Objective. To characterize care to patients with AL amyloidosis in accordance with current regulations, to analyze survey data from medical specialists on modern care and to identify current issues in medical education regarding diagnosis and treatment of patients with paraproteinemic hemoblastosis. Material and methods. We analyzed regulatory documents and problematic issues in organization of care for patients with AL amyloidosis taking into account expert assessments from chief hematologists in constituent entities of the Russian Federation. Specialists in care for patients with AL amyloidosis were surveyed. Results. Regulatory acts governing care to patients with AL amyloidosis and status of hematologists as primary specialists for pathogenetic therapy were identified. Patient pathways issues were identified, and potential solutions were proposed (creation of regional regulatory documents regulating patient pathways to receive high-quality care). Survey of specialists identified the need for advanced professional program on organization of care, diagnosis and treatment of patients with AL amyloidosis. Conclusion. Improved treatment of patients with AL amyloidosis is possible in case of state funding for expensive diagnosis and therapy. Correct coding of AL amyloidosis cases will enable organization of a patient registry and outcome monitoring, reduce the period between diagnosis and treatment, as well as facilitate patient pathways. It is necessary to develop and implement advanced educational programs for diagnosis and treatment of AL amyloidosis with practice-oriented training for hematologists, pathologists, and specialists in laboratory testing. Multidisciplinary teams, including hematologist, nephrologist and cardiologist, should be formed to ensure timely diagnosis and treatment, including pathogenetic antitumor targeted therapy.
Objective. To analyze international approaches to assessing the labor complexity for different specialists with higher medical education (physicians). Material and methods. We performed a systematic searching and content analysis of foreign and national studies and documents devoted to labor complexity of different specialists with higher medical education (doctors). A group of experts among the authors of this study discussed and identified significant factors in assessing complexity. Results. There are 2 main systems to assess physician workload complexity in foreign countries. The first approach is based on analysis of «patient complexity» and includes number of comorbidities and prescribed medications, mental disorders, admission and redo admission rate, risk of mortality. The second approach involves assessing the overall workload, including work-related, mental, and emotional stress. After analysis of international and national approaches to assessing the labor complexity of medical stuff, specialists of the Center for Expertise and Quality Control of Medical Care developed a set of 8 factors for assessing the complexity of work of various doctors taking into account specifics of their professional activities. Conclusion. Analysis of international approaches to assessing the labor complexity of medical stuff underlies expert survey to rank various factors of work complexity relative to each other.
Objective. To evaluate economic significance of febrile neutropenia (FN) prophylaxis using granulocyte colony-stimulating factors (G-CSF) in oncology patients receiving antineoplastic drug therapy (ADT) within compulsory health insurance (CHI) system. Material and methods. We compared the total costs of CHI system when using two alternative G-CSF drugs (filgrastim 300 µg for 4 days and empegfilgrastim 7.5 mg once), direct costs of CHI system aimed at reimbursing hospitals for purchase of G-CSF and subsequent savings of CHI funds that could be spent on care for immediate and mid-term (up to 12 months) outcomes of prevented FN. Results. The estimated costs for prevention of FN determined by reimbursing purchase of a medicinal product and cost of care for FN and its consequences at the intermediate and final points of the study amounted to 43.81 billion rubles for filgrastim and 41.89 billion rubles for empegfilgrastim. The difference in such costs for empegfilgrastim (with complete abandonment of filgrastim) demonstrated savings for CHI budget in amount of 1.92 billion rubles/year or 16 071 rubles/year per a patient. Conclusion. Despite higher costs of empegfilgrastim, subsequent reduction of costs following more effective prevention of adverse outcomes will ensure a positive financial result for CHI system over a 12-month period.
Objective. A systematic review of studies on development, implementation and application of surgical safety checklists, as well as attitudes of healthcare workers towards ensuring safety using these checklists in the Russian Federation. Material and methods. The review included publications describing development and/or implementation and/or results of surgical safety checklists and/or attitude of healthcare workers towards surgical safety in the Russian Federation. We reviewed the PubMed, Google Scholar, eLibrary.Ru, CyberLeninka, Yandex (https://ya.ru/) and Google (https://www.google.ru/) platforms using the terms and phrases (in Russian and English) «surgical safety checklist» and «safe surgery checklist». No formal assessment of study quality was conducted. Results. This review indicates local use of surgical safety checklists in several Russian healthcare facilities. In some cases, lower complication rates and better process organization were reported. However, available data are limited in scope, not representative and characterized by low methodological quality (no control groups, standardized assessment criteria and long-term monitoring). Key barriers to checklist implementation include insufficient staff training and resistance from certain healthcare professionals. Successful integration requires educational initiatives and leadership support. Conclusion. Available data in Russia are limited and do not allow for general conclusions about effectiveness of checklists. This determines the need for further research with higher evidence level.
Objective. To assess the methodological quality of Russian clinical guidelines using standards developed by specialists at the Center for Expertise and Quality Control of Medical Care. Material and methods. A meta-epidemiological study included clinical guidelines for the treatment of children. These guidelines were published on the website of the Russian Ministry of Health and approved in 2024. Quality of guidelines was assessed in several stages. The first stage implied analysis of availability and completeness of information provided in section “Methodology of clinical guidelines”. The second stage assessed compliance of the stated development process with the actual one. All references included in abstracts of guidelines were checked for availability in appropriate databases and compliance with stated searching depth and appropriate publication type. Results. The study included 51 clinical guidelines. All guidelines provided information on methodology. However, comprehensiveness varied and was often insufficient. All guidelines did not provide criteria for inclusion of evidence sources or strategy for their searching and selection. Critical assessment of quality of sources was provided in only one-third of guidelines. Systematic and/or statistical methods of data analysis were not described in all guidelines. Assessment of compliance of the stated development process with the actual one was possible for only half of guidelines. The stated development process matched the actual one in none case. Conclusion. The recently approved Russian clinical guidelines are characterized by unsatisfactory methodological quality and do not comply with the stated development process.
Objective. To analyze psychological and pedagogical concepts, as well as data on effectiveness of game-based approaches to substantiate design of simulator for development of clinical reasoning. Material and methods. We reviewed the PubMed, Scopus, and eLibrary databases regarding self-determination theory, flow theory, Bedwell’s taxonomy, systematic reviews of gamification and Russian regulatory documents. Results. Gamification and cognitive simulations are effective for knowledge acquisition (SMD 0.40—1.95), while VR simulators are effective for motor skills. Clinical reasoning remains the least explored. The following mechanisms of engagement have been identified: autonomy, competence, connectedness, and flow. Conclusion. The identified gap justifies the need to create a digital simulator. A conceptual model integrating game mechanics with clinical scenarios and adapted to requirements of Russian medical education system is proposed. These results underlie subsequent development and validation of the tool.
The content and/or weight coefficients of Russian diagnosis-related groups (DRG) for inpatient and day care payment have been updated for 2026. Following clinical guidelines, changes were made in DRG for payment of therapy for malignant neoplasms in adults, intestinal infections and infections caused by polyresistant microflora. Six new groups were formed to pay for preimplantation genetic testing in fertilization in vitro (IVF). Weight coefficients of DRG for the treatment of chronic viral hepatitis B and C, for using genetically engineered biological agents and selective immunosuppressants, as well as IVF were recalculated. Three new groups were formed in medical rehabilitation profile. Accounting for the dose of normal human immunoglobulin in the treatment of complex neurological diseases was introduced.
Increasing the coverage of patients with chronic cardiovascular diseases with regular medical checkups and expanding the free drug provision program remain key public policy objectives. Prototyping as a tool for adaptive optimization of centralized drug provision in federal project «The fight against cardiovascular diseases» is presented. Prototyping is interpreted as a mechanism for flexible resource management and proactive modeling of procurement planning and drug write-off processes in real time. This mitigates management risks. Under regulatory dynamics and changing clinical guidelines, this model enables prompt adjustments to procurement parameters, supply volumes and logistics decisions based on up-to-date data on patient needs. This underlies transition from retrospective control to proactive resource management. Formalizing the project using the function-process model provides a basis for iterative hypothesis testing and rapid decision adjustments. This approach creates end-to-end management data framework ensuring traceability of information flow at all stages of procurement lifecycle (from demand generation to subsidy utilization reporting). The Boehm spiral in procurement practices avoids formulaic tenders, improves alignment of stakeholder requirements and expedites regulatory updates. Prototyping should be considered a socially oriented tool for adapting innovations in management of regional healthcare projects. Spiral approach allows for phased testing of management decisions before their scaling. This reduces the likelihood of systemic errors and ensures controllable adoption of uncertainty. Spiral prototyping is reasonable for adaptive optimization of centralized drug supply for patients with cardiovascular diseases. The function-process model and Boehm spiral reduce management risks and minimize write-offs. Integration of spiral logic into the project participant interaction architecture ensures alignment of functions, processes and data creating a stable management framework capable of adapting to changing budget constraints and federal program requirements.
Objective. To evaluate the effectiveness of lean technologies for standardization of elective hospitalization process in outpatient polyclinics of the Moscow region. Material and methods. The study was conducted in 2 polyclinics of the Moscow region. Value stream mapping, time tracking, and patient surveys were used. Standard operating procedures (SOPs) for elective hospitalization were developed and implemented. Results. Lean technologies enabled creation and adoption of unified SOPs. This resulted in a 5—6-fold reduction of time for patient registration for elective hospitalization, decreased number of polyclinic visits from 6.2 to 2.4, and significant increased patient satisfaction from 31% to 68%. Opening of specialized hospitalization rooms made it possible to achieve a throughput of up to 800 patients per month. Patient pathway standardization eliminated duplicate examinations, reduced time and logistical costs, as well as improved process transparency and manageability. Conclusion. Organizational technology for standardizing the elective hospitalization process based on lean technologies is effective and reproducible at pilot sites in the Moscow region. These results may be recommended for adoption in other regions of Russia, taking into account local conditions.
Objective. To develop a methodology for automated sociological survey data processing and to create a prototype of innovative information-analytical system for presenting results in graphical form and formalized textual format to support decision-making in healthcare. Material and methods. The study was based on a demonstration dataset designed to assess preparedness of healthcare organizations for emergencies. Each record in dataset included demographic and professional characteristics of respondent, as well as answers to 25 questions covering key aspects of preparedness for emergencies (presence of plans for epidemics and disasters, resources, training, interaction with emergency services, etc.). Data preprocessing included removal of missing entries and duplicates, validation via a derived variable and outlier detection using interquartile range. Exploratory data analysis was conducted using descriptive statistics and visualization. For group comparisons, a suite of statistical tests was applied. Natural language processing (NLP) methods were applied for processing of open-ended text responses. Textual responses were converted into quantitative assessments or thematic categories using semantic modeling and classification (a pre-trained RuBERT model was used). Results. A prototype of information-analytical system (IAS) for automated survey data processing was developed. This prototype was tested on survey of medical professionals evaluating preparedness of healthcare organizations for emergencies. The system is built on open technology stack and includes modules for data storage, processing (cleaning and aggregation), analysis of textual responses, and visualization of results providing a complete cycle of transforming raw survey data into informative reports. The information-analytical system ensures comprehensive analysis of large-volume survey data, identification of hidden patterns, and creation of interactive dashboards, charts, summary tables, and heatmaps. This tool enables healthcare professionals to obtain significant and up-to-date information on preparedness of healthcare system, particularly for emergencies and global challenges. Conclusion. The study demonstrated the feasibility of integrating classical statistical analysis methods and NLP technologies on a single platform to assess healthcare system preparedness for emergencies. Original IAS is effective as a decision-making support tool. This system allows for transforming disparate survey data into quantitative indicators, promptly identifying problem areas in healthcare system and tracking their changes over time. The proposed methodology can be scaled and adapted to other tasks contributing to accelerated digital transformation of healthcare system.
The authors analyze the prospects of a unified methodology for calculating care cost funded by public sources. This issue is important due to growing demand for care, more complex treatment technologies, limited budgetary resources and the need to improve validity and transparency of care cost calculations. The Russian healthcare system has many disparate methods for calculating the cost of care differing in objectives, funding sources and details. This leads to incomparable results and insufficient transparency, as well as complicates financial management. A unified methodology as a basic concept for all participants in healthcare system is proposed. The key principles of this methodology are uniform units of calculation (medical service and case of care), separation of costs into direct and indirect ones, as well as combination of normative and actual approaches to their determination. Flow charts allowing for detailed cost structure and ensuring comparability of calculations are an important tool. This methodology is highly flexible and adaptable to various types of care. Its application to funding through the Circle of Kindness foundation, clinical trials, high-tech personalized interventions (including mRNA vaccines) and calculation of reimbursement for procurement and storage of blood plasma is discussed. In each case, basic principles are preserved, while specific features are taken into account by detailing the cost structure and introducing additional calculation elements. Particular attention is paid to prospects of this methodology. Key areas include further unification of approaches for various financing channels, digitalization of calculations and integration with medical information systems. This will automate processes, improve calculation accuracy, and ensure monitoring of resource efficiency. Thus, a unified methodology is seen as foundation for improving efficiency, transparency, and sustainability of healthcare system.
Objective. To identify strengths and weaknesses of weal-world evidence (RWE) studies in Russia, needs and proposals in this area. Material and methods. The study used the method of semi-structured in-depth interviews with experts in RWE: 10 pharmaceutical companies, 6 contract research organizations and 3 providers of study infrastructure. There were 19 expert interviews between September 23, 2025 and November 14, 2025. Each one included 23 questions combined into 4 blocks: 1) description of respondents, 2) problems in RWE studies, 3) ensuring the quality of RWE studies, 4) regulatory needs. Results. Analysis of responses revealed 9 main categories reflecting the key barriers for RWE studies. All respondents noted barriers in such areas as regulatory and legislative aspects, study planning; 94.7% of experts — interaction between RWE study sites, competencies and expertise, data quality; 89.5% of respondents — agreement and coordination, 73.7% — budget and financing, 52.6% — standardization, 10.5% — technical and infrastructure constraints. All three groups of respondents unanimously identified the following critical problems: RWD quality, regulatory uncertainty (lack of significant regulations for decision-making), lack of competences, and significant underestimation of RWE study complexity. Conclusion. Only institutionalized quality management at all levels of study, supported by regulatory framework, centralization of data and certification of market participants can ensure that RWE studies are recognized by the state as an equal source of evidence for medical, regulatory, and economic decision-making.
Objective. Cost-effectiveness analysis of screening for type 1 diabetes (T1D) in 6-year-old children by measuring autoantibodies to beta-cell and pancreatic islet antigens followed by longitudinal monitoring of individuals with positive results. Material and methods. The Markov model was used to predict efficacy, direct and indirect costs for three screening scenarios in 6-year-old children after testing for autoantibodies to beta-cell and pancreatic islet antigens: 1) general population; 2) first-degree relatives (FDR); 3) children with autoimmune diseases (AID). For each scenario, two cohorts (screening vs no screening) were simulated over a 50-year time horizon, and incremental cost-effectiveness ratios (ICER) were calculated using quality-adjusted life year (QALY). Results. Across all three scenarios, T1D screening reduced mortality and incidence of long-term complications by preventing diabetic ketoacidosis (DKA) at disease onset and increased QALY. The largest numbers of prevented long-term complications were observed in FDR and AID scenarios: by 18 years for diabetic neuropathy and by 56 years for lower extremity amputation and end-stage chronic kidney disease. In FDR and AID scenarios, ICER fell below 2.3 million rubbles after 7 years. After 16 years, ICER became negative that indicated cost savings alongside higher clinical benefit. In general population, ICER fell below 2.3 million rubbles after 28-year modelling and amounted to 2.287.652.27 RUB per QALY gained. Conclusion. In high-risk groups (FDR and children with AID), T1D screening followed by monitoring of autoantibody-positive individuals is economically justified for Russian healthcare system. In general population, cost-effectiveness emerges only over a long-term horizon (after 28 years). This highlights the need for long-term planning and confirming key clinical effects of screening in routine practice during program scale-up (reduced proportion of DKA at onset and early-disease HbA1c trajectories).
Objective. To assess the clinical and economic feasibility of using CDK4/6 inhibitors (abemaciclib, ribociclib) in adjuvant therapy of luminal HER2-negative breast cancer (BC). Material and methods. Socio-economic consequences of CDK4/6 inhibitors (abemaciclib and ribociclib) application in adjuvant therapy regimes in patients with HR+HER2-negative BC were evaluated. The analysis included patients with affected lymph nodes, similar in their characteristics to patients from the MonarchE randomized clinical trial (RCT) and patients with N1—3 status of the lymph nodes from the NATALEE RCT. Mathematical modeling was used to evaluate the clinical efficacy of adjuvant endocrine therapy (ET) with CDK4/6 inhibitor and without it in a hypothetical cohort of 1000 people within 5 and 10 years based on a calculated risk of recurrence and death. Direct medical costs for adjuvant therapy, drug treatment of metastatic BC in case of the disease progression, indirect (supplementary) costs associated with loss of gross domestic product (GDP) due to disability, as well as the value of the incremental cost-effectiveness ratio and the return on investment indicator per 1 invested rouble were predicted. Results. The use of CDK4/6 inhibitors (abemaciclib and ribociclib) in regimens of ET of HR+HER2-negative BC with affected lymph nodes leads to a statistically significant threat of adverse events (death or progression) compared to ET (threat ratio 0.70 (95% CI 0.64; 0.77). Based on a hypothetical cohort of 1000 patients, the decrease in the number of adverse events over 5 and 10 years would be 53 (27.9%) and 89 (25.7%) events, respectively. The estimated costs of CDK4/6 inhibitors application are significantly higher than that of standard adjuvant ET. However, considering the reduced risk of progression of the disease in presence of the therapy with abemaciclib and ribociclib, lower costs for treatment of the progressive disease — metastatic BC — for the population of patients have been noted for 5 and 10 years by 35.0 and 36.8%, respectively. The return on investment indicators per 1 invested rouble, taking into account the avoided loss of GDP and lower costs for therapy at the stage of progression in the group of adjuvant therapy with CDK4/6 inhibitors were 0.14 RUB and 0.52 RUB excluding discount, 0.13 RUB and 0.36 RUB considering 5% discount on the 5- and 10-year modelling horizon, respectively. Conclusion. The use of CDK4/6 inhibitors (abemaciclib, ribociclib) in adjuvant therapy of luminal HER2-negative breast cancer may be clinically and economically feasible, thus the analysis results should be updated in the future taking into account the availability of data from ongoing clinical trials.
Objective. To develop prognostic models of the individual risk of developing chronic non-communicable diseases (CNCDs) with integration of sociomedical determinants in the population of persons older than working age (POWA) using artificial intelligence. Material and methods. Modeling and prediction of CNCDs in POWA through the use of artificial intelligence consisted of studying the prevalence of CNCDs per surveyed person by performing preventive medical examinations of 5170 people aged 60—95 years, analyzing the prevalence of risk factors in POWA with CNCDs, formation of the variance complexes, quantification of the effect size (η²) of risk factors on the development of CNCDs. In addition, calculations of normalized intensity indicators, relative risk and prognostic coefficient were carried out. Individual prediction matrix and software for artificial intelligence were developed. Results. It has been established that there was an average of 3.3 cases of CNCDs per surveyed person in the 60—65 age group compared to 4.9 in the subjects aged 90 and older. The degree and proportion of the impact of both individual factors and the set of sociomedical factors on the development of CNCDs have been determined as well. A matrix of individual prediction of the probability of CNCDs occurrence, which can be used to manage the risk factors, has been proposed in order to determine the weighted prognostic risk factors for development of CNDCs. Standardized intensity indicator, relative risk and prognostic coefficient of these diseases have been identified. A flow-synthesis algorithm for artificial intelligence on modeling CNCDs in POWA has been created. Conclusion. A program using artificial intelligence for modeling and prediction of CNCDs in POWA creates conditions for the implementation of measures for reduction of the risk of developing this pathology. The proposed program will allow to minimize healthcare costs and improve patients’ quality of life. The application of software with artificial intelligence and constantly updated database in medicine can contribute to the effective implementation of preventive measures for persons older than working age, which will reduce the incidence of CNDCs.
The issue of patient adherence to treatment and compliance of medical practice with existing standards remains relevant in all areas of medicine. This aspect is the most studied in relation to the treatment of chronic diseases. Adjuvant hormone therapy for breast cancer is one the leading directions in oncology. Patients who adhere to the doctor’s recommendations are more likely to achieve their treatment goals. The applied methods can be divided into two main groups: direct and indirect. Each of them has its own limitations, and the choice of a specific method depends on the study objectives. Doctors who adhere to the established practices ensure consistent quality of the provided medical care. Questionnaire survey of specialists about the regulations included in official guidelines is one of the most common methods for assessment of doctors’ adherence to treatment standards. This method is not perfect because it is subjective, but there are no alternatives. Effective implementation of medical advances in clinical practice depends directly on the degree of adherence of doctors to up-to-date guidelines and patients — to specialist assignments.
Objective. To study the opinion of experts on supporting measures for young professionals in health care. Material and methods. In 2024, a survey of 28 experts holding senior overhead posts in the state medical organizations of the Stavropol Territory was carried out. Descriptive statistics of the survey results is presented by relative indicators calculated per 100 respondents and expressed as a percentage. Arithmetic mean and standard deviation were used to describe the quantitative data. Results. The mean age of experts was 56.5±7.3 years, total medical experience — at least 15 years, length of service on senior positions in health care — not less than 10 years. According to the experts, high level of infrastructure development (60.7%), proximity of human settlement to the regional center (53.6%) and possibility to live and work in their birthplace (46.4%) are among the priority factors for young doctors in choice of their place of work. In the experts’ assessment of the attractiveness factors of work in public health organizations for young doctors, such parameters as stability of salary (4.61±0.96 scores), availability of annual paid leave (4.46±0.96 scores) and resilience of the organization during crisis periods (4.39±1.03 scores) obtained the highest rating. Insufficient material and technical equipment ranked first — 3.46±1.45 scores, insufficiently comfortable living conditions ranked second — 3.43±1.45 scores among the shortcomings of work in public health organizations for young doctors in the opinion of experts. Insufficient salary level (3.29±1.56 scores) and restrictions of the doctor’s activity by established standards (3.29±1.56 scores) received the same estimate and the third ranking position. Benefits provided to medical workers (3.25±1.1.79 scores), opportunities for prospects and career advance (2.96±1.73 scores) as well as possibility of independent life (2.71±1.65 scores) could be the main factors for attracting young doctors to work in rural health organizations. Conclusion. The opportunity of professional and career development is the main factor that can attract young doctors to the medical profession, and the possibility of financial stability and security should be first of all the factor of choice of professional trajectory of medical school graduates. The desire to be a specialist of a narrow profile is an important factor that attracts graduates of medical universities for the work in the chosen specialty. Experts believe that the high level of infrastructure development influence the young doctor’s choice of location for his job.
A scientific review, which summarizes and critically interprets previously published information posted in Scopus, Web of Science, PubMed, eLibrary.ru, CyberLeninka databases on the application of artificial intelligence (AI) technologies in the diagnostic process, treatment, prediction of cardiovascular diseases and optimization of intervention procedures, was presented. Search period — 8 years. Real application of AI in clinical practice has been considered. It has been shown that the use of AI based on machine learning and deep learning algorithms offers unique opportunities for analyzing large volumes of medical data, interpreting the results of instrumental research methods (echocardiography, electrocardiography, computed tomography angiography, computed tomography of the heart, magnetic resonance imaging) and assessment of the risk of adverse cardiovascular events. Machine learning methods can complement and extend the traditional statistical methods of AI algorithms. Deep learning is a subdomain of machine learning and is characterized by algorithms that are based on the principle of human brain work, including a class of algorithms called neural networks. Artificial, recurrent and convolutional neural networks have been used in interventional cardiology. Artificial neural networks can be used in robotic systems and neural interfaces, providing energy-efficient real-time signal processing. Convolutional networks are used for medical image processing, assisting in organ segmentation, pathology detection and navigation during operations, and recurrent networks — for analysis of the dynamic indicators of data and prediction of complications. Together, these technologies improve diagnostic accuracy, reduce risk and optimize intervention course. Thus, the introduction of AI in the interventional cardiology opens new horizons for diagnosis, treatment and prediction of cardiovascular diseases. The high efficiency of modern machine learning algorithms in analyzing the results of instrumental research methods, processing large amounts of data and detecting genetic markers of cardiovascular diseases has been shown. However, the introduction of AI into interventional cardiology faces a number of challenges despite significant progress. In the long term, AI is expected to become an integral part of interventional cardiology, making treatment more accurate, safe and affordable.
Objective. To develop a tool for assessing and predicting potential risks when implementing innovative medical technologies in multi-specialty hospitals. Material and methods. A systematic analysis of the scientific literature and legal framework was carried out. The search for publications was done in PubMed and eLibrary databases, regulatory acts — in ConsultantPlus and Garant systems by keywords related to the implementation of medical technologies. Risk factors were identified and systematized in 124 selected sources (97 publications and 27 regulations) by means of content analysis and classification grouping. Results. Classification of risks including four groups was developed: A. Legal (lack of license, intellectual property infringement, insufficient accreditation of staff); B. Organizational (redistribution of load, staffing schedule changes, need for training); C. Financial (absence of quotas and adequate funding in the system of compulsory health insurance, costs for staff motivation); D. Infrastructural (increase in the time of use of premises and facilities, need for repairs). Management measures were proposed for each group. A scoring system in which each risk category is rated at 1 score (maximum cumulative number of scores — 12), which allows to perform a quantitative ranking of the risk level, was presented. Conclusion. The proposed tool provides a structured approach to risk management, allowing prioritization of organizational and managerial decisions at the stages of planning and direct implementation of innovations in a multi-specialty hospital. Its application contributes to increase in the validity and effectiveness of the introduction of new medical technologies.
Objective. To evaluate the effectiveness of a multidisciplinary approach to emergency care provision for patients with purulent-septic complications of neuropathic and neuro-ischemic forms of diabetic foot syndrome and lower extremity peripheral artery disease at the Center for Rescue of Extremities of the St. George City Hospital and compare this approach with previously applied one in settings of surgical hospital and lack of specialized vascular care. Material and methods. A single-center cohort retrospective study was carried out. Demographic and laboratory data, information on interventions performed for patients with diabetic foot syndrome (DFS) and lower extremity peripheral artery disease (LEPAD) in 2022—2024 were analyzed. The following clinical outcomes were evaluated: mortality, frequency of minor and high amputations, as well as economic outcomes: number of hospitalizations per year, their duration and cost. Results. Information about 1680 patients has been obtained. Elderly and senile patients with poor control of glycemia and lipid profile predominated. The frequency of performing high amputations in patients with neuro-ischemic form of DFS was 4.66%, with neuropathic — 2.26%, in patients with LEPAD — 3.8%. None of the evaluated indicators had a statistically significant influence on the probability of high amputation performance. The highest costs were related to the treatment of patients with neuro-ischemic DFS (478 277.75 RUB), the lowest — with neuropathic DFS (112 942.6 RUB). Conclusion. Multidisciplinary approach to the treatment of patients with diabetic foot syndrome and lower extremity peripheral artery disease allowed to reduce the frequency of high amputations. Compliance with continuity between the inpatient and outpatient stages is necessary to ensure timeliness and quality of health care for patients with this pathology, as well as to reduce the costs of its provision.
