Influence of administrative factors on the effectiveness of health care delivery to victims with acute spine and spinal cord injuries: regional retrospective study as a base for improving national clinical guidelines
Objective. To identify key organizational factors that determine the effectiveness of the system for delivering medical care to victims with acute spinal cord injury in the setting of large constituent entity of the Russian Federation, and to develop appropriate proposals for im-proving the national...
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| Format: | Article |
| Language: | English |
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Ministry of Health of Russian Federation, Federal State Budgetary Institution "Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan"
2020-09-01
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| Series: | Хирургия позвоночника |
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| Online Access: | https://www.spinesurgery.ru/jour/article/view/1723/1714 |
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| author | Alexandr K. Dulaev Denis I. Kutyanov Vadim A. Manukovskiy Sergey V. Iskrovskiy Pavel V. Zhelnov |
| author_facet | Alexandr K. Dulaev Denis I. Kutyanov Vadim A. Manukovskiy Sergey V. Iskrovskiy Pavel V. Zhelnov |
| author_sort | Alexandr K. Dulaev |
| collection | DOAJ |
| description | Objective. To identify key organizational factors that determine the effectiveness of the system for delivering medical care to victims with acute spinal cord injury in the setting of large constituent entity of the Russian Federation, and to develop appropriate proposals for im-proving the national clinical guidelines.
Material and Methods. The study included data on 2,283 patients with acute spinal cord injury who were treated within the framework of three successively existed organizational models of the health care delivery system: I – decentralized unprofiled (306 patients); II – decentralized profiled (454 patients); and III – centralized profiled (1523 patients). Using the methods of nonparametric statistics, the medical and statistical indicators were compared in patients examined when evaluating the results of treatment: 44, 75 and 148 patients from each organizational model, respectively (p > 0.05).
Results. The effectiveness of the treatment of victims with acute spinal cord injury depends on the interaction of organizational factors that determine the structure and operation of the health care system at the level of the federation subject as a whole (centralization fac-tor) and at the level of the relevant hospital (profiling factor). Specialized departments/centers for emergency spine surgery housed by multidisciplinary emergency hospitals – level I trauma centers (profiling factor) operate to maximum effect only when a centralized model of health care is organized in the subject of the federation (centralization factor).
Conclusion. Within the framework of national clinical guidelines for the treatment of patients with acute spinal cord injury, the principles of their routing and the requirements to be met by the involved hospitals should be clearly regulated. |
| first_indexed | 2024-03-12T10:23:31Z |
| format | Article |
| id | doaj.art-3718d5c4b79847b99c2830da2715d6a1 |
| institution | Directory Open Access Journal |
| issn | 1810-8997 2313-1497 |
| language | English |
| last_indexed | 2024-03-12T10:23:31Z |
| publishDate | 2020-09-01 |
| publisher | Ministry of Health of Russian Federation, Federal State Budgetary Institution "Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan" |
| record_format | Article |
| series | Хирургия позвоночника |
| spelling | doaj.art-3718d5c4b79847b99c2830da2715d6a12023-09-02T09:54:48ZengMinistry of Health of Russian Federation, Federal State Budgetary Institution "Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan"Хирургия позвоночника1810-89972313-14972020-09-01173324210.14531/ss2020.3.32-42Influence of administrative factors on the effectiveness of health care delivery to victims with acute spine and spinal cord injuries: regional retrospective study as a base for improving national clinical guidelinesAlexandr K. Dulaev0https://orcid.org/0000-0003-4079-5541Denis I. Kutyanov1https://orcid.org/0000-0002-8556-3923Vadim A. Manukovskiy2https://orcid.org/0000-0003-0319-814XSergey V. Iskrovskiy3https://orcid.org/0000-0003-2858-1743Pavel V. Zhelnov4https://orcid.org/0000-0003-2767-5123St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia; Pavlov First Saint Petersburg State Medical University, St. Petersburg, RussiaPavlov First St. Petersburg State Medical University, St. Petersburg, RussiaSt. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St.Petersburg, RussiaPavlov First St. Petersburg State Medical University, St. Petersburg, RussiaPavlov First St. Petersburg State Medical University, St. Petersburg, RussiaObjective. To identify key organizational factors that determine the effectiveness of the system for delivering medical care to victims with acute spinal cord injury in the setting of large constituent entity of the Russian Federation, and to develop appropriate proposals for im-proving the national clinical guidelines. Material and Methods. The study included data on 2,283 patients with acute spinal cord injury who were treated within the framework of three successively existed organizational models of the health care delivery system: I – decentralized unprofiled (306 patients); II – decentralized profiled (454 patients); and III – centralized profiled (1523 patients). Using the methods of nonparametric statistics, the medical and statistical indicators were compared in patients examined when evaluating the results of treatment: 44, 75 and 148 patients from each organizational model, respectively (p > 0.05). Results. The effectiveness of the treatment of victims with acute spinal cord injury depends on the interaction of organizational factors that determine the structure and operation of the health care system at the level of the federation subject as a whole (centralization fac-tor) and at the level of the relevant hospital (profiling factor). Specialized departments/centers for emergency spine surgery housed by multidisciplinary emergency hospitals – level I trauma centers (profiling factor) operate to maximum effect only when a centralized model of health care is organized in the subject of the federation (centralization factor). Conclusion. Within the framework of national clinical guidelines for the treatment of patients with acute spinal cord injury, the principles of their routing and the requirements to be met by the involved hospitals should be clearly regulated.https://www.spinesurgery.ru/jour/article/view/1723/1714spine and spinal cord injuryclinical guidelinesorganization of health carespecialized health carespine surgerytrauma centers |
| spellingShingle | Alexandr K. Dulaev Denis I. Kutyanov Vadim A. Manukovskiy Sergey V. Iskrovskiy Pavel V. Zhelnov Influence of administrative factors on the effectiveness of health care delivery to victims with acute spine and spinal cord injuries: regional retrospective study as a base for improving national clinical guidelines Хирургия позвоночника spine and spinal cord injury clinical guidelines organization of health care specialized health care spine surgery trauma centers |
| title | Influence of administrative factors on the effectiveness of health care delivery to victims with acute spine and spinal cord injuries: regional retrospective study as a base for improving national clinical guidelines |
| title_full | Influence of administrative factors on the effectiveness of health care delivery to victims with acute spine and spinal cord injuries: regional retrospective study as a base for improving national clinical guidelines |
| title_fullStr | Influence of administrative factors on the effectiveness of health care delivery to victims with acute spine and spinal cord injuries: regional retrospective study as a base for improving national clinical guidelines |
| title_full_unstemmed | Influence of administrative factors on the effectiveness of health care delivery to victims with acute spine and spinal cord injuries: regional retrospective study as a base for improving national clinical guidelines |
| title_short | Influence of administrative factors on the effectiveness of health care delivery to victims with acute spine and spinal cord injuries: regional retrospective study as a base for improving national clinical guidelines |
| title_sort | influence of administrative factors on the effectiveness of health care delivery to victims with acute spine and spinal cord injuries regional retrospective study as a base for improving national clinical guidelines |
| topic | spine and spinal cord injury clinical guidelines organization of health care specialized health care spine surgery trauma centers |
| url | https://www.spinesurgery.ru/jour/article/view/1723/1714 |
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