jandacvis xarisxis struqtura da misi gazomvis

Report
jandacvis xarisxis struqtura da misi gazomvis
saSualebebi
Tbilisi
ivnisi
2010
1
ra aris Secdoma
• Secdoma aris dagegmili moqmedebis ar Sesruleba ise, rogorc
winaswar iyo gansazRvruli…an Sedegis misaRwevad araswori
gegmis gamoyeneba
A
anu
• standartis ugulebelyofa?…
2
standarti - Secdomebis dasaSvebi minimaluri raodenoba
• A230 – ze naklebi (wuni, defeqti)
1 milion warmoebul produqtSi anu 0,023%
• 5 –ze naklebi yovel 1 milionSi Secdomebi dakavSirebuli finansuri
servisebis tranzaqciebTan anu 0,0005 %
• ra xdeba jandacvaSi?
3
ra xdeba jandacvaSi
6,000 dan 300,000 mde xarvezi, yovel 1 mlnSi
Sesabamisad 0,6 – 30%
Source: Kohn, LT, Corrigan, JM, and Donaldson, MS (Eds).
4
pirveli sagangaSo aRmoCenebi
• IOM Report 1999, 2006
100,000 mde
2004 wels 37 milioni pacientis istoria Seswavlili
• IOM Report 2006
Sedegi – umniSvnelo gaumjobeseba
5
jandacvis da cudi xarisxiT gamowveuli xarjebis dinamika wlebis mixedviT
2,5
2,3
jandacvis xarjebi sul
2
1,5
1,4
1
0,7
cud xarisxTan asocirebuli xarjebi
0,69
0,5
0,42
0,25
0
0,2
0,07
1980
1990
2001
2008
6
cudi xarisxis efeqti
problema
efeqti
1
wamlebis araswored gamoyeneba
300 mlrd
2
antibiotikebis araswori daniSvna
5 mlrd
3
nozokomialuri infeqciebi
20-60,000 sikvdilis SemTxveva + 18 mlr
4
diabeti
132 mlrd
5
depresia
80 mlrd
6
araadekvaturad namkurnalebi gulis mwvave iSemiuri daavadebebis sikvdilobis SemTxveva
yovelwliurad
18, 000 sikvdilis SemTxveva
7
arasworad marTuli gripisa da pnevmokokuri vaqcinacia
10,000 - 20,000 sikvdilis SemTxveva
8
asTmis cudi marTva
18 mlrd
9
gulis qronikuli iSemiuri daavadebebis uxarisxod marTva
10 – 40 mlrd
7
Source Juran Institute Inc
cudi xarisxis ganmapirobebeli faqtorebi
•
sistemuri Tu arasistemuri Secdomebi,
•
qmedebebi, araklasificirebuli rogorc Secdoma....……
8
dilemis buneba
sxvadasxva kategoriis xarisxis problemebi (araklasificirebuli, rogorc Sedcdoma)
xarisxis problemebis 3 kategoria
EBM medicinis
1. zedmeti Seruleba, 2. bolomde ar Sesruleba
3. araswori Sesruleba
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cudi xarisxis xelSewoba
• mimwodeblebis kontraqtireba fasis mixedviT (mimwodeblis Sefasebisa da
Sesrulebis Seswavlis gareSe)
• tranzaqciaze dafuZnebuli da ara Sedegze dafuZnebuli gadaxdis struqtura
• momxmareblis xarsixis procesSi CarTvis deficiti
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xelSewyoba II
kerZo struqturebi da saxelmwifo arian yvelaze didi momxmarebliebi, rogorc
Semsyidvelebi
• ar aprotesteben, zedmeti Serulebas, bolomde ar Sesrulebas da an araswori
Sesrulebas
• agrZeleben aqedan gamowveuli gazrdili danaxarjebis dafarvas
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jandacvis xarisxis struqtura
avedis donabedianis mixedviT
struqtura
procesi
kapitaluri Senobebi, aparatura,
saSualebebi trenirebuli samed.
personali (eqimebi, eqTnebi,
administratorebi)
Sedegi
adekvaturi, efeqturi, eTikurad
relevantuli, koordinirebuli da
socialurad misaRebi samedicino
momsaxureba
sistemis maxasiaTeblebi
sikvdiloba, avadoba, cxovrebis
xarisxi, pacientTa
kmayofileba
Ppacientis maxasiaTeblebi
source: Hopkins: Measuring the quality of medical care, Royal College of Physicians of London, 1991
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procesis Semafasebeli mimarTulebebi
•
adekvaturi momsaxureba
•
momsaxurebis uwyvetoba
•
momsaxurebis koordinacia
•
momsaxurebis drouloba
•
Tanasworoba momsaxurebis procesSi
•
xelmisawvdomi momsaxureba
•
socialurad miRebadi momsaxureba momsaxurebis usafrTxoeba
•
source (Chassin MR, Park RE, Kahn KL, Kosecoff J
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xarisxis Semafasebeli indikatorebi
1. unda iyos gasagebi da relevanturi pacientisaTvis da klinikuri gadawyvetilebis mimRebisaTvis;
2. unda iyos mecnierulad srulyofili da dasabuTebuli;
3. unda iZleodes saSualebas daskvna gakeTdes pacientis gamosavalze da pozitiuri Sedegis dadgomaze;
4. unda Seexos rogorc individualuri ise mTlianad mosaxleobis gamosavals;
5. unda asaxavdes xarisxobriv gaumjobesebas da progress;
6. unda iyos advili implementaciisa da administrirebisaTvis;
7. unda iyos Sesrulebadi da xarjT efeqturi;
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janmos mier mowodebuli indikatorebis ramodenime magaliTi
1. sakeisro kveTaTa sixSire
2. profilaqtikis mizniT antibiotis gamoyenebis sixSire
3. sikvdiloba
4. Semobruneba hospitalSi
5. ambulatoriuli qirurgiebis sixSire
6. hospitalizacia dRis qirurgiis Semdeg
7. intensiur palataSi Semobrunebis sixSire
8. sawolze saSualo dayovneba
9. saoperacios gamoyenebis sixSire
10. personalis treningebze daxarjuli Tanxis raodenoba
11. nemsiT Cxvletebis sixSire
12. zedmeti samuSao saaTebi
13. mweveli TanamSromlebis sixSire
14. ZuZuTi kvebaze myofi axalSobilebis sixSire gawerisas
15. pacientTa sxva saavadmyofoebSi gadayvanis sixSire
16. pacientTa kmayofileba
15
xarisxis gaumjobesebis meTodebi
modeli I
finansuri stimulireba:
1.1 pirdapiri finansuri stimulebi mimwodebels kargi xarisxisTvis
1.2 rogorc saukeTeso mimwodeblis saxalxo aRiareba
1.3 momxmareblis finansuri stimulireba ukeTesi xarisxis arCevisaTvis
1.4 xarisxTan dakavSirebuli aqtivobebis subsidireba
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modeli #2
seleqtiuri kontraqtireba saukeTeso maCveneblebis mqone mimwodebelTan
2.1 kontraqtiT gansazRvruli ufleba movaleobebi
2.2 Sesrulebis kriteriumebis danergva
2.3 saukeTeso centrebis aRiareba – referens centrebad qceva, seleqtiuri
kontraqtireba
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modeli #3
regulirebis sxva saSualebebi,
3.1 mimwodebelTa qcevis regulacia (licenzireba uwyveti samedicino ganaTlebisa da
profesiuli ganviTarebis CarTviT). Tanamedrove klinikuri gaidlainebisa da protokolebis
danergva;
3.2 struqturis gaumjobesebis xelSewyoba, dawesebulebaTa gamkacrebuli standartebis da
axali kriteriumebis danergviT
3.3 procesis xelSewyoba akreditaciis procesis danergviT
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didi madloba yuradRebisaTvis
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