Methods of state regulation on mortality rates. Population mortality. General and special mortality rates. Causes of mortality in different age and sex groups. Methods of state regulation on mortality rates By

Mortality rate- the process of natural reduction in the number of people due to deaths in a specific population over a certain period of time.

In accordance with the legislation of the Russian Federation, all cases of death are subject to registration with state civil registration authorities at the place of residence of the deceased or at the place of death on the basis of the conclusion of a medical institution no later than 3 days from the moment of death or discovery of the corpse. To register deaths, a “Medical Death Certificate” (f. 106/u-08) has been approved. The issuance of a corpse without a “Medical Death Certificate” is prohibited.

A “medical death certificate” is issued by the attending physician of a health care institution based on observations of the patient and records in the medical documentation reflecting the patient’s condition before his death, or by a pathologist based on the study of medical documentation and autopsy results.

All those who died from diseases in health care institutions are subject to a pathoanatomical autopsy. The chief physician has the right to cancel the autopsy in the most exceptional cases. The chief physician gives a written order to cancel the autopsy in the inpatient’s chart, justifying the reason.

Cancellation of a pathoanatomical autopsy is not allowed if it is impossible to establish a final clinical diagnosis of the disease that led to death and (or) the immediate cause of death, regardless of the length of the patient’s stay in the hospital or outpatient observation; if an overdose or intolerance to drugs or diagnostic drugs is suspected in the following cases of death:

• related to the implementation of preventive diagnostic instrumental, anesthesiological, resuscitation, therapeutic measures during or after a blood transfusion operation;
• from an infectious disease or suspicion of it;
• from cancer in the absence of histological verification of the tumor;
• from diseases associated with the consequences of environmental disasters;
• pregnant women, women in labor and postpartum;
• in all cases requiring forensic medical examination.

If there is a suspicion of violent death or if death resulted from mechanical asphyxia, poisoning, extreme temperatures, electricity, after an artificial abortion performed outside a medical institution, in the sudden death of children who were not under medical supervision, as well as for deceased persons whose identity is unknown established, a “Medical Certificate of Death” is issued by a medical examiner after an autopsy.

It is prohibited to issue a “Medical Death Certificate” in absentia, without the personal participation of a doctor in establishing the fact of death.

In exceptional cases, a death certificate may be issued by a doctor who has determined death only on the basis of an examination of the corpse (in the absence of suspicion of violent death). This does not apply to forensic experts, who are prohibited from issuing a “Medical Death Certificate” solely on the basis of an external examination of a corpse.

A “medical death certificate” is issued with the mark “final”, “preliminary” or “instead of the preliminary”. This procedure was adopted in order to ensure greater reliability of the registered causes of death and in order not to delay the registration of death in the registry office and burial authorities.

A “medical death certificate” marked “preliminary” is issued in cases where additional research is necessary to establish or clarify the cause of death or if by the time the certificate is issued the nature of death (an accident outside of work or in connection with work, suicide, murder) is not established, but may be clarified in the future. After clarifying the cause and nature of death, a new certificate is drawn up, which, with the mark “instead of the preliminary one,” is sent by the health care institution directly to the state statistics body no later than a month later.

If a “Medical Death Certificate” marked “final” was issued, but an error was later discovered in recording the diagnosis, a new “Medical Death Certificate” should be drawn up with a handwritten inscription “in place of the final medical death certificate No. _” and send directly to the state statistics body.

The accuracy and reliability of statistical information about the causes of death depends on the correctness of establishing the cause of death and the quality of filling out the medical death certificate. The WHO has defined the causes of death to be included on a medical death certificate as “all those diseases, conditions or injuries that caused or contributed to death, and the circumstances of the accident or act of violence that caused any such injuries.”

This definition is formulated to ensure that all death-related information is recorded so that it is not possible to select certain pathological conditions and exclude others only at one's own discretion. If there is only one cause of death, then the problem is solved quite simply. However, if death is caused by two or more pathological conditions, it is necessary for statistical processing to select only one of the causes of death, which is designated by the term “primary cause of death.”

The underlying cause of death is defined as “the disease or injury that caused the successive series of disease processes leading directly to death.”

To get a complete picture of the state of population mortality and the quality of registration of individual death cases, the following indicators are calculated and analyzed.

The crude mortality rate provides a first, approximate estimate of mortality and is calculated as the ratio of the total number of deaths per year to the average annual population. Since the 90s, this indicator has maintained an upward trend and in 2003 amounted to 16.5 per 1000 population. According to the scale below, the mortality rate of the population in the Russian Federation is assessed as high.

Among the partial coefficients, the most important place belongs to age-specific mortality rates, which are calculated as the ratio of the number of deaths of a certain age group to the average annual population of this age group. These coefficients can be calculated for the entire population or separately for men and women.

For an in-depth analysis of the prevalence and structure of causes of mortality, the following indicators are calculated:

• overall mortality rate from the i-th cause;
• mortality rate from the i-th cause in a certain age group;
• structure of mortality by causes, age, gender.

In epidemiological studies, standardized mortality rates are calculated to compare two or more populations with different internal structures.

The value of the indicator depends on the composition (structure) of the population being studied: age, gender and other characteristics. For example, mortality will be higher if a larger percentage of the population is elderly. Therefore, only on the basis of rough indicators it is impossible to compare the health status of population groups whose structure is different.

The method of standardizing indicators makes it possible to compare populations with different internal structures. It consists in calculating new indicators based on the assumption that the internal structures of the populations being studied correspond to the internal structure of the population conventionally taken as a sample (standard). The standardized indicators calculated in this way are compared directly with each other.

The age-standardized mortality rate represents what a population would have had if it had a “standard” age structure. The population whose age structure is taken as such a standard is called “standard”.

For international comparisons of standardized mortality rates, two types of population age structure are used: world and European standards; for interregional comparisons, the age distribution of the population of the Russian Federation is used. When studying the dynamics of changes in indicators in one territory, the age structure of the population of this territory for the base calendar year (usually the census year) is often used.

However, standardized indicators must be used with some caution.

They cannot be used to analyze and develop targeted programs for maintaining and improving public health. With the same values ​​of standardized mortality rates, territories with higher dependency ratios (the number of children and pensioners per 100 people of working age) will be in a less advantageous position, since when implementing a target program they will require more resources than territories with a lower demographic load.

There are two methods for calculating standardized indicators. The essence of these methods is that they conditionally take any composition of the population as a standard and consider it the same in the compared populations. Then, taking into account the actual size of the phenomenon by group indicators, the overall standardized indicators are calculated.

If there are age-specific mortality rates for the population being studied, the standardized age-specific rate is obtained by calculating the weighted average of these age-specific rates, using as group weights the numbers (or proportions) of people from the corresponding age groups of the standard population. This technique is called the direct standardization method.

To calculate standardized indicators using a direct method, it is necessary to know the composition of the population and the composition of the phenomenon being studied.

Direct standardization method consists of the following series of sequential stages:

• Stage I - calculation of general intensive indicators for all groups in two compared populations;
• Stage II - determination of the standard;
• Stage III - calculation of expected values ​​in each group of the standard;
• Stage IV - comparison of groups according to intensive and standardized indicators.

Using this method, the standard can be taken as follows:

• age composition of the population of one of the compared population groups;
• the average age composition of the population of both compared population groups;
• another general standard.

When choosing a general standard, it is very important not to take it arbitrarily, but to choose the one closest in content to the populations being studied. For example, when comparing the mortality rate of the urban and rural population of a region or district, it is advisable to take as the standard the age composition of the population of the region or district as a whole to which the population being compared belongs.

Analytically this method can be described as follows:

Indirect (indirect) method of standardization of indicators applies in two cases:

• in the absence of data on the composition of patients and deaths;
• at small numbers of the phenomenon being studied.

This method involves obtaining a "correction" multiplier (also called a standardizing multiplier). Multiplying the overall mortality rate by this multiplier gives the SDR.

The adjustment factor takes into account the effect of differences between the age structure of the study population and the standard population.

The analytically indirect (indirect) method can be described as follows:

The denominator of the adjustment multiplier is called the “mortality index” and is calculated by multiplying the age-specific mortality rates of the standard population by the age structure of the population under study.

Comparisons between different standardized indicators are valid only if they relate to the same standard population. If different researchers use different standard populations to obtain standardized scores, the scores cannot be compared.

Methods of age-sex standardization can be applied not only to general mortality, but also to other indicators characterizing the health of the population (morbidity, disability).

“MEDICAL AND DEMOGRAPHIC ASPECTS OF HEALTHCARE ORGANIZATION”
001. Late neonatal mortality is the mortality of children:

a) Over the age of one month before they reach one year of age

b) At 2-4 weeks of life

c) In the first month of life

c) Over 15

003. The maternal mortality rate is calculated using the formula: 1) (number of deaths of pregnant women, women in labor, and postpartum women within 42 days after termination of pregnancy * 100,000) / number of live births; 2) (number of deaths of pregnant women * 1000 live births) / total number of pregnancies; 3) (number of deaths after 28 weeks of pregnancy * 100,000 live births) / total number of pregnancies; 4) (number of pregnant women who died * 100,000 live births and stillbirths) / total number of pregnant women after 28 weeks; 5) (number of pregnant women who died after 28 weeks * 100,000 live births) / total number of pregnancies after 28 weeks
b) 2
d) 4

e) 5
004. An overall mortality rate of 16%0 is estimated as:

a) Low

b) Average

c) High
005. Fertility rate 18%0 is estimated as:

a) Low

b) Average

c) High

a) Low

b) Average

c) High

a) Narrowed

b) Extended

c) Simple

d) Uncertain
008. The state of population health is assessed by the following groups of indicators: 1) level and structure of morbidity and disability; demographic indicators; level of physical development; 2) level and structure of morbidity and disability; fertility indicators; level of physical development; 3) fertility indicators; demographic indicators; mortality rates by morbidity groups

at 3
009. For children of what age group is the “Infant Mortality” indicator determined:

a) 2-4 weeks of life

b) Older than 1 month

c) In the first 28 days of life

d) Up to the 1st year

a) Number of deaths from this pathology * 100 / total number of deaths

b) Number of deaths from a given pathology/total number of diseases * 100
011. The mortality rate of children in the first 28 days of life is called:

a) Neonatal mortality

b) Perinatal mortality

c) Postneonatal mortality

d) Infant mortality
012. The average overall mortality rate in Russia over the past 5 years has been within the range (in %0):

a) 5 to 10

b) from 11 to 17

c) from 18 to 20

CN - population size

SCN - average population size

SgChN - average annual population

NU - number of deaths per year

a) (NC for 1 year * 1000) СgCN

b) (NC for 1 year 1000) / CN

c) (CN older than 1 minute * 1000) / SCHN

d) (CH older than 1 year * 1000) / UN older than 1 year.

e) (CN * 1000) / CN at the end of the year

a) Low

b) Average

c) High

a) Low

b) Average

c) High

a) Narrowed

b) Extended

c) Simple

d) Uncertain
017. Natural population movement includes: 1) birth rate, general population mortality (including infant mortality), natural increase; 2) birth rate, migration of the current population, natural increase; 3) general mortality (including infant mortality), external migration, natural increase

at 3
018. An infant mortality rate of 7-9%0 is typically characteristic of:

a) highly developed countries

b) Third world countries

c) Developing countries
019. Statistical measures of public health of the population are indicators:

a) Morbidity

b) Disabilities

c) Physical development

d) Demographic

e) All of the above

a) Alive

b) dead

c) Alive and dead

a) Increased birth rate

b) Declining birth rate

c) Stabilization of the birth rate

d) Optimization of natural population growth rates

e) Decrease in mortality

f) All of the above
022. The main document for civil registration of the death of a child in Russia is:

a) Birth certificate

b) Marriage certificate

c) Statement of 2 witnesses

d) Certificate from the maternity hospital about the birth of the child

e) All of the above

a) Birth certificate

b) Passport

c) Statement of 2 witnesses

d) Conclusion of a pathologist

e) Medical certificate of perinatal death

f) Medical death certificate

g) All of the above

a) Injuries

b) Diseases of the circulatory system

c) Respiratory diseases

d) Oncological diseases
025. What types of population movements need to be taken into account when developing a demographic policy strategy in the region:

a) Mechanical

b) Mechanical and natural

c) Mechanical, natural and social

d) Mechanical, natural, social, age-related
026. Indicate which factors regulating fertility must be taken into account when assessing the demographic situation:

a) Population migration

b) Contraception coverage

c) Age at marriage

d) Socio-economic conditions

e) Parents' health status

f) All of the above
027. An overall mortality rate of 10%0 is estimated as:

a) Low

b) Average

c) High

a) Low

b) Average

c) High

a) Low

b) Average

c) High

a) All of the above

c) 3.4
031. A general indicator of the vital movement of the population is:

a) Fertility

b) Mortality

c) Natural increase
032. General indicators of population reproduction (natural movement) do not include:

a) Fertility

b) Mortality

c) Natural increase

d) Average life expectancy
033. Age-specific mortality rates are calculated by: 1) the ratio of the number of deaths in each age group to the number of the given age group; 2) subtracting births and deaths per 1000 population in each five-year age group; 3) the ratio of the number of deaths in each age group to the average annual population of the territory

a) Age-specific fertility rates

b) Age-specific mortality rates

c) All of the above

a) Third

b) First

c) Second

a) Second

b) First

c) Third

a) First

b) Second
039. The natural increase rate is the ratio of: 1) the annual number of births to the annual number of deaths; 2) the annual number of deaths to the annual number of births; 3) (annual number of births - annual number of deaths) * 1000 to the average annual population

e) All answers are correct.

f) All answers are wrong
052. Neonatal mortality is the mortality of children out of 1000 live births for:

a) the first week of life

b) the first month of life

c) first year of life

053. Early neonatal mortality is the mortality of children for:

a) The first week of life or the first 168 hours of life

b) the first month of life

c) first year of life

d) Second to twelfth month of life
054. The birth rate that has developed in Russia in recent years ensures the reproduction of the population (the numerical replacement of generations of parents with their children):

a) 50-60%

b) 60-65%

c) 80-90%

d) Practically ensures simple reproduction by 95-105%

e) Provides slightly expanded reproduction by 105-110%

a) About 10%

b) About 15%

c) About 25%

d) About 35%

e) About 40%

“MEDICAL AND DEMOGRAPHIC ASPECTS OF HEALTHCARE ORGANIZATION”

SECTION 06

“Quality management in healthcare. Examination of Temporary Disability"
001. Medical documentation contains information about:

a) Commercial activities of a medical institution

b) The state of health of the population and individuals, the volume and quality of medical care provided

c) Economic activities of a medical institution

d) Prospects for the development of health services

e) Financial resources of the medical institution

a) Determining the needs of the population for medical care and its planning, organization and management of health services

b) Bureaucratization of health care

c) Determining the needs of a medical institution

d) Conducting financial and commercial activities of a medical institution

e) Administration and control of execution of orders

a) Any document in healthcare

b) Documents provided upon any request

c) Statistical forms

d) The system of documents of the established form, submitted by institutions and health authorities to higher health authorities

e) Procedure for submitting reports

a) “Outpatient pass” (025-1 0/у Т-03)

b) “Book of calling a doctor at home” (031/у)

a) If this information can cause significant harm to the patient

b) If the patient himself refuses this information

c) In case of severe incurable disease

d) If the patient has an unbalanced character

e) If the relatives of the patient do not give permission for this

a) A certain state of the organization, characterized by the difference between the presented need and the organization’s ability to satisfy this need at the time of its occurrence

e) The teacher sabotages the implementation of a rating system for assessing students' educational achievements at his department. After a conversation with the head of the academic department of the department, he obeyed and began to fulfill his demands, although he internally did not agree with them.

b) Resolving the discrepancy between the presented need and the organization’s ability to satisfy this need at the time of its occurrence

c) The process of identifying activities aimed at eliminating the discrepancy between the presented need and the organization’s ability to satisfy this need at the time of its occurrence

d) The identified difference (between the presented need and the organization’s ability to satisfy this need at the moment of its occurrence) in conjunction with its external environment (the set of acceptable decision options, decision-making rules, etc.) through which a decision is made on this difference

a) A certain state of the organization, characterized by the difference between the presented need and the organization’s ability to satisfy this need at the time of its occurrence.

b) Resolving the discrepancy between the presented need and the organization’s ability to satisfy this need at the time of its occurrence.

c) The process of identifying activities aimed at eliminating the discrepancy between the presented need and the organization’s ability to satisfy this need at the time of its occurrence

d) The identified difference (between the presented need and the organization’s ability to satisfy this need at the time of its occurrence) in conjunction with its external environment (the set of acceptable decision options, decision-making rules, etc.) through which a decision is made on this difference.

e) The teacher sabotages the implementation of a rating system for assessing students' educational achievements at his department. After a conversation with the head of the academic department of the department, he obeyed and began to fulfill his demands, although he internally did not agree with them.

a) A certain state of the organization, characterized by the difference between the presented need and the organization’s ability to satisfy this need at the time of its occurrence

b) Resolving the discrepancy between the presented need and the organization’s ability to satisfy this need at the time of its occurrence

c) The process of identifying activities aimed at eliminating the discrepancy between the presented need and the organization’s ability to satisfy this need at the time of its occurrence

d) The identified difference (between the presented need and the organization’s ability to satisfy this need at the moment of its occurrence) in conjunction with its external environment (the set of acceptable decision options, decision-making rules, etc.) through which a decision is made on this difference

e) The teacher sabotages the implementation of a rating system for assessing students' educational achievements at his department. After a conversation with the head of the academic department of the department, he obeyed and began to fulfill his demands, although he internally did not agree with them.

a) Characteristics of the organization’s ability to successfully perceive, develop and implement innovations, which is a prerequisite for maintaining the balance of the enterprise in the process of innovation;

b) A successfully developing organization that effectively implements advanced technologies into its life that help it solve emerging production problems;

c) The qualitative side (a kind of alloy of emotional and rational) of interpersonal relationships in a social group, manifested in the form of a set of psychological conditions that promote or hinder productive joint activity and the development of the individual in it;

d) This is a set of actions, judgments, concepts, conclusions, expectations and emotional experiences of employees, in which the negative states of these employees caused by innovations are consciously or unconsciously expressed;

e) That is a set of actions, judgments, concepts, conclusions, expectations and emotional experiences of employees, in which the consent of these employees with the innovations planned in their department is consciously or unconsciously expressed

a) The tendency to attribute responsibility for the results of one’s activities to one’s own abilities and efforts, rather than shift responsibility to “external forces”;

b) A holistic, active attitude to the problems and contradictions of the life of one’s organization; manifests itself in the way an employee determines his role in the system of business relations, in the way he solves problems and in the way he regulates the most significant aspects of the life of his department;

c) The measure of acceptance by others of the business and personal qualities of the employee;

d) A stable mental state of the individual, formed as a result of understanding the content and significance of the innovation and expressed in a positively active attitude towards it;

e) A turning point in the life of an individual, arising as a consequence of achieving a certain level of mental maturity and social demands; characterizes the moment when a person makes progressive or regressive decisions

a) Organization and control of employees' activities

b) Making decisions in situations that are significant for the group

c) Influencing others through official sanctions

d) Official responsibility for the state of affairs in the group

e) Representation in the external social environment

a) Active influence on consumer demand in order to expand sales of products and services

b) System of market research activities

c) The process of defining goals and implementing activities to achieve the goals

d) Formation of a system of material interest of employees in the final results of their activities (quantitative and qualitative)

e) A system of measures to study the market and actively influence consumer demand in order to expand sales of products and services

1) Resource standards

2) Process standards

3) Economic standards

4) Standards for results

5) Quality standards

a) 1, 2,4 are correct;

b) 2, 3,4 are correct;

c) 1,3,4 is correct;

d) 2,3,5 is correct;

d) all of the above are incorrect
033. Non-departmental examination of the quality of medical care is carried out:

a) Certification and licensing bodies

b) Insurance medical organizations

c) Federal and territorial social insurance funds

d) All of the above are true

e) There is no correct answer

a) Availability

b) Economical

c) Effectiveness

d) All of the above are true

e) There is no correct answer

a) Territorial Compulsory Medical Insurance Fund

b) State Accreditation and Licensing Medical Commission

d) Executive body of the social insurance fund

e) There is no correct answer

a) Creation of certain rules, protocols before the start of work, documents reflecting the regulation of labor relations, these are: job descriptions; employment contracts; local regulations; internal labor regulations; methods of attraction to work and motivation of work

b) Assessing the compliance of financial costs with the services provided
037. Current control provides

a) Detection of non-compliance with a procedure or operation;

b) Establishing the reason for failure to perform a procedure or operation;

c) Determining the way to resolve the situation (problem);

d) Providing conditions for performing a procedure or operation.

e) All of the above are true

e) There is no correct answer
038. Who should carry out departmental control of medical care in a hospital at the first level?

a) Chief physician

b) Deputy chief physician for medical work

c) Deputy chief physician for clinical expert work

d) Head of department
039. What basic medical document is subject to departmental and non-departmental control in a hospital?

c) “Statistical card of a hospital patient who left the hospital” (066/u)

d) “Dispensary observation checklist” (033/u)

e) “Outpatient Patient Card” (025-12/U)

a) “Medical record of an outpatient” (025/у)

b) “Medical record of an inpatient” (003/у)

c) “Statistical card of a patient leaving the hospital” (066/u)

d) “Dispensary observation checklist” (030/u)

e) There is no correct answer

a) Introduction of new technologies.

b) Continuous and total quality improvement.

c) Increase in the number of patients satisfied with medical care

d) Achieving average annual results.
042. To assess the quality of medical technologies in the daily practice of clinics, the following methods are most often used:

a) Statistical.

b) Expert assessments.

c) Medical and economic analysis.

d) Questionnaire.
043. Patient satisfaction with the quality of medical care is studied using the following method:

a) Analysis of statements and complaints

b) Sociological research

c) Survey of medical workers

d) Testing

e) Direct observation

1) Questionnaires

1. 
   Analysis of statements and complaints
2. 
   Testing

d) all answers are correct

a) The scope of medical care provided to the patient in accordance with the diagnosis and treatment protocol

b) Maintaining medical records

c) Patient satisfaction

d) All of the above are true

e) There is no correct answer

1) Improvements in health care delivery

2) Forward planning

1. 
   Quality management of medical care
2. 
   Compiling a statistical report

a) 1, 2, 4 are true; b) 2, 3, 4 are true; c) 1, 3, 4 are true;

d) 2, 3, 5 are correct; e) correct 1,3,5
047. A set of measures aimed at the prevention of diseases, their diagnosis and treatment, which have an independent complete meaning and a certain cost - this is

a) Medical assistance

b) Comprehensive medical service

c) Medical service

d) Protecting the health of citizens

e) Medical examination of the population

a) A set of measures aimed at meeting the needs of the population in maintaining and restoring health

b) A set of measures aimed at preventing diseases, their diagnosis and treatment, having an independent complete meaning and a certain cost

c) A set of actions of medical personnel carried out according to a specific plan, performed either to establish a diagnosis, or to complete a certain stage of treatment, or to carry out prevention

e) The set of medical services, the result of which is a change in the course of the disease (disease outcome)

a) A set of measures aimed at preventing diseases, their diagnosis and treatment, having an independent complete meaning and a certain cost

b) A set of measures aimed at meeting the needs of the population in maintaining and restoring health

c) An indivisible service performed according to the formula “patient” + “specialist” = “one element of prevention, diagnosis or treatment”

d) Doctor’s actions carried out according to a specific plan, which make it possible to get an idea of ​​the state of the patient’s body, the result of which is the prevention, diagnosis or treatment of a certain disease, syndrome

e) A set of actions of medical personnel carried out according to a specific plan, performed either to establish a diagnosis, or to complete a certain stage of treatment, or to carry out prevention

a) A set of regulatory documents and organizational and technical measures, covering all stages of the life cycle of a regulatory document containing requirements for standardization objects in the field of healthcare

b) Activities aimed at achieving the optimal degree of regulation in healthcare by developing and establishing requirements, norms, rules, characteristics of conditions, products, technologies, works, services used in healthcare

c) Activities to apply the standard in their scientific, technical, development, technological, design, production, management, educational, pedagogical and other types of activities in healthcare

d) A process that establishes “rules, general principles or characteristics relating to objects of standardization, various types of activities or their

results

a) Medical services

b) Technologies for performing medical services

c) Technical support for the provision of medical services

d) Quality of medical services

e) All of the above

a) Organizational technologies

b) Medical services

c) Technologies for performing medical services

d) Technical support for the provision of medical services

e) Quality of medical services.

f) Qualification of medical, pharmaceutical, support personnel

g) Production, sales conditions, quality of medicines and medical equipment products

h) Accounting and reporting documentation used in the healthcare and health insurance system

i) Information technology

j) Economic aspects of health care

k) Obtaining, processing and introduction into the body of organs and tissues received from a donor

l) Ensuring ethical rules in healthcare

n) Everything listed is correct

o) There is no correct answer
053. Medical and economic standard is a document defining ...

a) The pricing mechanism in the health insurance system for individuals, institutions and their units and is based on diagnostic, treatment and technological standards.

b) The volume of medical diagnostic procedures and the technology for their implementation

c) The effectiveness of treatment and cost indicators

1. 
   Objectively reflect reality and contain the optimal solution to the problem

1. 
   Be practical and have an organizing role
2. 
   Ensure continuity in organizing the production process

a) Comprehensive medical service

b) Complex medical service

c) Reception (examination, consultation)

d) Complex of research

e) There is no correct answer

a) Only state (municipal)

b) health care facilities with any form of ownership

c) health care facilities of any level, profile, departmental affiliation

d) Any health care facility, including a frequently practicing doctor licensed to carry out work ability examinations
057. Under what conditions is a health care institution created?

b) If there are 20 or more medical positions

c) By order of the head of the institution, if there is a license to conduct a work ability examination (order No. 170)

a) From the 1st day of incapacity for work

b) From the 3rd day of incapacity for work

c) From the 6th day of incapacity for work

d) From the 10th day of incapacity for work

e) If there are 25 or more outpatient appointments

a) In the presence of a polyclinic (polyclinic department)

b) If there are 30 or more medical positions

c) If there are 20 or more outpatient appointments

d) If there are 25 or more outpatient appointments
060. To whom does the deputy chief physician of a multidisciplinary hospital for clinical expert work directly report?

a) The chief physician of the hospital for medical services to the population

b) Deputy chief physician of the hospital for medical care of the population

c) Deputy chief physician of the hospital about organizational and methodological work

d) Deputy chief physician of the hospital for medical work

e) Deputy chief physician of the hospital for the outpatient section of work

a) Monthly

a) For the chief physician

b) For the chief physician and chief (senior) nurse

c) For the deputy chief physician for clinical expert work (in the absence - for the chief physician)

a) A certificate of incapacity for work is not issued, only a record of the assistance provided is made, and if necessary, a free-form certificate is issued

b) A certificate of the established form is issued

c) A certificate of incapacity for work may be issued for a period of up to 3 days.

a) Number of cases of VUT per 100 workers

b) Number of days of labor protection per 100 working members of working age

c) Everything is correct

a) In all cases of sending a patient to a sanatorium

b) When referred for follow-up treatment to a sanatorium after inpatient treatment

c) In all cases of sanatorium treatment, a certificate of incapacity for work is issued only for the missing days of labor leave

a) No later than 4 months with an obvious unfavorable clinical and labor prognosis

b) No later than 10 months with a favorable labor forecast

c) Regardless of the period, working disabled people in the event of a worsening clinical and work prognosis

d) All of the above are true

e) There is no correct answer

a) Cannot be under any circumstances

b) Can be carried out at the request of a disabled person

c) Can be carried out at the request of higher authorities

d) Can be carried out at the request of the court and prosecutor's office

e) Can be carried out when there is a change in the state of health and ability to work or when it is revealed that the MSEC has made an unreasonable decision at the request of the patient

a) Chief physician of the hospital (polyclinic)

b) Head of the department together with the chief physician

c) Attending physician, chief physician

d) The attending physician together with the head of the department and the chief physician with the approval of the district (city) healthcare and the chief physician with the approval of the district (city) healthcare.
069. In what cases is the mother issued a certificate of incapacity for work for the entire duration of the child’s hospital stay?

a) In all cases when seriously ill children need care;

b) When hospitalizing children under two years of age;

c) During hospitalization under the age of 7 years, as well as seriously ill older children who, according to the conclusion of the CEC, require maternal care.

a) Attending physicians of the state healthcare system

b) Attending physicians of the municipal health care system

c) Attending physicians of the private healthcare system

d) Chief doctors and their deputies.
071. Until what period can the attending physician unilaterally extend the certificate of incapacity for work?

a) Up to 10 days

b) Up to 30 days

c) Up to 45 days

d) Up to 60 days
072. For what maximum period can the KEC extend a certificate of incapacity for work?

a) Up to 2 months

b) Up to 3 months

c) Up to 6 months

d) Up to 10-12 months

d) Up to 4 months

a) After myocardial infarction

b) After a stroke

c) For cancer

d) For injuries, tuberculosis and after reconstructive operations
074. Who has the right to refer citizens for a medical and social examination?

a) Heads of health care facilities and clinics

b) The attending physician with the approval of the head. department

c) The attending physician with the approval of the head. department

d) The attending physician with approval of the VC referral
075. What document is presented to patients in a medical institution to obtain a certificate of incapacity for work?

a) Certificate of employment

b) Document on marital status

c) Patient’s identification document

d) Document on registration and place of residence
076. Who issues a certificate of incapacity for work for sanitary-resort treatment?

a) Industry trade unions

b) Social Insurance Fund

c) Health authority

d) Medical and preventive institution

e) MSEC Commission

a) From 26 weeks of pregnancy

b) From 30 weeks of pregnancy

c) From 32 weeks of pregnancy

d) From 29 weeks of pregnancy
078. Who pays for mandatory and periodic examinations of persons working in occupational hazard conditions?

a) Medical insurance organizations

b) Local administration

c) Health authority

d) Employers of these institutions
079. What benefits are provided to working parents of disabled children and people with disabilities from childhood to care for them until the age of 18?

a) Monthly compensation to wages

b) Additional monthly paid leave

c) Shortened working hours

d) 4 additional paid days off per month
ANSWERS TO SECTION 05

“Quality management in healthcare. examination of temporary disability"

12. Main indicators of mortality

Total mortality rate:

total number of deaths for the year X

However, the overall mortality rate is of little use for any comparisons, since its value largely depends on the characteristics of the age composition of the population. Thus, the increase in the overall mortality rate in recent years in some economically developed countries does not so much indicate a real increase in mortality as reflects an increase in the proportion of elderly people in the age structure of the population.

Mortality rates of individual age and sex groups:

the number of persons of a given sex and age who died in a year X 1000 / number of persons of a given age and sex.

Mortality from this disease(intensive indicator):

the number of deaths from this disease per year x x 1000 / average annual population.

Structure of causes of death(extensive indicator):

the number of deaths from a given cause X 1000 / total number of deaths.

The development of materials on population mortality by cause is based on data from the “Medical Death Certificate” (f. 106/u), “Paramedic’s Certificate of Death” (f. 106-1/u), “Medical Certificate of Perinatal Death” (f. 106-2/у). Filling out death certificates and selecting the underlying cause of death are carried out in accordance with existing rules.

Natural increase is expressed as an absolute number as the difference between the number of births and the number of deaths in a year. Moreover, it can be calculated as the difference between birth and death rates.

High natural increase can be considered as a positive phenomenon only if the mortality rate is low. High growth with high mortality characterizes the unfavorable situation with population reproduction, despite the relatively high birth rate.

Low growth with high mortality indicates an unfavorable demographic situation. Low growth with low mortality indicates a low birth rate.

Negative natural growth indicates trouble in society, which is typical during periods of war, economic crises and other shocks and is associated with the negative influence of three main factors, such as:

1) continuation in our country of the global process of demographic transition to a small family;

2) a change in the age composition of the population - currently, a small number of women have entered the age group of greatest fertility (20–29 years);

3) the crisis state of the socio-economic sphere.

Average life expectancy indicator shows how many years on average a given generation of those born will live if, throughout the life of this generation, mortality rates remain as they are at the moment, and is calculated on the basis of age-specific mortality rates by constructing mortality tables.

BASIC PRINCIPLES OF EXAMINATION OF CHILDREN WITH DYSARTRIA (BASIC INDICATORS OF DIAGNOSIS OF DYSARTRIA)

11. Basic indicators of fertility Indicator of general fertility (fertility): total number of live births per year x 1000 / / average number of women aged 15-49 years. This indicator depends on the proportion of women of childbearing age in the total population and

13. Indicators of infant mortality Infant mortality characterizes the death of newborn children from birth to the age of one. It stands out from the general problem of population mortality due to its special social significance. Its level is used to evaluate

14. Infant mortality and perinatal mortality rate Infant mortality rate from a given cause: the number of deaths under the age of one year from a given cause? 1000 / 2/3 live births in this year + 1/3 live births last year.

15. Maternal mortality rate As defined by WHO, maternal mortality refers to the death of a woman due to pregnancy (regardless of its duration and location) and occurring during pregnancy or within 42 days after its termination.

30. Indicators of disability If there are indications for referral of a patient to a medical and social examination (MSE), health facilities issue a “Referral to ITU” (f.088 / y). The following documents are filled out in the ITU Bureau: “The Certificate of Inspection in the ITU”, “Book of Minutes of ITU Meetings”,

31. Rehabilitation indicators Assessment of rehabilitation measures is carried out on the basis of three groups of indicators: 1) medical and professional rehabilitation of disabled people; 2) stability of disability groups during repeated examination; 3) weighting of groups

44. Statistical indicators of morbidity, labor losses. Hospitalization indicators Statistical morbidity indicators Overall frequency (level) of primary morbidity (%0): number of all primary visits h1000 / average annual number of attached

Immunological indicators Immunodeficiency is an integral part of protein-energy deficiency. Damage to immune function occurs already in the early stages of malnutrition: the total number of T cells, their differentiation, and function decrease

Mortality Curve An insurance statistician named Benjamin Gompertz noticed in 1825 that mortality statistics have some peculiarities. The age-specific mortality curve had an elegant "U" shape. The risk of dying at birth was very high, then decreased significantly

The Ominous Mortality Curve and the Aggression of Survival History is a union between the dead, the living and the unborn. Edmund Burke As we see, human curiosity and its vanguard, science, are put at the service of creation and survival, seemingly unthinkable for

Chapter 4 Causes of maternal and infant mortality You should get acquainted with these unpleasant statistics only in order to know the most dangerous complications of pregnancy, childbirth and the postpartum period. The maternal mortality rate in Russia is 2–3 times higher

Appendix 1 Main stages and indicators of fetal development and other useful information Table 1 Hereditary traits determined by dominant and recessive genes Table 2 Main indicators of fetal development depending on gestational age

Anthropometric indicators Anthropometric indicators include the level of physical development, muscle strength, body weight, coordination of movements. Body weight indicators are one of the signs of fitness. To determine body weight, various

How to calculate basic heart rate indicators I suggest you do some calculations because, despite their simplicity, they are very important. First, subtract your age from 220. Let's say you are sixty, then the answer is 160.

Mortality is the process of extinction of a generation, consisting of many single deaths that occur at different ages and, in their totality, determine the order of extinction of a generation.

Population mortality depends on a large number of biological and social mortality factors.

These include:

1) natural and climatic factors;

2) genetic factors;

3) economic factors;

4) sociological factors;

5) political factors and others.

From the point of view of demographic analysis of mortality, it is more important to divide these factors into two groups:

1) endogenous factors are factors generated by the internal development of the human body;

2) exogenous factors are factors associated with the effect of the external environment on the human body.

Death is always the result of the interaction of factors from both of these groups, but the role of each of them may be different.

Mortality rates

Mortality rates are used to assess the social, demographic and health well-being of an area. The interaction between fertility and mortality rates, the replacement of one generation by another ensures the continuous reproduction of the population. The calculation of indicators is presented in the methodological manual.

1. Overall mortality rate. The overall mortality rate is of little use for any comparisons, since its value largely depends on the characteristics of the age composition of the population. Based on it, a first approximate estimate is made.

However, the overall mortality rate is significantly affected by age and sex composition of the population :

1) In many countries of the world, in all age groups, mortality rates men significantly exceed mortality rate women: so-called supermortality men, especially pronounced at the age of 20-44 years, when mortality rates can be almost 4 times higher than the corresponding rates for women. This leads to a pronounced gender imbalance in the population, a large proportion of widowed women, including women of reproductive age, an increase in single-parent families and, to some extent, a decrease in the birth rate.

2) Both men and women are characterized by an increase in indicators with increasing age. However, the age indicators for men are growing at a faster rate.

3) If ordinary the final mortality rates for men exceeded the corresponding rates for women in some years by 1.1-1.3 times, then standardized by age the coefficients of men were higher than those of women by 1.9 - 2.1 times. In other words, if the age composition of men were the same as women, then the overall mortality rate of men would be 2 times higher than that of women.

2. Mortality rates for specific age and sex groups of the population. These indicators are more accurate because The age structure of the population has almost no effect on them.

3. Infant, perinatal and maternal mortality rates have specificity in calculations and analysis.

Infant mortality. Infant mortality is the death rate of children in the first year of life (0 – 12 months). Infant mortality significantly exceeds mortality in all other age groups, with the exception of the elderly and senile age. A decrease in infant mortality contributes to an increase in the average life expectancy of the population.

However, due to the fact that a child may be born in one calendar year (for example, in December 2000) and die in another calendar year (for example, in January 2001), some difficulties arise in determining the environment, so for the calculation There are a number of different ways to measure this indicator. :

1) Rough indicator:

————————————————————————— · 1000

Number of live births in a given year

2) Refined indicator (Rats Formula):

Number of children who died during the year in the 1st year of life

—————————————————————————— · 1000

(2/3 of those born alive in a given year + 1/3 of those born

alive in the previous year)

Maternal mortality

Number of women who died during pregnancy

(regardless of its duration), childbirth

and in the first 42 days after termination of pregnancy

from reasons related to pregnancy and childbirth

————————————————————————— · 100.000

Number of live births

Perinatal mortality:

(Number of stillbirths + Number of deaths

in the first week (168 hours) of life)

——————————————————————- · 1000

Number of live and still births

4. Mortality rate from this disease. The mortality rate from individual causes depends on the frequency of spread of specific nosological forms of diseases and on the mortality rate associated with them. Precise terminology should be adhered to and the confusion of these two concepts, which is often found among clinicians, should be avoided.

Number of deaths from this disease per year

————————————————————- · 1000

Average annual population

5. Indicator of the structure of causes of death:

Number of deaths from a given cause per year

——————————————————- · 100%

Total number of deaths for the year

Structure of causes of death for 2002

1st place - cardiovascular diseases - 55.9%

2nd place - from accidents, poisonings and injuries - 14.1%

3rd place – from neoplasms – 12.6%

Crude death rate = number of deaths per year x1000

average annual population

The reliability of information about the causes of death directly depends on the doctor’s correct completion of the “Medical Death Certificate.” In rural areas, if there are less than two doctors in a health care facility, the fact and cause of death are allowed to be determined by paramedics with the issuance of a “Paramedic’s Certificate of Death,” which is then necessarily replaced with a “Medical Death Certificate.”

Registration of stillbirths and children who died in the first week of life (0-6 days) before discharge from the maternity hospital is carried out by this institution on the basis of the “Medical Certificate of Perinatal Death”.

When analyzing mortality, special indicators are also calculated: age-sex mortality rates, mortality rates from individual causes for the entire population and its individual groups.

Age-specific mortality rate = number of deaths of persons of a given age per year x1000

average annual population of a given age

High mortality rates are observed in the age group of 0-4 years, by 10-14 years it decreases to its lowest values, and then begins to rise, reaching maximum figures at the age of 70 years and older.

The mortality rate for men in every age group is higher than for women. Reasons: biological, social and hygienic, medical.

The mortality rate of the population depends on the level of socio-economic development of medical sciences, accessibility of medical care, quality of treatment, age structure of the population, lifestyle of the population, working conditions, etc.

Main causes of mortality

1. Cardiovascular diseases

2. Poisoning and injury

3. Oncological diseases.

Natural population growth = birth rate – death rate

Currently, there is a negative value of this indicator, mortality exceeds birth rate, population depopulation is observed, which indicates an unfavorable demographic situation in the country.

infant mortality. The infant mortality rate is considered as an operational criterion for assessing the sanitary well-being of the population, the level and quality of medical and social care, the efficiency and quality of obstetric and pediatric services.

Registration of the deceased is carried out on the basis of a medical death certificate and a perinatal death certificate.

Determining the cause of death is extremely important, since the “Medical Certificate of Death” and the “Paramedic’s Certificate of Death” are not only a medical document certifying the fact of death, but also important statistical documents that form the basis of state statistics on causes of death. The accuracy and reliability of statistical information about the causes of death depends on the correctness of establishing the causes of death and the quality of filling out the medical death certificate.

The cause of death is recorded by the doctor in 2 parts of paragraph 11 of the “Medical Death Certificate”. The first part of this paragraph is divided into 3 lines: a), b), c). This part indicates etiologically and pathogenetically related diseases. In line a) the doctor should write down the immediate cause of death, which most often includes complications of the underlying disease. In line b) the doctor must indicate the disease that caused the immediate cause of death. This disease, in turn, could be a consequence of some disease. If there was one, it is recorded in line c).

The second part of paragraph 11 notes other important diseases that existed at the time of death and had an adverse effect on the course of the main disease that caused death.

Currently, infant mortality in Russia and Perm is 1.5 - 2 times higher than in a number of economically developed countries and is about 10-15 per 1000 births.

The first year of a child’s life is characterized by drastic changes in its various periods. Mortality is highest in the first days after birth, and tends to decrease in the first week of life. And it decreases even more by the first month, six months, or year of life. To assess the level of infant mortality in different periods of a child’s life, the following indicators are calculated: 1) early neonatal

(the ratio of the number of children who died in the first week of life to the number of those born alive, multiplied by 1000) (in Russia - 5-8 ppm); 2) late neonatal (the ratio of the number of children who died in the 2-4th week to the number of live births, multiplied by 1000); 3) neonatal mortality (the ratio of the number of children who died in the first 28 days of life to the number of live births, multiplied by 1000) (in Russia - 5-8 ppm); 4) postneonatal mortality (the ratio of the number of children who died between 28 days and 1 year of age to the number of live births, minus the number of deaths in the first 28 days of life, multiplied by 1000.

METHODOLOGY FOR CALCULATING INFANT MORTALITY RATES

Method 1 (used when the birth rate is stable):

Method 2 (used when there are sharp fluctuations in fertility rates; in this case, constant coefficients of 1/3,2/3 are used):

Criteria for assessing the overall infant mortality rate: low - up to 10%, average - 10.1-19.9%, high - 25% or more. In Russia it is about 13-15%o.

(In Russia 10-13%o).

Antenatal and intrapartum mortality add up to stillbirth.

In order to compare perinatal mortality rates in Russia with similar indicators in other countries, industry statistics in accordance with WHO recommendations include all cases of death of a fetus and newborn with a body weight of 500 g or more, a body length of 25 cm or more, and a gestational age of 22 weeks or more .

(In Russia this figure is 6-9%.)

(In Russia this figure is 5-8%.)

Postneonatal mortality in children aged 29 days to 1 year.

(In Russia this figure is 5-6%.)

Demographic indicators are assessed using the following tables:

Age structure of the population

Fertility rate assessment

Estimation of overall mortality rate

Estimation of infant mortality rate

In 1999, 1,500 children were born alive (in 1998 – 1,620). 30 people were stillborn. 40 people died under the age of 1 year, 30 people died before the age of one month, and 12 people died within 1 week of life.

Calculate infant mortality rates in 2 ways.

In the city, 2,075 children were born alive in 1999 (2000 – 1,982 children). 39 children died at 1 year of life in 2000 (of which 17 children were born in 1999).

MATERNAL MORTALITY is defined as pregnancy-related, regardless of duration and location, death of a woman that occurs during pregnancy or within 42 days after its end from any cause related to pregnancy, aggravated by it or its management, but not from an accident.

Cases of maternal mortality are divided into 2 groups:

1) Death directly related to obstetric causes, that is, death as a result of obstetric complications of pregnancy, as well as as a result of interventions, omissions, and improper treatment following any of the above reasons;

2) Death indirectly related to obstetric causes, that is, death as a result of a pre-existing disease or disease that occurred during pregnancy, unrelated to the direct obstetric cause, but aggravated by the physiological effects of pregnancy.

Number of deaths of pregnant women (from the beginning of pregnancy), women giving birth,

Maternal mortality = postpartum women within 42 days after the end of labor x100000

number of live births

Maternal mortality in economically developed countries does not exceed 10 per 100,000. In Russia, the indicator is at the level of 36.5%, Perm region - 23.5%, ooo.

The leading place is ¾ of all maternal losses, determined by three reasons: abortion, bleeding, late toxicosis .

Compiled by: Professor Lebedeva T.M., Associate Professor Okuneva G.Yu., Associate Professor Govyazina T.N.