Health_Care_Quality_Improvement_Dubna

Health Care Quality Improvement – a cooperative project to reform health care in Dubna Russia

Goal: The goal for this initiative was three-pronged: to design and implement a health care delivery system that addresses the Russian minimum health benefit requirements, design and implement financial payments and incentives for cost-effective delivery of care, and develop and implement a quality program that monitors outcomes of care.

Major achievements: The Health Care Quality Project has been viewed as one of the most significant health reform efforts in Russia. It has been identified as one of La Crosse’s most successful efforts in impacting health in the former Soviet Union. Russian doctors discovered they were admitting too many patients and prescribing too much medicine and needed to make some changes. Following are significant achievements:

Care paths, or clinical practice guidelines, have been developed and implemented in the five leading causes of hospitalizations in Dubna and include the areas of pediatric upper respiratory diseases, pelvic inflammatory disease, ischemic heart disease, hypertension, and peptic ulcer disease. Each have been approved by the Dubna City Administration for implementation in Dubna hospitals
The focus on outpatient services versus inpatient services has been altered to reflect a significant cost savings for the Dubna health care system; length of stay for an uncomplicated myocardial infarction has decreased from an average of 33 days to 14-16 days.
A bed reduction plan was implemented in Dubna resulting in the closing of an infectious disease unit in one hospital – a reduction of 40 beds; 25 pediatric beds were reduced, 10 gynecological beds were eliminated, and 15 obstetrical beds closed within the first year. To date, a total of 190 beds have been eliminated in Dubna hospitals, resulting in a savings of hundreds of thousands of dollars. These reductions were the result of a study to determine duplication of services in Dubna health care institutions.
Reductions in length of stay have been reduced for the diseases addressed: pediatric upper respiratory diseases reduced from 9.46 (1996) to 9.00 days (1998);bronchial asthma 14 (1996) to 9.2 (1998); pneumonia 22 (1996) to 14.2 (1998).
There was also a reduction in overall hospitalizations for children with respiratory diseases. In 1996, 43 children were hospitalized while in 1998 only 24 were hospitalized, showing an emphasis on outpatient treatment of upper respiratory conditions.
Russian and U.S. health officials convinced Russian authorities to financially reward the Dubna health care system for applying efficiency principles (shortening length of stay, providing home care services, reducing use of unnecessary medications). A new payment method was developed that encourages the use of appropriate resources in care delivery and discourages the use of inpatient care unless it is necessary as determined by care path guidelines.

Impact: The Dubna system for health care reform has been identified as the model for many cities throughout the Russian Federation and in other NIS countries. Training is occurring through regional conferences in the former Soviet Union. The American International Health Alliance has adopted the care path guideline approach developed in Russia by La Crosse staff and is promoting it through health partnerships throughout the former Soviet Union. It was also recognized as the model for Russia by MedSocEconomInform, Russia’s Health Care Quality Agency and by the U.S./Russia Health Committee with staff support from the Director of the U. S. Agency for Healthcare Research and Quality, John Eisenberg.

Funding: This successful program in Dubna, Russia was funded by a $495,000 grant (1996 – 1999) from the United States Agency for International Development (USAID) – Moscow Office and managed by staff of World Services of La Crosse, Inc.