Kalininskaya A A, Konovalov O E, Merekina M D, Balsamova L A, Chizhikova T V
The Federal State Budget Scientific Institution "The N. A. Semashko National Research Institute of Public Health" of the Minobrnauka of Russia, 105064, Moscow, Russia,
The Federal State Autonomous Educational Institution of Higher Education "The Peoples' Friendship University of Russia" (RUDN University) of Minobrnauki of Russia, 117198, Moscow, Russia.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2021 Jul;29(4):957-962. doi: 10.32687/0869-866X-2021-29-4-957-962.
In accordance with the Russian Federal Law No. 350 of January 2019 the retirement age for Russians is increased for men from 60 up to 65 years, for women from 55 up to 60 years that requires implementation of organizational technologies of health-preserving, promotion of life and labor potential of population of late able-bodied age. In this regard, the role of day hospitals (DH) functioning directed at maximal possible prolongation of autonomous life and working capacity of elderly population increases. Besides, DH also presents additional reserve of optimization of medical care costs. The purpose of the study is to elaborate guidelines of improving activities of DH for population of late able-bodied age, for the purpose of preventive hospitalization. The study was organized on the basis of pilot medical organization of the Moscow Oblast, consisted of hospital of 600 beds and day hospital of 120 beds. The methods applied included sociological survey, expert judgment, statistical direct observation. The primary data was obtained from the forms of federal and sectorial statistical monitoring for 2014-2018. The analysis of medical documentation concerning pilot medical organization functioning during the year of the study was applied. The sociological surveys of patients of late able-bodied age (5 years before retirement according to the new legislation - men 60-65 years old, women 55-60 years old) who received treatment in day hospital. The results. The analysis of main indices of round-the-clock functioning in-patient and day hospitals in the Russian Federation in 2014-2018 established trend towards improvement of using hospital beds due to development of day hospital. However, bed capacity of hospitals is used ineffectively and experts assume that more than 1/3 of patients could receive medical care or aftercare in day hospitals. The experimental study of planning hospitalization of patients with chronic diseases at out-patient level demonstrated that 11.5% of population of able-bodied age need planned and preventive hospitalization in day hospital. The cost of treatment of patient with chronic pathology is 2-3 times lower in day hospital than in common hospital at the stage of exacerbation. It is reliable to apply at the out-patient level experience of planning hospitalization of patients with chronic pathology in day hospitals followed by performance control. The organization of functioning of day hospital and common hospital requires particular enhancement, including issues of succession, financing of the DS, the remuneration of medical personnel through effective contract determining interest of physician in early discharge of patient to aftercare in day hospital. The day hospital functioning is to be implemented in 2-3 turns. The day hospital is to be located in detached placement and the departments of base medical institution are to used in fullness. The day hospital is be used more actively for purpose of health preservation of population of late able-bodied age who. This contingent suffers of chronic pathology and is in need of preventive and health-promoting therapy in conditions of day hospital.
根据俄罗斯联邦2019年1月第350号法律，俄罗斯人的退休年龄提高，男性从60岁提高到65岁，女性从55岁提高到60岁，这就需要实施养生组织技术，提高老年人口的生活和劳动潜力。在这方面，日间医院（DH）的作用日益增加，其运作旨在尽可能延长老年人口的自主生活和工作能力。此外，日间医院还为优化医疗费用提供了额外的储备。本研究的目的是制定改善日间医院针对老年人口活动的指导方针，以进行预防性住院治疗。该研究是在莫斯科州的试点医疗机构的基础上组织的，该机构包括一家拥有600张床位的医院和一家拥有120张床位的日间医院。应用的方法包括社会学调查、专家判断、统计直接观察。主要数据来自2014 - 2018年联邦和部门统计监测表格。对研究当年试点医疗机构运作的医疗文件进行了分析。对在日间医院接受治疗的老年患者（根据新立法退休前5年——男性60 - 65岁，女性55 - 60岁）进行了社会学调查。结果。对2014 - 2018年俄罗斯联邦全日制住院医院和日间医院主要运行指标的分析表明，由于日间医院的发展，医院床位的使用有改善趋势。然而，医院床位的使用效率低下，专家认为超过三分之一的患者可以在日间医院接受医疗护理或后续护理。对慢性病患者门诊层面住院规划的实验研究表明，11.5%的适龄人口需要在日间医院进行计划性和预防性住院治疗。在日间医院，慢性病患者在病情加重阶段的治疗费用比普通医院低2至3倍。在门诊层面应用日间医院慢性病患者住院规划经验并进行效果控制是可靠的。日间医院和普通医院的运作组织需要特别加强，包括连续性问题、日间医院的资金、通过有效合同确定医生对患者早日出院到日间医院后续护理的兴趣来支付医务人员薪酬。日间医院的运作应分2至3轮进行。日间医院应独立设置，基础医疗机构的科室应充分利用。日间医院应更积极地用于老年人口的养生，这部分人群患有慢性病，需要在日间医院条件下进行预防和促进健康的治疗。
