Updating the procedures for providing medical care services to patients with cardiovascular diseases

Highlights. The process of updating the procedures for providing medical care services affects the quality and safety of patients. The current requirements and the results of public health surveillance are analyzed. Hypotheses have been formed for expert analysis in case of update of regulatory and administrative laws.
Aim. To analyze the procedures for providing medical care services to further search for appropriate updating mechanisms.
Methods. The study focuses on the analysis of the current procedures for provision of medical care services to the adult population suffering from cardiovascular diseases, and the analysis of 1319 reports published by governmental organizations during public healthcare surveillance for the period from 2015 to 2019 which revealed violations of the procedures for provision of medical care services to patients with cardiovascular diseases.
Results. The procedures for providing medical care services to patients with cardiovascular diseases contain 983 provisions. 768 (78.13%) of them are equipment standards. Out of the remaining 215 provisions, excluding the equipment standards, 130 (60.46%) meet the criteria for mandatory requirements, and 63 provisions (29.30%) are unique (i.e., not duplicated in other legal acts). Of the 1319 inspections conducted by Roszdravnadzor (Federal Service for Surveillance in Healthcare) in 2015- 2019, 190 cases contained violations of the procedures for providing medical care services to cardiac patients. Of the 308 cases of detected violations, 206 (66.88%) were due to the absence of certain items provided for by the equipment standard. At the same time, 93.14% of all violations that were not associated with the equipment standards, occurred due to violation of 7 provisions of the Order of the Ministry of Healthcare of Russian Federation No. 918n. Identification of pattern of these violations revealed that issues related to the absence of two regulations of the equipment standard in medical organizations have never been addressed.
Conclusion. The procedures for provision of medical care services to patients with cardiovascular diseases contain a relatively small number of mandatory requirements (compared to the total number of provisions contained in the procedures). Identification of the same type of violations of the regulatory act committed by numerous medical organizations indicates necessity to further assess their real contribution to the quality and safety of healthcare. The analysis of the reports published by governmental organizations made it possible to develop hypotheses that can be analyzed as “input” data by experts who participate in the process of updating the procedures for providing medical care services. The existence of data that could initiate the process of updating the procedures (or the process of rejecting the amendments) will assist in systematization of this work.

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