Comparative analysis of the activity of VOKB No. 1 on the example of the otorhinolaryngology Department.

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RELEVANCE
Every year there is a complication of technologies for providing medical care and, consequently, an increase in its cost. In this regard, increased attention is paid to the problems of evaluating the effectiveness of medical organizations, which is an important component of the integrated system of planning the work of medical institutions [1]. The results of these measures are the basis for implementing management decisions aimed at improving the quality of medical care and the effective use of human, financial, and material and technical resources [2]. Analysis of statistical information about the activities of medical institutions helps not only to identify current problems and determine further tasks, but also to set priorities, the implementation of which will contribute to improving the efficiency of the medical organization. Shchepin and co-authors give the following definition:" the effectiveness of a health facility is the degree to which the goals set for a given institution are achieved at a certain cost " [3]. Therefore, you can evaluate the effectiveness after achieving a certain goal. The goal of the healthcare system is to provide the population with high-quality medical care at the lowest possible cost [4]. From this, we can distinguish two types of effectiveness: medical, which assesses the degree of satisfaction of patients ' needs in providing medical care, and economic, defined as the ratio of costs and results obtained [5]. These studies help both managers of medical organizations in planning development strategies, and patients in choosing medical institutions.
PURPOSE
To carry out a comparative analysis of the activities of VOKB No. 1 for the period from 2014 to 2018 on the example of the work of the otorhinolaryngology Department.
METHODS
Study design
In this study on the basis of the otorhinolaryngology Department of VOKB No. 1 for the reporting period from 2014. by 2018. the following performance indicators were evaluated: number of patients discharged at the end of the year; bed days spent; average annual bed occupancy; average patient stay in bed; bed turnover; lethality; surgical activity; number of treated nonresident patients; number of transferred to other hospital departments; % of the financial plan; implementation of the paid services plan. The results of the study were evaluated by the percentage of plan completion.
Compliance criteria
The study included the performance indicators of the ENT Department that most fully reflect the effectiveness of its activities.
Terms and conditions
The study was conducted on the basis of the otorhinolaryngological Department of VOKB No. 1. Voronezh's.
Duration of the study
This study did not have a planned duration; it was conducted until sufficient reporting material was collected for statistical analysis. This work began on October 9 and ended on November 15, 2019. During this time, 11 indicators of the ENT Department were evaluated for the reporting period from 2014 to 2018.
Description of medical intervention
Main outcome of the study
As a result of the comparative analysis, it was found that the number of patients discharged from the Department at the end of the year, as well as the indicator of the number of bed days spent by patients in the hospital, in each reporting year was more than 100% of the plan, the average annual bed occupancy rate also exceeded the planned value. The percentage of completion of the financial plan, as well as the implementation of the paid services plan, consistently exceeded the value of 100%. At the same time, in the course of this work, it was revealed that during the period from 2014 to 2018. the percentage of surgical activity in the otorhinolaryngology Department has steadily increased. An additional outcome of the study
Analysis in subgroups
Methods for registering outcomes
To register the main outcomes of the study, the method of comparative analysis was used.

Statistical analysis
Statistical processing of research data is represented by the percentage value obtained as a result of applying formulas for evaluating the performance of inpatient medical care, as well as the percentage of plan implementation.
RESULTS
Objects (participants) of the study
The objects of the study were the performance indicators of the otorhinolaryngology Department of VOKB No. 1 for the reporting period from 2014. by 2018: number of patients discharged at the end of the year; bed days spent; average annual bed occupancy; average patient stay in bed; bed turnover; lethality; surgical activity; number of treated nonresident patients; number of transferred to other hospital departments; % of the financial plan; implementation of the paid services plan. As the source of data was used in reporting documentation Department for a specified period of time.
Main results of the research
The number of patients discharged from the Department was 2,049 in 2014. (% of plan implementation - 118.1), in 2015, this indicator counted 2,150 patients (116.6%), in 2016 and 2017 - 2,229 (111.7%) and 2,180 (113.7%) patients, respectively, by 2018, the number of discharged patients approached the figure of 2,064 (107.5% of plan implementation). Number of hospital bed days spent by patients in 2014. it was -18446 (%of plan implementation - 110.9%), in 2015 - 18436 (110.1%), in 2016 - 17703 (104.1%), in 2017 - 17659 (106.9%), and in 2018 - 16642 (100.5%). The ENT Department has 50 beds in the state. Based on these data, the following indicators can be calculated using formulas: average annual bed occupancy, average patient stay in bed, and bed turnover. Average annual bed occupancy for 2014 it was 376.5 (plan - 339.4); in 2015-359.2 (326.4); in 2016 - 354.1 (340.1); in 2017 and 2018 - 353.2 (330.4) and 332.8 (331.3), respectively. Average patient stay in bed by 2014. there were 9.2 (plan - 9.9); in 2015 - 8.5 (8.9); in 2016 - 7.9 (8.5); in 2017 and 2018, the same values were noted (8.1) with the planned figures of 8.6. When evaluating such an indicator as bed turnover, the following values were obtained: in 2014 - 40.8; in 2015 - 42.5; in 2016 - 44.6; in 2017 - 43.6; in 2018 - 41.2. According to the mortality rate, the following data were obtained: in 2014. the mortality rate was 0.15% (three patients died), in 2015 - 0%, in 2016 - 0.04% (1 deceased), in 2017 - 0.18% (4 patients), in 2018 - 0.1% (two patients). Surgical activity for the period 2014. it was 101%, in 2015 -117.2%, in 2016-125%, in 2017 and 2018 this indicator reached the same values - 129.4%. The number of treated nonresident patients was 104 patients in 2014, 107 patients in 2015, 116 patients in 2016, 108 patients in 2017, and 99 patients in 2018. 22 patients were transferred to other departments of the hospital in 2014, 14 in 2015, 13 in 2016 and 2017, and 11 in 2018 And 2014. the financial plan was fulfilled by 111.2%, in 2015 by 113.4%, in 2016 this indicator acquired the value of 108.2%, in 2017-107.3%, in 2018 - 105.5%. Implementation of the paid services plan for 2014. it was 161%, in 2015 - 115.57%, in 2016-132%, in 2017. - 176%, and finally, in 2018 - 133%.
Additional findings of the study
Adverse event
No adverse events occurred during the study.
DISCUSSION
Summary of the main research result
When comparing the main performance indicators of the otorhinolaryngology Department of VOKB No. 1 for the reporting period from 2014. by 2018. there was a tendency to increase the percentage of surgical activity. Most of the results of the ENT Department exceeded the planned values stated for the year. This indicates an increase in the efficiency of the Department every year.
Discussion of the main research result
There are statistics from the Ministry of health of the Russian Federation for the Central Federal district on the work of otorhinolaryngological departments. According to these data, the average annual bed occupancy for 2017. the average stay of a patient in a bed in 2017 was 7.0, in 2018 this value was 6.9; the indicator of bed turnover in 2017 was 45.2, in 2018-45.0; the mortality rate was 0.04 in 2017 and 2018 equally. Due to the lack of data on indicators for the Voronezh region, our own research was conducted, during which it was found that the performance indicators of the otorhinolaryngology Department of VOKB No. 1 for the reporting period from 2014. by 2018. in each reporting year, they exceeded the planned values.
Limitations of the study
CONCLUSION
There are statistics from the Ministry of health of the Russian Federation for the Central Federal district on the work of otorhinolaryngological departments. Due to the lack of data on indicators for the Voronezh region, our own research was conducted. As a result of a comparative analysis of the activities of VOKB No. 1 for the period from 2014 to 2018. on the example of the Department of ENT was established the following data: the number of patients discharged from the Department at the end of the year, as a measure of the number of bed-days spent by patients in hospital, many of the reporting year made over 100% of plan implementation. The average annual bed occupancy rate also exceeded the planned value, while the average patient stay in a bed did not reach the planned value for any of the reporting years presented. The percentage of completion of the financial plan, as well as the implementation of the paid services plan, consistently exceeded the value of 100%. At the same time, in the course of this work, it was revealed that during the period from 2014 to 2018, the percentage of surgical activity in the otorhinolaryngology Department steadily increased. The results obtained in this study allow us to judge the highly effective work of the otorhinolaryngology Department of VOKB No. 1.

About the authors

Nelly A. Boyko

Voronezh state medical University named After N. N. Burdenko

Author for correspondence.
Email: nabojko@gmail.com
ORCID iD: 0000-0003-3610-6352
SPIN-code: 6022-5959

student

Russian Federation, Voronezh, St. Student 10, 394036

Anastasia A. Polshkova

Voronezh state medical University named After N. N. Burdenko

Email: polshkova.nastasya@mail.ru
ORCID iD: 0000-0002-7271-1800
SPIN-code: 4072-7969

student

Russian Federation, Voronezh, St. Student 10, 394036

Kseniya A. Sabynina

Voronezh state medical University named After N. N. Burdenko

Email: ska7172@mail.ru
ORCID iD: 0000-0003-1711-2386
SPIN-code: 5396-9233

student

Russian Federation, Voronezh, St. Student 10, 394036

Nadezhda Ivanovna Zhdanova

Voronezh state medical University named After N. N. Burdenko

Email: o-khrapova@mail.ru
ORCID iD: 0000-0001-7879-3491

student

Russian Federation, Voronezh, St. Student 10, 394036

References