sungatov

Dispatch Center of the Republic of Tatarstan Healthcare Ministry. Monitoring of vascular diseases. Experience.

Abstract
The paper presents an approach to solving an actual task of monitoring vascular diseases with the scale of a Russian region. It’s not a secret that vascular diseases are the top reasons of the population’s mortality rate. Along with technological tools offered by the federal ministry, the described means and solutions give an opportunity to tackle the problem of reducing cardiovascular accident cases efficiently, decrease the level of the population’s disability rate (especially the employable population).
Using the solution in Tatarstan made it possible to reduce the cardiovascular accident mortality rate by 17 percent over 1.5-2 years.

General prerequisites
Despite the measures taken for changing mortality and birth rate in Russia, today we still are far behind Europe, including the countries of the former «social camp».
Cardiovascular diseases contribute the largest percent.

 

Illustration 1. The world’s demographic hole – the territory of Russia

Illustration 1. The world’s demographic hole – the territory of Russia

In one and a half peaceful decades without wars and epidemics Russia lost approximately 12 million people – 8 percent of the whole population.

Some regions of the Russian Federation are trying to tackle these problems on their own, funded with federal programs, or by means of combining their own and federal programs.
Tatarstan had taken on tackling this problem long ago, before the federal programs were introduced.
The region chose its own approaches to solving the task of decreasing mortality caused by cardiovascular diseases.
Informatization of the task was realized on the basis of the information system Dispatch Center of the Republic of Tatarstan Healthcare Ministry.

Managing vascular centers

Vascular diseases cases require such management of medical care when immediate work with a patient can begin within the so called «golden hour» (60-90 minutes).
Three vascular centers opened in Tatarstan in 2008 for this purpose – in Kazan, Naberezhnye Chelny, and Almetyevsk. Each of the centers covers a certain zone of the population, which in numbers totals approximately 1 million people each.
Taking into account that a cluster approach is used within the Dispatch Center, it was decided that a vascular cluster will be created, with a main center in Kazan at the ICDC (Inter-regional Clinical-Diagnostic Center) (illustration 2).

Illustration 2. Map of the population zones covered by Tatarstan vascular centers

Illustration 2. Map of the population zones covered by Tatarstan vascular centers

Explanations to the illustration:

  • The green circles mark the 75-kilometer radius of first-aid station vehicles access from the three clinical centers.
  • The purple circles mark the 150-kilometer radius. Transportation of an AMI (acute myocardial infraction) patient or through using the transfer strategy will allow expanding the coverage zone far beyond the Republic of Tatarstan borders.

The vascular centers which were created in the Republic of Tatarstan on the basis of existing medical were connected to the subsystem of vascular centers monitoring – a part of the Dispatch Center information system.
Three modules of MIVC (Monitoring of Inter-municipal Vascular Centers) were created as part of the system:

  • Technology of registering cases and their attributes for vascular diseases cases;
  • Technology of vascular disease cases analytics;
  • Technology of export to the federal system of vascular disease registration (informational-analytical system of high-tech medical care).

 

Technology of monitoring of cases

Monitoring of vascular cases is based on the case results, as during the case the main task of doctors and nursing staff is to save the patient, bring him/her to the hospital and take the first measures in order to avoid drastic consequences, including disability.
The responsible persons carry out registration of parameters for each stage on a patient’s route. The time of when pain starts, the time of calling for an ambulance, the time of delivery, the time of taking the first measures must be recorded. Registering all these sectors allows detecting the «weak link» in the process of struggle against vascular cases.
For instance, late call for an ambulance after the start of pain is typical for most cases, which most likely means lack of informative measures taken by the healthcare system – people just don’t know what to do when they notice the first symptoms. Obviously, it is important to register as many indices as possible to get a complete picture of the situation and detect weak points which need managerial decisions.

Registration of cerebral accident cases

The technology of registering vascular disease cases was realized within the united conception of Tatarstan Healthcare Ministry Dispatch Center cluster management. The technology operates using a web-browser which uses a http-https protocol.
The technology is a set of sections with a set of necessary attributes relevant to each section. In addition, there is an opportunity to browse all cases beginning from the most recent one and all its attributes (if access rights are available).

Illustration 3. An example of a screen form with characteristics of a cerebral accident case

Illustration 3. An example of a screen form with characteristics of a cerebral accident case

Illustration 4. An example of a screen form with the register of cases

Illustration 4. An example of a screen form with the register of cases

The technology provides means of keeping all essential attributes of the case and using the technology of work with vascular diseases at the level of treatment regulations. It must be mentioned that there is an opportunity of customization by the system administrator. All key features of the module can be customized, for instance, the following:

  • sections;
  • name and content of references;
  • structure of references;
  • structure of sections;
  • attributes of sections, etc.

 

Analytics and management reporting

The technology targets executive heads in the healthcare system and significantly improves executives’ opportunities in managing the situation with vascular diseases, as it provides an immediate and diversified reporting in any convenient form. We can say that the technology provides tools for end-to-end management of a region or the Russian Federation subject’s healthcare system as related to vascular diseases.

Illustration 5. An example of operational report for executive heads of regional healthcare
Illustration 5. An example of operational report for executive heads of regional healthcare

Management analytical tools provide means of making objective assessment of the problem with vascular diseases patients. The color image segmentation helps to determine from which territory patients aren’t delivered, where healthy lifestyle propaganda is not realized well enough, where sufficient procedures of informing citizens about the first symptoms of a cerebral accident and clear instruction on what to do in such cases – what a simple person can do – aren’t provided. Certainly, all these details make a considerable influence on the overall picture, the reaction time of ambulance teams. It is a known fact that a timely call of a patient gives him/her chances to recover and prevent disability, which also is a socially significant task.
Unfortunately, federal program complexes don’t have a feedback system and don’t give healthcare executives of regions an opportunity to «order» the analytics they need. This means they don’t provide an executive with a necessary management tool and an opportunity to make an influence on the situation, despite the enormous desire to make changes that any contemporary executive has.

Integration with the federal register

The subsystem of vascular centers monitoring, which is a part of the Dispatch Center information system, is equipped with a necessary module of data export to the mandatory for all regions federal hospital register. The technology allows executing «transparent» downloading of data from the system of vascular center monitoring for each center in a required period of time.

Illustration 6. An example of a form of exporting data to the Territorial Population Register of Cardiovascular Accidents (the federal information system)

Illustration 6. An example of a form of exporting data to the Territorial Population Register of Cardiovascular Accidents (the federal information system)

 

Conclusion

Implementation of the Dispatch Center solutions related to vascular diseases provides means of making the process of medical care manageable, not chaotic, as it is in most cases you know.
Total mortality rate, including hospital mortality, has been considerably reduced in Tatarstan. These rates are among the lowest in the Russian Federation and close to figures of Europe and the U.S.
The percentage of patient hospitalization during the period of «therapeutic window» increased from 45% in 2008 to 51% in 2009 over two years of Tatarstan vascular centers’ operation.
At present the total number of primary vascular centers in Tatarstan is 6, of regional centers – 2.
It is one more successful example of realizing a system approach to tackling problems in the industry, to switching from intuitive management to management based on objective indices. The healthcare system must provide people with an opportunity to get the timely help and information they need in due time, make aide equally accessible both for citizens from both urban and rural areas.