Vice Mayor Rakova: Moscow is shifting to value-based medicine

The transition to a patient-centered healthcare system, the introduction of value-oriented medicine is a priority for the Moscow Government. The focus is shifting from the volume of services provided to the end results achieved in the course of treatment. The first direction in which such an approach — oncology. This was announced by Deputy Mayor of Moscow for Social Development Anastasia Rakova.

“We have been developing the oncological service of the city for the last few years. The first years were devoted to the transformation of the system as a whole, the creation of a new structure for the provision of assistance and the creation of a material and technical base. We identified 6 anchor oncology hospitals, equipped them with the latest equipment, created modern laboratories, and are opening new outpatient cancer care centers. Over the past year, the Moscow professional oncological community has been developing a unified city “client path” for oncological diagnoses. “Customer Path” — this is a built-in process of events, necessary studies, participants in the process, a system of responsibility for the patient from suspicion of a malignant neoplasm to life-long observation after treatment, taking into account federal clinical recommendations», — said the deputy mayor.

The key goal of every “customer journey” is is the timeliness and  quality of treatment of the patient due to the continuity and continuity of actions. For each of them, the maximum number of doctor's appointments and the maximum time for each stage should be determined: confirmation of the diagnosis, timeliness of the beginning and end of treatment, effective dispensary observation. Familiarize yourself with detailing and filling of the developed "client paths" available on website

Next step — development of a monitoring system for the implementation of “client paths”; for each disease. On a monthly basis, on the basis of medical records, data is generated that makes it possible to control the fulfillment of the deadlines and the quality of medical care provided in 6 hospitals. These data allow, firstly, to confirm the correctness of the developed “client paths”, and, secondly, to make the results of the work of medical institutions transparent and public.

“The work of forming customer journeys has been carried out systematically over the past year. In February, we approved the first client paths to diagnosis. This allowed us to form a rating of multidisciplinary oncology hospitals for the first time. When calculating it, the terms of verification of the diagnosis were estimated from the date of the first appointment to the date of diagnosis, the terms of the oncological consultation to determine the tactics of treating the patient, and the term for the start of specialized treatment. But in addition to the “bare numbers”, in value-based approach it is always important to take into account the feedback, focus on the needs of the patients themselves. Therefore, we have supplemented the medical rating with the “patient” one. It is based on the results of surveys that we have been conducting since the beginning of this year on questionnaires verified in international practice  — Anastasia Rakova noted.

Personal assistants are now conducting surveys of patients to assess their level of awareness about the results of oncoconsiliums, about the treatment plan and its possible complications, satisfaction with the explanations of the treatment plan. At the next stages, it is planned to conduct surveys to assess the condition of patients over time, quality of life after treatment, and involve patients in the decision-making process. Recall that the project “Personal Assistant” is being implemented in Moscow. on accompanying oncological patients, within the framework of which service specialists help patients to make an appointment with the doctor, remind the date of the visit and solve other problems.

“When a person has a suspicion of oncological disease, it is extremely important for him to have a clear and understandable algorithm for further actions — where to go, what examinations to undergo, how to get all the help you need, what time frame this or that step should fit. The work on detailing the client's paths for each oncological diagnosis will be continued. In soon we will determine clear algorithms and the patient route at all stages of treatment, and by the end of the year we will finalize     the part of lifelong follow-up. Together with finishing client paths and development of technologies for communication with patients — we will try to regularly update the ratings of cancer hospitals. We hope that clear “customer paths” and  public ratings will make the provision of oncological care as clear and transparent as possible for patients, and will also increase its quality», — noted Anastasia Rakova.

The final rating of six anchor oncology hospitals for the period January-May 2022 was distributed as follows:

1) A. S. Loginova:
Overall rating — 3.8
Patient evaluation — 4.4

2) GKB im. D. D. Pletneva:
Overall rating — 4
Patient evaluation — 3.8

3) MGOB № 62
Overall score — 3.5
Patient evaluation — 4.2

4) GKOB № 1
Overall score — 3.3
Patient evaluation — 3

5) City Clinical Hospital No. 40 on Kasatkina
Overall score — 2.8
Patient evaluation — 3.4

6) GKB im. S. P. Botkin
Overall score — 3.8
Patient evaluation — 2.2

“Developing clear and“patient pathways” consistently solves two major problems at once. Firstly, it allows you to make the whole process of diagnosis and treatment as transparent and understandable as possible, both for the doctor and for the patient. Secondly, it gives the patient confidence in  strict observance of all steps on the part of the medical organization.

“Patient Ways”, enshrined in official regulatory documents — this is the most important social obligation, and the city has every opportunity to fully realize it, including thanks to a unified digital platform, equipping our oncology clinics, creating ambulatory oncology care centers  — commented on the new approach Vsevolod Galkin, chief physician of the State Clinical Hospital No. 1.

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