Medical statistics. Cheat sheet: briefly, the most important

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Medical statistics. Cheat sheet: briefly, the most important

Lecture notes, cheat sheets

Directory / Lecture notes, cheat sheets

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Table of contents

Introduction to Medical Statistics
Medical statistics, morbidity, disability, mortality
Polyclinic activities
Clinic work. Hospitalization
Medical care of the rural population
First aid and urgent care
Tasks of the regional hospital
Methods for studying public health
Demography
Mechanical and natural population movement
Basic Fertility Indicators
Key mortality rates
Infant mortality rates
Infant mortality and perinatal mortality rate
Maternal mortality rate
Physical development
Anthropometric measurements
Methods for studying physical development
Technique of variation - statistical development of anthropometric data. Derivation of physical development standards using the index method
Assessment of physical development by the method of sigma deviations
Assessment of physical development on a regression scale
Methodology of group assessment of physical development. Acceleration
Morbidity. Methodology for studying general morbidity
Methodology for studying infectious morbidity
Methodology for studying the most important non-epidemic diseases
Methodology for studying hospitalized morbidity. Methodology for studying morbidity according to medical examinations
Methodology for studying morbidity with temporary disability and according to data on the causes of death
Targeted medical examinations
Disability
Disability rates
Rehabilitation indicators
International Classification of Diseases and Related Health Problems
The concept of a "family" of classifications of diseases and related health problems
Organization of statistical work of a medical institution
Department of medical statistics of the polyclinic. Medical archive
Department of Medical Statistics of the Hospital
Medical statistical analysis of medical institutions
Methodology for Analyzing the Annual Report of the Consolidated Hospital
Analysis of the work of the polyclinic
FVD
District public services
Dispensary services for the population
Indicators of the effectiveness of dispensary observation
Statistical indicators of morbidity, labor losses. Hospitalization rates
Hospital activities.
Hospital activities. The quality of the medical and diagnostic work of the hospital
The quality of medical diagnostics in the clinic and hospital
Quantitative indicators (coefficients) characterizing the ILC based on the results of the examination and questioning
Health Efficiency and Its Types
Analysis of the use of fixed assets of a medical institution
Indicators recommended for conducting an analysis of the economic activity of a polyclinic
Renovation of fixed assets. Analysis of the financial costs of health care institutions
Analysis of the effectiveness of the use of beds
Methodology for calculating economic losses from idle beds
Usage analysis
Prevented economic damage. Criteria of economic efficiency. Analysis of the effectiveness of the use of medical equipment

1. Introduction to medical statistics

Statistics - social science that studies the quantitative side of mass social phenomena in close connection with their qualitative side.

Statistics that study issues related to medicine and health care is called medical statistics.

Medical statistics is divided into two sections:

1) population health statistics;

2) health statistics.

Health status - This is an indicator that gives a medical assessment of the health of the population on the basis of a set of specially taken into account signs.

Depending on the state of health, according to preventive examinations, persons are divided into groups III.

Group I - healthy individuals who do not show any complaints, do not have a history of chronic diseases or dysfunctions of individual organs and systems, in whom no deviations from the established normal limits were found during the examination.

Group II - practically healthy individuals with a history of acute and chronic diseases that do not affect the functions of vital organs and do not affect the ability to work.

Group III - patients with chronic diseases requiring systematic medical supervision:

1) with compensated;

2) with subcompensated;

3) with decompensated course of the disease.

Physical development - an indicator that gives a medical assessment of the health status of a certain team or individual based on the totality of basic anthropometric data, indicators of physical performance and nutritional status.

Incidence The population characterizes the prevalence of diseases over a certain period of time.

Initial contact the first time a patient seeks medical help from a doctor about a disease is considered.

Re-appeal an appeal to a doctor about an acute disease (with an extension of treatment) or the same chronic disease is considered.

Primary incidence This is the sum of new, nowhere previously registered and newly detected diseases.

Under general morbidity refers to the sum of all (primary and repeated) requests for medical care.

The unit of account in the study of infectious morbidity is each case of an infectious disease, and in the study of injuries - a case of injury that entailed loss of work or death of the patient.

2. Medical statistics, morbidity, disability, mortality

Morbidity with hospitalization (hospitalization) is determined by the number of patients referred for inpatient treatment. The unit of account is the case of hospitalization.

Morbidity with temporary disability (labor loss) characterizes the amount of disability in days for medical reasons. The unit of account is the case of labor loss.

Disability - this is a long-term or permanent (persistent), complete or partial disability due to a significant impairment of body functions caused by a disease, injury or pathological condition.

Mortality - an indicator determined by the number of deaths in the reporting period. Information about the dead is taken into account by registering each death with an indication of the disease that caused the death.

Visit - this is the fact of interaction of a person who applied for medical help, consultation, obtaining a medical opinion, a medical diagnostic procedure or for another reason, with a doctor or paramedical worker during the hours provided for by the work schedule for an appointment at an institution or home care.

Preventive examinations are included in the number of visits, regardless of whether they are carried out within the walls of medical institutions or outside them.

Surgery - this is a therapeutic or diagnostic measure associated with the dissection and injury of tissues and organs, including endoscopic operations and medical abortions.

An operated patient is a patient who has undergone a surgical operation in a medical institution. One operated patient may undergo several surgical interventions, each of which is subject to special medical records.

A postoperative complication is a complication that occurs in the operated patient during or after the operation, associated with the operation itself, preparation for it and postoperative management of the patient.

The accounting units that are used to assess the quality of the work of the departments include: the case of a discrepancy between the diagnosis of the clinic and the final diagnosis of the inpatient facility, as well as a defect in the provision of medical care, indicating its nature and cause.

The essence of the defect disclosed in its name: late diagnosis, late hospitalization, defects in transportation, unrecognized underlying disease, unrecognized fatal complication, improper prescription of drugs, defects in medical examination.

К causes of defects include: late visit to the doctor, extremely serious condition of the patient, objective difficulties in diagnosis, lack of necessary diagnostic tools, inadequate examination, shortcomings in the organization of diagnostic and treatment work.

Medical records, medical reporting and statistical analysis medical data are the main components of the information and statistical activities of a medical institution.

3. Activities of the polyclinic

Medical care for the population is a complex system both in terms of the types of preventive and curative services provided and the types of institutions. Types of medical institutions:

1) health care;

2) hospital facilities;

3) specialized hospitals;

4) dispensaries;

5) outpatient clinics;

6) institutions for the protection of motherhood and childhood;

7) institutions for emergency and emergency care and blood transfusion;

8) sanatorium-resort institutions. Outpatient clinics are divided into five categories according to their capacity, depending on the number of medical visits per shift.

Treatment and preventive care for the population is divided into polyclinic and inpatient.

Polyclinic - This is a multidisciplinary medical and preventive institution that provides medical care to the population in the assigned territory at the pre-hospital stage.

The structure of the city polyclinic provides for the following units:

1) management of the clinic;

2) registry;

3) pre-medical reception room;

4) prevention department;

5) medical and preventive units. The main functions and tasks of the city polyclinic:

1) provision of qualified specialized medical care to the population in a polyclinic and at home;

2) provision of first aid in case of acute diseases, injuries, poisoning and other urgent conditions;

3) timely hospitalization of those in need of inpatient treatment;

4) examination of temporary incapacity for work, release of patients from work, referral for medical and social examination of persons with signs of permanent disability;

5) organization and implementation of a set of preventive measures aimed at reducing morbidity, disability and mortality among the population;

6) organization and implementation of medical examination of the population;

7) referral of patients to sanatorium treatment;

8) organizing and conducting activities for sanitary and hygienic education of the population, promotion of a healthy lifestyle.

Clinical examination - this is an active method of monitoring the state of health of the population and a system of scientifically based socio-economic, organizational, sanitary and health-improving, treatment-and-prophylactic and anti-epidemic measures aimed at maintaining and quickly restoring health, reducing morbidity, labor and social rehabilitation.

4. The work of the clinic. Hospitalization

Preventive medical examination - active medical examination of certain groups of the population by doctors and laboratory diagnostic studies for the purpose of early detection of diseases and the implementation of medical and recreational activities.

В registry for each patient, an "Outpatient Medical Card" is created, all other medical documents are registered, stored and executed, and the workload on doctors is regulated through a coupon system or self-recording. Data on all received calls are entered in the "Doctor's House Call Record Book" (f.031 / y).

In the clinic district doctor works on a staggered schedule, sees patients at the polyclinic and provides home care: handles primary house calls and schedules active visits depending on the patient's health status.

One of the most important sections of the work of a doctor in a polyclinic is performance appraisal. The medical institution maintains a special "Book of registration of disability certificates" (f.036 / y).

The clinic has a "Journal for recording the conclusions of the KEK" (f.035 / y).

In cases of chronic, protracted diseases, the patient is transferred to disability - temporary or permanent.

Day hospital in the hospital and day hospital in the polyclinic are organized for patients who do not need round-the-clock medical supervision and treatment on the basis of multidisciplinary hospitals or outpatient clinics.

Hospital at home in outpatient clinics is organized for patients with acute and chronic diseases, whose condition does not require hospitalization.

Stationary medical care It turns out in the most severe diseases that require an integrated approach to diagnosis and treatment, the use of complex instrumental methods of examination and treatment, surgical intervention, constant medical supervision and intensive care.

The polyclinic maintains a "Book of Registration of Patients Appointed for Hospitalization" (f.034 / y). Patients are delivered to the hospital "Ambulance" or in the order of transfer from other hospitals; in emergencies, patients may be admitted without a referral.

In the admissions department, a "Medical record of an inpatient" is entered (f. 003 / y), and registered in the "Journal of admission of patients and refusals in hospitalization" (f. 001 / y).

Department of the hospital is the main structural unit of the hospital. States of ward doctors are determined depending on the number of beds.

A complete clinical examination of the patient should be carried out during the first 3 days of his stay in the hospital. The patient is to be discharged upon full recovery. For a patient who has left the hospital, the "Statistical card of the person who has left the hospital" (form 066 / y-02) is filled out.

In the event of the patient's death, a "Medical death certificate" (f. 106 / y) is issued. The autopsy data is recorded in the "Medical record of the inpatient".

К paraclinical services include laboratories, treatment and diagnostic rooms.

5. Medical care of the rural population

Tasks and functions of the rural medical district:

1) outpatient and inpatient medical care to the population;

2) patronage of pregnant women;

3) measures to protect the health of children and adolescents;

4) sanitary and anti-epidemic measures;

5) study of morbidity at the site;

6) health education and organization of the work of a sanitary asset;

7) monitoring the sanitary condition of settlements and other objects;

8) medical and sanitary support for field work;

9) preparation of a sanitary asset and sanitary and educational work.

Feldsher-obstetric station (FAP), where medical and preventive work is carried out:

1) for the provision of emergency pre-medical care on an outpatient basis and at home;

2) to identify and isolate patients with acutely contagious diseases;

3) for the prevention and reduction of morbidity;

4) on current sanitary supervision of children's preschool and school institutions, communal, food, industrial facilities, water supply;

5) on the organization of medical examinations of the population, the selection of patients for dispensary observation,

6) on the employment of patients;

7) control over the state of health of patients, accounting;

8) for the preparation and maintenance of accounting and reporting documentation on their activities.

District hospital - a medical institution in which first aid is provided. Its capacity is determined by the number of beds and depends on the radius of service, the number and density of the population, the presence of industrial enterprises.

The second stage of medical care for the rural population is central district hospital (CRH), where they provide the rural population with qualified medical and preventive care, inpatient and outpatient. Tasks of the CRH:

1) providing the population of the district and the district center with highly qualified, specialized inpatient and outpatient medical care;

2) management and control over the activities of all health care institutions of the district;

3) planning, financing and organization of material and technical supply of medical institutions of the district;

4) development and implementation of measures aimed at improving the quality of medical care for the rural population;

5) introduction of modern methods and means of prevention, diagnostics and treatment into the practice of work of the medical institution of the district;

6) carrying out activities for the placement, rational use and professional development of personnel.

At least 5 departments in such specialties as therapy, surgery, pediatrics, obstetrics and gynecology, and infectious diseases should be organized in the CRH hospital.

6. Ambulance and emergency care

First aid and urgent care is carried out by the relevant department, which is part of the Central District Hospital, which is responsible for providing this type of assistance to the population of the regional center and the settlements assigned to it.

One of the structural subdivisions of the Central District Hospital is the organizational and methodological office, headed by the Deputy Chief Physician of the Central District Hospital for medical care of the population of the district. The main tasks of the OMK, which is the main assistant to the chief physician in matters of management, organization and coordination of the entire organizational and methodological work of the Central District Hospital and other medical institutions of the district, include:

1) analysis and generalization of data on the state of health of the population and the activities of the health care facilities of the district;

2) calculation of estimated indicators and analysis of the activities of the Central District Hospital as a whole and for individual specialized services;

3) drawing up a summary report on the network, personnel and activities of the health care facility of the district;

4) identification of shortcomings in the work of health care facilities and development of measures to eliminate them;

5) development of an action plan for medical care for the entire population of the district, control over its implementation.

The OMK work plan is actually a plan for the organizational and methodological work of the entire CRH. Its mandatory sections are:

1) analysis of demographic indicators and reporting materials on the network, personnel and activities of healthcare facilities in the district and on the state of public health;

2) organization and implementation of measures to provide medical advisory and organizational and methodological assistance to medical institutions of the district;

3) carrying out activities to improve the skills of medical workers;

4) strengthening the material and technical base of the health care facilities of the district.

The main (district) specialists of the district work in contact with OMK CRH, who are also heads of departments of the CRH.

Each district hospital should have at least a therapeutic, surgical, maternity, infectious diseases department and separate wards for children, for patients with tuberculosis.

Regional medical institutions (OMU) - the third stage of providing highly qualified medical care to the rural population - includes:

1) a regional hospital with a consultative polyclinic;

2) regional specialized centers;

3) regional dispensaries and specialized hospitals;

4) regional center for sanitary and epidemiological supervision;

5) clinics of medical institutes, research institutes and other medical institutions of the regional center.

The main medical institution is the regional hospital. This is a large multidisciplinary institution that provides not only qualified inpatient and outpatient care, but is also an organizational and methodological center, a base for specialization and advanced training of doctors, and a clinical base for medical institutes.

7. Tasks of the regional hospital

Tasks of the regional hospital:

1) providing the population of the region with highly qualified specialized advisory, outpatient and inpatient care;

2) provision of emergency and planned advisory medical care by means of air ambulance and ground transport;

3) providing organizational and methodological assistance to the health care facilities of the region in improving the medical care of the population;

4) management and control over statistical accounting and reporting of health care facilities of the region.

The regional hospital has a consultative polyclinic and a hospital with specialized and highly specialized departments, an emergency and planned medical care department, an organizational and methodological department, a dissecting department, an administrative and economic part and paraclinical services, the number and set of which are much wider than in the Central District Hospital.

The most important element of the regional hospital is the advisory polyclinic, whose specialists establish or clarify the diagnosis of patients referred from the regional hospitals, decide on their further treatment and, in particular, on the need for hospitalization. For each patient, the advisory polyclinic gives a medical report, which indicates the diagnosis, treatment and further recommendations.

The advisory polyclinic develops proposals on the procedure and indications for referral of patients from the health care facility of the region, analyzes cases of discrepancies in the diagnoses established by the institution that referred the patient for a consultation. Hospital of the regional hospital, includes departments for the main clinical specialties (therapy, surgery, pediatrics, obstetrics and gynecology, etc.), as well as highly specialized departments - urological, endocrinological, neurosurgical, etc. Emergency and planned patients are treated in the surgical departments.

The regional hospital provides scheduled visits, emergency and urgent specialized medical care to rural residents in any locality of the region.

The structure of the regional hospital has organizational and methodological department (OMO), which, together with specialists, analyzes the activities of district and district hospitals based on annual reports and materials from examinations and field trips of doctors.

On the basis of the received data, OMO develops proposals and measures to improve the quality of medical care, organizes statistical accounting and reporting in all health facilities of the region, trains staff on these issues and carries out statistical audits.

The most important functions of the regional hospital are also training of medical specialists and advanced training of doctors. To this end, primary specialization of young doctors, as well as ten days, meetings, seminars on the latest methods and means of diagnosing, treating and preventing various diseases are held on the basis of the regional hospital.

8. Methods of studying public health

According to the WHO, "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".

There is also a so-called third (or intermediate) state, which is close either to health or to a disease, but is neither one nor the other. It includes: neurasthenia, loss of appetite, irritability, headache, fatigue, etc.

Human health is researched and measured at various levels. If we are talking about individuals, they talk about individual health, if about their communities - about group health, if about the health of the population living in a certain territory - about the health of the population.

The health of the population is also studied at the sociological level, that is, at the level of public health. Public health reflects the health of the individuals that make up society. This is not only a medical concept, but to a large extent a social, socio-political and economic category, since the external social and natural environment is mediated through specific living conditions - work and life.

There are three groups of indicators by which the state of health of the population is judged, these are:

1) demographic indicators;

2) indicators of morbidity and disability;

3) indicators of physical development.

The concept of health is closely related to ideas about risk factors - conditions that contribute to the emergence and development of diseases.

Health determinants include:

1) environmental factors - the climate of a given territory, relief, flora and fauna of the area, solar radiation, average annual temperature;

2) biological and psychological factors that characterize the individuality of a person: heredity, adaptive properties of the body, temperament, constitution, behavior;

3) socio-economic factors - socio-economic and political development of society, living conditions, work, life;

4) medical factors - the state of healthcare, the development of medical and sanitary services, defects and shortcomings in the organization of medical care.

There are primary risk factors that depend on socio-economic, political, natural conditions, and secondary risk factors that contribute to the emergence of pathological conditions and the development of diseases.

The most adequate criterion of public health is the category of lifestyle, and the indicator is the medical and social potential of working capacity. Public health research, especially the health of the healthy, is of strategic importance in preventing disease and improving the health of the population.

9. Demographics

Demography is the science of population. The task of demography is to study the territorial distribution of the population, trends and processes occurring in the life of the population in connection with socio-economic conditions, life, traditions, environmental, medical, legal and other factors.

Medical demography studies the relationship between population reproduction and social and hygienic factors and develops medical and social measures aimed at ensuring the most favorable development of demographic processes and improving the health of the population.

Statistical study of the population is carried out in two main directions.

1. Population statics - these are data on the size of the population, the composition of the population by sex, age, social status, profession, marital status, cultural level, population location and density. Accounting for the size and composition of the population is carried out by periodically conducted population censuses - every 10 years. Between censuses, the population is recorded by registering births and deaths, as well as registering the population by place of residence.

In the production of the census, two categories of the population are distinguished: cash and permanent.

Cash (or actual) is the population that is at the time of the census in this locality, regardless of how long this or that person lives in it and whether or not he intends to stay there in the future.

A permanent population is a population permanently living in a given locality, regardless of whether it is present or temporarily absent at the time of the census.

From a socio-economic point of view, it is of great interest to distinguish three main age groups in the composition of the population:

1) younger than working age (0-15 years);

2) working age (men - 16-59, women - 16-54 years);

3) older than working age (men - 60 years and older, women - 55 years and older).

A progressive population is one in which the proportion of children aged 0-14 exceeds the proportion of the population aged 50 and over.

The regressive type is considered to be the population in which the proportion of people aged 50 years and older exceeds the proportion of the child population.

Stationary is the type in which the proportion of children is equal to the proportion of persons aged 50 years and older.

The process of population aging affects the processes of population reproduction, the nature of pathology and the prevalence of chronic diseases, and the level of the population's need for social assistance.

2. Population dynamics - this is the movement and change in the size and composition of the population, which can occur as a result of mechanical movement - under the influence of migration processes, social movement associated with the transition from one social group to another, and the natural movement of the population as a result of fertility and mortality.

10. Mechanical and natural population movement

Mechanical population movement occurs as a result of migration processes. Distinguish between internal and external migration, according to duration - temporary, permanent, as well as seasonal and pendulum. According to the nature, planned and spontaneous migrations are distinguished.

When evaluating migration processes, indicators such as:

1) turnover of migration processes;

2) balance of migration;

3) intensity of migration, etc.

The turnover of migration processes is the sum of arrivals and departures.

The balance of migration (D) is defined as the difference between the number of arrivals M + and departed Mi can be positive and negative:

D = M+ - M-

The overall intensity of migration (b) is the ratio of the number of migrants to the population of a given territory (S):

b = D / S x 1000.

Accordingly, the intensity of migration of arriving b+ and departing b- is determined:

b+ = M+ / S x 1000; b- \u1000d M- / S x XNUMX.

Similarly, the age-sex intensity of migration of arrivals and departures is calculated. Migration efficiency ratio:

migration gain (balance) / sum of arrivals and departures x 1000.

Natural movement of the population assessed by sanitary and demographic indicators.

The main indicators are indicators of fertility, mortality, natural population growth, infant mortality, average life expectancy, and maternal mortality.

Specifying indicators of the natural movement of the population are: fertility, mortality of children under 5 years of age, perinatal mortality, maternal mortality.

Birthrate - the process of renewal of new generations, which is based on biological factors that affect the body's ability to reproduce offspring.

used to characterize the birth rate. total fertility rate:

total number of live births per year x 1000 / / average annual population.

The average annual population is equal to half the sum of the population at the beginning and end of the year (population on 1.01 + 31.12 and divided by 2).

When calculating fertility rates (fertility) calculation is carried out for women of childbearing (fertile) age - from 15 to 40 years.

11. Basic indicators of fertility

Total fertility rate (fertility):

total number of live births per year x 1000 / / average number of women aged 15-49 years.

This rate depends on the proportion of women of childbearing age in the total population and is usually 4-5 times the total fertility rate.

Marriage fertility rate (fertility):

total number of live births per year to married women x 1000 / average number of women aged 15-49 who are married.

In addition, the birth rate is specified by age-specific fertility rates, for which the entire generative period of a woman is conventionally divided into intervals (15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49 years) .

Age-specific fertility rates:

number of live births in women of the corresponding age x 1000 / average number of women of the corresponding age.

In fertility statistics, they calculate total fertility rate which shows the number of children born on average to one woman during the entire fertile period of her life. The indicator is calculated as the sum of age-specific fertility rates calculated for one-year age intervals.

Gross ratio - the number of girls born on average to one woman during the entire fertile period of life. To calculate it, the total fertility rate is multiplied by the percentage of girls born in a given year.

Theoretically, the maximum value of the gross coefficient is 4,9; if it is more than 2, then this indicates the absence of a conscious birth control on a large scale.

Has a certain meaning net ratio - the net reproduction rate of the female population, showing how many girls, on average, born by one woman throughout her life, would have survived to the age of the mother at the time of their birth, provided that the birth and death rates of this period are maintained at each age. The indicator gives a generalized characterization of fertility and mortality in a given period of time.

The birth rate in Russia tends to decrease, having reached catastrophic limits at the present time.

To assess the social, demographic and medical well-being of a particular territory, it is necessary to take into account not only birth rates, but also mortality rates, since the interaction between them ensures continuous reproduction of the population.

In the analysis of mortality, a number of indicators with different cognitive significance are used.

12. Main indicators of mortality

Total mortality rate:

total number of deaths per year x 1000 / average annual population.

However, the overall mortality rate is hardly suitable for any comparison, since its value largely depends on the characteristics of the age composition of the population. Thus, the increase in the overall mortality rate in recent years in some economically developed countries does not so much indicate an actual increase in mortality as it reflects an increase in the proportion of elderly people in the age structure of the population.

Mortality rates of individual age and sex groups:

number of persons of a given sex and age who died per year x 1000 / number of persons of a given age and sex.

Mortality from this disease (intensive indicator):

the number of deaths from this disease per year x x1000 / average annual population.

Structure of causes of death (extensive indicator):

number of deaths from a given cause x 1000 / total number of deaths.

The development of materials on the mortality of the population by cause is based on the data of the "Medical death certificate" (f. 106 / y), "Medical certificate of death" (f. 106-1 / y), "Medical certificate of perinatal death" (f. 106-2/y). Completion of death certificates and selection of the original cause of death are made in accordance with existing rules.

Natural increase is expressed as an absolute number as the difference between the number of births and the number of deaths in a year. Moreover, it can be calculated as the difference between birth and death rates.

A high natural increase can be considered as a positive phenomenon only if the mortality rate is low. High growth with high mortality characterizes the unfavorable situation with the reproduction of the population, despite the relatively high birth rate.

Low growth with high mortality indicates an unfavorable demographic situation. Low growth with low mortality indicates a low birth rate.

Negative natural growth indicates trouble in society, which is typical for a period of war, economic crises and other shocks and is associated with the negative influence of three main factors, such as:

1) continuation in our country of the global global process of the demographic transition to a small family;

2) change in the age composition of the population - at present, the age group of the highest fertility (20-29 years) has entered a small contingent of women;

3) the crisis state of the socio-economic sphere.

Average life expectancy indicator shows how many years, on average, a given generation of those born will have to live if, throughout the life of this generation, the mortality rates remain the same as they are at the moment, and is calculated on the basis of age-specific mortality rates by constructing mortality tables.

13. Infant mortality rates

infant mortality characterizes the death of newborn children from birth to the age of one year. It stands out from the general problem of population mortality due to its special social significance. Its level is used to assess the health of the population as a whole, social well-being, and the quality of medical and preventive care for women and children.

Documents for registration of infant mortality are "Medical death certificate" (f. 106/y) and "Medical certificate of perinatal death" (f. 106-2/y).

Analysis of infant mortality includes:

1) infant mortality for a calendar year;

2) infant mortality by months of a calendar year;

3) infant mortality by periods of the first year of life;

4) indicators of infant mortality from a given cause.

Infant mortality rate is equal to: the number of children who died under the age of 1 year in a given year h1000 / the number of live births in a given calendar year.

Since among the dead children there may be those born both in the given and in the previous calendar year, and the number of children born, as a rule, is not the same, there are formulas for a more accurate calculation of infant mortality.

WHO RATS formula:

the number of children who died during the year in the 1st year of life h1000 / 2/3 of those born alive in this year + 1/3 of those born alive in the previous year.

The infant mortality rate is specified by its analysis by periods of the first year of life. The level and causes of infant mortality are not the same in different periods of life.

The death of children in the first year of life is distributed unevenly over different age periods. The maximum rates of deaths were noted on the first day after birth, but subsequently, at first sharply, and then more gradually, there is a decrease with every passing day, week and month.

According to the periods of the first year of life, the following indicators of infant mortality are distinguished:

1) early neonatal mortality (death of children in the first week of life):

number of children who died at the age of 0-6 days (168 hours) h1000 / number of live births;

2) neonatal mortality (death of children in the first month of life):

number of children who died under the age of one month (0-27 days) h1000 / number of live births;

3) late neonatal mortality (death from the 7th to the 27th day of life):

the number of children who died on the 2nd, 3rd, 4th weeks of life h1000 / / the number of live births - the number of deaths during the first week;

4) postneonatal mortality (death of children over the age of one month before they reach one year of age):

number of children who died over the age of one month h1000 / number of births - the number of deaths in the first month.

14. Infant mortality and perinatal mortality rate

Infant mortality rate from this cause:

number of deaths under the age of one year from a given cause ×1000 / ²/₃ born alive in a given year + ¹/₃ born alive in the last year.

In assessing the health of children in the first year, the indicator of perinatal mortality is important. The perinatal period begins at 22 weeks of fetal development, includes the period of childbirth and ends after 7 full days of the newborn's life.

The perinatal period includes 3 periods:

1) antenatal (from 22 weeks of pregnancy to delivery);

2) intrapartum (period of childbirth);

3) postnatal (the first 168 hours of life), which corresponds to the early neonatal period.

The predominance of death in any of the periods indicates to a certain extent the level of medical care, the quality of preventive measures during pregnancy, childbirth, in the first week of life.

Perinatal mortality rate: number of stillborns + number of deaths in the first 168 hours of life × 1000 / number of live and dead births.

Antenatal and intranatal mortality add up to stillbirth. According to the WHO definition, stillbirth includes all deaths of a fetus and newborn weighing 500 g or more (or, if birth weight is unknown, a body length of 25 cm or more, or a gestational age of 22 weeks or more).

Despite the fact that this definition was officially adopted in Russia in 1993, the number of fetuses and newborns with a body weight of 1000 g or more (or, if birth weight is unknown, a body length of 35 cm) is still taken into account when calculating the perinatal mortality rate. or more, or gestational age of 28 weeks or more).

Stillbirth rate:

number of stillborns h1000 / number of live and dead births.

Infant mortality by months of the calendar year:

the number of deaths under the age of 1 year in a given calendar month h1000 / average monthly number of births.

Average monthly number of births = number of births in a given calendar month + number of births in the previous 12 months divided by 13.

In the structure of the causes of infant mortality in Russia, perinatal diseases (hypoxia, asphyxia, birth trauma, intrauterine infection) occupy the first place, congenital malformations occupy the second place, respiratory diseases occupy the third place, and infectious diseases fourth.

Mortality rate of children under 5 years of age. This indicator was chosen by UNICEF as characterizing the situation of children in various states and as an indicator of the well-being of the child population.

Under-5 mortality rate:

number of children under the age of 5 who died per year h1000 / number of live births.

To characterize the health of the population, the indicator is used mortality in children under 15 years of age.

15. Maternal mortality rate

According to the WHO definition, maternal mortality refers to the death of a woman caused by pregnancy (regardless of its duration and location) and occurring during pregnancy or within 42 days after its termination from any cause associated with pregnancy, aggravated by it or its management, but not from an accident or an accidental cause.

This indicator allows you to evaluate all losses of pregnant women (from abortions, ectopic pregnancy, obstetric and extragenital pathology during the entire gestation period), as well as women in labor and puerperas within 42 days after the end of pregnancy. Not included in the concept of "maternal mortality" are cases of death as a result of murder, suicide, poisoning, trauma and other violent causes.

Maternal mortality rate:

the number of dead pregnant women (since the beginning of pregnancy), women in labor, puerperas within 42 days after termination of pregnancy × 100 / number of live births.

The maternal mortality rate should be calculated at the level of district, city, region, territory, republic. In the institution where the death occurred, a detailed analysis of each case (without calculating the indicator) of death should be carried out from the standpoint of its preventability.

When assessing the dynamics of maternal mortality in areas with low birth rates, in order to avoid errors, statistical methods should be used,

in particular, alignment of the dynamic series using the moving average method, which allows you to replace each level of the series with the average value from this level and two neighboring ones, eliminate the influence of random fluctuations on the level of the dynamic series and helps to identify the main trend.

An analysis of the structure of the causes of maternal mortality makes it possible to establish the place of one or another cause among all the dead women.

Structure of causes of maternal death:

number of women who died from a given cause × 1000 / total number of women who died from all causes.

Of essential importance in the analysis of maternal mortality is the calculation of the frequency of death from individual causes.

Maternal mortality from individual causes:

number of women who died from a given cause × 100 / number of live births.

In the structure of the causes of maternal death, a large part (80%) is occupied by obstetric causes, and approximately 20% are occupied by causes associated with pregnancy and childbirth only indirectly (in particular, extragenital diseases).

Among obstetric causes, 70% belong to complications of pregnancy and childbirth, 25% to the consequences of abortion and 5% to ectopic pregnancy. Among extragenital diseases, diseases of the cardiovascular system predominate.

The high level of maternal mortality in the country is due to a number of reasons. In recent years, there has been an ever-increasing deterioration in the health of pregnant women, the rate of early coverage of their medical supervision, the quality of medical examinations of pregnant women are declining, and there is a high prevalence of abortions.

16. Physical development

Physical development is one of the objective indicators of the state of health of the population. The methods of statistical accounting and analysis of data on the physical development of the population have received a deep scientific justification and are widely used in the practical research activities of healthcare institutions.

Physical development is understood as a complex of morphological and functional properties of the body, characterizing the size, shape, structural and mechanical qualities and the harmony of the development of the human body, as well as the reserve of its physical strength.

The foundations of physical development are laid in childhood, so the indicators that characterize it are mandatory when assessing the health of the younger generation. Physical development is usually studied in newborns, children of various age groups and adolescents, as well as in the adult population to characterize generations of different years of birth.

There are differences in the physical development of the population living in different economic and geographical zones, people of different nationalities. Under the influence of long-term adverse factors, the level of physical development decreases, and vice versa, the improvement of conditions, the normalization of lifestyle contribute to an increase in the level of physical development.

Three groups of factors that determine the direction and degree of physical development:

1) endogenous factors (heredity, intrauterine effects);

2) natural and climatic factors (climate, terrain);

3) socio-economic factors (degree of economic development, working conditions, life, food, rest).

Physical development is an integral indicator of the state of health, which is influenced by a variety of external and internal factors. The tasks of studying the physical development of the population are:

1) monitoring the level and changes in the physical development of various groups of the population;

2) in-depth study of the age-sex patterns of physical development in connection with the peculiarities of living conditions, work and life, the nature and forms of medical care, sports;

3) development of age-sex assessment norms-standards for the physical development of the population for various ethnic groups in different climatic zones and economic regions;

4) evaluation of the effectiveness of recreational activities.

Observation and control over the physical development of a person begins from the moment the child is born: in the maternity hospital, the features of the physical development of newborns are studied. This work continues in children's polyclinics and preschool institutions. The physical development of schoolchildren and adolescents is subject to observation and medical control. School doctors make a group and individual assessment of the level of physical development of schoolchildren and correct it as necessary by the methods of physical education. Observation of the physical development of the adult population is carried out in the pre-conscription period, when called up for military service.

17. Anthropometric measurements

Anthropometric measurements should be carried out in relation to certain groups of the population in the following order:

1) newborns are measured in maternity hospitals at birth and discharge;

2) children of the first year of life and aged 1 to 3 years - in nurseries and children's clinics on a monthly basis;

3) children from 3 to 7 years old - in kindergartens and children's clinics 2 times a year;

4) children and adolescents (schoolchildren) from 7 to 18 years old - in schools 1-2 times a year;

5) pupils and students of vocational schools, secondary specialized and higher educational institutions during medical examinations once a year;

6) pre-conscripts - in the military registration and enlistment offices at the place of residence;

7) working youth - in medical units of enterprises during medical examinations;

8) military personnel - in first-aid posts at the place of service during in-depth medical examinations 1-2 times a year;

9) athletes - in medical and sanitary institutions of sports societies and medical and physical education dispensaries in the prescribed manner.

Physical development depends on age and gender, indicators are calculated for homogeneous age and sex groups in each observation area. The main signs of physical development:

1. anthropometric, based on measuring the dimensions of the human body and skeleton, including:

1) somatometric - the dimensions of the body and its parts;

2) osteometric - the dimensions of the skeleton and its parts;

3) craniometric - the dimensions of the skull.

2. anthroposcopic, based on the description of the body as a whole and its individual parts.

These include:

1) body type;

2) development of the fat layer, muscles;

3) the shape of the chest, back, abdomen, legs;

4) pigmentation;

5) hairline;

6) secondary sexual characteristics, etc.

3. Physiometric, determined with the help of special physical instruments.

These include:

1) vital capacity of the lungs (measured with a spirometer);

2) muscle strength of the hands (measured with a dynamometer).

The main signs of physical development are the length and weight of the body, expressing fatness, the development of the bone skeleton and muscles. Also, they include the circumference of the chest during inhalation and exhalation, which characterizes its capacity and the development of the respiratory organs.

In hygiene, indicators of physical development are necessary for the standardization of clothing, footwear, furniture, and the rational arrangement of workplaces.

In military medicine, indicators of physical development help determine fitness for military service and the type of troops.

A comprehensive assessment of physical development, taking into account both the level of biological development and the morpho-functional state of the body, makes it possible to identify both children with harmonic physical development corresponding to their age, and children with various deviations due to excess or deficiency of body weight.

18. Methods for studying physical development

To obtain accurate results in the assessment of physical development, it is necessary to comply with a number of standard conditions, namely: the assessment should be carried out in the morning, with optimal lighting, the presence of serviceable instruments, using a unified measurement methodology and technique.

According to WHO, birth weight is the result of the first weighing of the fetus or newborn, recorded after birth. This weight should preferably be established within the first hour of life, before significant postnatal weight loss occurs.

Measurement of the length of the body of a newborn or fetus must be carried out with its extended position on a horizontal stadiometer.

Regular assessment of the physical development of children continues in the children's clinic, preschool institutions, schools within the time limits established by special orders. The results of the assessment are entered in the "History of the development of the newborn" (f.097 / y), "History of the development of the child" (f.112 / y), "Medical record of the child" (f.025 / y).

To study, analyze and evaluate physical development, two main observation methods are used: 1) generalizing method (population cross-sectional method) - based on a one-time measurement of children of different ages, i.e. each child is measured 1 time at any age. Each age group must consist of at least 100 people. This method is very common. It reflects the level of physical development of children at a certain moment and is new on a large number of observations. It is the most representative for determining the level of physical development of the general population;

2) individualizing method (longitudinal section) - based on the measurement of the same children during the period of their growth and development. The same group of children is observed over a certain period (for example, a year of life), making it possible to obtain sufficient saturation of each age-sex group by months or years of life with a relatively small number of observations. This technique allows you to determine the features of the physical formation of the body from month to month (or from year to year) of the observed group of children in a homogeneous population. This method is of particular importance in connection with the process of acceleration, as well as for the standardization of school and preschool equipment, the construction of type-height scales, for the clothing and footwear industries. This method does not contradict the generalizing method and is an essential addition to it both in studying the process of the child's general development and in clarifying the influence of environmental factors in the course of this development.

To obtain average indicators of physical development, a survey of large groups of practically healthy people of various ages and sexes is carried out. The obtained average values are the standards of the physical development of the corresponding groups of the population.

19. Methods of variation - statistical development of anthropometric data. Derivation of physical development standards using the index method

The numerical data of individual signs obtained during anthropometric surveys (height, weight, chest circumference, etc.) are processed by the method of variation statistics to obtain average indicators - standards of physical development.

First of all, a thorough review of the collected material is carried out in order to screen out maps that are not subject to development. Cards with erroneous and dubious entries, as well as cards of children with pronounced deviations in health status are not included: endocrine disorders, bone tuberculosis, the consequences of poliomyelitis, recent severe infectious diseases, etc. Cards indicating severe rickets, malnutrition III are also excluded. degrees, cards of premature and twins.

In statistical development, only maps of practically healthy children who do not have sharp health problems are used to derive physical development standards.

After viewing the material, it is divided into groups, which are a homogeneous statistical aggregate by age, sex, place of residence, etc. Each age and sex group must be represented by at least 100 cards.

After grouping the material, variation series are compiled separately for each feature. Then the average values are calculated - a simple, weighted or arithmetic average is calculated according to the method of moments; average parameters:

1) standard deviation (s), which is a measure of the typicality of the arithmetic mean for the population from which it is obtained;

2) the average error of the arithmetic mean (m), which is a measure of the reliability of the average value and allows, with varying degrees of probability, to determine the limits of fluctuations in the average in the general population.

There are various ways of individual and group assessment of the physical development of the population.

Methods of individual assessment of physical development

Assessment of physical development by the method of indices. For a long time, the index method was used to assess physical development. Indices of physical development are the ratio of individual anthropometric indicators, expressed in mathematical formulas. Different indexes include a different number of features. When using this technique, it is assumed that the dimensions of the body change proportionally with respect to each other. However, it has now been established that anthropometric indicators change disproportionately, so the value of indices for assessing physical development has decreased.

20. Assessment of physical development by the method of sigma deviations

The sigma deviation method is the simplest. In this case, the indicators of the physical development of the individual are compared with the arithmetic mean of the corresponding age and sex groups, taken from the table of standards. The data of the subject, as a rule, differ to some extent from the average indicators, either in the direction of an increase or in the direction of a decrease in the sign. To judge the degree of their difference, this difference with the corresponding sign (+ or -) is divided by the standard deviation (s), obtaining the so-called sigma deviation. This is how it is established by what proportion of the sigma or by how many sigmas the individual indicator differs from the arithmetic mean of this sign of a given age and sex group. Consistently determine sigma deviations for height, weight, chest circumference. The degree of physical development is judged by the magnitude of sigma deviations.

Such an assessment is carried out according to the formula: V - M / s,

where V is a variant of one or another feature; M is the arithmetic mean of a trait for a given age and sex group; s - standard deviation. With average physical development, individual values differ from age standards (M) by no more than one sigma in one direction or another.

The average height of 10-year-old boys is 137 cm, the standard deviation is 5,2 cm, then a student of this age, having a height of 142 cm, will receive a height estimate in sigma equal to 142 - 137 / 5,2 = 0,96, i.e., the height of the student is within M + 1s and is assessed as average, normal growth.

The data obtained for each sign of physical development, in sigma terms, can be presented in the form of an anthropometric profile, which is performed graphically and shows the differences in the physique of a given person from other persons. This method is used for dynamic medical monitoring of the physical development of children, athletes, military personnel and other population groups.

To build a profile of physical development, horizontal lines are drawn at an equal distance from each other according to the number of evaluated signs. Most often, 3 main indicators are used: height, weight, chest circumference. In the middle of these lines, an average vertical line is drawn, corresponding to M of these indicators. On the right side of this middle line at an equal distance, the boundaries of deviations within +1s, +2s, +3s are applied, and on the left - respectively -1s, -2s, -3s. Vertical lines are also drawn along these boundaries.

The magnitude of the sigma deviations of each feature is plotted as a dot on the corresponding horizontal line. Then these points are connected in series. When assessing physical development, they proceed from the location of the profile.

In addition to the level of physical development, with the help of the anthropometric profile, the proportionality of development is determined.

21. Assessment of physical development on a regression scale

This method makes it possible to single out persons with harmonious and disharmonic development, and also gives a comprehensive assessment of physical development based on the totality of signs in their relationship, since none of the signs, taken individually, can give an objective and complete assessment of physical development.

The essence of the regression scale assessment method: if there is a relationship between two features, there is a consistent increase in the values of one of the features (for example, weight) with a corresponding increase in another feature (for example, growth) with a direct relationship and a similar sequential decrease with a reverse one.

Evaluation tables for a comprehensive assessment of physical development indicators in the form of regression scales are compiled using a number of parameters. These include:

1) correlation coefficient (c), expressing the magnitude of the relationship between features;

2) the regression coefficient (R), showing the amount of change in one attribute when the other changes by one;

3) regression sigma, or partial sigma (sR), which serves to determine the magnitude of an individual deviation of a trait associated with another.

The method of regression scales provides for the distribution of signs of physical development into two categories: independent (height) and dependent (weight and chest circumference). Thus, growth is considered the leading sign of physical development and a necessary basis for a correct assessment. With the normal development of the child, an increase in height is accompanied by an increase in body weight and chest circumference.

Depending on the ratio between body weight, chest circumference and height, physical development is considered harmonious (normal), disharmonious and sharply disharmonious.

Physical development is considered to be harmonious, in which body weight and chest circumference correspond to body length or differ from due within one regression sigma (Sr).

Physical development is considered disharmonious, in which body weight and chest circumference lag behind due by 1,1-2Sr, and also more than due by the same amount.

Sharply disharmonious should be considered physical development, in which body weight and chest circumference lag behind due by 2Sr or more or exceed due by the same amount.

When assessing physical development on a regression scale, it is determined which growth group the subject belongs to, after which the proper weight and chest circumference are found. In the table of regression scales, the values of dependent signs are presented with fluctuation boundaries within ±1s, which corresponds to normal, harmonious development. Therefore, in some cases, a simple comparison is sufficient to assess physical development. The assessment of physical development on regression scales is carried out as follows: the difference between the survey data and the due values is calculated, expressing it in regression sigmas (Sr), i.e., the difference is divided by the regression sigma.

22. Methods of group assessment of physical development. Acceleration

Assessment of the physical development of the team is carried out by analyzing age-related changes in the average values of their standard deviations, annual increases in indicators in different age periods; identifying gender differences in the dynamics of physical development indicators.

Comparative assessment of the level of physical development of different teams or the same team in dynamics is made by determining significant differences in the average values of the main features. In both cases, indicators of the physical development of homogeneous age and sex groups are subject to comparison.

The significance of differences in the average values of the studied characteristics is determined by calculating the reliability criterion (criterion t) according to the formula:

t = (M₁ - M₂) / ( √m₁ + m₂),

where M1 and M2 are arithmetic averages;

m₁ and m₂ - mean errors of mean values.

The resulting criterion t is estimated as follows: if t ≥ 2, then the differences in the mean values are significant, if t < 2, then the differences are not proven.

Acceleration

A feature of the modern era of the development of human society is the acceleration of the pace of physical development of children and adolescents in comparison with previous generations. The phenomenon of acceleration is typical for most economically developed countries and to some extent manifests itself in representatives of all nations and affects all age and sex groups of the population.

The following factors influence the occurrence of acceleration shifts in the body:

1) more intense insolation;

2) improving the nutrition of children (increasing the consumption of animal proteins and fats, vitamins, concentrates for feeding infants);

3) a genetic factor (constant mixing of the population, heterolocal marriages and acceleration of the development of offspring due to heterosis, i.e., the property of hybrids of the first generation to surpass the best of the parental forms in a number of ways).

The process of acceleration is observed already in the period of intrauterine development of the fetus - there is an increase in the length and body weight of children at birth. In adolescents, there is an acceleration in the rate of growth and body weight, earlier puberty and ossification of the skeleton.

Among children with accelerated development, subgroups with harmonic and disharmonic acceleration are distinguished.

Acceleration issues:

1) earlier biological maturation, which occurs before social maturity and civil capacity (earlier onset of sexual activity, an increase in the number of young mothers, the number of abortions among minors);

2) the need to establish new forms of labor, physical activity, nutrition, standards for children's clothing, shoes, furniture and household items;

3) the increasing variability of all signs of age-related development and maturation, the complication of the differentiation of the norm and pathology.

23. Morbidity. Methodology for studying general morbidity

Morbidity, along with sanitary-demographic indicators and indicators of physical development, is one of the most important criteria characterizing the health of the population.

Under morbidity refers to data on the prevalence, structure and dynamics of various diseases registered among the population as a whole or in its individual groups.

Incidence (primary morbidity) - a set of new, nowhere previously recorded and first detected diseases in a given calendar year.

Prevalence (morbidity) - the totality of all existing diseases, for which the patient again sought medical help in a given calendar year.

Pathological affection - a set of diseases, as well as premorbid forms and conditions identified during medical examinations.

True incidence - the sum of all diseases identified according to the data of appeals and medical examinations in a given year.

In the incidence statistics, it is customary to single out:

1) morbidity according to the data on seeking medical care;

2) morbidity according to medical examinations;

3) morbidity according to the causes of death.

Methodology for studying general morbidity

General morbidity - is a set of diseases among certain groups of the population for a certain calendar year.

Unit of observation is the initial visit of the patient to the doctor about a specific disease in a given calendar year. The main accounting document is the "Statistical coupon for registration of final (refined) diagnoses" (form 025-2/y).

Primary morbidity:

number of diseases newly diagnosed per year x 1000 (10, 000) / average annual population.

Prevalence:

number of diseases first detected in a year and re-registered from previous years x 1000 (10, 000) / average annual population.

Age-sex incidence rates:

the number of diseases detected per year in persons of a given sex and age x 1000 (10, 000) / / average annual population of this sex and age.

Overall morbidity rate by diagnosis:

the number of diseases with this diagnosis detected per year x 1000 (10, 000) / average annual population.

Structure of general morbidity:

the number of diseases with this diagnosis detected per year x 1000 / total number of diseases.

Mortality rate:

the number of deaths from this disease per year x 1000 (10, 000) / average annual population.

Lethality rate:

the number of deaths from this disease per year x 1000 / the number of patients with this disease.

24. Methodology for studying infectious morbidity

All infectious diseases, depending on the method of notification about them, can be divided into four groups.

1. quarantine diseases - especially dangerous infections.

2. About diseases such as influenza, acute respiratory infections, medical institutions submit to the center of sanitary and epidemiological supervision total (digital) information for the month.

3. Diseases, each case of which is reported to the Sanitary and Epidemiological Surveillance Center with detailed information.

If these diseases are detected, the "Emergency notification of an infectious disease, food, acute occupational poisoning, unusual reaction to vaccination" (f.058 / y) is filled in by doctors or paramedical personnel of medical institutions of all departments and is transmitted to the district within 12 hours or city CSEN.

4. Diseases that are registered as the most important non-epidemic diseases with simultaneous information from sanitary and epidemiological services.

Not only a "Notice of a patient with a first-ever diagnosed active tuberculosis, venereal disease, trichophytosis, microsporia, favus, scabies, trachoma" (f.089 / y), but also an "Emergency notification of an infectious disease" (f.058) is issued /y).

Emergency notices sent to the CSES are registered in the "Journal of Infectious Diseases" (f.060 / y). The journal is kept in all medical and preventive institutions, medical offices of schools, preschool institutions, in TsSEN.

On the basis of the entries in this journal, the CSES prepares a "Report on the movement of infectious diseases" (f. 85-inf.) with an analysis of data for each month, quarter, half year and year.

For a detailed analysis of each case of infectious morbidity, the "Card of the epidemiological examination of the focus of infectious diseases" (f. 357 / y), filled out in the TsSEN, is used.

General indicator of infectious morbidity:

number of infectious diseases detected per year x 1000 (10, 000) / average annual population.

The indicator of infectious morbidity according to diagnoses:

the number of diseases with this diagnosis detected per year x 1000 (10, 000) / average annual population.

The structure of infectious morbidity (extensive indicator):

the number of diseases with this diagnosis detected per year x 100% / total number of infectious diseases.

focality (intensive indicator): the number of detected infectious patients with a given disease / the number of foci of a given disease.

25. Methodology for studying the most important non-epidemic diseases

The organization of a special record of such major non-epidemic diseases as tuberculosis, venereal diseases, mycoses, trachoma, malignant neoplasms and mental illness is due to the fact that they require early detection, a comprehensive examination of patients, taking them to a dispensary, constant monitoring and special treatment, and in some cases - and identifying contacts. Upon their discovery, a "Notice of a patient with a first-ever diagnosed active tuberculosis, venereal disease, trichophytosis, microsporia, favus, scabies, trachoma, mental illness" (f.089 / y) or a "Notice of a patient with a first-time diagnosed diagnosis of cancer or other malignant neoplasm" (f.090/y).

"Notice" (f.089 / y) is drawn up by doctors of all health facilities, regardless of their specialty, place of work and conditions for detecting the disease for all patients who have a disease for the first time in their lives.

"Notice" (f.090/y) is drawn up by doctors of the general and special network of medical institutions in which the patient was diagnosed with a malignant neoplasm for the first time in his life.

Compiled notices (f.089 / y) or (f.090 / y) are sent within three days to the appropriate dispensaries at the patient's place of residence.

General incidence rate of the most important non-epidemic diseases (frequency of non-epidemic diseases):

number of non-epidemic cases reported for the first time in a given year × 1000 (10, 000) / average population.

Prevalence of the most important non-epidemic diseases:

number of cases of non-epidemic diseases first reported in the current year and earlier × 1000 (10, 000) / average population.

Incidence rate of one or another major non-epidemic disease - the number of newly registered certain major non-epidemic diseases in a given year per 1000 (10, 000) population.

Prevalence rate for a major non-epidemic disease - the number of certain major non-epidemic diseases first registered in a given year and transferred from previous years per 1000 (10, 000) population.

The incidence rate of the most important non-epidemic diseases depending on age, gender, profession, place of residence and other - the number of the most important non-epidemic diseases registered for the first time in a given year among persons of a certain sex, age, profession per 1000 (10, 000) population of a certain sex, age, profession, etc.

Morbidity structure of the most important non-epidemic diseases is the percentage of non-epidemic disease reported in a given year to the total number of all major non-epidemic diseases.

Lethality rate - the number of deaths from one or another major non-epidemic disease in a given year per 100 registered patients of the corresponding non-epidemic disease.

26. Methodology for studying hospitalized morbidity. Methodology for studying morbidity according to medical examinations

The unit of account in this case is the case of hospitalization of the patient in the hospital, and the accounting document is the "Statistical card of the patient who left the hospital" (f.066 / y), which is compiled on the basis of the "Medical card of the hospital patient" (f.003 / y) and is statistical document.

Based on the development of "Statistical cards of the hospitalized" and annual reports, the following indicators of hospitalized morbidity are calculated.

Frequency (level) of hospitalization:

number of hospitalized per year × 1000 / average annual population.

Hospitalization rate:

number of hospitalized per year × 1000 / number of those requiring hospitalization.

The frequency of hospitalizations for this disease:

number of hospitalized for this disease per year × 1000 / average annual population.

Structure (composition) of hospitalized morbidity:

number of hospitalized with selected diseases × 100 / total number of hospitalized.

The composition of hospitalized patients by sex, age, profession and other groups:

number of hospitalized of a certain gender, age, etc. × 100 / total number of hospitalized.

Average duration of hospitalization:

number of hospital days spent by patients per year / total number of hospitalized.

Hospital mortality rate:

the number of deaths × 100 / the number of those who left the hospital (the sum of those discharged + the deaths).

Methodology for studying morbidity according to medical examinations

Medical examinations are divided into:

1) preliminary;

2) periodic;

3) target.

All contingents subjected to preliminary and periodic medical examinations can be divided into three groups:

1) employees of enterprises, institutions and organizations that have contact with adverse production factors;

2) employees of food, children's and some municipal institutions who, upon entering a job and subsequently after a certain period of time, undergo a bacteriological examination to identify infectious diseases or bacillus carriers, since they can become a source of mass infection;

3) children, adolescents, students of vocational schools and secondary specialized educational institutions, full-time students.

27. Methodology for studying morbidity with temporary disability and according to data on the causes of death

The study of morbidity with temporary disability is of great medical, social and economic importance.

The unit of observation in the study of morbidity with temporary disability is each case of disability in a given year.

Each case of disability is registered with a certificate of incapacity for work, which is issued not only for diseases and injuries, but also for nursing, pregnancy and childbirth, quarantine, prosthetics, and spa treatment.

Based on the development of data from sick leave sheets, a "Report on the incidence of temporary disability" (f.016) is compiled.

For the analysis of morbidity with temporary disability, the following indicators are calculated:

Number of disability cases per 100 employees:

the number of all cases of disability × 100 / / the average number of employees.

Average duration of one case of incapacity for work:

number of days of incapacity for work / number of cases of incapacity for work.

Morbidity structure with temporary disability in days:

number of days of incapacity for work for this disease × 100 / total number of days of incapacity for work.

The structure of morbidity with temporary disability in cases of:

number of disability cases for the disease × 100 / total number of disability cases.

"Health Index"is the proportion of those who are not ill among all workers:

the number of those who never fell ill in a given year × 100 / the number of employees at a given enterprise.

Methodology for studying morbidity according to data on causes of death Total mortality rate:

number of deaths per year × 1000 / average annual population.

Mortality rate depending on the disease:

the number of deaths from a particular disease per year × 1000 / average annual population.

Mortality rate depending on sex, age and other groups:

number of deaths per year × 1000 / average annual population.

Structure of causes of death:

number of deaths from specific causes × 100 / number of all deaths.

28. Targeted medical examinations

Targeted medical examinations are carried out for the early detection of a number of diseases (tuberculosis, malignant neoplasms, diseases of the circulatory system, respiratory diseases, gynecological diseases, etc.) during one-stage examinations in organized groups or during examination of all persons seeking medical care in medical institutions (MPIs).

The results of medical examinations are recorded in the following documents of health facilities:

1) "Card subject to periodic inspection" (f.046 / y) for persons undergoing mandatory periodic inspections;

2) "Medical record of an outpatient" (f.025 / y);

3) "History of the development of the child" (f.112 / y);

4) "Medical record of the child" (f.026 / y) for schools, boarding schools, orphanages, kindergartens, nursery gardens;

5) "Medical record of a university student, student of a secondary specialized educational institution" (f.025-3 / y);

6) "Medical examination record card" (f.131 / y) for all persons living, students attending preschool institutions in the area of the polyclinic, working at enterprises and undergoing annual medical examinations;

7) "Card of prophylactically examined for the purpose of detection" (f.047 / y) - serves to register examinations carried out for the purpose of early detection of individual forms and groups of diseases. It is conducted in all medical and preventive institutions that conduct targeted examinations of the population, and is used to record persons who have applied for a preventive examination. The card is not filled out for persons subject to periodic inspections, since targeted inspections of these contingents are carried out simultaneously with the periodic inspection (join it) and are registered in f.046 / y;

8) "List of persons subject to targeted medical examination" (f. 048 / y), which is filled in instead of f. 047 / y in small medical institutions, where it is impractical to create special card indexes of those examined. The documents listed above allow:

1) get an accurate idea of the prevalence of pathology among the population;

2) determine the dynamics of its change;

3) evaluate the effectiveness of the treatment;

4) view organizational activities for a number of years.

The frequency of detected diseases during preventive examinations:

the number of diseases detected during the physical examination × 1000 / the number of all examined.

The frequency of detected diseases during preventive examinations for individual nosological forms:

the number of diseases with a given diagnosis identified during medical examinations × 1000 / the number of all examined.

The structure of morbidity according to professional examinations:

number of persons with this disease × 100 / number of all identified patients.

"Health Index":

number of healthy individuals × 100 / number of all examined.

29. Disability

The classification of disability is based on two main concepts:

1) the degree of disability (three groups of disability);

2) causes of disability (six causes of disability).

The first group of disability installed:

1) persons who, as a result of persistent and severe violations of body functions, have experienced a complete permanent or long-term loss of ability to work;

2) in some cases - to persons with persistent, pronounced functional impairments and in need of outside care or assistance, but who can be attracted and adapted to certain types of labor activity in specially organized conditions.

The second group of disability installed:

1) persons with a complete permanent or long-term disability due to a violation of the functions of the body, but not in need of constant outside care, assistance or supervision;

2) persons for whom all types of labor are contraindicated for a long period due to the possibility of worsening the course of the disease under the influence of labor activity;

3) persons with severe chronic diseases, with combined defects of the musculoskeletal system and significant loss of vision, for whom labor is not contraindicated, but is available only in conditions specially created for them.

Third group of disability installed:

1) if it is necessary to transfer for health reasons to work in another profession of lower qualification due to the inability to continue working in the previous profession;

2) if necessary, due to health reasons, significant changes in working conditions in their profession, which lead to a significant reduction in the volume of production activities and, thereby, to a decrease in qualifications;

3) with a significant restriction of the possibility of employment due to pronounced functional impairments in working persons or those who have not previously worked;

4) regardless of the work performed, with anatomical defects or deformities that lead to dysfunction and significant difficulties in the performance of professional work;

5) persons who are not allowed to perform their work for epidemiological reasons.

For dynamic monitoring of health and work capacity disabled people of group I are examined after 2 years, and disabled people of groups II and III - after a year. In case of serious illnesses and in the absence of prospects for improvement, the disability group is established without specifying the period for re-examination.

30. Disability rates

If there are indications for referral of a patient to a medical and social examination (MSE), health facilities issue a "Referral to the ITU" (f.088 / y). The following documents are filled in the ITU Bureau: "The Certificate of Inspection in the ITU", "The Book of Minutes of the ITU Meetings", "Statistical Coupon for the Certificate of Inspection in the ITU", a report is compiled annually on f. 7.

Detailed statistical information on the composition of persons who first came out and are on disability, on the nature of diseases and the causes of disability, can be obtained upon presentation of the "Certificate of examination in the ITU" or "Statistical coupon for the act".

For analysis, indicators are calculated:

1) by disability groups;

2) for reasons of disability;

3) types of diseases, etc.

Analysis of the dynamics of disability by groups makes it possible to identify positive, negative, stable and variable types of dynamics according to the trend of indicators characterizing an increase or decrease in groups.

Primary Disability:

number of persons recognized as disabled for the first time during the year x 1000 / total population.

Structure of primary disability (by disease, gender, age, etc.):

number of persons recognized as disabled for the first time during the year for this disease x 1000 / total number of persons recognized as disabled for the first time during the year.

The frequency of primary disability by disability groups:

the number of persons recognized as disabled of group I (II group, III group) x 1000 / total population.

The structure of primary disability by disability groups:

the number of persons recognized as disabled of group I (II group, III group) x 100 / total number of persons recognized as disabled for the first time during the year.

General disability (contingents of disabled people): total number of disabled people (number of persons receiving disability pensions, i.e. persons recognized as disabled for the first time and earlier) x 1000 / total population.

Change of disability group during examination:

the number of persons whose disability group was changed during the examination x 100 / the number of persons with disabilities who underwent re-examination during the year.

The share of disabled people who first became disabled among all disabled people:

number of persons recognized as disabled for the first time during the year x 100 / total number of disabled.

The proportion of people with disabilities since childhood among all people with disabilities:

number of persons recognized as disabled since childhood for the first time during the year x 100 / total number of disabled.

31. Rehabilitation indicators

Evaluation of rehabilitation measures is carried out on the basis of three groups of indicators:

1) medical and professional rehabilitation of disabled people;

2) stability of disability groups during re-examination;

3) aggravation of the disability groups of the re-examined.

Indicators of medical and professional rehabilitation of disabled people:

1) complete rehabilitation:

the total number of disabled people recognized as disabled x 100 / the total number of re-examined disabled people;

2) partial rehabilitation:

the total number of persons recognized as disabled of group III x 100 / the total number of re-examined invalids of groups I and II.

Indicators of stability of disability groups: stability of the I disability group(II and III disability groups):

the total number of disabled people who remained after the next examination in the previous group x 100 / the total number of examined disabled people of this group.

Indicators of weighting of disability groups:

1) weighting II group of disability:

the number of those transferred to group I (from among the disabled of group II) x 100 / the total number of those examined in group II;

2) weighting III group of disability:

the number of those transferred to groups I and II (from among the disabled of group III) x 100 / the total number of those examined in group III.

The methodology for studying disability provides not only for the analysis of documents from the ITU and health facilities, but also methods for direct observation of persons with permanent disability in order to characterize their quality of life. Methods of expert assessments of the quality of medical and social assistance to disabled people are also used.

In the structure of primary disability, disabled people of group I make up approximately 15%, group II - 60%, group III - 25%. In recent years, there has been an increase in the primary exit to disability.

In the structure of disability for reasons, 1st place is occupied by diseases of the cardiovascular system (more than 30%), 2nd place - by malignant neoplasms (about 20%), 3rd place - by injuries (about 15%).

A special place in disability is occupied by the problem of disabled children, who make up more than 200 thousand people in Russia. The structure of disability from childhood is dominated by neuropsychiatric diseases, including mental retardation (more than 50%), followed by diseases of the nervous system, including cerebral palsy, congenital anomalies, consequences of injuries and poisoning. Every year in Russia more than 30 thousand children are born with congenital and hereditary pathologies, of which 2/3 subsequently become disabled, and in 60-80% of cases, the disability of children is due to perinatal pathology.

32. International Classification of Diseases and Related Health Problems

The International Classification of Diseases (ICD) is a system of grouping diseases and pathological conditions that reflects the current stage in the development of medical science. The ICD is the main regulatory document in the study of public health in the member countries of the World Health Organization.

Purpose and scope of the ICD-10. The classification of diseases can be defined as a system of headings in which specific nosological units are included in accordance with accepted criteria.

The purpose of the ICD is to create conditions for the systematic registration, analysis and comparison of data on morbidity and mortality obtained in different countries and regions at different times.

The ICD is used to convert the verbal formulation of diagnoses of diseases and other health-related problems into alphanumeric codes that provide easy storage, retrieval and analysis of data.

The structure of the ICD-10. The ICD is a variable-axial classification. Its scheme is that the statistical data on diseases are grouped in such a way as to ensure its maximum acceptability for use both for all practical and epidemiological purposes, and for assessing the quality of health care.

The following main groups are distinguished:

1) epidemic diseases;

2) constitutional (or general) diseases;

3) local diseases grouped by anatomical localization;

4) developmental diseases;

5) injury.

The ICD is built on a decimal system with sequential detailing from large classes (there are 10 in ICD-21) and groups of diseases to three-digit headings and four-digit subheadings up to ten. As classes, for example, infectious and parasitic diseases, neoplasms, injuries and poisonings, diseases of the digestive system and others are presented; as groups - tuberculosis, malignant neoplasms of the genitourinary organs, burns, hernia of the abdominal cavity, etc. The rubrics combine the manifestations of one disease, for example, amoebiasis, pulmonary tuberculosis; they can also include collective concepts: mineral metabolism disorders, adrenal diseases, etc. The most detailed information is given at the level of subheadings.

An important part of the ICD is an alphabetical list containing diagnostic terms indicating which heading and subheading they belong to.

In ICD-10, diseases are classified into classes as follows.

Headings from I to XVII class refer to diseases and pathological conditions, XIX class - to injuries and poisoning and some other consequences of external factors, the rest of the classes contain a number of modern concepts related to diagnostic data.

ICD-10 consists of 3 volumes. Volume 1 - contains the main classification. Volume 2 - instructions for use for users. Volume 3 is an alphabetical index to the classification.

33. The concept of a "family" of classifications of diseases and related health problems

1. Classifications based on diagnosis:

1) special lists for statistical development follow directly from the main classification and are used to present data and facilitate the analysis of information on the state of health and its dynamics at the national and international level.

2) specialized options combine in one compact volume those sections and headings of the ICD that relate to a particular specialty; they are developed by international groups of specialists in oncology, dermatology, neurology, rheumatology and orthopedics, pediatrics, mental disorders, dentistry and dentistry.

2. Non-diagnostic classifications:

1) procedures used in medicine include diagnostic, prophylactic, therapeutic, X-ray, medical, surgical and laboratory procedures;

2) the International Classification of Impairment, Disability and Social Insufficiency (ICNST and HF) deals with the consequences of illness, including injuries and impairments:

a) the classification of disorders represents disorders at the level of a particular organ;

b) the classification of disability reflects the consequences of violations in the form of a limitation or inability to carry out activities within the limits considered normal for a person, i.e. it reflects disorders at the level of an individual; c) the classification of social insufficiency characterizes violations in which a person can perform only to a limited extent or cannot perform a role that is quite usual for his position in life, that is, it reflects the discrepancy between the real possibilities and desires of the person himself. This is a classification of circumstances that place a disabled person at a disadvantage compared to other people in terms of social norms.

International Nomenclature of Diseases (INB) The main goal of the MNB is to give each nosological unit one recommended name. The main criteria for choosing this name should be:

1) specificity (applicability to one and only one disease);

2) uniqueness (so that the name itself indicates the essence of the disease);

3) etiology (so that the name of the disease is based on its cause).

Each disease or syndrome with a recommended name is given an unambiguous concise definition followed by a list of synonyms.

34. Organization of the statistical work of a medical institution

Statistics help to control the activities of the institution, to manage it promptly, to judge the quality and effectiveness of treatment and preventive work. When drawing up current and long-term work plans, the leader should be based on the study and analysis of trends and patterns in the development of both health care and the health status of the population of his district, city, region, etc.

The traditional statistical system in health care is based on the receipt of data in the form of reports, which are compiled in grass-roots institutions and then summarized at intermediate and higher levels.

The plan of statistical research is drawn up on the organization of work in accordance with the planned program. The main points of the plan are:

1) definition of the object of observation;

2) determination of the period of work at all stages;

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

4) determining the place where observations will be made;

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) the stage of observation;

2) statistical grouping and summary;

3) counting processing;

4) scientific analysis;

5) literary and graphic design of the research data.

Organization of statistical accounting and reporting

The functional subdivision of the health facility responsible for the organization of statistical accounting and reporting is the department of medical statistics, which is structurally part of the organizational and methodological department. The head of the department is a statistician.

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

1) the department of statistics in the polyclinic - is responsible for the collection and processing of information received from the outpatient-polyclinic service;

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

3) medical archive - is responsible for the collection, accounting, storage of medical documentation, its selection and issuance according to requirements.

On the basis of the received data, OMO develops proposals and measures to improve the quality of medical care, organizes statistical accounting and reporting in all health facilities of the region.

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, the correct maintenance of records and providing the management of the institution with the necessary operational and final statistical information. They prepare reports and work with primary documentation.

35. Department of medical statistics of the polyclinic. Medical archive

The department of medical statistics of the polyclinic carries out work on the collection, processing of primary accounting documentation and the preparation of appropriate reporting forms for the work of the polyclinic. The main primary accounting document is the "Statistical coupon of an outpatient", coming in the form of a generally accepted form No. 025-6 / y-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;

3) service category;

4) belonging to the main production or work with occupational hazard (for the attached contingent).

Coupons from workshop polyclinics and health centers are processed according to the same parameters.

Monthly, quarterly reports are prepared on the results of the work of the polyclinic:

1) data on attendance by incidence with distribution by departments of the polyclinic, by doctors and by funding streams (budget, CHI, VHI, contractual, paid);

2) data on attendance by incidence of day hospitals, hospitals at home, an outpatient surgery center and other types of hospital-replacing types of medical care in a similar form;

3) information on attendance by incidence of shop polyclinics and health centers in the same form;

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

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

Medical archive is designed to collect, record and store medical records, select and issue requested documents for work. The medical archive is located in a room designed for long-term storage of documentation. The archive receives the case histories of retired patients, which are taken into account in the journals, marked, sorted by departments and alphabetically. In the archive, the selection and issuance of case histories per month on applications and, accordingly, the return of previously requested ones are carried out. At the end of the year, the records of retired patients, case histories of deceased patients, and case histories of outpatients are accepted for storage, accounting, and sorting; final sorting and packing of case histories for long-term storage are carried out.

36. Department of medical statistics of the hospital

In the department of medical statistics of the hospital, work is carried out to collect and process primary accounting documentation and draw up appropriate reporting forms based on the results of the work of the clinical hospital. The main primary accounting forms are the medical card of the inpatient (f.003 / y), the card of the person who left the hospital (f.066 / y), the sheet for registering the movement of patients and the hospital bed fund (f.007 / y). The department receives primary accounting forms from the admission department and clinical departments. Processing of received forms of several types is carried out daily.

1. The movement of patients in departments and in the hospital as a whole:

1) verification of the accuracy of the data specified in the form 007 / y;

2) correction of data in the summary table of the movement of patients (form 16 / y);

3) surname registration of the movement of patients in multidisciplinary departments, intensive care units and cardioreanimation;

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

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

2. Entering data into the journal of oncological patients with the issuance of appropriate registration forms (027-1 / y, 027-2 / y).

Entering data into the register of deceased patients. Statistical processing of forms 003/y, 003-1/y, 066/y:

1) registration of case histories received from departments in f.007 / y, specifying the profile and terms of treatment;

2) checking the accuracy and completeness of filling out forms 066 / y;

3) withdrawal from the history of coupons to the accompanying sheet of the SSMP (form 114 / y);

4) verification of the compliance of the cipher of the medical history (flows of financing) with the order of receipt, the availability of a referral, the tariff agreement with the TF CHI;

5) coding of case histories with indication of codes.

5. Entering information into a computer network: for CMI and VHI patients and for patients financed from several sources, it is carried out under direct contracts, letters of guarantee.

6. Analysis of the processed case histories with the withdrawal of form 066 / y and their sorting by department profiles and discharge dates. Delivery of case histories to the medical archive.

7. Continuous monitoring of the timeliness of the delivery of case histories from clinical departments according to the sheets of records of the movement of patients with a periodic report to the head of the department.

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

1) used in a hospital;

2) for polyclinics;

3) used in a hospital and clinic;

4) for other medical and preventive institutions;

5) for institutions of forensic medical examination;

6) for laboratories;

7) for sanitary and preventive institutions.

37. Medical and statistical analysis of medical institutions

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

The annual report (f. 30 "Report of the medical institution") is compiled on the basis of the data of the current accounting of the elements of the work of the institution and the forms of primary medical documentation. The report form is approved by the Central Statistical Bureau of the Russian Federation and is the same for all types of institutions.

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 causes and is associated with various performance indicators. Therefore, when evaluating the activities of the institution as a whole, one should keep in mind the various influences of various factors on the results of the work of health care institutions and the range of the relationship between performance indicators.

The essence of the analysis lies in assessing the value of the indicator, comparing and comparing it in dynamics with other objects and groups of observations, in determining the relationship between indicators, their dependence on various factors and causes, in interpreting data and conclusions.

The performance indicators of health care facilities are evaluated based on comparison with norms, standards, official guidelines, optimal and achieved indicators, comparisons with other institutions, teams, aggregates in dynamics by years, months of the year, days, followed by determination of work efficiency.

In the analysis, indicators are combined into groups that characterize a particular function of a health facility, a section of work, a division or a serviced contingent, sections.

1) General characteristics.

2) Organization of work.

3) Specific performance indicators.

4) The quality of medical care.

5) Continuity in the work of institutions.

Consolidated Hospital Annual Report composed

from the following main sections:

1) general characteristics of the institution;

2) states;

3) activities of the polyclinic;

4) operation of the hospital;

5) activities of paraclinical services;

6) sanitary and educational work.

Economic analysis of the activities 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 the bed fund;

3) use of medical equipment;

4) use of medical and other personnel.

38. Methodology for analyzing the annual report of the joint hospital

Based on the reporting data, indicators are calculated that characterize the work of the institution, according to which the analysis of each section of the work is carried out. Using the data obtained, the head 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.

Staffing with doctors (by positions and individuals):

number of occupied medical positions (individuals) x x100 / number of full-time medical positions (normally (N) = 93,5).

Staffing with paramedical personnel (by positions and individuals):

the number of occupied positions (individuals) of nursing staff x100 / the number of full-time positions of nursing staff (N = 100%).

Staffing of junior medical personnel (by occupied positions and individuals): the number of occupied positions (individuals) of junior medical staff x100 / the number of full-time positions of junior medical staff.

Compatibility coefficient (CS):

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

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

1) analysis of the staffing of the polyclinic, the state of its material and technical base and the provision of medical equipment, the compliance of the organizational and staffing structure of its divisions with the volume and nature of the tasks to be solved;

2) state of health, morbidity, hospitalization, labor losses, mortality;

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

4) medical and diagnostic work in the following sections:

a) medical work of departments of therapeutic and surgical profile;

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

c) the work of diagnostic units;

d) the work of auxiliary medical departments and polyclinic rooms (physiotherapy 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 pre-hospital stage, the reasons for discrepancies in diagnoses between the clinic and the hospital;

h) organizing and conducting a consultative expert commission and medical and social expertise;

5) preventive work;

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

39. Analysis of the work of the clinic

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

Analysis of the work of the clinic for the year. All areas of activity of the clinic are analyzed. At the same time, recommendations and methods for calculating medical and statistical indicators are used, which are set out in the guidelines for compiling 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 of the clinic for the reporting and previous years with the performance of other clinics, with average indicators for the city (region, district). Inside the polyclinic, the performance of departments with similar profiles is compared.

Particular attention should be paid to the analysis of the effectiveness of introducing new modern medical technologies into the practice of diagnostics and treatment, including hospital replacements, as well as the implementation of proposals to improve the material and technical base.

The degree of fulfillment of the tasks set by the departments of the polyclinic and the institution as a whole is assessed, the correspondence of the forces and means available in the polyclinic to the nature and characteristics of the tasks it solves is reflected. Statistical analysis is carried out according to the scheme:

1) general information about the clinic;

2) organization of work of the polyclinic;

3) preventive work of the polyclinic;

4) quality of medical diagnostics.

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

Provision of the population with polyclinic care is determined by the average number of visits per 1 inhabitant per year:

number of medical visits in the polyclinic (at home) / number of population served. In the same way, it is possible to determine the provision of the population with medical care in general and in individual specialties. This indicator is analyzed in dynamics and compared with other polyclinics. The indicator of the load of doctors for 1 hour of work: total number of visits during the year / / total number of hours of admission during the year.

40. FVD

The function of a medical position (FVD) is the number of visits to one doctor working at the same rate per year. Distinguish FVD actual and planned:

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

2) The planned PVD should be calculated taking into account the standard workload of a specialist for 1 hour at the reception and at home according to the formula:

FVD \u1d (a hb h c) + (a1 hb1 hvXNUMX),

where (a h b h c) - work at the reception; (a1 h b1 h v1) - work at home; a - the load of the therapist for 1 hour at the reception (5 people per hour);

b - number of hours at the reception (3 hours); c - the number of working days of health facilities per year (285); a1 - load for 1 hour at home (2 people); b1 - the number of hours of work at home (3 hours); в1 - the number of working days of health facilities in a year.

The degree of implementation of the FVD - this is the percentage of the actual FVD to the planned one:

FVD actual h100 / FVD planned.

The value of the actual FVD and the degree of fulfillment are influenced by:

1) the accuracy of registration of the accounting form 039 / y;

2) work experience and qualifications of the doctor;

3) reception conditions (equipment, staffing with medical personnel and paramedical personnel);

4) the need of the population for outpatient care;

5) mode and work schedule of a specialist;

6) the number of days worked by a specialist in a 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 affecting its value (standards for the function 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, employment and staffing of medical positions.

Structure of visits by specialties: number of visits to a therapist h100 / / number of visits to doctors of all specialties (in N = 30-40%).

The share of rural residents in the total number of visits to the polyclinic (%):

number of visits to polyclinic doctors by rural residents h100 / total number of visits to the polyclinic.

This indicator is calculated both for the clinic as a whole and for individual specialists.

Structure of visits by types of appeals:

1) the structure of visits for diseases:

number of visits to a specialist for diseases h100 / total number of visits to this specialist;

2) the structure of visits for medical examinations:

number of visits for preventive examinations h100 / 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 to individual doctors is compared with their workload and employment in time during the month.

Home visiting activity (%): number of home doctor visits made actively h100 / total number of home doctor visits.

41. Local public services

One of the main forms of polyclinic services for the population is the territorial-district principle in the provision of medical care to the population. The reliability of the indicators characterizing the district service to the population, to a large extent, depends on the quality of the design of the doctor's diary (f. 39 / y).

Average population in the area (therapeutic, pediatric, obstetric-gynecological, workshop, etc.):

average annual adult population assigned to the polyclinic / number of sites (eg therapeutic) in the polyclinic.

The rate of visits to a district doctor at an appointment in a polyclinic (%) is one of the leading indicators:

number of visits to the district doctor by residents of their district h 100 / total number of visits to district doctors during the year.

The indicator of the locality at the reception characterizes the organization of the work of doctors in the polyclinic and indicates the degree of compliance with the district 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 a district therapist in the event that he constantly works at the site or replaces another doctor for at least 1 month).

Home care coverage: number of home visits made by your GP h100 / total number of home visits.

With reliable registration (f. 039 / y), this indicator, 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 during the year, it can be calculated for individual district doctors and for months.

With a decrease in the district coverage 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.

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

number of return visits to doctors / / number of initial visits to the same doctors. If this indicator is high (5-6%), one can think about the groundlessness of repeated visits prescribed by doctors due to an insufficiently thoughtful attitude towards patients; a very low rate (1,2-1,5%) indicates insufficiently qualified medical care in the clinic and that the main goal of repeated visits to patients is to mark a disability certificate.

42. Dispensary services for the population

The source of information on periodic inspections is the "Map subject to periodic inspection" (f. 046 / y).

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

number actually examined × 100 / number to be inspected according to the plan.

Frequency of detected diseases ("pathological lesion") is calculated for all diagnoses that are indicated in the report for 100, 1000 examined:

number of diseases detected during professional examinations × 1000 / total number of examined persons.

This indicator reflects the quality of preventive examinations and indicates how often the detected pathology occurs in the “environment” of those examined or in the “environment” of the population of the area where the polyclinic operates. More detailed results of preventive examinations can be obtained by developing "Dispensary observation cards" (f. 030 / y). This allows you to examine this contingent of patients by sex, age, profession, length of service, duration of observation; in addition, to evaluate the participation in examinations of doctors of various specialties, the performance of the required number of examinations per person, the effectiveness of examinations and the nature of the measures taken to improve and examine these contingents.

Dispensary observation of patients For the analysis of dispensary work, three groups of indicators are used:

1) dispensary observation coverage indicators;

2) indicators of the quality of dispensary observation;

3) indicators of the effectiveness of dispensary observation.

1. Frequency indicators.

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

"D"-observation during the year × 1000 / / the total number of the population served.

The structure of patients under "D"-observation, according to nosological forms (%):

the number of patients under "D"-observation for this disease × 100 / total number of dispensary patients.

2. Indicators of the quality of clinical examination.

Timeliness of taking patients on "D"-account

(%) (for all diagnoses):

the number of patients newly diagnosed and taken under "D"-observation G 100 / total number of newly diagnosed patients.

Completeness of coverage by "D"-observation of patients (%): the number of patients on the "D"-registration at the beginning

years + newly taken under "D"-observation - never appeared × 100 / number of registered patients requiring "D"-registration.

Compliance with the terms of dispensary examinations

(scheduled observation), %: number of prophylactic patients who observed the terms of appearance for "D"-observation × 100 / total number of prophylactic patients.

Completeness of medical and recreational activities (%):

underwent this type of treatment (recovery) × 100 / needed this type of treatment (recovery) during the year.

43. Indicators of the effectiveness of dispensary observation

The effectiveness of dispensary observation depends on the efforts and qualifications of the doctor, the level of organization of dispensary observation, the quality of medical and recreational activities, the patient himself, his material and living conditions, working conditions, socio-economic and environmental factors.

It is possible to evaluate the effectiveness of clinical examination based on the study of the completeness of the examination, the regularity of observation, the implementation of a complex of medical and recreational activities and its results. This requires an in-depth analysis of the data contained in the "Medical record of the outpatient" (f.025 / y) and the "Control card for dispensary observation" (f.030 / y).

Evaluation of the effectiveness of clinical examination should be carried out separately by groups:

1) healthy;

2) persons who have had acute illnesses;

3) patients with chronic diseases.

The proportion of patients removed from the "D"-registration in connection with recovery:

the number of persons removed from the "D"-registration in connection with the recovery × 100 / the number of patients on the "D"-registration.

The proportion of relapses in the dispensary group:

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

The proportion of patients on "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 × 100 / the number of employees in the dispensary group.

The proportion of newly taken "D"-registration among those under observation:

the number of newly taken patients on the "D"-registration with this disease × 100 / the number of patients on the "D"-registration at the beginning of the year + newly taken patients in this year.

Morbidity with temporary disability (TS) in cases and days for specific diseases, for which patients are taken to the "D"-registration

(per 100 medical examinations):

the number of cases (days) of morbidity with VUT with a given disease among those who were clinically examined in a given year × 100 / the number of those who were clinically examined with this disease.

The indicator of primary disability consisting on the "D"-registration for the year (per 10 medical examinations): recognized for the first time as disabled in a given year for this disease from those on the "D"-registration × 000 / the number of those on the "D"-registration during the year for this disease.

Mortality among patients on the "D"-registration (per 100 medical examinations):

the number of deaths among those on the "D"-registration × 1000 / the total number of persons on the "D"-registration.

44. Statistical indicators of morbidity, labor losses. Hospitalization rates

Statistical indicators of morbidity General frequency (level) of primary morbidity (%0):

the number of all initial applications h1000 / the average annual number of attached population.

Frequency (level) of primary morbidity by disease classes (%):

number of initial complaints about diseases × 1000 / average annual number of attached population.

The structure of primary morbidity by disease classes (%):

number of initial visits for diseases × 100 / number of initial visits for all classes of diseases.

Statistical indicators of labor losses Total frequency of cases (days) of labor losses (%): number of all cases (or days) of labor loss × 1000 / average annual fixed population.

Frequency of cases (days) of labor loss by disease class (%):

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

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

number of cases (days) of labor losses by classes (groups, separate forms) of diseases × 100 / number of cases (or days) of labor losses by all classes of diseases.

The average duration of cases of labor loss by disease class:

the number of days of labor loss by classes (groups, separate forms) of diseases / the number of cases of labor loss due to diseases.

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

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

The average duration of treatment in a day hospital by classes (groups, separate forms) of diseases (days):

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

by classes (groups, individual forms) of diseases.

Hospitalization rates Overall frequency (rate) of hospitalization (%): number of all hospitalized patients × 1000 / average annual fixed population.

45. Activities of the hospital.

Use of hospital beds

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

Provision of the population with hospital beds (per 10 population):

total number of hospital beds h10 / / population served.

Average annual employment (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 per month of the year in 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 the calculated standards for departments of various profiles.

Analyzing this indicator, it should be taken into account that the number of actually spent hospital days includes days spent by patients on the so-called side beds, which are not counted among the average annual beds; Therefore, the average annual bed occupancy may be more than the number of days in a year (over 365 days).

Degree of use of beds (fulfillment of the plan for bed days):

the number of hospital days actually spent by patients h100 / the planned number of hospital days.

Hospital bed turnover:

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

This indicator indicates how many patients were "served" by one bed during the year. The speed of bed turnover depends on the duration of hospitalization, which, in turn, is determined by the nature and course of the disease. 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 the planned standards for city hospitals of a general type, the bed turnover is considered optimal in the range of 25-30, and for dispensaries - 8-10 patients per year.

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

the number of hospital days spent by patients per year / / the number of discharged patients (discharged + deceased).

Like the previous indicators, it is calculated both for the hospital as a whole and for departments, bed profiles, and individual diseases.

The proportion of rural residents among hospitalized patients:

the number of rural residents hospitalized in a hospital for the year h100 / the number of all those admitted to the hospital.

46. Activities of the hospital. The quality of the medical and diagnostic work of the hospital

The composition of patients in the hospital for certain diseases (%):

the number of patients who left the hospital with a certain diagnosis h100 / the number of all patients who left the hospital.

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

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

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

When evaluating this indicator, it is necessary to take into account various factors that affect its value: the timing of the examination of the patient, the timeliness of diagnosis, the appointment of effective treatment, the presence of complications, the correctness of the examination of working capacity. 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 care (selection and examination of patients for hospitalization, the ability to continue treatment after discharge from the hospital in the clinic). Hospital mortality (per 100 patients, %): number of deceased patients × 100 / number of discharged patients (discharged + deceased).

Daily lethality (per 100 patients, intensive indicator): the number of deaths before 24 hours of hospital stay h100 / the number of those admitted to the hospital.

The formula can be calculated like this: share of all deaths on the first day in the total number of deaths (extensive indicator): number of deaths up to 24 hours of hospital stay hh 100 / number of all deaths in hospital.

The structure of surgical interventions (%): number of patients operated on for a given disease × 100 / total number of operated patients for all diseases.

The frequency of complications during operations (per 100 patients):

number of operations in which complications were observed × 100 / number of operated patients.

When evaluating 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 during the development of "Statistical cards of the patient who left the hospital" (f. 066 / y). This indicator should be analyzed together with the duration of hospital treatment and mortality (both general and postoperative).

47. The quality of medical diagnostics in the clinic and hospital

To assess the quality of medical diagnosis in medical statistics, a more accurate interpretation of the concept of "incorrect diagnosis" is used:

1) misdiagnosis;

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

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

4) incorrect diagnoses - the sum of erroneous and overlooked diagnoses for a particular disease.

As a result of comparison of the received data, proportion of incorrect diagnoses:

the number of outpatient diagnoses that were not confirmed

in hospital × 100 / total number of patients referred for hospitalization with this diagnosis.

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

Evaluation of the quality of medical diagnostics in a hospital is carried out on the basis of a comparison of clinical (vital) and pathoanatomical (sectional) diagnoses. In this case, the source of information is the "Medical records of an inpatient" (f.003 / y) and the results of autopsies of the dead.

The indicator of coincidence (discrepancy) of diagnoses (%)

number of diagnoses confirmed (not confirmed) at autopsy × 100 / total number of autopsies for a given cause.

The reasons for the discrepancy between clinical and pathoanatomical 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 studies;

5) absence, underestimation or overestimation of the consultant's opinion.

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

1) late hospitalization of the patient;

2) insufficient staffing of medical and nursing staff of medical and diagnostic departments;

3) shortcomings in the work of individual services of the hospital. The analysis of the epicrises of the dead is far from being exhausted by comparing the diagnoses - intravital and pathoanatomical. 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.

48. Quantitative indicators (coefficients) characterizing the ILC based on the results of the examination and questioning

1. Integral intensity factor(Ki) - the derivative of the coefficients of medical performance (Kp), social satisfaction (K_from), volume of work performed (K_about) and cost ratio (K_з): Ki = Kr × Ks × Kob × Kz.

At the first stages of work, due to possible difficulties in conducting economic calculations when determining K_з can only be limited to_р, K_с and K_about.

2. Medical success rate

(TO_р) - the ratio of the number of cases with an achieved medical result (Rd) to the total number of assessed cases of medical care (R): K_р = P_д/ R.

If the K level is also taken into account_рthen

Kp = SP_i3 to_i/ R,

where S is the summation sign;

P_i - the level of the result obtained (complete recovery, improvement, etc.);

a_i - scoring of the level of the result obtained.

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

К_к= number of cases of full compliance with adequate technologies / total number of cases of medical care assessed, and also as indicators of the structure of the reasons for the wrong choice of technology or their non-compliance.

3. Social Satisfaction Ratio (TO_с) - the ratio of the number of cases of consumer (patient, staff) satisfaction (Y) to the total number of assessed cases of medical care (N).

К_с = U / N.

If satisfaction is also taken into account, then

Kp = S y_i / R,

where y_i - the number of respondents who answered positively to the i-th question;

a_i - scoring of the level of the result obtained.

4. Work done ratio! (TO_about) is one of the most important performance indicators of a medical institution and its divisions.

К_about = O_ф / O_п,

where O_ф - the number of actually performed medical services;

О_п - the number of planned medical services.

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

Kin = H_ф × 100 / N_н,

where H_ф - indicator of the actual load;

Н_н - an indicator of the standard load.

49. The effectiveness of health care and its types

Health economics - one of the sections of social medicine and healthcare organization, the subjects of which are the study and use of the objective laws of the development of economic relations that develop in the industry in the process of protecting public health.

Effect in health care characterizes the medical, social and economic results of a method, intervention, event.

Efficiency - this is a broader concept that characterizes the effect and shows how material, labor and financial resources were used in a given method, intervention, event. There are medical, social and economic efficiency.

Under medical efficiency refers to the qualitative and quantitative characteristics of the degree of achievement of the objectives in the field of prevention, diagnosis and treatment of diseases.

Social efficiency its content is very close to medical effectiveness. At the same time, if medical efficiency is measured by the result of direct medical intervention, by indicators of improving the health of workers from the onset of the disease to complete recovery with the restoration of working capacity, then the social effectiveness of health care is characterized by an improvement in public health, a decrease in morbidity, premature mortality, a change in demographic indicators, and an ever-increasing satisfaction of the population in medical care and sanitary and epidemiological services.

Cost-effectiveness characterizes the direct and indirect (indirect) contribution made by health care to the growth of labor productivity, the increase in national income, and the development of production. Often, medical effectiveness is dominant, requiring significant costs, the return on which may take place in the distant future or is completely excluded. When organizing medical care for elderly people with chronic degenerative diseases, patients with mental retardation, severe damage to the central and peripheral nervous system, and some other conditions, with obvious medical and social efficiency, the economic effect will be negative.

The economic efficiency of health care creates the following types of economic benefits for the state: reduction of temporary disability, disability, premature death, reduction of medical care costs.

An economic analysis of the activities of medical institutions is carried out in the following areas: the use of fixed assets, the efficiency of the use of beds and medical equipment, the assessment of financial costs and the cost of various types of medical care, the use of medical and other personnel. Along with this, the main economic indicators are calculated: the total economic damage due to morbidity, disability and mortality, the prevented economic damage and the criterion for the economic efficiency of medical care.

50. Analysis of the use of fixed assets of a medical institution

Fixed assets - a set of material values produced by social labor, acting for a long period.

The fixed assets belonging to the institution include buildings and structures, machinery, equipment and inventory. The main funds are:

1) active part;

2) passive part;

3) other fixed assets.

Capital-labor ratio of personnel - this is an indicator that characterizes the level of technical equipment of labor processes, the amount of fixed production assets per employee.

The capital-labor ratio is determined by dividing the value of fixed assets by the average annual number of employees according to the staffing table.

Capital-labor ratio of personnel: cost of fixed assets / average annual number of employees.

Capital-labor ratio of medical staff:

the cost of the active part of fixed assets / the average annual number of medical staff.

return on assets - the volume of production per unit cost of fixed assets.

Capital productivity for the hospital:

number of hospitalized patients × 1000 / cost of fixed assets for a hospital (rubles).

About the return on capital for the clinic:

number of applicants × 1000 / cost of fixed assets for the polyclinic (rubles).

Capital productivity for the hospital:

costs of maintaining a hospital × 1000 / cost of fixed assets for a hospital (rubles).

Return on assets for the clinic:

polyclinic maintenance costs × 1000 / cost of fixed assets for the polyclinic (rubles).

capital intensity - the cost of fixed production assets per unit volume of production. The higher the return on assets, the lower the capital intensity, ceteris paribus, and vice versa.

Direct capital intensity is defined as the ratio of the fixed assets of a healthcare institution to the volume of production in monetary terms.

Full capital intensity takes into account not only fixed assets directly involved in the production of industry products (health care institutions), but also those that functioned in industries that indirectly participated in the production of these products.

Capital intensity by hospital:

fixed assets of the polyclinic (rubles) × 1000 / number of hospitalized patients.

Return on assets for the clinic:

fixed assets of the polyclinic (rubles) × 1000 / number of people who applied to the polyclinic.

51. Indicators recommended for conducting an analysis of the economic activity of a polyclinic

Efficiency (E_ф), or the ratio of results to costs, is calculated using the following formulas:

Э_ф = profit × 100 / cost = %,

where profit \uXNUMXd revenue - costs, the cost is equal to the costs incurred in the provision of medical care. The cost price reflects the costs incurred in the provision of services on a paid basis. Or

Э_ф = gross income × 100 / cost price,

where gross income as a result of paid activities is equal to the sum of wages and profits.

Operational efficiency is considered taking into account the cost, expressed as the total cost of all paid services, and the profit received as a result of all paid activities.

Gross profit (AT_п): turnover (revenue) - the cost of purchased raw materials, materials, other costs.

Уlike net profit

(AT_п) - (overhead costs and amounts of depreciation of equipment).

Revenue from the sale of medical services is calculated by multiplying the price of one service by their number:

Q = S(P × N),

where Q - revenue, i.e. the volume of paid medical services in rubles, the turnover of the institution;

P - the price of one service;

N - the number of services of this type.

Labor efficiency - labor productivity (PT) of employees:

П_т = net profit (NP) × 100 / average number of employees,

where net profit (NP) - profit after tax and interest on the loan.

Эefficient use of material resources (medicines, soft materials, etc.) expresses material consumption (M_е)

М_е \uXNUMXd material costs (M) / net profit (after the sale of services).

Profitability (RT), or profitability, profitability:

Р_т \u100d net profit (NP) × XNUMX / book value of fixed and working assets \uXNUMXd%,

where P_т - profitability (should not be lower than 8-10%);

Р_т - the expression of profit in relative terms, as a rule, is calculated as the expected profit when calculating the price of medical services. An indicator of the growth of performance efficiency can also be a tendency to reduce costs per unit of service, i.e. average cost indicator

(si):

Si = gross costs (B_и) / number of services (K_у),

where in_и - the sum of all costs incurred by the polyclinic in the organization and implementation of medical care on a paid basis;

К_у - all medical services for the reporting period.

used to characterize funding. indicator of the specific weight of the source of financing (in %):

П_т = amount of a specific source of funding (budget, CHI, etc.) × 100 / sum of all funding sources.

Revenue per doctor:

revenue / average annual number of doctors.

52. Renovation of fixed assets. Analysis of the financial costs of health care institutions

Fixed assets reflect the state of the material and technical base of a healthcare institution (polyclinic, hospital, etc.). The renewal of fixed assets is characterized by 3 indicators.

1. Retirement rate characterizes the intensity of retirement of fixed assets for the year (rubles) to the value of fixed assets at the end of the year.

Retirement ratio = amount of retired fixed assets for the year (rubles) / cost of fixed assets at the end of the year (rubles).

2. Refresh rate shows the share of the value of new fixed assets put into operation in a given year to their total value at the beginning of the year:

Renewal coefficient = amount of introduced fixed assets for the year (rubles) / value of fixed assets at the beginning of the year (rubles).

The standard for the renewal of fixed assets is 10-15%.

3. Accumulation ratio characterizes the process of replenishment of fixed assets of the institution:

Accumulation coefficient = difference between the amount of introduction and retirement of fixed assets for the year (rubles) / cost of fixed assets at the beginning of the year (rubles).

Profitability of fixed assets - is the ratio of profit (the amount of self-supporting income in rubles) to the average annual cost in rubles, expressed as a percentage:

Profitability \uXNUMXd profit (the amount of self-supporting income in rubles) / average annual cost of fixed assets (rubles).

Productivity (rub.):

income from the sale of medical services / the number of employees who participated in the receipt of this income.

Analysis of the financial costs of health care institutions.

Analysis of financial costs is one of the important sections of the economic analysis of the activities of health care institutions. These indicators include:

1) the structure of financial expenses for the institution;

2) the cost of treatment in a hospital;

3) the cost of medical services in outpatient clinics.

Share of payroll costs by institution (%). Determination of costs is carried out by analyzing primary expenditure documents. Payroll costs are determined on the basis of monthly payrolls.

Share of payroll costs:

the amount of salary costs for the year × 100 / the amount of expenses for the institution as a whole for the year.

The share of expenses for food of patients:

expenditures on medical facilities for food of patients × 100 / sum of expenditures for the institution as a whole for the year.

The share of these costs is about 9%.

Share of spending on medicines:

facility spending on medicines × 100 / total facility spending for the year.

This figure is about 10%.

The share of equipment costs:

equipment costs for the year × 100 / the amount of expenses for the institution as a whole for the year.

53. Analysis of the effectiveness of the use of beds

Hospitals are the most expensive healthcare facilities, so the rational use of the bed fund is of great importance. Bed idling in hospitals not only reduces the volume of inpatient care and worsens the health care of the population as a whole, but also causes significant economic losses. Reducing bed downtime reduces overhead costs for hospitals and reduces the cost of their bed day.

The main reasons for bed downtime are the lack of uniform admission of patients, bed absenteeism between discharge and admission of patients, preventive disinfection, quarantine due to nosocomial infection, repair, etc. d.

Hospital bed turnover defined as a ratio:

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

The ability to serve one or another number of patients with one bed is determined sick leave function

bunks (F), which is calculated as the quotient of the average annual bed occupancy, taking into account its profile (D), divided by the average number of days the patient stays in a bed of the same profile (P).

F = D / P

Average annual employment (work) of a hospital bed calculated:

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

The assessment of this indicator is carried out by comparison with the calculated standards. The optimal average annual bed occupancy can be calculated for each hospital separately, taking into account its bed capacity using the following formula:

D = 365N / (N + 3√N),

where D is the average number of days a bed works in a year;

H is the average annual number of beds in a hospital.

The calculation is made according to the following method:

1) the average number of beds closed during the year due to repairs is calculated:

number of days of closure for repairs / number of calendar days per year;

2) the average number of beds that functioned during the year is determined:

average annual number of beds - the number of beds that were closed due to repairs.

The average number of days of work of a bed per year, taking into account repairs, is calculated:

the number of bed days actually spent by patients / the number of beds that functioned during the year (not closed for repairs).

T \u365d (XNUMX - D) / F,

where T is the idle time of a bed of a given profile due to turnover;

D - the actual average annual occupancy of a bed of a given profile;

Ф - bed turnover.

54. Methodology for calculating economic losses from idle beds

Economic losses as a result of idle beds are calculated on the basis of determining the difference between the estimated and actual cost of one bed day. The cost of a hospital day is calculated by dividing the cost of maintaining a hospital by the corresponding number of hospital days (estimated and actual). This excludes the cost of food for patients and the purchase of medicines, which do not affect the amount of losses from idle beds, since they are made only for the bed occupied by the patient.

Estimated number of bed days is calculated based on the optimal average annual bed occupancy.

Implementation of the plan for hospital stays defined like this:

the number of hospital days actually spent by patients h100 / the planned number of hospital days.

Methodology for calculating economic losses from underfulfillment of the plan of coykodays:

Economic losses associated with underfulfillment by the hospital of the plan for bed days (U_с), are calculated by the formula:

У_с = (B - PM) × (1 - (Kf / Kp)),

where B - costs according to the estimate for the maintenance of the hospital;

PM - the amount of expenses for food of patients and medicines;

К_п - planned number of hospital days;

К_ф - the actual number of bed-days.

For simplified calculations_с can be calculated as follows

У_с \u0,75d 1 × B h (XNUMX - (Kf / Kp)),

where 0,75 is a coefficient reflecting the average ratio of the cost of an empty bed compared to the cost of an occupied bed.

Average length of stay of a patient in a hospital (average bed day) is defined as the following ratio:

the number of hospital days spent by patients in the hospital / the number of discharged patients (discharged + deceased).

With a decrease in the average duration of a patient's stay in a bed, the cost of treatment decreases, while a reduction in the duration of treatment allows hospitals to provide inpatient care to a larger number of patients with the same amount of budget allocations. In this case, public funds are used more efficiently (the so-called conditional budget savings).

E \uXNUMXd B / Kp × (P_р- P_ф) × A,

where E - conditional savings of budgetary funds;

B - expenses according to the estimate for the maintenance of the hospital;

К_п - planned number of hospital days;

П_р- estimated average length of stay in a hospital (standard);

П_ф - actual average length of stay in hospital;

A is the number of patients treated in the hospital per year.

55. Usage Analysis

medical personnel. General environmental damage due to morbidity, disability, mortality

To analyze the effectiveness of the use of medical personnel of a medical institution, the following indicators are calculated. Number of medical workers in a polyclinic per 1000 inhabitants = number of medical staff × 1000 / average population.

Similarly, the indicators of the number of doctors and paramedical personnel per 1000 inhabitants of a given territory are calculated.

The indicator of the ratio of the number of doctors and paramedical workers = number of medical staff × 1000 / average annual number of paramedical workers.

Similarly, the ratio of the number of doctors and paramedical personnel for a hospital is determined.

Number of all health workers per 100 beds = number of health workers in hospital × 100 / average annual number of hospital beds.

Number of doctors per 100 hospital beds = number of hospital doctors × 100 / average annual number of hospital beds.

Number of paramedical staff per 100 hospital beds = number of paramedical workers ×100 / average annual number of hospital beds.

General environmental damage due to morbidity, disability and mortality

Economic losses due to temporary and permanent disability are composed of the following components:

1) the cost of uncreated products;

2) payment of benefits for temporary and permanent disability at the expense of social insurance and social protection funds;

3) funds spent on all types of medical care.

The calculation of the cost of medical care is carried out by summing up:

1) the cost of outpatient, inpatient, paraclinical and sanatorium care;

2) the cost of ambulance and emergency care, delivery of the patient on vehicles to the hospital;

3) the cost of epidemiological care for infectious diseases.

The cost of outpatient care consists of the cost of all:

1) visits to doctors in the clinic and at home;

2) diagnostic studies;

3) medical manipulations and procedures.

Economic damage due to disability consists of funds spent on treatment and payment of disability pensions, and losses in the value of uncreated products due to a decrease in the number of people employed in production activities.

56. Prevented economic damage. Criteria of economic efficiency. Analysis of the effectiveness of the use of medical equipment

Economic efficiency of health care is determined not only by the amount of economic damage from certain cases of morbidity, disability, disability associated with social causes, but also by the reduction of this damage as a result of a complex of therapeutic and preventive measures aimed at eliminating morbidity and mortality. In this case, one speaks of averted economic damage.

Amount of prevented economic damageis determined for a patient or a group of patients who are under dispensary observation for a long time (at least 3 years), and is the difference between the economic damage of the first and each subsequent year.

The criterion of economic efficiency is determined by dividing the amount of prevented economic damage by the amount of funds spent.

Example. The economic damage due to the disease of the seamstress O., who suffers from chronic cholecystitis, in the first year of being taken to the dispensary account amounted to 7500 USD. e., in the second year - 5300 c.u. e., in the third year - 2600 c.u. e. The cost of medical care during the medical examination (3 years) amounted to 3000 c.u. e.

Amount of prevented economic damage will be:

for the first year: 7500 c.u. e. - 1500 c.u. e. = 6000 c.u. e.;

for the second year: 7500 c.u. e. - 5300 c.u. e. = 2200 c.u. e.;

for the third year: 7500 c.u. e. - 2600 c.u. e. = 4900 c.u. e.;

Total for 3 years: 2200 c.u. e. + 4900 c.u. e. = 7100 c.u. e.

Criterion of economic efficiency = 7700 c.u. e. (amount of prevented economic damage) / 300 c.u. e. (cost of medical care) = 2,37.

The result obtained means that the ratio of the cost of costs and the prevented economic damage is 1 / 2,37, i.e. 1 c.u. e. the cost of medical care for this patient received an economic effect in the amount of 2,37 c.u. e.

Analysis of the effectiveness of the use of medical equipment

Under the conditions of insurance medicine, the technical re-equipment of medical institutions with medical equipment began. Taking into account the high cost of medical equipment, especially imported, there was a need for an economic analysis of its effective use.

Calendar service factor:

time of possible use of medical equipment in accordance with the mode of operation of the health facility / number of calendar days per year (365) × h maximum possible time of work per day (8 hours), standard average - 0,9.

Author: Zhidkova O.I.

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Artificial leather for touch emulation 15.04.2024

In a modern technology world where distance is becoming increasingly commonplace, maintaining connection and a sense of closeness is important. Recent developments in artificial skin by German scientists from Saarland University represent a new era in virtual interactions. German researchers from Saarland University have developed ultra-thin films that can transmit the sensation of touch over a distance. This cutting-edge technology provides new opportunities for virtual communication, especially for those who find themselves far from their loved ones. The ultra-thin films developed by the researchers, just 50 micrometers thick, can be integrated into textiles and worn like a second skin. These films act as sensors that recognize tactile signals from mom or dad, and as actuators that transmit these movements to the baby. Parents' touch to the fabric activates sensors that react to pressure and deform the ultra-thin film. This ... >>

Petgugu Global cat litter 15.04.2024

Taking care of pets can often be a challenge, especially when it comes to keeping your home clean. A new interesting solution from the Petgugu Global startup has been presented, which will make life easier for cat owners and help them keep their home perfectly clean and tidy. Startup Petgugu Global has unveiled a unique cat toilet that can automatically flush feces, keeping your home clean and fresh. This innovative device is equipped with various smart sensors that monitor your pet's toilet activity and activate to automatically clean after use. The device connects to the sewer system and ensures efficient waste removal without the need for intervention from the owner. Additionally, the toilet has a large flushable storage capacity, making it ideal for multi-cat households. The Petgugu cat litter bowl is designed for use with water-soluble litters and offers a range of additional ... >>

The attractiveness of caring men 14.04.2024

The stereotype that women prefer "bad boys" has long been widespread. However, recent research conducted by British scientists from Monash University offers a new perspective on this issue. They looked at how women responded to men's emotional responsibility and willingness to help others. The study's findings could change our understanding of what makes men attractive to women. A study conducted by scientists from Monash University leads to new findings about men's attractiveness to women. In the experiment, women were shown photographs of men with brief stories about their behavior in various situations, including their reaction to an encounter with a homeless person. Some of the men ignored the homeless man, while others helped him, such as buying him food. A study found that men who showed empathy and kindness were more attractive to women compared to men who showed empathy and kindness. ... >>

Random news from the Archive

SilverStone ECU01 expansion card will add 4 USB 3.0 ports 11.09.2014

SilverStone's product range has been expanded with the ECU01 expansion card. According to the manufacturer, it is the world's first PCI Express 2.0 x2 expansion card equipped with two 19-pin USB 3.0 connectors (four ports). The PCI Express 2.0 x2 bandwidth of 10 Gb/s ensures stable operation and fast data transfer when connecting multiple devices to USB ports at the same time.

The ECU01 supports UASP (USB Attached SCSI Protocol) and comes with a Turbo Boost driver that allows you to increase the data transfer speed. The card is low-profile, which can also be attributed to its advantages, since the ECU01 can be installed in a small-sized case.

The suggested price for ECU01 is $30,45.

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