Issues of the quality assessment of medical rehabilitation and medical and social expertise in the Republic of Belarus

Abstract

Abstract.

Objectives. To identify the list of relevant and priority issues that hinder the high-quality provision of the specified types of medical services with subsequent formalization of the grounds for developing modern quality criteria.

Material and methods. The study was conducted in 2022 and consisted of three stages. In the first stage on the basis of the official documents analysis (the results of republican meetings of the Ministry of Health for 2017, 2019, 2020), the list of systemic problems in the field of MR and MSE was formed. The second stage included content analysis of 8 regulatory documents governing the conduct of quality assessment, with the participation of 3 experts. The third stage included an expert survey of 18 specialists using the Delphi method to determine the significance and priority of previously revealed problems. Descriptive and non-parametric statistical methods were used, as well as the calculation of the intraclass correlation coefficient (ICC).

Results. At the first stage of the study, the analysis of official materials from the Ministry of Health of the Republic of Belarus was conducted, including reports on the results of republican meetings of the medical examination and rehabilitation service for 2017, 2019 and 2020. The list of 23 key problems (10 in the field of medical and social examination and 13 in the field of medical rehabilitation) was identified that hinder the effective implementation of procedures and affect the final quality of care.

The second stage involved the content analysis of regulatory documents governing the assessment of the quality of medical care (including regulations on the quality management system, departmental instructions, and orders). The sample included eight documents selected using the

Keywords:

 ‘quality of medical care,’ ‘quality of MSEC,’ and ‘quality of rehabilitation.’ During the expert assessment using a pre-developed form, it was found that most documents poorly disclose the procedural components of the assessment (according to the Donabedian model) and do not reflect the criteria for recording effectiveness and patient’s satisfaction.

In the third stage, the Delphi survey was conducted with the participation of 18 experts, including medical rehabilitation specialists, representatives of the MREC, and heads of healthcare institutions. Each expert assessed 23 previously identified problems on two scales: relevance and priority of solution. The analysis results showed a high degree of agreement among the experts (intraclass correlation coefficient ICC = 0.94). The most significant problems included: low level of coordination between MSE commissions and IPRI (individual programs of rehabilitation of invalids) implementers, poor assessment of comorbidities when determining disability, violation of the stages of rehabilitation, and lack of systematic recording of patients’ feedback. This confirmed the need for systematic refinement of the existing quality assessment criteria.

Conclusions. The study made it possible to identify objectively deficiencies in the regulatory framework for assessing the quality of MR and MSE, as well as to systematize problem areas. The data obtained formed the basis for the subsequent development of criteria for assessing the quality of medical rehabilitation and medical and social expertise.