Multidisciplinary expertise as a tool for medical care quality control at stages of routing of patients with acute cerebrovascular disorders

Background. Multidisciplinary expertise of the medical care quality (MEMCQ) is one of the most complex, but also highly sensitive tools in the analysis of multi-stage medical assistance. An example of this type of assistance is the Program of Care for Patients with Acute Cerebrovascular Disorders (ACVDs). The complexity of the program is that, starting from the stage of emergency care, it covers the subsequent rehabilitation stage and follow-up care. The Order of the Ministry of Health of the Russian Federation «On approval of the criteria for assessment of the medical care quality» № 203n dated May 10, 2017 offers dichotomous checklists describing the key technological elements of treatment of patients with ACVDs in primary vascular units (PVUs), but does not determine the criteria for the quality of care in neurological units that are not PVUs, rehabilitation and outpatient units, which is not sufficient for a multidisciplinary expertise. Objective. Development and approbation of a set of local checklists for monitoring the regulations of the organizational and methodological tool for a multidisciplinary examination of the quality of multi-stage treatment systems by the example of patients with ACVDs. Methods. A prospective cohort non-randomized study without a comparison group using formalized checklists to monitor the quality of the implementation of the regulation for medical care for patients with ACVDs in the Sverdlovsk Region. Data collection was carried out in accordance with the inclusion criteria within 3 months. Primary endpoint: obtaining an opinion on the results of the multidisciplinary expertise for each case of multi-stage treatment. Results. Expert control was carried out for 491 cases of medical care to 72 patients with ACVDs in the amount of 11 452 313.47 rubles at all stages of medical care. A total of 299 cases (60.9% of verified cases) with defects in medical care delivery and coding of medical care were identified. Conclusion. MEMCQ is a reproducible effective tool for quality control of medical care both at the level of individual medical organizations and individually in every case of ACVDs.

multidisciplinary expertise, medical care quality, acute cerebrovascular disorder, rehabilitation