CLINICAL AND ECONOMIC ASSESSMENT OF AN INTEGRATED CLINICAL AND STATISTICAL GROUPS FOR NUTRITIONAL SUPPORT OF PATIENTS WITH MALIGNANT TUMORS, NEED SURGICAL TREATMENT
Eating disorders in patients with ZNO are an important factor that significantly affects treatment outcomes and overall survival. Nutritional support for patients with malignant tumors in need of surgical treatment has its own characteristics. Changes in metabolism are determined by the intervention itself and significantly affect the occurrence of postoperative complications. To achieve effective healing of the postoperative wound and functional recovery of the body, a high-quality metabolic response is necessary, which is possible only in the case of nutritional support of the patient, especially if the inflammation is prolonged or the patient does not finish eating. Purpose of research. The inclusion of nutritional status screening in the program of the state guarantee for providing free medical care to patients with ESR will allow forming clinical and statistical groups and rates for the completed case of treatment of an ESR patient in need of nutritional support. Materials and methods. The study presents methodological and clinical - economic approaches to the formation of a new clinical and statistical group (CSG) for patients of the ZNO who are being treated in a round - the-clock hospital, who are undergoing surgical treatment. The analysis of European clinical recommendations on nutritional support for patients with ZNO, the analysis of the legal framework and methodological support for the formation of clinical and statistical groups in the framework of the program of state guarantees for free medical care for citizens of the Russian Federation from the budget of the MHI was carried out. The method of pharmaco-economic analysis was used to collect and analyze direct medical costs for the diagnosis, treatment and observation of a patient with ESRD who needs nutritional support, according to international clinical recommendations. The method of expert assessments in the formation of the average frequency of use and the average frequency of provision of various medical services according to the nomenclature of medical services accepted for use in the Russian Federation. Research result. It is proposed to include new classification criteria in the guidelines for the formation of CSG, such as" primary screening "for the purpose of identifying nutritional risk, consisting of only 4 questions, and" main screening", which allows assessing the severity of violations of the nutritional status by a point system. In the presented algorithm of CSG formation, nutritional support is divided into enteral probe and parenteral nutrition, as well as into blocks: ICU for 3 days and stay in the Department for 14 days. Conclusion. The proposed comprehensive CSG, designed for 21 days of stay in a round-the-clock hospital, will have a rate equal to 200,058 rubles 66 kopecks for one completed case of surgical treatment of a patient with ZNO who needs nutritional support.