Comparative benchmark analysis of coverage by specialists involved in healthcare provision to patients with cardiovascular diseases in the regions of the Northwestern Federal District

Control of cardiovascular diseases  (CVDs), which are the cause of premature mortality and high economic  costs,  is one of the priorities of social policy. Human resources are a key link in health system performance.  In Russia, there is a significant geographical  heterogeneity  in the distribution of medical workers and structural disproportions  in certain specialties.  Regional  differences  in the availability of specialists in cardiology system have not been studied enough.Aim. To perform a comparative benchmark analysis of coverage by specialists involved  in healthcare  provision  to patients with cardiovascular  diseases  in the regions of the Northwestern Federal District (NWFD), identifying regional differences for the period from 2015 to 2019.Material and methods. To assess the number of specialists involved in providing care to patients with CVDs, data from the federal statistical monitoring forms №30 “Information on a medical organization” for 2015-2019 of the subjects of the Northwestern Federal District were used. Multiple linear regression was used to compare the basic estimated parameters of provision per 10000 population with specialists at the level of district as a whole and in NWFD regions  with data for Russia as a whole. P<0,05 was considered significant.Results. Among the subjects of Northwestern Federal District, differences  were revealed  in all specialties  of varying severity. While the estimated parameter of provision with cardiologists  in Russia is 0,896 (95%  CI, 0,794-0,998),  there are differences  in the regions in a wide range from -0,446 (Vologda Oblast) to +0,502 (St. Petersburg).  Regional  differences  in the provision of vascular radiology specialists from the basic estimated level for Russia were observed  only in two subjects. At the same time, for all subjects in general, an increase in the indicator from 2015 to 2019 by 0,011 [95% CI, 0,006; 0,016] per year (p<0,001) was observed.  The smallest range of differences was observed for cardiovascular surgeons:  with a baseline  estimate  in Russia of 0,158 [95% CI, 0,140; 0,176] the range of differences was from -0,086 to +0,198. For emergency  medicine paramedic, the largest number of subjects with positive values of the statistical correction of the average relative to Russia was noted (7 out of 11 regions). For neurologists and intensivists, on the contrary, the largest number of subjects with negative values (7 out of 11 regions)  was revealed.  Structural staff disproportions in cardiology care system were revealed.Conclusion. In the NWFD, in general, coverage  by specialists involved in health-care provision for CVD are higher than the estimated base level for Russia. However,  their uneven distribution within the district and its subjects is observed. The demonstrated mathematical approach to assessing staff differences  at the subject or district level can be used to develop measures to achieve the goals of the regional health personnel policy

ICD-10 code-based definition of heart failure in Saint Petersburg electronic health records: prevalence, health care utilization and outcomes

Aim. To analyze prevalence of heart failure (HF), clinical and demographic characteristics, health care utilization, and outcomes according to the used International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes in regional integrated electronic health record database in Saint Petersburg.Material and methods. The retrospective analysis of the Saint Petersburg regional integrated electronic health record database for 2019 was performed. At least one of the following ICD-10 codes has been considered as HF case: I50.x (standard coding) and/or I11.0, I13.0, I13.2, I25.5, I42.0, I42.9, I09.9, I43.0, I43.1, I43.2, I43.8, I42.5, I42.6, I42.7, I42.8 (extended coding).Results. A total of 64070 adult patients with HF had medical encounters in 2019, 34,5% of whom were identified using standard coding, 65,5% — using extended coding. The combination of codes was observed in 9,9% of cases. HF prevalence/mortality was 1,4%/6,8% in general, as well as 0,49%/15,7% and 0,93%/2,1% with standard and extended coding, respectively. HF patients had high healthcare utilization with the mean number of 14 encounters per patient per year. Actually, 24% of patients had more than 20 both inpatient and outpatient encounters and 54% of patients — at least 1 all-cause hospitalization during the year. Encounters of patients with HF accounted for 4,3% of all visits, 6,5% of all hospitalizations, 4,1% of all outpatient visits and 9,7% of all emergency contacts during the year. Patients identified by the standard coding compared with the extended coding had older age and higher incidence of comorbidities, as well as greater hospitalization and death rates, but lower number of outpatient visits.Conclusion. The prevalence of HF among the adult population of Saint. Petersburg in 2019 was 1,4%. HF was characterized by a high health care utilization and mortality rate reaching 15,7 % per year. The use of different approaches to coding presumably could help to identify different groups of patients with HF, which requires the adaptation of healthcare models and an active monitoring system to reduce the risk of adverse events

Assessment of prevalence and monitoring of outcomes in patients with heart failure in Russia

The increasing prevalence of heart failure (HF) serves as a reverse side of the effective treatment for cardiovascular diseases (CVD) and increasing patient survival. Data on the epidemiology of HF and related mortality in Russia are limited. According to the EPOCHA trial (hospital phase), the prevalence of HF in the Russian Federation is 7%. HF can significantly contribute to cardiovascular mortality. However, its recognition is limited by the peculiarities of the mortality coding system in Russia. The article presents the authors’ view on the registration of HF-related morbidity and mortality cases and perspectives of using left ventricular ejection fraction <50% for statistical reporting

Association of medical staffing and outcomes in cardiovascular diseases

Raised life expectancy of patients with cardiovascular diseases (CVD), due to continuous progress in drug treatment options and widespread use of innovate technologies, increase the burden of CVD on healthcare system. The development of human resources by highly qualified specialists is of fundamental importance. For the rational use of human resources to achieve the targets of federal project on the prevention of cardiovascular diseases, it is necessary not only to analyze the actual situation with medical staffing, but also the potential effects of staff shortages and imbalances on mortality. The review presents evidence of associations between staffing and quality of care and CVD outcomes

Implemented models and elements for heart failure care in the regions of the Russian Federation: prospects for transformation into regional cardiovascular risk management systems

The high and growing incidence and mortality of patients with heart failure (HF) should receive priority attention when developing an action plan to reduce cardiovascular mortality in the Russian Federation. The article provides an analysis of the implemented elements of HF care in 40 Russian regions (Northwestern, North Caucasian, Volga, Southern Federal districts), some of the best practices, as well as prospects for implementation of the cardiovascular risk management system