IMPLEMENTATION OF QUALITY VALIDATION INDICATORS IN HEALTHCARE.

Accordingly, the purpose of the actions taken by the state services in the field of health care is mainly to avoid the negative consequences of healthcare services. Despite advances in modern medicine, millions of people around the world die each year as a result of medical errors, and patient safety remains a relevant and topical issue. Various regulations, guidelines, laws, standards and guidelines, effects of evidence-based medicine and Best Practice provided to improve patient safety. Data about medical errors show that 50-70.2% damage can be reduced with a systemic and sophisticated approach to patient safety. Like the rest of the world, providing high-quality healthcare services is one of the most significant and problematic issues in the healthcare system of Georgia. Despite the competitive environment in the healthcare market, there are no fundamental shifts in terms of quality assurance. There are several difficulties with the management and quality control of healthcare facilities. Unfortunately working on quality assurance, management and improvement is not a priority; For avoiding undesirable consequences, preventive measures are not considered as an essential approach; The directive standards and quality indicators almost are not created and what exists are sufficient. Effective interrelationships have not been achieved between critical components of quality assurance, such as technical competence, accessibility, efficiency, safety, effectiveness, continuity, etc. The structural units of the quality management system in the healthcare facilities are mainly focused on making the medical documentation under the norms required by the legislation. Methods for monitoring, measuring, analyzing and evaluating of the quality management system have not been well organized. In case of discrepancies, Instead of defensive measures to prevent the recurrence of the same defect, the main forces are directed to correct the unit cases and achieve compliance with the established norms. Establishment of a quality control system for healthcare organizations, development and implementation of quality indicators, and considering for continuous improvement requires a specific and multifaceted approach.

[; PROBLEMS OF MONITORING THE QUALITY OF HOSPITALS IN GEORGIA IN THE CONTEXT OF THE COVID 19 PANDEMIC (REVIEW)].

The purpose of the study - scientific justification, development and implementation of an automated information system for assessing the results of the examination of quality and technology of medical care in hospitals at the regional level.; Based on the developed unified expert map for assessing the quality and technology of medical care, a mathematical model is built and the quantification method is used to form a unified regional system for automated monitoring of the quality of medical care in hospitals. The use of this system of monitoring the quality of medical care allows using the statistical methods to manage the quality of care ; to form homogeneous groups of patients according to specific parameters (nozology, gender, age, severity of condition, etc.) and evaluate the quality of the Health Care provided to them; monitor and conduct a comparative analysis of the quality health care in the work of individual doctors, structural divisions, and for institution as a whole, create a database of results carried out according to a unified.; The quality of the diagnostic and treatment process is characterized by many quantitative indicators. The formation of seven groups of process indicators from the number of questions included in the developed formalized expert map concentrates the attention of experts on the main logical stages of medical activity, optimizes decision-making on eliminating identified defects and objectifies collegial management of the level of professional activity of a medical institution.; Using a mathematical model and a quantification method to create an automated information-analytical system for monitoring the quality of medical care allows us to evaluate the qualitative features in quantitative terms. The unified technology for conducting examinations allows you to coordinate expert work at the intra-departmental and extra-departmental levels, carry out cross-expertise and determine the reliability of the examination.; The introduction of formalization in the work on examination of hospital quality and the use of an automated system for monitoring the quality of medical care, allows using statistical methods to generate specific ones. parameters (nozology, gender, age, severity of condition, etc.) are homogeneous groups of patients and assess the quality of care provided to them to monitor and conduct a comparative analysis of the work of individual doctors, structural divisions, the institution as a whole create a database of the results of the examinations carried out by a single technology in all medical institutions at the regional level.; A dynamic analysis of the quality of medical care in hospitals revealed the presence of a significant reserve for its further improvement. The greatest number of defects in the organization and technology of medical care is noted in two blocks: the quality of medical records and diagnostic measures.

IMPROVEMENT OF QUALITY STANDARDS IN HOSPITAL CARE IN GEORGIA. PROBLEMS AND PROSPECTIVES.

Health systems provide health actions-activities to improve or maintain health. These actions take place in the context of and are influenced by political, cultural, social, and institutional factors. Demographic and socioeconomic makeup, including genetics and personal resources, affect the health status of individuals seeking care. Access to the health care system is required to obtain the care that maintains or improves health, but simple access is not enough; the system's capacities must be applied skillfully. Thus, quality means optimizing material inputs and practitioner skills to produce health. As the Institute of Medicine defines it, quality is "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." Globally, there is an acute shortage of human resources for health (HRH), and low-income countries bear the highest burden. This shortage has not only considerably constrained the achievement of health-related development goals but also impeded accelerated progress towards universal health coverage (UHC). Like any other low-income country, Georgia is experiencing a health workforce shortage, particularly in specialized healthcare workers to cater to the rapidly growing need for specialized health care (MOH Training Needs Assessment report (2015). The efficient use of the existing health workforce, including task shifting, is under consideration as a short-term stopgap measure. At the same time, deliberate efforts are being put on retention policies and increased production of HRH. The results of the analysis confirmed the essential leadership and managerial competencies for public hospital managers in Georgia. These competencies include Policy development and implementation, strategy development and orientation; plan-making; human resource management; financial management; equipment and infrastructure management, information management, risk and disaster management, self-management; quality management; investigation, supervision, monitoring and evaluation, ethics and knowledge. There are necessary competencies. Managers have to fulfill their tasks effectively and use them as a basis to develop competency-based training for the current management taskforce and preparing future hospital managers. This kind of study was limited before starting short and long term (including Master program Health Management and Administration) educational programs in different regions of Georgia. Thus, it should be further studied to gain an overall and clear picture of leadership and managerial competencies for hospital public managers. Taking into account the labor market flows in Georgia, to train and inspire a new generation of Health Administration professionals in global network atmosphere, provide broad knowledge, skills and expertise that is needed to undertake leadership roles in addressing critical issues of Health Administration at the national and global level is an urgent need. For this purpose, the elaboration and implementation of student-centered and competence-oriented Georgian-USA Collaborative Master Program in Health Administration with our future activities will be a relevant approach.

HEALTH OF CHILDREN UNDER 12 MONTHS OF AGE IN GEORGIA.

The main goal of this study is to determine trends in the field of health of children under the age of 1 in Georgia. Methodological basis of this research is the qualitative research, method of cabinet research ("Desk Research"), it was used gathering, descriptive, systematization, comparison, analysis, interpretation of statistical dates. The date on child health indicators were taken from the National Center for Disease Control and Public Health, National Statistics Office of Georgia. The following indicators have been studied: the dynamics of birth, Mortality and Morbidity of children under the age of 0-1, neonatal mortality, early neonatal mortality, late neonatal mortality, perinatal mortality, stillbirth. For studying the legal basis, we used Regulations of the Government of Georgia and normative acts of the Ministry of Labor, Health and Social Protection. 0-1 years old Child mortality, perinatal, neonatal, early neonatal mortality rates was decreased. The rate of late neonatal mortality, stillbirth, perinatal mortality and ratio of stillbirth with early neonatal mortality was increased. Incidence of "Infections specific to the perinatal period "and "Bacterial sepsis of newborn" was increased. Among the reasons of 0-1 year's old child mortality was increased "Certain conditions originating in the perinatal period" and "Congenital malformations, deformations and chromosomal abnormalitis". Among the reasons of 0-1 year's child morbidity was increased "Diseases of the respiratory system", "Diseases of the ear and mastoid process", "Certain infectious and parasitic diseases". High rates of late neonatal mortality, perinatal mortality and stillbirth, increasing incidence of "Infections specific to the perinatal period "and "Bacterial sepsis of newborn", indicates that the quality of antenatal care does not fit to the international standard, The risks of fetus and pregnant woman are not identified and prevented timely, Infections are not diagnosed timely. Because of the delayed identification, prevention and treatment is not adequate.

[Problems of reforming pension schemes of the Georgian population].

Decent level of pension provision for older people is one of the indispensable condition of any democratic society. Over time, the objectives pursued by the public pension system, have undergone many changes, but remains a constant problem preventing poverty of older citizens, and later, ensuring adequate standards of living of this, increasing the proportion of citizens. Certainly, the question of the relationship of the working population of premiums and pensions becomes essential economic and political importance. In the countries with transitive economy, which include Georgia, the most vulnerable because limited possibilities of pensioners fit into the new economic development. Georgia has not yet happened formation sufficiently clear approach to the reform of the existing system of social protection, which is characterized by extremely high paternalistic role of the state and very poorly marked public institutions. The system mainly focuses on targeted, efficient solution of problems of the crisis, however, this approach does not provide a long-term effect, because is not aimed at preventing repetition of crises on social protection perspective of each individual and the population as a whole. It is need creating highly focused on society's expectations of a multidisciplinary task of social protection, which should provide a comprehensive multifaceted assistance in solving problems throughout his life. In this context, social protection should be seen as a protection against social risks of loss or limitation of economic independence and social well-being. Forms and methods of organization of social protection of the elderly should be differentiated, affordable, high-grade, fully oriented to the prevention and resolution of the positive ways to separate the individual complex emergencies. Requires special consideration problem with the level of pensions, the solution of which depends not only on the economy but also on the new concept of pensions, which should include the introduction of a funded pension.

[Problems of accessibility for the population of Georgian modern outpatient and inpatient care].

Which began in 2013, the implementation of the priority national project - Universal health programs for population of Georgia - has important social significance, given the increased accessibility of the population in case of timely and quality medical care. Various forms of public participation in the payment of services received in varying degrees allow us to find a compromise between containment of demand and increase access to treatment. And if the insurance in its various forms, largely solves the last problem, but may create a problem of rising costs, the different types of direct payments more efficient demand, however creates a need to control access to health care for populations with a high demand for medical care. Co-payments under the defined government programs and directly to the patient, on the one hand, imply severally pay for health care and the fear of the occurrence of catastrophic costs of treatment, and on the other hand, allow you to control the rising costs of the health system. The problem of reducing the availability of medical care is overcome by introducing exemptions from co-payments for vulnerable groups, which in turn leads to a substantial increase in government spending. It must be emphasized that the tools developed and the results of the calculations can be used to compare the effects of the introduction of various schemes of co-payments and choose the most suitable scheme, in terms of the extent of the burden of private expenditure on treatment, as well as income and expenses of the health system in general.

Peculiarities of medication safety.

The modern concept of patient safe medical treatment lays responsibility for undesirable complications on lacks of healthcare system (structural, organizational and operative); not on medical workers or products of medical purpose. A spirit to comprehension of scales of a problem of a safety the sharp increase of number of judicial claims in occasion of causing harm has served health of patients. If to the beginning of 1970 th in the USA one claim on 100 doctors to 2011 frequency of supply of claims has increased in 12 times was annually registered on the average, and average payment under claims has increased for the same period about 2000 dollars up to 1500000 dollars. The problem of ensuring patient safety is topical. 72 (24%) of the 300 patients interrogated by the authors have declared that at various times were victims of inadequate rendering of medical aid. Among them of 96 (32%) have specified an establishment to them of the wrong diagnosis or purpose of wrong treatment. Results from the current study show the necessity of creation in Georgia systems of monitoring to increase the security of treatment, participation in this business of patients, creation of special preventive and training programs for the medical personnel and students, strengthening of cooperation with the international organizations in area of improvement of quality and a security of medical aid.

[Problem of motivation of the population to prevention and treatment dental diseases].

Dental health is an integral part of a normal state of a human body and, first of all, depends on knowledge of the population of bases of individual hygiene of an oral cavity and ability to use them in practical life. Numerous researches indicate low level of knowledge of the population in questions of prevention of dental diseases and individual hygiene of an oral cavity that testifies to existence of problems in the organization of sanitary education. Existing practice of hygienic training and education, in a certain measure, lags behind modern requirements, and some questions demand specification and optimization. For efficiency of sanitary and preventive actions it is necessary to study character and motivation structure to prevention and treatment of dental diseases and to develop an effective method of its increase. Therefore actual search of new forms of psycho hygiene and psycho prevention with use of modern information technologies which should provide high level of dental health of the military personnel is represented. The purpose of the real research was establishment of the factors forming motivation to prevention and treatment of the main dental diseases, and development of a psycho physiological method of its increase. The carried-out research allows to expand and systematize ideas necessary for the practical doctor of the major factors forming motivation to prevention and treatment of the main dental diseases. Development of an objective technique of a complex assessment of level of motivation of patients to prevention and treatment of dental pathology will allow to prove the new perspective direction of the sanitary educational work, allowing to reduce fobiya level, effectively to increase motivation of the patient to receiving the timely dental help. It especially is important if to consider that numerous programs of hygienic training and the education, applied in our country, didn't lead to change of hygienic skills of the population in expected scales. At the same time, priority questions in prevention of caries and diseases of a periodontium there is a hygienic education and training to methods and means of clarification of a mouth.

[Results of an estimation promotion of the stomatologic diseases].

The purpose of research was the estimation of preventability of stomatologic diseases by increase of adherence of the population to preventive maintenance measures. The aims of the research: 1. To estimate adherence of the population to measures of preventive maintenance of stomatologic diseases and to reveal sexual and social groups of risk. 2. To study opinion of experts (doctors-stomatologists) on effectiveness of various measures of preventive maintenance on strengthening of stomatologic health and their distribution among the population. 3. To investigate character of negotiability of the population concerning stomatologic diseases. 4. To give the forecast of stomatologic disease in the conditions of new model of preventive behavior of the population. 5. To define reserves to prevent stomatologic diseases, including loss of teeth, in the conditions of strengthening of preventive work. It is established that the adequate economic, organizational and administrative decisions aimed at development of preventive work in stomatologic service, promote decrease in expenses at rendering of the treatment-and-prophylactic help to the population.

[Development of medical tourism in Georgia. Problems and prospectiv (review)].

Medical tourism is the movement of patients through a global network of health services. Medical tourists seek affordable healthcare on a timely basis in a variety of destination nations. The expansion of global medical services has sparked immense economic growth in developing nations and has created a new market for advertising access to care. Beyond offering a unique untapped market of services, medical tourism has invited a host of liability, malpractice and ethical concerns. The explosion of off-shore "mini-surgical" vacations will surely incite global unification and increased access, quality and affordability of care. Medical tourism is a dynamic subset of global health care that incorporates a variety of services, procedures and venues of care. Health insurance coverage, the impact on domestic and global markets, and the use of international standards of care will be examined in combination with quality, access and cost parameters. The global nature of medical tourism invites a variety of legal and ethical issues and calls for an organizational body to monitor this new phenomenon. Finally, the future implications of the globalization of health services and systems will be discussed.

[Gender differences in medical activities and self-evaluation of health status among people displaced from Abkhazia].

A growing scientific literature highlights concern about the influence of social bias in medical care. Differential treatment of male and female patients has been among the documented concerns. Yet, little is known about the extent to which differential treatment of male and female patients reflects the influence of social bias or of more acceptable factors, such as different patient preferences or different anticipated outcomes of care. This paper attempts to ascertain the underlying basis for an observed differential in physicians' tendency to advice activity restrictions for male and female patients. We explore the extent to which the gender-based treatment differential is attributable to: (1) patients' health profile, (2) patients' role responsibilities, (3) patients' illness behaviors, and (4) physician characteristics. These four categories of variables correspond to four prominent social science hypotheses concerning gender differences in health and health care utilization. Data are drawn from the longitudinal observational study more of the 2000 IDP patients from Abkhazia. Gender differences in illness behavior and medical activities of the patients both appear to contribute to the observed differential. Female patients exhibit more illness behavior than males, and these behaviors increase physicians' tendency to prescribe activity restrictions.

[Management problems of improving the quality and efficiency of primary health care system of Georgia].

Improving the quality and efficiency of primary health care system is a key challenge. In this regard, problems that have accumulated in the system over the past decade - a weak material base of outpatient-polyclinic institutions, especially in rural areas; a surplus of medical personnel; lack of control by local, regional and central authorities--still remain as serious obstacle. The issue of financing the provided health services, is also particularly important, given the fact that a significant portion of the cost of medical services is covered by the patient directly. And as a consequence, the low level of applications for outpatient-polyclinic assistance due to declining affordability of medical services. In connection with the foregoing, the authors of the paper raise the question of implementing strict, multi-component system of quality control of medical care for patients. In particular, they propose: to base modern organization works on improving the quality of primary health care system on the principles of general management theory; Modern management of service quality should be clearly oriented towards the needs of the population in health care, its structure and dynamics; accessibility, incentives, determined by economic and technological competition characteristic to the market; Modern quality management, regardless of ownership and scale of outpatient-polyclinic establishment should optimally combine the actions, methods and tools that provide, on the one hand--the organization of diagnostic and therapeutic-prophylactic processes meeting the needs of the people, and on the other--the introduction of new methods and means to ensure the modern level of medical care; Schematic diagram of quality control mechanism organically interacts with the market research and includes a block of policy development in terms of quality.

The health impact and consequences of war in Shida Kartli region.

The current crisis between Russia and Georgia comes after several years of deterioration of relations between the countries. Given the disintegration of the health care systems and poor water and sanitation, there is a strong need for emergency life-saving interventions. The quality and availability of public medical care in Tskhinvali region deteriorated during the war. Policy making is affected during periods of political violence: by conflicting approaches by different agencies, by parallel health systems organised during the war, and by conflicts between international funding agencies and national policy makers; Operational capabilities of the health sector are difficult to establish. In Shida Qartli, policy making capacity, health workers' morale, and mechanisms for resolving conflict seem to have been negatively affected by the conflict and its aftermath.

Most common poisonings and their management--data from Tbilisi.

The purpose of the present study was to evaluate the toxicological aid and efficiency of preventive measures and methods in treatment of acute exogenous intoxications in hospitals in Tbilisi in 1990-2005. Structure of poisoning accidents in Tbilisi, its trends in last decade is analyzed and explained. The data were obtained in Georgian National Center for Disease Control and Medical statistics in Tbilisi. The study revealed that total number of hospitalizations due to acute poisoning in Tbilisi exceeded the number of hospitalizations due to acute myocardial infarction. In 1992-1994 Georgia was in severe social-economic crisis: the cases of acute poisoning increased and the number of hospitalizations had been reduced with concomitant longer hospital stay (in 1992--10.7 hospital days; in 1993-1994--13.7 hospital days), and higher mortality (in 1992--4%; in 1993--5.5%; 1994--5.2%). Low hospitalization rates in 1992-1994 should be explained by late patient referral to hospitals. Longer hospital stay was available due to free hospital care at that time. In 1995 with termination of free medical care number of hospitalized patients with acute intoxication raised annually; hospital stay shortened and mortality rate decreased. In 2003 mortality was reduced by 0.74% in Tbilisi. The prevalence of acute alcoholic intoxication incidence was noticed. Therefore hospital stay decreases. High prevalence of acute alcoholic intoxication was explained by the growth of alcohol consumption; lack of quality control of beverage production resulting in huge amount of unconditioned and counterfeit substances in the market, etc. As to poisonings due to medical substances 42% of cases were intoxications with anticonvulsants, sedative and psychotropic preparations; 17% with cardiovascular drugs; and 10% with narcotic substances. It was found, that poisoning incidence and their outcome significantly depend on social-economical conditions in Georgia. Measures to improve toxicology care in the country are outlined and the ways are ushered to reach it soon.

[Lung cancer morbidity rate among the Georgian population according to sex and age and expected morbidity prognosis].

Real index of lung cancer morbidity rate among the Georgian population according to sex and age has been studied and expected morbidity prognosis has been made. Sex and age breakdown of the morbidity with lung cancer during 1980-2001 indicates to the predominant prevalence of this disease in males and elderly. The study of age peculiarities separately in males and females has revealed a number of specific features. Frequency of lung cancer in young ages (below 40) prevails in females, while none of the cases have been revealed in females below 20. In patients aged from 40 to 50 lung cancer cases are equally distributed. In the 50-70 years age group the disease is more frequent in males, while above 70--in females. These data are especially interesting from the epidemiological point of view. It indicates that in Georgia the time necessary for the development of lung cancer in females is 10-20 years more than for males, i.e. additional factors should influence the cancer development in males which shortens the latent period necessary for development of lung cancer by 10-20 years compared to females.

[Public health reforms in the CIS countries]. / Reformy zdravookhraneniia v stranakh SNG.

The health status of the population has been deteriorating at virtually all territories of the former USSR during the last decade. The author considers that cooperation within the framework of the Coordination Committee of the CIS countries, aimed at creating a universal organ rendering methodological and practical assistance to member countries, already through with the disintegration stage and striving to reintegration, is the most effective approach to public health reformation.