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TECHNOLOGY OF JUDICIAL EXAMINATION OF QUALITY OF THE MEDICAL AID, BASED ON PRINCIPLES OF DEMONSTRATIVE MEDICINE

Keywords:

A.V. Bereznikov


Absence of the scientifically-proved technology of examination of cases of rendering of medical aid is one of actual problems of modern public health services. Productive work in this direction is possible on border of disciplines with use of a substantial part medical specialities (therapy, surgery, etc.) and methods of forensic medicine. The purpose: to develop demonstrative base of technology of examination of cases of rendering of medical aid at a pathology of bodies of digestion. During work it is analysed 2427 examinations of cases of medical aid at a pathology of bodies of the digestion selected by a method of randomization from 5659 cases of thematic examinations by means of the generator of random numbers, supervision within 36 months of each case is lead. The grouping of defects of the medical aid revealed by experts is made. By means of methods of nonparametric statistics we have revealed, what groups of defects define negative outcomes. For each of the defects influencing efficiency of medical aid, the degree of influence by means of diagnostic factor and a mathematical parameter of force of influence of the factor is certain. For definition of influence of set of defects on an outcome it is used the algebraic sum of mathematical parameters of force of influence of factors. On set of the algebraic sums of mathematical parameters of force of influence of factors by means of a method of binary logistical regress numerical borders of qualitative and poor-quality medical aid are certain, its character is established. The technology assumes comparison of a case of medical aid with the standard, an estimation of influence of the revealed defects on tabulared values. At the final stage the expert compares the numerical parameters received in this case reflecting force of influence of defects on outcomes, with tabulared values of borders and defines on them the forecast, quality and character of medical aid. The basic criterion of objectivity of examination we consider an opportunity of its recurrence as other expert or other expert establishment. Within 2007 on the given technology in a number of medical establishments and the insurance medical organizations examinations of medical aid in 342 cases are lead. In 19 (5,56) cases the opinion of experts of medical establishment and the insurance company have not coincided. Before introduction of the given technology the quantity of disagreements was more. So in 2006 from 304 examinations of a disagreement took place in 91 (29,90) case, in 2005? From 287 cases in 76 (26,57). Judicial examination of cases of rendering of medical aid within the limits of civil, arbitration processes or the pre-judicial order per 2007 on the given technology was spent in 32 cases; the conclusions expert did not cause the commission of doubts. On the basis of the received results are drawn following conclusions: 1. The demonstrative base of technology of examination of cases of rendering of medical aid is developed; 2. In the offered technology subjectivity of the expert, due to introduction of a numerical scale of the importance of defects and their combinations that allows to talk about the examination based on proofs is eliminated; 3. During research stages of diagnostics and treatment which infringement of technology come to light leads to negative outcomes; 4. Spheres of possible application of technology - Forensic medicine, insurance business, the organization of public health services, gastroenterology, internal illnesses.
References:
June 24, 2020
May 29, 2020

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