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Monday, 25 December 2017

DOI: 10.21045/2071-5021-2017-58-6-4

Bogachevskaya S.A.
Federal Centre for Cardiovascular Surgery, Khabarovsk, Russia

Contacts: Bogachevskaia Svetlana, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about author:
Bogachevskaia S.A., http://orcid.org/0000-0001-7150-2620
Conflict of interests. The author declares no conflict of interest.
Acknowledgments. The study had no sponsorship.


The article presents a multifactorial cluster analysis of the subjects of the Far East Federal District with due regard to medical care for the circulatory system diseases. The article also suggests priority areas for reforming medical care according to results of the macro-region multifactorial clustering.

The purpose of the study: to evaluate performance of the three-level system of medical care for cardiovascular diseases to the population of the Far Eastern Federal District.

Materials and methods. Clustering of the nine subjects of the Far East was carried out through the hierarchical analysis and analysis of k-averages by 26 economic, demographic, resource and climatic, epidemiological and medico-social indicators (cardiovascular profile).

Results. The generalized cluster analysis shows that the Far Eastern region is divided into the three functionally and territorially isolated cluster systems.

The first cluster included Primorsky territory, Khabarovsk territory, Amur region and Sakhalin region, Kamchatka territory, Jewish Autonomous region (the territories of the Near North and South within the main infrastructure corridor). This cluster can be considered as a system-forming element of the territorial organization of medical care delivery for the circulatory system diseases to population of the Far East Federal District as well as the entire economy of the Russian Far East. Because of its isolation on major basic parameters of clustering the second cluster was formed by the Republic of Sakha (Yakutia), while the third cluster was formed by the Chukotka Autonomous district.

Discussion. Low population density, specific climatic and geographic conditions and marked heterogeneity of territorial accessibility of the regional and federal centers by the subjects limit the all-Russia concept of healthcare reforming. It requires adaptive approaches to resource-consuming medical care for the circulatory system diseases in each of the cluster as well as their cooperation in the general model of care delivery.

Peculiarities of the second cluster of the macro-region require expanded capacities of care delivery within the subject. The third cluster determines the need for specific patient routing in the system of high-tech medical care to ensure transport accessibility.

Authority crossover of the regional and federal levels (including research institutes) in the three-level system of high-tech care for the circulatory system diseases results in ineffective redistribution of patient flows between clinics, reducing the overall system performance.

Conclusions. The marked heterogeneity of the subjects of the Far East Federal District requires a differentiated approach to organize care for the circulatory system diseases in the entire region. The article outlines the presented approach.

Keywords: availability and quality of medical care; circulatory system diseases; a multifactorial cluster analysis.


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