Summary. This paper deals with the problem of loading the bed facilities through the referral system of anti-tuberculosis outpatient clinic (ATOPC) in the town of Korolyov, Moscow Region. This cohort study critically investigated into feasibility of referral treatment of every individual patient in a regular hospital (division of this outpatient clinic), the grounds for regular hospitalization being examined with scrutiny, and an alternative – day hospital – being strongly proposed.

Regular-hospitalized patients stayed all in all for 68,243 bed-days in the years 2004-8. Mean duration of regular hospitalization was 70.4 days. Performed expertise had assessed that all established groups of patients had been quite capable to reduce regular hospital stay, the all-groups-through summed-up reduction by 21.7% of bed-days being feasible. Regular hospital stay for differential diagnosis could be readily reduced by 39.%; and 86.9% of follow-up patients could have continued their maintenance treatment at a day hospital, not in regular hospital, while 13.1% of them could have refused hospitalization at all to complete their overall treatment at outpatient facilities.

Patients’ stay duration in inpatient facility of the ATOPC on the motive of intensive phase chemotherapy was assessed as well-founded.

It has been estimated that more rational usage of regular hospital bed facility of this ATOPC due to more efficient diagnostic and therapeutic measures could make it possible to reduce then existing 60 beds facility (intended for regular hospitalization) by 13 beds. This scheme being realized, the economic gain reached 2.6 million rubles a year.

Expertise evaluation put calculated capacity of beds in a day hospital as 1.51 beds upon 10, 000 of population-based persons, while sociologic questionnaire has put it as 1.16 beds accordingly. In any case, number of beds in the day hospital by this ATOPC should be enlarged by 30%.

This experimental organizational and functional model of a day hospital as a facility of ATOPC proved to safeguard step-wise treatment of TB patients through the comprehensive controlled therapy courses, and under sound sanitary hygienic regimen.

Day hospital facility is a factual reserve of hospitalization capabilities without expanding overall (regular+day hospital) amount of beds. Medical and social efficiency of introduction of day hospital is fully proved in this study. Economic gain from it reached 0.5 million rubles a year.

Key words. Outpatient clinic, anti-tuberculosis, day hospital, hospitalization, respiratory and extra-respiratory pathology.

References

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