based on the results of treatment in 2005, there is an increase in patients “with improvement” by 0.9% compared to 2006.

7. The frequency of postoperative complications in 2006 increased by 0.08% compared to 2005.

8. The surgical activity rate decreased in 2006 by 0.5% compared to 2005. The decrease in surgical activity is due to the fact that the elective surgery department was closed and elective operations were performed in the emergency surgery department.

9. In the structure of discharged patients, compared to 2005, there is a decrease in the number of patients “with improvement” - by 6%, “with recovery” - by 3% in 2006, and there is also a decrease in the number of patients “without changes” for 2006. compared to 2005 by 1%.

Conclusions:

1. Low rates of average annual bed occupancy for 2005-2006. indicate insufficient use of the department's bed capacity.

2. The increase in the average duration of treatment for a patient in a bed was possibly due to late admission, improved material and technical support of the department, the availability of a wide range of laboratory and instrumental research methods, highly effective modern medications, which allows for more thorough examination and treatment of patients.

3. Bed turnover remained the same, which may be due to the fact that in 2005-2006. A different number of children were admitted for treatment.

4. The rate of on-time delivery decreased in 2006, which is due to self-medication, the inattentive attitude of the local doctor to this problem, and the fault of other hospitals.

5. The number of postoperative complications has increased.

6. The rate of surgical activity has decreased. The decrease in surgical activity is due to the fact that the elective surgery department was closed and elective operations were performed in the emergency surgery department.

7. Thanks to the highly qualified medical personnel and good organization of diagnostic and treatment work, the hospital mortality rate for 2005-2006 was. equal to zero.

Offers:

1. Providing each doctor’s workplace with a personal computer will facilitate the doctor’s work with medical documentation and provide the opportunity to use information from domestic and foreign medical institutions and libraries.

2.Equip wards for mothers with children.

3.Improving material and technical equipment, expanding the patient’s examination plan to exclude the diagnosis of emergency pathology.

4. Mastering modern methods of diagnosis and treatment of patients, leading to improved quality of diagnostic and treatment work and further improvement of department performance indicators.

5..Increasing wages for doctors and paramedics. to the staff.

6. Attracting young specialists to work.

7. Good, kind, sympathetic parents of young patients.

Deputy Ch. vr. according to children chir.:

Head of department:

Student's signature:

HEALTHCARE ORGANIZATIONS

The most important section in the work of all healthcare organizations is activity analysis. It is carried out according to a universal methodology, which involves the sequential implementation of the following stages:

1. Goals and objectives are determined.

2. In accordance with the chosen goals and objectives, the method of study is determined.

3. All indicators necessary for analysis are calculated.

4. The features of the analyzed indicators in various statistical groups are studied.

5. The dynamics of indicators are studied.

6. The reasons and factors that influenced the positive or negative dynamics of the studied indicators are clarified.

7. Treatment and health-improving and medical-organizational

new measures to improve the activities of healthcare organizations with their subsequent implementation into practice.

8. The effectiveness of activities is assessed.

Stage I. Defining goals and objectives.

At the end of the calendar year, the hospital management sets its goal to analyze the activities of the organization and its structural divisions in the reporting year.

To achieve this goal, it is necessary to solve the following tasks:

1. Conduct an analysis of performance indicators reflecting the health status of the population.

2. Assess performance indicators characterizing the activities of the hospital.

3. Study defect rates.

Stage 2. Determining the study method.

To analyze the activities of the hospital, we use the method of system analysis, which involves considering the object under study in the relationship of internal and external factors. In other cases, other methods may be used, for example, historical-analytical, mathematical-statistical, expert assessments, modeling, etc.

Stage 3. Calculation of indicators.

To carry out the analysis, we need to calculate all the indicators that are included in the final results model.

Hospital staff use the appropriate formulas to calculate the following indicators:

― performance indicators reflecting the health status of the population;

— performance indicators characterizing the activities of the hospital;

— indicators of defects.

INDICATORS CHARACTERIZING THE ACTIVITIES OF THE HOSPITAL

1. Provision of the population with inpatient care.

1.1. Number of beds per 1000 population:

number of average annual beds x 1000

1.2. Hospitalization rate per 1000 population:

total number of patients received x 1000

average annual population

1.3. Availability of beds of individual profiles per 1000 population:

number of average annual beds in the department. profiles x 1000

average annual population

1.4. Bed structure:

number of beds for this specialty x 100

total number of hospital beds

1.5. Structure of hospitalized patients by profile:

number of hospitalized patients for this profile x 100

1.6. Level of hospitalization of the child population:

children received (0―15 years) x 1000

Average annual population

.

2.1. Number of beds per position (per shift of doctor, nursing staff):

number of average annual hospital beds (department)

number of occupied positions of doctors, average

medical staff in a hospital (department)

2.2. Staffing of the hospital with doctors and nursing staff:

number of full-time positions of doctors, paramedics

2.3. Part-time ratio of doctors and nursing staff:

Number of occupied positions of doctors, paramedics

number of individuals, paramedical staff

3. Indicators of bed capacity utilization.

3.1. Rhythm of hospitalization (by month, day of week):

number of patients hospitalized in a given month (day of the week) x 100

number of patients hospitalized during the year (week)

3.2. Repeated hospitalization:

Number of patients readmitted to hospital

about the same disease x 100

total number of hospitalized

3.3. Average number of days of bed use (number of days of bed occupancy, number of days of bed operation, bed functioning):

Number of bed days spent by all patients in hospital per year

number of average annual beds

3.4. Fulfillment of the bed occupancy plan (per year, quarter, month):

actual number of bed working days (bed days) x 100

planned number of days the bed is open (bed days)

3.5 Used patients:

number of admitted patients + number of discharged + number of deaths.

To analyze the performance indicators of departments at the hospital level, you can calculate the patient utilization rate taking into account intra-hospital transfers:

admitted to the department + transferred from the department + discharged + transferred to another department + died.

3.6. Bed turnover:

Number of patients used

number of average annual beds

3.7. Average length of stay of a patient in bed:

number of patients used

3.8. Average treatment time for patients with certain diseases:

Number of bed days spent by those discharged

Patients with this disease

Number of patients discharged with this

disease (used patients)

3.9. Average number of bed days closed for repairs per bed:

Number of bed days closed for repairs

number of average annual beds

3.10. Number of bed days of bed downtime for organizational reasons per turn (from the moment of discharge of one patient to the admission of the next patient):

365 ― bed occupancy ― number of days closed for repairs one

bed - number of days of closure for other reasons per bed

bed turnover

3.11. Number of actually working beds:

Number of bed days spent by all patients

number of calendar days in a year (month)

4. Quality and efficiency of inpatient medical care:

4.1. General hospital mortality:

number of deaths in hospital x 100

number of patients used

4.2. Daily mortality

number of deaths within the first 24 hours after

admission to hospital (for this disease) x 100

number of all deaths in hospital (from a given disease)

4.3. Mortality from this disease:

number of deaths from this disease x 100

number of people discharged + deaths from this disease

4.4. Frequency of late delivery of patients for emergency surgical care:

number of patients delivered later than 24 hours from the beginning

diseases regarding this disease x 100

total number of patients delivered for emergency treatment

surgical care for this disease

4.5. Operational activity in the surgical department:

number of operated patients in the department from

number of departures (discharged + transferred + deaths) x 100

number of patients leaving the department

(discharged + transferred + deceased)

4.6. Frequency of postoperative complications:

number of operations in which complications were observed x 100

number of operations performed

4.7. Postoperative mortality:

number of patients who died after the operation x 100

number of patients who were operated on (discharged

Transferred + deceased)

4.8. Structure of surgical interventions:

number of surgical interventions in this regard x 100

total number of operations performed

4.9. Structure of postoperative mortality:

number of deceased patients operated on for this reason x 100

number of operated patients - total

4.10. Length of stay of patients before surgery (pre-operative period):

Number of bed days spent by the operated patient before surgery

number of operated patients (calculated

for certain types of operations)

4.11. Percentage of autopsies of deaths in hospital:

number of autopsies of deaths in hospital x 100

number of deaths in hospital

4.12. Frequency of agreement between clinical and pathological diagnoses:

number of cases of coincidence between wedge and pathologist, diagnoses x 100

number of autopsies

4.13. Indicators of use of auxiliary treatment methods and examinations:

number of procedures performed (studies, tests performed)

number of patients used.

MANAGEMENT, ORGANIZATION AND CONTENT

WORK OF MATERNAL CARE INSTITUTIONS

1. Provision of the population of a given territory with beds of a certain profile:

(Average annual number of beds for a given profile / average annual population) x 10,000.

2. Seasonality of hospitalization:

(Number of people admitted to the hospital in January (February, etc.) / number of people admitted to the hospital) x 100%.

3. Distribution of those admitted to the hospital by day of the week:

(Number of people admitted to the hospital on Monday (Tuesday, etc.) / number of people admitted to the hospital) x 100%,

4. Proportion of planned and emergency hospitalized patients:

(The number of patients admitted to the hospital as planned (or for emergency reasons) / number of patients admitted) x 100%.

BED FUNCTION INDICATORS

1. Average number of days of work (occupancy) of a bed per year:

Number of bed days actually spent by patients in the hospital (department) / average annual number of beds in the hospital (department).

2. Average length of stay of a patient in bed:

Number of bed days spent by patients / number of patients who left*.

* Discharged from the hospital - discharged + deceased + transferred (to other departments, hospitals).

3. Bed turnover:

Number of patients treated (half the sum of admissions and departures) / average annual number of beds.

4. Indicator of bed capacity dynamics:

(Number of beds at the beginning of the reporting year / number of beds at the end of the reporting year) x 100%.

5. Indicator of development of the estimated bed capacity:

((Number of beds actually deployed at the end of the year + number of beds closed for repairs) / number of estimated beds at the end of the year) x 100%.

6. Number of bed days spent per 1000 population:

(Number of bed days spent by patients in a hospital / average annual population) x 1000.

SOME INDICATORS OF THE QUALITY OF INPATIENT MEDICAL CARE

1. Distribution of patients by duration of treatment in hospital:

(The number of patients with this diagnosis who were treated in a hospital for 10 days (11-20, 21-30, 31 and more days) / the total number of patients with this diagnosis who were treated in a hospital) x 100%.

2. Repeated hospitalization during the year:

(Number of patients hospitalized again in a given year / number of hospitalized patients) x 100%.

3. Overall mortality:

(Number of deceased patients / number of dropped out patients) x 100%.

4. Daily mortality (proportion of deaths on the first day of hospital stay):

(Number of deaths in the first 24 hours after admission to the hospital / total number of deaths in the hospital) x 100%.

5. Mortality by department (or bed profile):

(Number of deaths in this department / number of people leaving this department) x 100%.

6. Mortality in certain diseases:

(Number of deaths from a given disease / number of those who retired with a given disease) x 100%.

7. Frequency of coincidences of clinical and pathological diagnoses:

(Number of cases of coincidence of clinical and pathological diagnoses / total number of autopsies of the deceased) x 100%.

INDICATORS OF ORGANIZATION AND QUALITY OF SERVICE FOR PATIENTS IN SURGICAL DEPARTMENTS

1. Surgical activity indicator:

(Number of operations performed on patients who left the surgical department / number of people who left the surgical department) x 100%.

2. Average length of stay of patients in the department before (after) surgery:

Number of bed days spent by patients before (or after) surgery / number of operated patients.

3. The overall average length of stay of operated patients in the hospital:

Number of bed days spent by operated patients / number of operated patients.

4. Structure of surgical interventions:

(Number of operations performed on this occasion / total number of operations) x 100%.

5. Frequency of postoperative complications:

(Number of operations in which complications were observed / total number of operations) x 100%.

6. Overall postoperative mortality:

(Number of deaths after surgery / number of those operated on) x 100%.

7. Postoperative mortality of those operated on for this reason:

(Number of deaths operated on for this reason / number of operations operated on for this reason) x 100%.

8. Structure of postoperative mortality:

(Number of deaths operated on for this reason / total number of deaths from all operations) x 100%.

9. Indicators of emergency surgical care:

a) timely delivery of patients in need of emergency surgical care:

(number of patients delivered earlier than 24 hours (in a timely manner) from the onset of the disease requiring emergency surgical care / total number of patients delivered for emergency surgical care) x 100%;

b ) share of operations performed for emergency reasons:

(number of operations performed for emergency reasons / total number of operations) x 100%.

Health care statistics help the heads of an institution to quickly manage their facility, and doctors of all specialties to judge the quality and effectiveness of treatment and preventive work.

The intensification of the work of medical workers in the conditions of budgetary and insurance healthcare places increased demands on scientific and organizational factors. Under these conditions, the role and importance of medical statistics in the scientific and practical activities of a medical institution are increasing.

Healthcare managers constantly use statistical data in operational and prognostic work. Only a qualified analysis of statistical data, assessment of events and corresponding conclusions make it possible to make the right management decision, contribute to better organization of work, more accurate planning and forecasting. Statistics help to monitor the activities of an institution, manage it promptly, and judge the quality and effectiveness of treatment and preventive work. When drawing up current and long-term work plans, the manager must be based on the study and analysis of trends and patterns of development of both healthcare and the health status of the population of his district, city, region, etc.

The traditional statistical system in health care is based on obtaining data in the form of reports, which are compiled at grassroots institutions and then summarized at intermediate and higher levels. The reporting system has not only advantages (a single program, ensuring comparability, indicators of the volume of work and use of resources, simplicity and low cost of collecting materials), but also certain disadvantages (low efficiency, rigidity, inflexible program, limited set of information, uncontrolled accounting errors, etc. .).

Analysis and generalization of the work done should be carried out by doctors not only on the basis of existing reporting documentation, but also through specially conducted selective statistical studies.

A statistical research plan is drawn up to organize work in accordance with the intended program. The main issues of the plan are:

1) identification of the object of observation;

2) determining the duration of the work at all stages;

3) indication of the type of statistical observation and method;

4) determination of the place where observations will be carried out;

5) finding out by what forces and under whose methodological and organizational leadership the research will be carried out.

The organization of statistical research is divided into several stages:

1) observation stage;

2) statistical grouping and summary;

3) counting processing;

4) scientific analysis;

5) literary and graphic design of research data.

2. Organization of statistical accounting and reporting

Staffing and organizational structure of the medical statistics department

The functional unit of health care facilities responsible for organizing statistical accounting and reporting is the medical statistics department, which is structurally part of the organizational and methodological department. The department is headed by a head – a statistician.

The structure of the department may include the following functional units depending on the form of the health care facility:

1) statistics department in the clinic - is responsible for collecting and processing information received from the outpatient clinic service;

2) hospital statistics department - is responsible for collecting and processing information received from the departments of the clinical hospital;

3) medical archive – is responsible for collecting, recording, storing medical documentation, selecting it and issuing it according to requirements.

The statistics department must be equipped with automated workstations connected to the local network of health care facilities.

Based on the data received, the OMO develops proposals and measures to improve the quality of medical care, organizes the maintenance of statistical records and reporting in all health care facilities in the region, trains personnel on these issues and carries out statistical audits.

Accounting and statistics offices in health care facilities carry out work on organizing a primary accounting system, are responsible for the current registration of activities, correct maintenance of accounting documentation and providing the management of the institution with the necessary operational and final statistical information. They draw up reports and work with primary documentation.

A feature of statistical work is that there are several streams of patient financing - budgetary (attached contingent), direct contracts, voluntary health insurance, paid and compulsory health insurance.

Department of Medical Statistics of the Clinic

The medical statistics department of the clinic carries out work on collecting, processing primary accounting documentation and drawing up appropriate reporting forms for the work of the clinic. The main primary accounting document is the “Statistical Outpatient Patient Certificate”, received in the form of the generally accepted form No. 025-6/u-89.

Every day, after checking and sorting statistical coupons, they are processed. Information from coupons is processed manually or entered into a computer database through a local network program according to the following parameters:

1) the reason for the appeal;

2) diagnosis;

4) belonging to the main production or work with occupational hazards (for the assigned contingent).

Coupons from shop clinics and health centers are processed according to the same parameters.

Monthly and quarterly reports are compiled on the results of the clinic’s work:

1) information on attendance by morbidity with distribution by departments of the clinic, by doctors and by funding streams (budget, compulsory medical insurance, voluntary health insurance, contractual, paid);

2) information on morbidity attendance at day hospitals, home hospitals, ambulatory surgery centers and other types of hospital-substituting types of medical care in a similar form;

3) information on sickness attendance at shop clinics and health centers using the same form;

4) information on the attendance of assigned contingents with distribution by enterprise and category (working, non-working, pensioners, war veterans, beneficiaries, employees, etc.);

5) summary table of attendance by morbidity with distribution by departments of outpatient services and funding streams.

At the end of the year, annual reports of state statistical forms No. 7, 8, 9, 10, 11, 12, 15, 16, 16-VN, 30, 33, 34, 35, 36, 37, 57, 63, 01-S are generated.

Dispensary groups of clinic doctors are processed and a corresponding report is compiled. Reports (general morbidity, 21st class morbidity (form No. 12), XIX class morbidity (form No. 57)). A report in Form No. 16-VN can be generated in a special program. Reports on the work of workshop clinics and health centers, as well as a report f. No. 01-C are formed by manual processing.

Hospital Medical Statistics Department

In the department of medical statistics of the hospital, work is carried out on the collection, processing of primary accounting documentation and the preparation of appropriate reporting forms based on the results of the work of the clinical hospital. The main primary accounting forms are the medical card of an inpatient (form No. 003/u), the card of those leaving the hospital (form No. 066/u), and the sheet recording the movement of patients and hospital beds (form No. 007/u). The department receives primary accounting forms from the admissions department and clinical departments. The received forms are processed daily according to several types.

1. Movement of patients in departments and throughout the hospital as a whole:

1) checking the accuracy of the data specified in form No. 007/u;

2) adjustment of data in the summary table of patient movement (form No. 16/u);

3) surname-by-name recording of the movement of patients in multidisciplinary departments, intensive care units and cardiac intensive care units;

4) entering data on the movement of patients per day into a summary table using statistics software;

5) transfer of the report to the city hospitalization bureau.

2. Entering data into the journal on cancer patients with the issuance of appropriate accounting forms (No. 027-1/u, No. 027-2/u).

3. Entering data into the journal for deceased patients.

4. Statistical processing of forms No. 003/у, 003-1/у, 066/у:

1) registration of medical histories coming from departments in the f. No. 007/у, specifying the profile and timing of treatment;

2) checking the accuracy and completeness of filling out forms No. 066/u;

3) removal from the history of coupons for the accompanying sheet of the SSMP (form No. 114/u);

4) checking the compliance of the medical history code (financing flows) with the admission procedure, the presence of a referral, and the tariff agreement with the Compulsory Medical Insurance Fund;

5) coding of medical records indicating data codes (such as department profile, patient age, timing of admission (for emergency surgery, transfers and deaths), date of discharge, number of bed days, disease code according to ICD-X, operation code indicating the number of days until and after the operation and its indefiniteness in case of emergency surgery, the level of comfort of the room, the category of complexity of the operation, the level of anesthesia, the number of consultations with doctors);

6) sorting medical records by funding streams (compulsory health insurance, voluntary health insurance, paid services or direct contracts financed from two sources).

5. Entering information into a computer network: for compulsory medical insurance and voluntary medical insurance patients and for patients financed from several sources, it is carried out under direct contracts, letters of guarantee. After processing the information, it is transferred to the financial group for further generation of invoices to the relevant payers.

6. Analysis of processed medical records with withdrawal of form No. 066/у and sorting them by department profiles and discharge dates. Submission of medical records to the medical archive.

7. Constant monitoring of the timely submission of medical records from clinical departments according to sheets for recording the movement of patients with a periodic report to the head of the department.

Based on the results of the work of the departments and the hospital as a whole, statistical data processing is carried out and reports are generated. Data is processed from the card of those leaving the hospital, filling out patient distribution sheets by funding streams for each profile and patient distribution sheets for attached enterprises. Cards are sorted by diagnosis for each profile. Based on the grouped information, reports are generated in the table editor:

1) report on the movement of patients and beds (form No. 16/u);

2) a report on the distribution of patients by department, profile and funding stream;

3) a report on the distribution of retired patients among attached enterprises;

4) a report on the surgical activities of the hospital by type of operation;

5) report on emergency surgical care;

6) a report on the surgical work of the departments and the hospital as a whole;

7) report on abortions.

These reporting forms are prepared quarterly, six months, 9 months and a year.

Based on the results of work for the year, national statistical forms No. 13, 14, 30 are compiled.

Statistical recording and reporting must be organized in accordance with the basics of statistical recording and reporting adopted in health care facilities of the Russian Federation, based on the requirements of governing documents, methodological recommendations of the Central Statistical Office, the Ministry of Health of the Russian Federation and additional instructions from the administration.

The activities of health care facilities are taken into account by primary statistical documentation, divided into seven groups:

1) used in a hospital;

2) for clinics;

3) used in hospitals and clinics;

4) for other medical and preventive institutions;

5) for forensic medical examination institutions;

6) for laboratories;

7) for sanitary institutions.

Based on statistical studies, the department:

1) provides the administration with operational and final statistical information for making optimal management decisions and improving the organization of work, including in matters of planning and forecasting;

2) conducts an analysis of the activities of departments and individual services that are part of the health care facility, based on the materials of statistical reports using methods for assessing variability, the typical value of a sign, qualitative and quantitative methods for the reliability of differences and methods for studying the dependence between signs;

3) ensures the reliability of statistical recording and reporting and provides organizational and methodological guidance on issues of medical statistics;

4) compiles annual and other periodic and summary reports;

5) determines the policy in the field of correct registration of medical documentation;

6) participates in the development and implementation of computer programs in the work of the department.

Medical archive designed for collecting, recording and storing medical documentation, selecting and issuing requested documents for work. The medical archive is located in a room designed for long-term storage of documentation. The archive receives medical histories of retired patients, which are recorded in journals, labeled, sorted by department and alphabetically. The archive carries out the selection and issuance of medical histories per month upon request and, accordingly, the return of previously requested ones. At the end of the year, the records of retired patients, medical histories of deceased patients, medical histories of outpatients are accepted for storage, recording, and sorting; final sorting and packaging of medical records for long-term storage is carried out.

3. Medical and statistical analysis of medical institutions

Analysis of the activities of health care facilities is carried out according to the annual report on the basis of state statistical reporting forms. Statistical data from the annual report are used to analyze and evaluate the activities of health care facilities as a whole, its structural divisions, assess the quality of medical care and preventive measures.

The annual report (form 30 “Report of a medical institution”) is compiled on the basis of data from the current accounting of elements of the institution’s work and forms of primary medical documentation. The report form is approved by the CSB of the Russian Federation and is the same for all types of institutions. Each of them fills out that part of the report that relates to its activities. Features of medical care for individual populations (children, pregnant women and women in labor, patients with tuberculosis, malignant neoplasms, etc.) are given in the appendices to the main report in the form of insert reports (there are 12 of them).

In the summary tables of reporting forms 30, 12, 14, information is given in absolute values, which are of little use for comparison and completely unsuitable for analysis, evaluation and conclusions. Thus, absolute values ​​are needed only as initial data for calculating relative values ​​(indicators) for which statistical and economic analysis of the activities of a medical institution is carried out. Their reliability is influenced by the type and method of observation and the accuracy of absolute values, which depends on the quality of registration of accounting documents.

When developing primary documentation, various indicators are calculated that are used in the analysis and evaluation of the institution’s activities. The value of any indicator depends on many factors and reasons and is associated with various performance indicators. Therefore, when assessing the performance of an institution as a whole, one should keep in mind the various influences of various factors on the performance of healthcare institutions and the range of relationships between performance indicators.

The essence of the analysis is to assess the value of the indicator, compare and contrast it in dynamics with other objects and groups of observations, to determine the relationship between indicators, their conditionality by various factors and reasons, to interpret data and conclusions.

The performance indicators of health care facilities are assessed based on comparison with norms, standards, official instructions, optimal and achieved indicators, comparison with other institutions, teams, aggregates over time by year, month of year, day, with subsequent determination of work efficiency.

When analyzing, indicators are combined into groups that characterize a particular function of a healthcare facility, section of work, department or population served. The generalized analysis scheme includes the following sections.

1. General characteristics.

2. Organization of work.

3. Specific performance indicators.

4. Quality of medical care.

5. Continuity in the work of institutions.

United Hospital Annual Report consists of the following main sections:

1) general characteristics of the institution;

3) activities of the clinic;

4) hospital activities;

5) activities of paraclinical services;

6) sanitary educational work.

Economic analysis of health care facilities in the conditions of insurance medicine, it should be carried out in parallel in the following main areas:

1) use of fixed assets;

2) use of bed capacity;

3) use of medical equipment;

4) the use of medical and other personnel (see “Economic Fundamentals of Health Care”).

Below is a methodology for analyzing the activities of health care facilities using the example of a united hospital, but the work of any medical institution can be analyzed using this scheme.

4. Methodology for analyzing the annual report of a merged hospital

Based on the reporting data, indicators characterizing the work of the institution are calculated, for which the analysis of each section of work is carried out. Using the data obtained, the chief physician of the institution writes an explanatory note in which he gives a complete and detailed analysis of all indicators and activities of the institution as a whole.

Section 1. General characteristics of the hospital and its area of ​​operation

The general characteristics of the hospital are given on the basis of the passport part of the report, which indicates the structure of the hospital, its capacity and category (Table 10), lists the medical, auxiliary and diagnostic services included in it, the number of medical areas (therapeutic, workshop, etc.) , equipment of the institution. Knowing the size of the population served by the clinic, it is possible to calculate the average number of people in one area and compare it with the calculated standards.

Table 10

Section 2. Hospital States

The “Staffs” section indicates the staff of the clinic and hospital, the number of occupied positions of doctors, paramedical and junior medical personnel. According to the report table (f. 30), absolute values ​​in the report columns “States”, “Employed”, “Individuals” are considered as initial data.

Column of reporting form No. 30 “States” is controlled and must correspond to the staffing schedule; the “Employed” column during control must correspond to the payroll; in the “Individuals” column, the absolute number of individuals must correspond to the number of work books of the institution’s employees in the personnel department.

The numbers in the “States” column may be greater than or equal to those in the “Employed” column. “Employed” should never exceed the number of full-time positions.

Staffing with doctors

number of occupied medical positions (individuals) x 100 / number of full-time medical positions (normal (N) = 93.5).

Staffing level of nursing staff (by positions occupied and individuals):

number of occupied positions (individuals) of nursing staff x 100 / number of full-time positions of nursing staff (N= 100%).

Staffing with junior medical personnel (by positions and individuals):

number of occupied positions (individuals) of junior medical staff x 100 / number of full-time positions of junior medical staff.

Part-time ratio (KS):

number of occupied medical positions / number of physical. persons in occupied positions.

Example: the number of occupied medical positions is 18, the number of physical. persons in occupied positions – 10 K.S. = 18 / 10 = 1.8.

Optimally, the indicator should be equal to one; the higher it is, the lower the quality of medical care.

Section 3. Activities of the clinic

Comprehensive analysis and objective assessment of the work of the clinic are the basis for effective management of its activities, making optimal management decisions, timely control, clear, targeted planning and, ultimately, an effective means of improving the quality of medical care for assigned contingents.

The activities of the clinic are analyzed in the following main areas:

1) analysis of the personnel composition of the clinic, the state of its material and technical base and provision of medical equipment, compliance of the organizational structure of its departments with the volume and nature of the tasks being solved;

2) health status, morbidity, hospitalization, labor loss, mortality;

3) dispensary work, the effectiveness of ongoing medical and recreational activities;

4) diagnostic and treatment work in the following sections:

a) medical work of therapeutic and surgical departments;

b) work of the hospital department (day hospital);

c) work of diagnostic units;

d) work of auxiliary medical departments and clinic rooms (physiotherapeutic department, exercise therapy rooms, reflexology, manual therapy, etc.);

e) organization and condition of emergency medical care and home care, preparation of patients for planned hospitalization;

f) organization of rehabilitation treatment;

g) defects in the provision of medical care at the prehospital stage, reasons for discrepancies in diagnoses between the clinic and the hospital;

5) organization and conduct of a consultative expert commission and medical and social examination;

6) preventive work;

7) financial, economic and economic work.

The analysis is based on objective and complete accounting of all work carried out in the clinic and compliance with established methods for calculating indicators, which ensures reliable and comparable results.

An essential element of the analysis is to identify the dynamics (positive or negative) of indicators and the reasons that determined its change.

The scope of the analysis of the work of the clinic is determined depending on its frequency. The most in-depth and comprehensive analysis is carried out over the course of a year when drawing up an annual medical report and an explanatory note to it. In the period between annual reports, an interim analysis is carried out quarterly with a cumulative total. Operational analysis, reflecting the main issues of the clinic, should be performed daily, weekly and monthly.

This frequency allows the management of the clinic to know the state of work in the clinic and correct it in a timely manner. During the analysis, both positive results and shortcomings are determined, their assessment is given, and necessary measures are outlined to eliminate shortcomings and improve the work of the clinic.

Analysis of the work of the clinic for a month, quarter, half a year and nine months is carried out in the same areas of activity of the clinic. Additionally, the implementation of treatment and preventive measures for contingents assigned to the clinic for medical support is analyzed. All performance indicators are compared with similar indicators for the corresponding period of the previous year.

Analysis of the clinic's work for the year. All areas of the clinic’s activities are analyzed. In this case, recommendations and methods for calculating medical and statistical indicators are used, set out in the instructions for drawing up an annual medical report and an explanatory note to it.

In order to draw objective conclusions from the analysis of work for the year, it is necessary to conduct a comparative analysis of the performance indicators of the clinic for the reporting and preceding years with the performance indicators of other clinics, with the average indicators for the city (region, district). Within the clinic, the performance indicators of similar departments are compared.

Particular attention should be paid to analyzing the effectiveness of introducing new modern medical technologies into diagnostic and treatment practice, including hospital-substituting ones, as well as implementing proposals to improve the material and technical base.

The degree of fulfillment of assigned tasks by the departments of the clinic and the institution as a whole is assessed, and the compliance of the forces and means available in the clinic with the nature and characteristics of the tasks it solves is reflected.

Statistical analysis is carried out according to the following scheme:

1) general information about the clinic;

2) organization of the work of the clinic;

3) preventive work of the clinic;

To calculate the performance indicators of the clinic, the source of information is the annual report (form 30).

Provision of population with polyclinic care determined by the average number of visits per resident per year:

number of medical visits to the clinic (at home) / number of population served.

In the same way, it is possible to determine the provision of medical care to the population in general and in individual specialties. This indicator is analyzed over time and compared with other clinics.

Doctors’ workload indicator per 1 hour of work:

total number of visits during the year / total number of hours of admission during the year.

Calculated workload standards for doctors are presented in Table 11.

Table 11

Estimated norms of the function of a medical position for different work schedule options

Note. The chief physician has the right to change norms reception in the clinic and home care, however, the annual planned function of positions in the entire institution must be fulfilled

Function of the medical position(FVD) is the number of visits to one doctor working at one rate per year. There are actual and planned FVD:

1) The actual FVD is obtained from the amount of visits for the year according to the doctor’s diary (f. 039/u). For example, 5678 visits per year to a general practitioner;

2) Planned physical activity should be calculated taking into account the standard specialist workload for 1 hour at the reception and at home according to the formula:

FVD = (a x 6 x c) + (a1 x b1 x c1),

where (a x b x c) – reception work;

(a1 x b1 x c1) – ​​work from home;

a – therapist’s workload for 1 hour during an appointment (5 people per hour);

b – number of hours at the reception (3 hours);

c – number of working days of health care facilities per year (285);

b1 – number of hours of work at home (3 hours);

c1 – number of working days of health care facilities in a year.

Degree of FVD fulfillment – this is the percentage ratio of the actual FVD to the planned one:

FVD actual x 100 / FVD planned.

The magnitude of the actual FVD and the degree of implementation are influenced by:

1) reliability of registration form 039/у;

2) work experience and qualifications of the doctor;

3) conditions of admission (equipment, staffing with doctors and paramedical personnel);

4) the population’s need for outpatient care;

5) mode and schedule of the specialist’s work;

6) the number of days worked by a specialist per year (may be less due to the doctor’s illness, business trips, etc.).

This indicator is analyzed for each specialist, taking into account the factors influencing its value (standards for the functions of the main medical positions). The function of a medical position depends not so much on the doctor’s workload at the reception or at home, but on the number of days worked during the year, occupancy and staffing of medical positions.

Structure of visits by specialty (using the example of a therapist, %). The structure of visits to the clinic depends on the staffing level of its specialists, their workload and the quality of registration form 039/у:

number of visits to a therapist x 100 / number of visits to doctors of all specialties (in N = 30 – 40%).

Thus, for each specialist, the proportion of his visits to the total number of visits to all doctors for the year is determined, with an indicator of 95% - no specialized medical care was provided.

Share of rural residents in the total number of visits to the clinic (%):

number of visits to doctors to the clinic by rural residents x 100 / total number of visits to the clinic.

This indicator is calculated both for the clinic as a whole and for individual specialists. Its reliability depends on the quality of filling out the primary accounting documentation (form 039/u).

Structure of visits by type of request (using the example of a therapist,%):

1) structure of visits regarding diseases:

number of visits to a specialist regarding diseases x 100 / / total number of visits to this specialist;

2) structure of visits regarding medical examination:

number of visits for preventive examinations x 100 / total number of visits to this specialist.

This indicator makes it possible to see the main direction in the work of doctors of certain specialties. The ratio of preventive visits for diseases by individual doctors is compared with their workload and time commitment during the month.

With properly organized work, visits for diseases to therapists account for 60%, to surgeons - 70 - 80%, to obstetricians-gynecologists - 30 - 40%.

Home visiting activity (%):

number of home visits made actively x 100 / total number of home visits.

The activity indicator, depending on the ratio of initial and repeat visits, the number of which is determined by the dynamics and nature of the disease (severity, seasonality), as well as the possibility of hospitalization, ranges from 30 to 60%.

When analyzing the indicator calculated using the above formula, it should be borne in mind that it characterizes the volume of active visits to patients at home (an active visit should be understood as a visit made on the initiative of a doctor). To more accurately characterize the activity of this type of visit, it is necessary to differentiate initial and repeat visits and calculate this indicator only in relation to repeat visits, which makes it possible to conduct an in-depth analysis based on the data contained in the “Book of Doctors’ House Calls” (f. 031/u ).

It is advisable to calculate this indicator in relation to patients with pathology that requires active monitoring (lobar pneumonia, hypertension, etc.). It indicates the degree of attention doctors pay to patients. The reliability of this indicator depends both on the quality of keeping records of active visits in accounting form 039/u and the staffing level of doctors, as well as on the structure of diseases in the area. With proper organization of work, its value ranges from 85 to 90 %.

Local public services

One of the main forms of outpatient services to the population is the territorial-precinct principle in providing medical care to the population. The reliability of indicators characterizing local services to the population largely depends on the quality of the doctor’s diary (f. 039/u).

Average population per site(therapeutic, pediatric, obstetric-gynecological, workshop, etc.):

average annual size of the adult population assigned to the clinic / number of areas (for example, therapeutic) in the clinic.

Currently, one territorial therapeutic site in the Russian Federation accounts for an average of 1,700 adults, a pediatric department - 800 children, an obstetric and gynecological department - approximately 3,000 women (of which 2,000 are women of childbearing age), and a workshop - 1,500 - 2,000 workers. Standards of service for doctors in outpatient clinics are shown in Table 12.

Table 12

Estimated standards of service for doctors in outpatient clinics

Indicator of visiting a local doctor at a clinic appointment (%) is one of the leading indicators:

number of visits to a local doctor by residents of their area x 100 / total number of visits to local doctors during the year.

The indicator of locality at the reception characterizes the organization of the work of doctors in the clinic and indicates the degree of compliance with the local principle of providing medical care to the population, one of the advantages of which is that patients in the district should be served by one, “their” doctor (“their” doctor should be considered the local therapist in the event that he constantly works at the site or replaces another doctor for at least 1 month).

From this point of view, the locality indicator, with proper organization of work, equal to 80 - 85%, can be considered optimal. It practically cannot reach 100%, since due to the absence of their local doctor for objective reasons, residents of this area visit other doctors. If the indicator is lower, one should look for the reasons and factors influencing it (inconvenient appointment schedule for the population, absence of a doctor, etc.).

Participation in home service:

number of home visits made by your local doctor x 100 / total number of home visits.

With reliable registration f. 039/у this figure, as a rule, is high and reaches 90 - 95% with sufficient staffing. To analyze the state of medical care at home in order to correct it throughout the year, it can be calculated in relation to individual local doctors and by month.

If the locality indicators decrease below 50–60%, one can make an assumption about a low level of work organization or understaffing, which negatively affects the quality of outpatient services for the population.

Compliance with locality largely depends on the efficient work of the registry, the ability to correctly distribute patients, correctly draw up a work schedule for doctors, and the population size in the area.

Using the data contained in the doctor’s diary (f. 039/u), you can determine repetition of outpatient visits:

number of repeat visits to doctors / number of initial visits to the same doctors.

If this indicator is high (5 - 6%), one can think about the unreasonableness of repeat visits prescribed by doctors due to an insufficiently thoughtful attitude towards patients; a very low indicator (1.2 - 1.5%) indicates insufficiently qualified medical care in the clinic and that the main purpose of repeated visits to patients is to mark a certificate of incapacity for work.

Dispensary services for the population

The source of information on periodic inspections is the “Map of those subject to periodic inspection” (f. 046/u).

To assess the preventive work of the clinic, the following indicators are calculated.

Complete coverage of the population with preventive examinations (%):

number actually inspected x 100 / number to be inspected according to plan.

This indicator is calculated for all contingents (form 30-health, section 2, subsection 5 “Preventive examinations carried out by this institution”). The size of the indicator is usually high and approaches 100%.

Frequency of detected diseases (“pathological involvement”) is calculated for all diagnoses that are indicated in the report per 100, 1000 examined:

number of diseases identified during medical examinations x 1000 / total number of persons examined.

This indicator reflects the quality of preventive examinations and indicates how often the identified pathology occurs in the “environment” of those examined or in the “environment” of the population in the area where the clinic operates.

More detailed results of preventive examinations can be obtained by developing “Dispensary observation cards” (f. 030/u). This allows this group of patients to be examined by gender, age, profession, length of service, duration of observation; in addition, evaluate the participation of doctors of various specialties in examinations, the completion of the required number of examinations per person, the effectiveness of examinations and the nature of the activities carried out for the purpose of improving the health and examination of these contingents.

To obtain a reliable indicator, it is important to timely and correctly issue statistical coupons during medical examinations (f. 025-2/u). The quality of examinations depends on the detection of pathology and its timely registration in accounting and reporting documents. Per 1000 examined, the frequency of detection of hypertension is 15, chronic bronchitis – 13, thyrotoxicosis – 5, rheumatism – 2.

Dispensary observation of patients

To analyze dispensary work, three groups of indicators are used:

1) indicators of coverage with dispensary observation;

2) indicators of the quality of dispensary observation;

3) indicators of the effectiveness of dispensary observation.

The data necessary to calculate these indicators can be obtained from accounting and reporting documents (form 12, 030/у, 025/у, 025-2/у).

The dispensary observation coverage indicators are as follows.

In this group, indicators of the frequency and structure of coverage with dispensary observation (“D”-observation) are distinguished.

1. Frequency indicators.

Coverage of the population with medical examination (per 1000 inhabitants):

is on “D” observation during the year x 1000 / total population served.

Structure of patients under “D” observation, according to nosological forms (%):

the number of patients under “D” observation for a given disease x 100 / total number of dispensary patients.

2. Indicators of the quality of clinical examination.

Timely registration of patients for “D” registration (%) (for all diagnoses):

the number of patients newly identified and taken under “D” observation x 100 / total number of newly identified patients.

The indicator characterizes the work on early registration with “D”, therefore it is calculated from the totality of diseases with a diagnosis established for the first time in life for individual nosological forms. With proper organization of work, this figure should approach 100%: hypertension - 35%, peptic ulcer - 24%, coronary artery disease - 19%, diabetes mellitus - 14.5%, rheumatism - 6.5%.

Completeness of coverage of “D”-observation of patients (%):

the number of patients on “D” registration at the beginning of the year + those newly taken under “D” observation – who never showed up x 100 / number of registered patients who need “D” registration.

This indicator characterizes the activity of doctors in organizing and conducting medical examinations and should be 90–100%. It can be calculated both for the entire dispensary patient population, and separately for those nosological forms, information about which is available in the report.

Frequency of visits:

number of doctor visits made by patients in the dispensary group / number of persons in the dispensary group. Compliance with the terms of medical examinations (observation planning), %:

the number of those undergoing medical examination who complied with the deadlines for appearing for “D”-observation x 100 / total number of those undergoing medical examination.

The percentage of “disconnected” (who have never seen a doctor in a year) is normally acceptable from 1.5 to 3%.

Completeness of therapeutic and recreational activities (%):

completed this type of treatment (health improvement) in a year x 100 / needed this type of treatment (health improvement).

Indicators of effectiveness of clinical observation

The effectiveness of clinical examination is assessed by indicators characterizing the achievement of the set goal of clinical examination and its final results. It depends not only on the efforts and qualifications of the doctor, the level of organization of dispensary observation, the quality of medical and health measures, but also on the patient himself, his material and living conditions, working conditions, socio-economic and environmental factors.

The effectiveness of clinical examination can be assessed by studying the completeness of the examination, the regularity of observation, the implementation of a set of therapeutic and health measures and its results. This requires an in-depth analysis of the data contained in the “Outpatient Medical Record” (f. 025/u) and the “Dispensary Observation Control Card” (f. 030/u).

The main criteria for the effectiveness of clinical examination are changes in the health status of patients (improvement, deterioration, no change), the presence or absence of relapses, indicators of loss of ability to work, a decrease in morbidity and mortality in the dispensary group, as well as access to disability and the results of rehabilitation and re-examination of disabled people who are on “D”-accounting. To assess these changes, a so-called staged epicrisis is compiled for each patient once a year, which is recorded in the “Medical record of the outpatient”. In the stage-by-stage epicrisis, the patient’s subjective state, objective examination data, therapeutic and preventive measures taken, as well as employment measures are briefly recorded. It is recommended to evaluate the effectiveness of clinical examination over a period of 3–5 years.

The effectiveness of clinical examination should be assessed separately by groups:

1) healthy;

2) persons who have suffered acute illnesses;

3) patients with chronic diseases.

The criteria for the effectiveness of clinical examination of healthy people (group I “D”-observation) are the absence of diseases, preservation of health and ability to work, i.e., no transfer to the sick group.

The criteria for the effectiveness of clinical examination of persons who have suffered acute diseases (group II “D”-observation) are complete recovery and transfer to the healthy group.

The indicators characterizing the effectiveness of clinical examination of chronic patients are as follows.

The proportion of patients removed from the “D” register due to recovery:

the number of persons removed from the “D” register due to recovery x 100 / the number of patients who are on the “D” register.

The proportion of patients removed from the “D” register due to recovery is normally acceptable for hypertension - 1%, peptic ulcer - 3%, rheumatism - 2%.

Proportion of patients removed from the “D” register due to death (for all diagnoses):

the number of patients removed from the “D”-registration due to death x 100 / the number of patients on the “D”-registration.

The share of relapses in the dispensary group:

number of exacerbations (relapses) in the dispensary group x 100 / number of people with this disease undergoing treatment.

This indicator is calculated and analyzed for each nosological form separately.

Proportion of patients undergoing “D” observation who did not have temporary disability during the year(VUT):

the number of patients in the dispensary group who did not have VUT during the year x 100 / the number of working persons in the dispensary group.

The share of those newly taken into “D” registration among those under supervision:

the number of newly admitted patients on the “D” registration with this disease x 100/the number of patients registered on the “D” registration at the beginning of the year + newly admitted patients in a given year.

This indicator gives an idea of ​​the systematicity of medical examination work in the clinic. It should not be high, as otherwise it will indicate a decrease in the quality of detection of a particular pathology in previous years. If the indicator is above 50%, we can conclude that insufficient work on clinical examination is being carried out. It is recommended to analyze this indicator by individual nosological forms, since for long-term diseases it is less than 30%, and for quickly curable diseases it can be significantly higher.

Morbidity with temporary loss of ability to work (TL) in cases and days for specific diseases for which patients were registered as “D”(per 100 dispensaries):

number of cases (days) of morbidity with VUT for a given disease among those screened in a given year x 100 / number of people screened for this disease.

The effectiveness of clinical examination is confirmed by a decrease in the value of this indicator when comparing it with the indicator for the previous year (or several years).

Indicator of primary disability of those registered as “D” for the year (per 10,000 dispensaries):

recognized as disabled for the first time in a given year for a given disease among those who are registered as “D” x 1000 / the number of those who are registered as “D” during the year for this disease.

Mortality among patients registered as “D” (per 100 dispensaries):

number of deaths among those on the “D” register x 1000 / total number of persons on the “D” register.

The average number of patients registered at the dispensary at the therapeutic site: it is considered optimal when the local doctor has 100 - 150 patients with various diseases registered with them.

Statistical incidence rates

Overall frequency (level) of primary morbidity (‰):

number of all initial requests x 1000 / average annual number of attached population.

Frequency (level) of primary morbidity by classes (groups, individual forms) of diseases (‰):

number of initial calls for diseases x 1000 / average annual number of attached population.

Structure of primary morbidity by classes (groups, individual forms) of diseases (%):

number of initial calls for diseases x 100 / number of initial calls for all classes of diseases.

Statistical indicators of labor losses

Total frequency of cases (days) of labor loss (‰):

number of all cases (or days) of labor loss x 1000 / average annual number of attached population.

Frequency of cases (days) of labor losses by classes (groups, individual forms) of diseases (‰):

number of cases (days) of labor loss due to all diseases x 1000 / average annual number of the attached population.

Structure of cases (days) of labor loss by classes (groups, individual forms) of diseases (%):

number of cases (days) of labor losses by classes (groups, individual forms) of diseases x 100 / number of cases (or days) of labor losses for all classes of diseases.

Average duration of labor loss cases by classes (groups, individual forms) of diseases (days):

number of days of labor loss by class (groups, individual forms) of diseases / number of cases of labor loss due to skin diseases (injuries, influenza, etc.).

Day hospital performance indicators

Structure of patients treated in the day hospital by class (groups, individual forms of diseases) (%):

the number of patients treated by classes (groups, individual forms) of diseases x 100 / total number of patients treated in a day hospital.

Average duration of treatment for patients in a day hospital (days):

number of days of treatment spent in the day hospital by all patients treated / total number of patients treated in the day hospital.

Average duration of treatment in a day hospital by classes (groups, individual forms) of diseases (days):

number of days of treatment of patients in a day hospital by classes (groups, individual forms) of diseases / number of patients treated in a day hospital by classes (groups, individual forms) of diseases.

Number of days of treatment in a day hospital per 1000 attached population (‰):

number of beds x 1000 / total number of attached population.

Hospitalization rates

Overall frequency (level) of hospitalization (‰):

number of all hospitalized patients x 1000 / average annual number of attached population.

Frequency (level) of hospitalization by classes (groups, individual forms) of diseases (‰):

number of hospitalized patients by classes (groups, individual forms) of diseases x 1000 / average annual number of the attached population.

Structure of hospitalization by classes (groups, individual forms) of diseases (%):

the number of hospitalized people by class (group, individual form) of disease x 100 / the number of all hospitalized people.

Section 4. Activities of the hospital

Statistical data on the work of the hospital is presented in the annual report (form 30-health) in Section 3 “Bed fund and its use” and in the “Report on the activities of the hospital for the year” (form 14). These data make it possible to determine the indicators necessary to assess the use of hospital beds and the quality of treatment.

However, the assessment of the hospital's performance should not be limited to these sections of the report. A detailed analysis is possible only by using, studying and correctly completing primary accounting documentation:

1) medical record of an inpatient (f. 003/u);

2) a journal for recording the movement of patients and hospital beds (f. 001/u);

3) a consolidated monthly record of the movement of patients and beds in the hospital (department, bed profile) (f. 016/u);

4) statistical card of a person leaving the hospital (f. 066/u).

The hospital performance assessment is based on the analysis of two groups of indicators:

1) bed capacity and its use;

2) the quality of diagnostic and treatment work.

Use of hospital beds

Rational use of the actually deployed bed capacity (in the absence of overload) and compliance with the required period of treatment in the departments, taking into account the specialization of beds, diagnosis, severity of pathology, and concomitant diseases are of great importance in organizing the work of a hospital.

To assess the use of bed capacity, the following most important indicators are calculated:

1) provision of the population with hospital beds;

2) average annual hospital bed occupancy;

3) degree of bed capacity utilization;

4) hospital bed turnover;

5) the average length of stay of the patient in bed.

Provision of population with hospital beds (per 10,000 population):

total number of hospital beds x 10,000 / population served.

Average annual occupancy (work) of a hospital bed:

number of bed days actually spent by patients in the hospital / average annual number of beds.

Average annual number of hospital beds is defined as follows:

number of actually occupied beds in each month of the year in a hospital / 12 months.

This indicator can be calculated both for the hospital as a whole and for departments. Its assessment is made by comparison with calculated standards for departments of various profiles.

When analyzing this indicator, it should be taken into account that the number of actually spent bed days includes days spent by patients in so-called attached beds, which are not taken into account in the number of average annual beds; therefore, the average annual bed occupancy may be greater than the number of days per year (over 365 days).

The operation of a bed less or more than the standard indicates, respectively, that the hospital is underloaded or overloaded.

Approximately this figure for city hospitals is 320 – 340 days a year.

Bed utilization rate (implementation of the plan for bed days):

number of actual bed days spent by patients x 100 / planned number of bed days.

The planned number of beds per year is determined by multiplying the average annual number of beds by the bed occupancy rate per year (Table 13).

Table 13

Average number of days of bed use (occupancy) per year

This indicator is calculated for the hospital as a whole and for departments. If the average annual bed occupancy is within the standard, then it is close to 30%; if the hospital is overloaded or underloaded, the indicator will be higher or lower than 100%, respectively.

Hospital bed turnover:

number of patients discharged (discharged + deaths) / average annual number of beds.

This indicator indicates how many patients were “served” by one bed during the year. The rate of bed turnover depends on the duration of hospitalization, which, in turn, is determined by the nature and course of the disease. At the same time, reducing the length of a patient’s stay in a bed and, consequently, increasing bed turnover largely depends on the quality of diagnosis, timely hospitalization, care and treatment in the hospital. The calculation of the indicator and its analysis should be carried out both for the hospital as a whole and for departments, bed profiles, and nosological forms. In accordance with planning standards for general urban hospitals, bed turnover is considered optimal within the range of 25 - 30, and for dispensaries - 8 - 10 patients per year.

Average length of stay for a patient in hospital (average bed day):

number of hospital stays spent by patients per year / number of people leaving (discharged + dead).

Like previous indicators, it is calculated both for the hospital as a whole and for departments, bed profiles, and individual diseases. The approximate standard for general hospitals is 14–17 days, taking into account the profile of beds, it is much higher (up to 180 days) (Table 14).

Table 14

Average number of days a patient stays in bed

The average bed day characterizes the organization and quality of the diagnostic and treatment process and indicates reserves for increasing the use of bed capacity. According to statistics, reducing the average length of stay in a bed by just one day would allow over 3 million additional patients to be hospitalized.

The value of this indicator largely depends on the type and profile of the hospital, the organization of its work, the quality of treatment, etc. One of the reasons for the long stay of patients in the hospital is insufficient examination and treatment in the clinic. Reducing the length of hospitalization, which frees up additional beds, should be carried out primarily taking into account the condition of the patients, since premature discharge can lead to re-hospitalization, which will ultimately result in an increase rather than a decrease in the indicator.

A significant decrease in the average hospital stay compared to the standard may indicate insufficient justification for reducing the length of hospitalization.

Proportion of rural residents among hospitalized patients (Section 3, subsection 1):

the number of rural residents hospitalized in a hospital per year x 100 / the number of all admitted to the hospital.

This indicator characterizes the use of city hospital beds by rural residents and affects the provision of inpatient medical care to the rural population of a given territory. In city hospitals it is 15–30%.

Quality of diagnostic and treatment work at the hospital

To assess the quality of diagnosis and treatment in a hospital, the following indicators are used:

1) composition of patients in the hospital;

2) the average duration of treatment of a patient in a hospital;

3) hospital mortality;

4) quality of medical diagnosis.

Composition of patients in hospital by individual diseases (%):

the number of patients who left the hospital with a certain diagnosis x 100 / the number of all patients who left the hospital.

This indicator is not a direct characteristic of the quality of treatment, but it is the indicators of this quality that are associated with it. Calculated separately by department.

Average duration of treatment for a patient in hospital (for individual diseases):

number of bed days spent by discharged patients with a certain diagnosis / number of discharged patients with a given diagnosis.

To calculate this indicator, in contrast to the indicator of the average length of stay of a patient in a hospital, not discharged (discharged + deceased) patients are used, but only discharged ones, and it is calculated by disease separately for discharged and deceased patients.

There are no standards for the average duration of treatment, and when assessing this indicator for a given hospital, it is compared with the average duration of treatment for various diseases that have developed in a given city or region.

When analyzing this indicator, we consider separately the average duration of treatment of patients transferred from department to department, as well as those re-admitted to the hospital for examination or follow-up treatment; For surgical patients, the duration of treatment before and after surgery is calculated separately.

When assessing this indicator, it is necessary to take into account various factors that influence its value: the timing of the examination of the patient, the timeliness of diagnosis, the prescription of effective treatment, the presence of complications, the correctness of the examination of work ability. A number of organizational issues are also of great importance, in particular the provision of the population with inpatient care and the level of outpatient services (selection and examination of patients for hospitalization, the ability to continue treatment after discharge from the hospital in the clinic).

Estimating this indicator presents significant difficulties, since its value is influenced by many factors that do not directly depend on the quality of treatment (cases started at the prehospital stage, irreversible processes, etc.). The level of this indicator also largely depends on the age, gender composition of patients, severity of the disease, length of hospitalization, and level of inpatient treatment.

This information, necessary for a more detailed analysis of the average duration of treatment for a patient in a hospital, is not contained in the annual report; they can be obtained from primary medical documents: “Medical card of an inpatient” (f. 003/u) and “Statistical card of a person leaving the hospital” (f. 066/u).

Hospital mortality (per 100 patients, %):

number of deceased patients x 100 / number of discharged patients (discharged + deceased).

This indicator is one of the most important and often used to assess the quality and effectiveness of treatment. It is calculated both for the hospital as a whole and separately for departments and nosological forms.

Daily mortality (per 100 patients, intensive rate):

number of deaths before 24 hours of hospital stay x 100 / number of people admitted to the hospital.

The formula can be calculated as follows: share of all deaths on the first day in the total number of deaths (extensive indicator):

the number of deaths before 24 hours of hospital stay x 100 / the number of all deaths in the hospital.

Death on the first day indicates the severity of the disease and, therefore, the special responsibility of medical personnel regarding the proper organization of emergency care. Both indicators complement the characteristics of the organization and quality of patient treatment.

In a consolidated hospital, hospital mortality rates cannot be considered in isolation from home mortality, since selection for hospitalization and prehospital mortality can have a large impact on the level of mortality in the hospital, reducing or increasing it. In particular, low hospital mortality with a large proportion of deaths at home may indicate defects in referral to hospital, when seriously ill patients were denied hospitalization due to a lack of beds or for some other reason.

In addition to the indicators listed above, indicators characterizing the activities of a surgical hospital are also calculated separately. These include the following: Structure of surgical interventions (%):

number of patients operated on for a given disease x 100 / total number of patients operated on for all diseases.

Postoperative mortality (per 100 patients):

number of patients who died after surgery x 100 / number of operated patients.

It is calculated for the entire hospital and for individual diseases requiring emergency surgical care.

Frequency of complications during operations (per 100 patients):

number of operations during which complications were observed x 100 / number of operated patients.

When assessing this indicator, it is necessary to take into account not only the level of frequency of complications during various operations, but also the types of complications, information about which can be obtained when developing “Statistical cards of those leaving the hospital” (f. 066/u). This indicator should be analyzed together with the duration of hospital treatment and mortality (both general and postoperative).

The quality of emergency surgical care is determined by the speed of admission of patients to the hospital after the onset of the disease and the timing of operations after admission, measured in hours. The higher the percentage of patients delivered to the hospital in the first hours (up to 6 hours from the onset of the disease), the better the ambulance and emergency care is provided and the higher the quality of diagnosis by local doctors. Cases of delivery of patients later than 24 hours from the onset of the disease should be considered as a major drawback in the organization of the work of the clinic, since the timeliness of hospitalization and surgical intervention is crucial for the successful outcome and recovery of patients in need of emergency care.

Quality of medical diagnostics in clinics and hospitals

One of the most important tasks of a doctor is to make an early correct diagnosis, allowing timely initiation of appropriate treatment. The causes of misdiagnosis are varied, and their analysis can improve the quality of diagnosis, treatment and the effectiveness of medical care. The quality of medical diagnosis is considered on the basis of the coincidence or discrepancy of diagnoses made by doctors at the clinic and hospital or by hospital doctors and pathologists.

To assess the quality of medical diagnosis in medical statistics, a more precise interpretation of the concept of “incorrect diagnosis” is used:

1) erroneous diagnoses;

2) diagnoses that are not confirmed; when corrected, they reduce the population of cases of a given disease;

3) reviewed diagnoses - diagnoses that are established in the hospital against the background of other diseases; they increase the number of cases of a given disease;

4) incorrect diagnoses – the sum of erroneous and overlooked diagnoses for a particular disease;

5) coincident diagnoses for all diseases - the sum of diagnoses that coincided in the hospital with those established in the clinic;

6) mismatched diagnoses - the difference between the total number of hospitalized patients and patients whose hospital diagnosis coincided with the outpatient diagnosis.

The assessment of the quality of medical diagnostics in the clinic is carried out by comparing the diagnoses of patients made upon referral for hospitalization with the diagnoses established in the hospital. The reporting data does not contain information on this issue, so the source of information is the “Statistical card of those leaving the hospital” (f. 066/u). As a result of comparing the obtained data, it is calculated proportion of incorrect diagnoses:

number of clinic diagnoses that were not confirmed in the hospital x 100 / total number of patients sent with this diagnosis for hospitalization.

This indicator serves as the basis for a more detailed analysis of errors in diagnosing patients sent for inpatient treatment, which may be due to both the difficulties of differential diagnosis and gross miscalculations of clinic doctors.

Assessing the quality of medical diagnostics in a hospital is carried out on the basis of a comparison of clinical (lifetime) and pathological (sectional) diagnoses. The source of information in this case is the “Medical records of an inpatient” (f. 003/u) and the results of autopsies of the deceased.

Indicator of agreement (divergence) of diagnoses (%):

number of diagnoses confirmed (not confirmed) during autopsy x 100 / total number of autopsies for a given reason.

The rate of agreement between clinical diagnoses and pathological diagnoses can be calculated using data from the annual report (Section “Autopsies of deaths in hospitals”) for individual diseases.

The discrepancy between clinical and pathological diagnoses of the underlying disease is about 10%. This indicator is also calculated for individual nosological forms that were the cause of death; In this case, it is necessary to take into account erroneous diagnoses and overlooked diagnoses.

The reasons for the discrepancy between clinical and pathological diagnoses can be divided into two groups.

1. Defects in medical work:

1) brevity of observation of the patient;

2) incompleteness and inaccuracy of the survey;

3) underestimation and overestimation of anamnestic data;

4) lack of necessary x-ray and laboratory tests;

5) absence, underestimation or overestimation of the consultant’s conclusion.

2. Organizational defects in the work of the clinic and hospital:

1) late hospitalization of the patient;

2) insufficient staffing of medical and nursing personnel in medical and diagnostic departments;

3) shortcomings in the work of individual hospital services (reception department, diagnostic rooms, etc.);

4) incorrect, careless maintenance of medical history.

A detailed analysis of discrepancies between clinical and anatomical diagnoses based on reviews and errors is possible only on the basis of a special development of “Statistical cards of those leaving the hospital” (f. 066/u), as well as epicrises filled out for deceased patients.

The analysis of epicrises of the deceased is far from being limited to a comparison of diagnoses - intravital and pathological. Even with complete coincidence of diagnoses, it is necessary to evaluate the timeliness of lifetime diagnosis. In this case, it may turn out that the correct final diagnosis is only the last stage of many incorrect, mutually exclusive diagnostic assumptions of the doctor during the entire period of observation of the patient. If the lifetime diagnosis is made correctly, then it is necessary to find out whether there were any treatment defects that would be directly or indirectly related to the death of the patient.

To compare clinical and pathological diagnoses and analyze epicrises of those who died in the hospital, clinical and anatomical conferences are periodically organized with analysis of each case of discrepancy in diagnoses, which helps to improve diagnosis, proper treatment and monitoring of patients.

Quantitative indicators (coefficients) characterizing the KMP based on the results of examination and questioning

1. Integral intensity factor (K and) is the derivative of the coefficients of medical effectiveness (K p), social satisfaction (K s), the volume of work performed (K ob) and the cost ratio (K z):

K and = K r x K c x K about x K z

At the first stages of work, due to possible difficulties in carrying out economic calculations when determining Kz, we can limit ourselves to three coefficients

K u = K r x K c x K vol.

2. Medical Performance Ratio (K p) – the ratio of the number of cases with achieved medical results (R d) to the total number of evaluated cases of medical care (R):

If the level of K p is also taken into account, then

К р = ?Р i 3 a i / Р,

Where? – summation sign;

Р i – level of the result obtained (full recovery, improvement, etc.);

a i – score of the level of the result obtained (complete cure – 5 points, partial improvement – ​​4 points, no changes – 3 points, significant deterioration – 1 point).

This coefficient can also be considered as a quality coefficient (Kk):

K k = number of cases of complete compliance with adequate technologies / total number of assessed cases of medical care, as well as indicators of the structure of the reasons for the incorrect choice of technology or their non-compliance.

Kr for the institution as a whole is defined as the quotient of the corresponding indicators (Рд and Р) for medical units.

3. Social satisfaction coefficient (K s) – the ratio of the number of cases of consumer (patient, staff) satisfaction (U) to the total number of evaluated cases of medical care (N).

If the degree of satisfaction is also taken into account, then

К р = ?У i x а i / Р,

where Y i is the number of respondents who answered positively to the i-th question (completely satisfied, dissatisfied, etc.);

and i is the score of the level of the result obtained.

When determining this coefficient, only information about patient satisfaction with the medical care provided is taken into account. Provided that “I find it difficult to answer” is marked in all points of the questionnaire, then such a questionnaire is not included in the calculation. If there is a negative assessment in at least one of the points, the patient should be considered dissatisfied with the care provided.

Kc for a medical institution as a whole is defined as the quotient of the corresponding indicators for the medical departments of the institution.

4. Work done ratio (K ob) is one of the most important indicators of the performance of a medical institution and its departments.

K ob = O f / O p,

where O f is the number of medical services actually performed;

О n – number of planned medical services.

The number of completed cases of outpatient or inpatient treatment, studies performed, etc. can be used as indicators characterizing the activities of an institution or its divisions to calculate the volume of work of institutions. It is not recommended to use the “number of visits” as volume indicators when analyzing the volume of work of institutions, since some Doctors can improve this indicator by making unreasonable appointments.

5. Individual load factor (K in) – takes into account the number of patients in comparison with the standard for the position of a doctor of the corresponding clinical profile and the category of complexity of supervision (operation):

K in = N f x 100 / N n,

where Nf is the actual load indicator,

N n – indicator of standard load.

This indicator serves to assess the contribution of each individual medical specialist and assess the quality of care provided to them. In the event that the actual number of patients is below the standard for the doctor’s position, a working time reserve is created. A doctor can develop a reserve by providing advisory assistance, being on duty, monitoring ILC, and providing other additional services.

The head of a healthcare facility has the right to change the workload of an individual doctor, taking into account the nature of the diseases and the severity of the condition of the patients he treats. In addition, the management of the institution, together with the head of the department, must plan the workload of doctors by type in order to distribute it evenly and meet standard indicators.

6. Cost Ratio (K z) – the ratio of standard costs (Z n) to the actual costs incurred for the assessed cases of medical care (Zf):

7. Surgical activity rate (K ha) – the ratio of the number of patients operated on by a specific doctor (N op) to the number of patients treated by a given doctor (N l):

K ha = N op / N l.

This indicator serves to evaluate the performance of surgical specialists.

8. As a qualitative criterion for assessing the activities of nursing staff, it can be used coefficient of compliance with medical care technology (K st), which is calculated by the formula:

K st = N – N d / N,

where N is the number of expert assessments;

N d – number of expert assessments with identified defects in the technology of medical care.

When assessing the values ​​of the obtained indicators, it is recommended to proceed from:

1) a “benchmark” indicator to which all medical workers should strive;

2) the average indicator for the territory (institution, unit), by deviation from which the level of medical care provided by a specific medical worker or unit is assessed;

3) the dynamics of this indicator for a specific medical worker, department, etc.

It is advisable to calculate coefficients quarterly. They can be calculated in the context of departments, the institution as a whole, individual specialists and nosological forms of interest.

Analysis of the activities of a city hospital based on an assessment of relevant indicators allows us to identify shortcomings in the organization of the treatment and diagnostic process, determine the efficiency of use and reserves of bed capacity, and develop specific measures to improve the quality of medical care for the population.

A variety of indicators are used to analyze hospital performance. Conservative estimates suggest that more than 100 different indicators of hospital care are widely used.

A number of indicators can be grouped, as they reflect certain areas of the hospital’s functioning.

In particular, there are indicators characterizing:

Provision of population with inpatient care;

Workload of medical personnel;

Material, technical and medical equipment;

Use of bed capacity;

Quality of inpatient medical care and its effectiveness.

The provision, accessibility and structure of inpatient care are determined by the following indicators: 1. Number of beds per 10,000 population Calculation method:

_____Number of average annual beds _____·10000

This indicator can be used at the level of a specific territory (district), and in cities - only at the level of the city or health zone in the largest cities.

2. Hospitalization rate of the population per 1000 inhabitants (territorial level indicator). Calculation method:

Total number of patients admitted· 1000

Average annual population

This group of indicators includes:

3. Availability of beds of individual profiles per 10,000 population

4. Bed structure

5. Structure of hospitalized patients by profile

6. Hospitalization rate of the child population, etc.

In recent years, such an important territorial indicator as:

7. Consumption of inpatient care per 1000 inhabitants per year (number of bed days per 1000 inhabitants per year in a given territory).

The workload of medical personnel is characterized by the following indicators:

8. Number of beds per 1 position (per shift) of a doctor (nursing medical personnel)

Calculation method:

Number of average annual beds in a hospital (department)

(nursing medical personnel)

in a hospital (department)

9. Staffing of the hospital with doctors (nursing medical personnel). Calculation method:

Number of occupied doctor positions

(secondary medical

____________staff in the hospital)· 100% ____________

Number of full-time positions of doctors

(nursing staff) in hospital

This group of indicators includes:

(Gun G.E., Dorofeev V.M., 1994), etc.

A large group consists of indicators use of bed capacity, which are very important for characterizing the volume of hospital activity, the efficiency of using beds, for calculating the economic indicators of the hospital, etc.

11. Average number of days a bed is open per year (bed occupancy per year) Calculation method:

Number of bed days actually spent by patients in hospital Number of average annual beds

The so-called overfulfillment of the plan for the use of bed capacity, exceeding the number of calendar days in a year, is considered a negative phenomenon. This situation is created as a result of the hospitalization of patients in additional (additional) beds, which are not included in the total number of beds in the hospital department, while the days of hospitalization of patients in additional beds are included in the total number of bed days.

An indicative indicator of average bed occupancy for city hospitals has been set at 330-340 days (without infectious diseases and maternity wards), for rural hospitals - 300-310 days, for infectious diseases hospitals - 310 days, for urban maternity hospitals and departments - 300-310 days and in rural areas - 280-290 days. These averages cannot be considered standards. They are determined taking into account the fact that some hospitals in the country are renovated every year, while others are put into operation again, at different times of the year, which leads to underutilization of their bed capacity during the year. Planned targets for the use of beds for each individual hospital should be set based on specific conditions.

12. Average length of stay of a patient in bed. Calculation method:

Number of bed days spent by patients

Number of patients who left

The level of this indicator varies depending on the severity of the disease and the organization of medical care. The duration of treatment in a hospital is influenced by: a) the severity of the disease; b) late diagnosis of the disease and initiation of treatment; c) cases when patients are not prepared by the clinic for hospitalization (not examined, etc.).

When assessing the performance of a hospital in terms of duration of treatment, departments of the same name and duration of treatment for the same nosological forms should be compared.

13. Bed turnover. Calculation method:

Number of patients treated (half the sum of those admitted,

_________________________________discharged and deceased)__________

Average annual number of beds

This is one of the most important indicators of the efficiency of bed use. Bed turnover is closely related to bed occupancy rates and duration of patient treatment.

Indicators of bed capacity utilization also include:

14. Average bed downtime.

15. Dynamics of bed capacity, etc.

Quality and efficiency of inpatient medical care is determined by a number of objective indicators: mortality, the frequency of discrepancies between clinical and pathological diagnoses, the frequency of postoperative complications, the length of hospitalization of patients requiring emergency surgical intervention (appendicitis, strangulated hernia, intestinal obstruction, ectopic pregnancy, etc.).

16. General hospital mortality rate:

Calculation method:

Number of deaths in hospital· 100%

Number of patients treated

(admitted, discharged and deceased)

Each case of death in a hospital hospital, as well as at home, must be examined in order to identify shortcomings in diagnosis and treatment, as well as to develop measures to eliminate them.

When analyzing the level of mortality in a hospital, one should take into account those who died at home (mortality at home) due to the disease of the same name, since among those who died at home there may be seriously ill people who were unreasonably early discharged from the hospital or were not hospitalized. At the same time, a low mortality rate in the hospital is possible with a high mortality rate at home for the disease of the same name. Data on the ratio of the number of deaths in hospitals and at home provide certain grounds for judging the availability of hospital beds for the population and the quality of out-of-hospital and hospital care.

The hospital mortality rate is calculated in each medical department of the hospital, for individual diseases. Always analyzed:

17. Structure of deceased patients: by bed profiles, by individual disease groups and individual nosological forms.

18. Proportion of deaths on the first day (mortality on the 1st day). Calculation method:

Number of deaths on day 1· 100%

Number of deaths in hospital

Particular attention is paid to the study of the causes of death of patients on the first day of hospital stay, which occurs due to the severity of the disease, and sometimes due to improper organization of emergency care (reduced mortality).

The group is of particular importance indicators, characterizing surgical work in a hospital. It should be noted that many indicators from this group characterize the quality of surgical inpatient care:

19. Postoperative mortality.

20. Frequency of postoperative complications, as well as:

21. Structure of surgical interventions.

22. Surgical activity indicator.

23. Length of stay of operated patients in the hospital.

24. Indicators of emergency surgical care.

The work of hospitals under conditions of compulsory health insurance has revealed an urgent need to develop uniform clinical and diagnostic standards for the management and treatment of patients (technological standards) belonging to the same nosological group of patients. Moreover, as the experience of most European countries that are developing one or another health insurance system for the population shows, these standards should be closely linked to economic indicators, in particular to the cost of treating certain patients (groups of patients).

Many European countries are developing a system of clinical statistical groups (CSGs) or diagnostic related groups (DRJ) in assessing the quality and cost of patient care. The DRG system was first developed and introduced into legislation in US hospitals in 1983. In Russia, in many regions in recent years, work has intensified to develop a DRG system adapted for domestic healthcare.

Many indicators influence the organization of inpatient care and must be taken into account when scheduling hospital staff.

These indicators include:

25. Proportion of electively and urgently hospitalized patients.

26. Seasonality of hospitalization.

27. Distribution of admitted patients by day of the week (by hour of day) and many other indicators.