DEFECTS OF THE TREATMENT AND DIAGNOSTIC PROCESS IN OUT-PATIENT PROFILE “PSYCHIATRY” CONDITIONS
Introduction: Effective internal quality control can promote improvement of quality of delivery of health care to patients on a profile psychiatry and to timely identification of defects of medical and diagnostic process. Materials and methods: 797 cards of internal quality control of delivery of health care to the patients with mental disorders undergoing treatment in GBUZ PKB No. 4 of DZM in the conditions of a psychoneurological clinic (PND) - 676 people (84.8%) from 2015 to 2018 and 121 (15.2%) in 2019 are retrospectively analyzed. Results and discussion: Examination of quality of delivery of health care was carried out at two levels of control by medical experts - managers of structural units and deputy heads of PND. On 12 points primary medical documentation, the maximum assessment - 1 point was estimated. The general coefficient of quality represents an arithmetic average of coefficients of quality on each of points. Defects of delivery of health care are revealed at 1 and 2 levels of quality control. At 1 level of control made quality coefficients 0.9167 (0.86; 1.0), at the 2nd level of control - 0.727 (0.625; 0.8). Established that coefficient of quality of control 2 levels from 2015 for 2018 (0.67 (0.54; 0.75)) was significantly below, than in 2019 (0.79 (0.67; 0.83)) (р <0.001). Before entry into force of the order of the Russian Ministry of Health of 07.06.2019 No. 381n "About the approval of Requirements to the organization and carrying out internal quality control and safety of medical activity" in the territory of the Russian Federation was absent uniform approach to implementation of internal quality control. In Moscow the internal quality control was regulated by the Order of the Moscow Department of Healthcare of 16.08.2013 No. 820 "About Improvement of the Organization of Internal Quality Control and Safety of Medical Activity in the Medical Organizations of the State Health Care System of the City of Moscow". Unfortunately, this normative document uniform for all medical organizations also did not provide feature of the psychiatric medical organizations, in it there was no standardization of defects, control of some important parameters was insufficiently captured. So, the lack of standardization of defects did not allow to compare effectively quality of the provided medical care in various medical organizations and in one organization, interfered with continuity at assistance. The last, in turn, negatively affected control of results of treatment and demanded introduction of other complex organizational management decisions. Conclusion. Timely identification of defects of medical and diagnostic process and continuous monitoring with use of the analysis of cards of internal quality control promoted improvement of quality of delivery of health care to patients on the psychiatry profile in out-patient conditions.