[A comprehensive evaluation of the management effectiveness in a multi-specialty hospital]. / Kompleksnaia otsenka éffektivnosti v upravlenii mnogoprofil'noi bol'nitsei.

The medical-and-economic efficiency, involving the traditional, newly designed and tested methodic approaches, was evaluated in respect to 19 inhospital department of a multidiscipline hospital in the city of Yekaterinburg. A necessity was proven to use the integral indices in assessing the medical efficiency. The economic and medical efficiencies were found to coincide in 62.5% of cases, which is indicative of that it is not always the case, when the amount of the spent means directly influence the activity output. The study results showed that the technology of integral assessments of the medical-and-economic activity efficiency enables the hospital's manager to define the best and worst functioning units and to make subsequently the appropriate correcting managerial decisions.

[Analysis of efficiency of the region's health facilities]. / Analiz éffektivnosti diiatel'nosti uchrezhdenii zdravookhraneniia raiona.

A comprehensive study of the efficiency of activities of 5 principle therapeutic-and-preventive institutions (TPI) was conducted in a typical Ural industrial region by using the traditional and newly developed approaches. Both the medical and economic efficiency of their activities was found to be not high in a majority of them. The analysis results were used to work out a scientifically substantiated program for reforming the health care system of the region.

[Information technologies for the management of the regional pediatric hospital]. / Informatsionnye tekhnologii v upravlenii oblastnoi detskoi bol'nitsei.

The article contains the technologies of working out a program of analysis to assess the health of the children population in the Sverdlovsk region as well as to assess the related basic factors. The program is addressed to the managers of the regional hospital for children of the ministry for health of the Sverdlovsk region, and its purpose is to effectively manage the children's health condition and to regulate the medical-aid system. It is noteworthy, that the program can be adapted to the conditions of other subjects of the Russian Federation. The program makes it possible to accumulate the limited health care resources and to communicate, on the subject-oriented basis, with the municipal health-care authorities.

[Integration of activities of regional hospitals and territorial medical institutions]. / Integratsiia deiatel'nosti oblastnykh bol'nits s meditsinskimi uchrezhdeniiami territorii.

Medical and economic efficiency of regional therapeutic and prophylactic institutions is to develop in integration with therapeutic and prophylactic institutions of administrative territories of a subject of the federation, which necessitates modifications in the functions and organizational structure of organization and methodology departments of regional, central, and municipal hospitals.

[Problems in reforming health care centers]. / Problemy reformirovaniia mediko-sanitarnykh chastei.

Reformation of therapeutic and prophylactic institutions attached to various institutions and ministries is and important problem of public health at the modern stage of its development. A model developed and tried in Magnitogorsk can serve as a perspective trend of such reforms. A medical institution with mixed form of property has been created. The institution was set up by administration of the territory and a plant (Magnitogorsk metallurgical plant). Creation of a new health center as a non-commercial institution promoted its integration in the municipal public health system; the institution possesses all the potentialities of a budget organization and retains close contact with the plant. Such a solution of the problem improved the financial status of the health center and promoted its adaptation to marketing conditions. Attraction of additional finances from industry to municipal public health allowed the administration of the health center start and carry out internal restructuring aimed at priority development of outpatient care, restructuring of the bed fund, technological updating, and, in general, more rational utilization of the available resources.

Creating a computer-aided intellectual environment for a consultative center of intensive care.

A consultative centre for intensive pediatrics (cip) is a center for rendering aid to children in urgent conditions who are hundreds kilometers from specialized help. Such aid is typically rendered by: 1)moving the patient to the another hospital, 2) the specialized team going out by plane, or 3) consulting the local physician by phone. The complexities of the cip dispatcher-consultation of the local physician entail a real-time system that provides a consultant with simultaneous operation with a computer and a local doctor over a phone. In 1987, a computer program, DINAR-1, was used. The core of this program was the scale of a patient's state severity "FHD-5.4" and essential elements of informative services: both a reference subsystem and one accumulating and analyzing data about cip activities, treated patients, and faults in the system of medical care. Two years of DINAR-usage showed the necessity of strengthening the decision support system for cip consultant. In 1989, a new program variant, DINAR-2, was completed. During the new variant's creation, we developed a model of decision making under conditions of information distortion (e.G., as a result of the subconscious influence of diagnostical hypotheses). This model was necessary for DINAR-2, because the most part of all information for decision making had subjective issue. Distinctions between levels of medical aid at the spot (in local hospitals) demanded the special assessment of a patient's state severity in order to adequately choose between tactical activities of the CIP. The severity of a patient's state original index depended on necessary therapy type; volume was developed. Special methodological interaction expedients between the user and the decision making system were verified in DINAR-2. The following improvements were also developed: subsystem of tuning on a definite area (1990); block of analytical final instructions on a patient's treatment (1991); visualization of introduced information (1991); determination of factors causing aggravation of a patient state (1992); and specialized subsystem of consultation of neonatals (1993). During the work, CIP got a new important function. CIP became a methodical center of the medical children aid. In keeping with this, a collection and analysis of information for regional health ministry became important part of DINAR-2. It is especially connected with touched discovery and analysis of medical defects. A system of child's death-rate analysis was especially created to make impartial decisions (1990). Expert subsystems had also an original continuation. This subsystem became a basis of the new system DINAR-created for the common pediatric physician who is attending a severely ill child. A principle addition to this system is a more complicated method of tactic solution choice. The technology of CIP supported by DINAR-systems had been bought by 35 different regions of the former USSR by 1994 (1989: one region; 1990: 2; 1991: 5; 1992: 10; 1993: 17 regions). The total population of all these regions is more than 59,000,000 people, and the total area is more than 11 million square kilometers. The main direction of DINAR's development is the creation of a regional computer network, allowing DINAR-to communicate with DINAR-in local hospitals. The first place for the usage of such a network is going to be the Big Urals Region. Big Ural consists of eight states. The total population of this territory is 28 million people and total area is 3.1 million square km. Computer networks will link eight regional CIPs to one another and the medical analytical center. The CIPs will have to be connected with 259 local hospitals. At present, the DINAR-2-CIP is installed in six states of the Big Ural, and DINAR-H is installed in four hospitals of the Sverdlovsk state.

[Prognostic significance of post-infarction "silent" ischemia]. / Prognosticheskoe znachenie "nemoi" ishemii posle infarkta miokarda.

To study the predictive value of silent ischemia, a total of 132 patients with first transmural myocardial infarction were examined, 69 had anterior and 63 had inferior myocardial infarction. On days 8-12 of onset of the disease, all the patients underwent loading two-dimensional echocardiography along with transesophageal pacing, as well as polyposition coronary angiography. According to the echocardiographic findings, 3 groups of patients were identified: 1) 34 (25.8%) with painful ischemia; 2) 37 (28.0%) with silent ischemia; 3) 61 (46.2%) with a negative test. Ischemic alterations were more frequently seen in inferior (73%) than in anterior (36.2%) myocardial infarction. The patients with painful ischemia showed a lower threshold of ischemia occurrence, more severe and prolonged ST segment depression, and greater extent of an asynergic area than did the patients with silent ischemia. A 1-5-year (mean 2.4) follow-up revealed that in terms of the risk for postinfarction angina, recurrent myocardial infarction and fatal outcomes, patients with silent ischemia represent an intermediate group between those with painful ischemia and those who have a negative load test.