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jandacvis xarisxis struqtura da misi gazomvis saSualebebi. Tbilisi ivnisi 2010. ra aris Secdoma. Secdoma aris dagegmili moqmedebis ar Sesruleba ise, rogorc winaswar iyo gansazRvruli…an Sedegis misaRwevad araswori gegmis gamoyeneba A anu standartis ugulebelyofa?….
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jandacvis xarisxis struqtura da misi gazomvis saSualebebi Tbilisi ivnisi 2010
ra aris Secdoma • Secdoma aris dagegmili moqmedebis ar Sesruleba ise, rogorc winaswar iyo gansazRvruli…an Sedegis misaRwevad araswori gegmis gamoyeneba A anu • standartis ugulebelyofa?…
standarti - Secdomebis dasaSvebi minimaluri raodenoba • A230 – ze naklebi (wuni, defeqti) 1 milion warmoebul produqtSi anu 0,023% • 5 –ze naklebi yovel 1 milionSi Secdomebi dakavSirebuli finansuri servisebis tranzaqciebTan anu 0,0005 % • ra xdeba jandacvaSi?
ra xdeba jandacvaSi 6,000 dan 300,000 mde xarvezi, yovel 1 mlnSi Sesabamisad 0,6 – 30% Source: Kohn, LT, Corrigan, JM, and Donaldson, MS (Eds).
pirveli sagangaSo aRmoCenebi • IOMReport 1999, 2006 100,000 mde 2004 wels 37 milioni pacientis istoria Seswavlili • IOMReport 2006 Sedegi – umniSvnelo gaumjobeseba
jandacvis da cudi xarisxiT gamowveuli xarjebis dinamika wlebis mixedviT jandacvisxarjebi sul cud xarisxTan asocirebuli xarjebi
cudi xarisxis efeqti Source Juran Institute Inc
cudi xarisxis ganmapirobebeli faqtorebi • sistemuri Tu arasistemuri Secdomebi, • qmedebebi, araklasificirebuli rogorc Secdoma....……
dilemis bunebasxvadasxva kategoriis xarisxis problemebi (araklasificirebuli, rogorc Sedcdoma) xarisxis problemebis 3 kategoria EBM medicinis 1. zedmeti Seruleba, 2. bolomde ar Sesruleba 3. araswori Sesruleba
cudi xarisxis xelSewoba • mimwodeblebis kontraqtireba fasis mixedviT (mimwodeblis Sefasebisa da Sesrulebis Seswavlis gareSe) • tranzaqciaze dafuZnebuli da ara Sedegze dafuZnebuli gadaxdis struqtura • momxmareblis xarsixis procesSi CarTvis deficiti
xelSewyoba II kerZo struqturebi da saxelmwifo arian yvelaze didi momxmarebliebi, rogorc Semsyidvelebi • ar aprotesteben, zedmeti Serulebas, bolomde ar Sesrulebas da an araswori Sesrulebas • agrZeleben aqedan gamowveuli gazrdili danaxarjebis dafarvas
kapitaluri Senobebi, aparatura, saSualebebi trenirebuli samed. personali (eqimebi, eqTnebi, administratorebi) adekvaturi, efeqturi, eTikurad relevantuli, koordinirebuli da socialurad misaRebi samedicino momsaxureba sikvdiloba, avadoba, cxovrebis xarisxi, pacientTa kmayofileba jandacvis xarisxis struqturaavedis donabedianis mixedviT struqtura procesi Sedegi sistemis maxasiaTeblebi Ppacientis maxasiaTeblebi source: Hopkins: Measuring the quality of medical care, Royal College of Physicians of London, 1991
procesis Semafasebeli mimarTulebebi • adekvaturi momsaxureba • momsaxurebis uwyvetoba • momsaxurebis koordinacia • momsaxurebis drouloba • Tanasworoba momsaxurebis procesSi • xelmisawvdomi momsaxureba • socialurad miRebadi momsaxureba momsaxurebis usafrTxoeba • source (Chassin MR, Park RE, Kahn KL, Kosecoff J
xarisxis Semafasebeli indikatorebi 1. unda iyos gasagebi da relevanturi pacientisaTvis da klinikuri gadawyvetilebis mimRebisaTvis; 2. unda iyos mecnierulad srulyofili da dasabuTebuli; 3. unda iZleodes saSualebas daskvna gakeTdes pacientis gamosavalze da pozitiuri Sedegis dadgomaze; 4. unda Seexos rogorc individualuri ise mTlianad mosaxleobis gamosavals; 5. unda asaxavdes xarisxobriv gaumjobesebas da progress; 6. unda iyos advili implementaciisa da administrirebisaTvis; 7. unda iyos Sesrulebadi da xarjT efeqturi;
janmos mier mowodebuli indikatorebis ramodenime magaliTi 1. sakeisro kveTaTa sixSire 2. profilaqtikis mizniT antibiotis gamoyenebis sixSire 3. sikvdiloba 4. Semobruneba hospitalSi 5. ambulatoriuli qirurgiebis sixSire 6. hospitalizacia dRis qirurgiis Semdeg 7. intensiur palataSi Semobrunebis sixSire 8. sawolze saSualo dayovneba 9. saoperacios gamoyenebis sixSire 10. personalis treningebze daxarjuli Tanxis raodenoba 11. nemsiT Cxvletebis sixSire 12. zedmeti samuSao saaTebi 13. mweveli TanamSromlebis sixSire 14. ZuZuTi kvebaze myofi axalSobilebis sixSire gawerisas 15. pacientTa sxva saavadmyofoebSi gadayvanis sixSire 16. pacientTa kmayofileba
xarisxis gaumjobesebis meTodebimodeli I finansuri stimulireba: 1.1 pirdapiri finansuri stimulebi mimwodebels kargi xarisxisTvis 1.2 rogorc saukeTeso mimwodeblis saxalxo aRiareba 1.3 momxmareblis finansuri stimulireba ukeTesi xarisxis arCevisaTvis 1.4 xarisxTan dakavSirebuli aqtivobebis subsidireba
modeli #2 seleqtiuri kontraqtireba saukeTeso maCveneblebis mqone mimwodebelTan 2.1 kontraqtiT gansazRvruli ufleba movaleobebi 2.2 Sesrulebis kriteriumebis danergva 2.3 saukeTeso centrebis aRiareba – referens centrebad qceva, seleqtiuri kontraqtireba
modeli #3 regulirebis sxva saSualebebi, 3.1 mimwodebelTa qcevis regulacia (licenzireba uwyveti samedicino ganaTlebisa da profesiuli ganviTarebis CarTviT). Tanamedrove klinikuri gaidlainebisa da protokolebis danergva; 3.2 struqturis gaumjobesebis xelSewyoba, dawesebulebaTa gamkacrebuli standartebis da axali kriteriumebis danergviT 3.3 procesis xelSewyoba akreditaciis procesis danergviT