DOI: 10.21045/2071-5021-2018-60-2-2

^1,2Edeleva A.N., ¹Starodubov V.I., ²Fedotkin M.A., ¹Sabgayda T.P., ¹Zaporozhchenko V.G.
¹ Federal Research Institute for Health Organization and Informatics of Ministry of Public Health of Russian Federation, Moscow
² Nizhny Novgorod State University named after N.I. Lobachevsky, Nizhny Novgorod

Contacts: Edeleva Anna, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Edeleva A.N., https://orcid.org/0000-0002-8683-5185
Starodubov V.I., https://orcid.org/0000-0002-3625-4278
Fedotkin M.A., https://orcid.org/0000-0003-3102-1333
Sabgaida T.P., http://orcid.org/0000-0002-5670-6315
Zaporozhchenko V.G., https://orcid.org/0000-0002-6167-7379

Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Rational use of limited health resources without decreasing medical effectiveness is relevant to the provision of inpatient care to the elderly with a high burden of chronic diseases, often accompanied by physical and mental problems. Within the context of the budgetary funding deficit, planning performance of the nursing care units, one should minimize expenditures related to the provision of comprehensive care. This can be done using optimization mathematical modelling.

Purpose: to analyze and manage performance of the nursing care units in hospitals based on the optimization mathematical model by the criterion of minimum financial expenditure.

Methods. Methods of operations research were used to analyze the structure of actual and optimal expenditure of the nursing care units in five multidisciplinary medical institutions of Nizhny Novgorod for the period from 2007 to 2015. Addressing the optimization problem of integer linear programming, the model limitations included a full capacity of the multidisciplinary medical institution with the nursing care unit.

For the analyzed year, the number of nursing beds was calculated if the number of treated patients was not lower than the actual number, and the number of deaths and the amount of financial resources spent were not higher than the actual figures. After that the optimal cost structure was determined across expenditure items. Calculations were made in the Microsoft Excel programme.

Results. The optimal total number of nursing beds in all five medical institutions in Nizhny Novgorod is lower than the actual number of beds in each year of the analyzed period. Optimal distribution of financial resources would have reduced the average number of beds by 30 in nine years. Setting the optimal numbers of beds and following the optimal structure of financial expenditures would have resulted in the total number of deaths decreased by about 32 people (32.2 %) for 9 years, the number of bed-days decreased by 11.5% and savings added up to 23.5%. With fewer occupied beds, inpatient care would have been provided to more elderly patients (more by 10 people).

Conclusion. Use of the optimization mathematical model by the criterion of minimum financial costs allows to develop recommendations for rational redistribution of resources to improve effectiveness of health care.

Distributions of actual and optimal costs across enlarged items of expenditure by the criterion of minimum financial expenditure hardly differ while the differences in medical and cost effectiveness are widely expressed. Comparison of the observed and optimal distribution of nursing beds allows to make a conclusion about performance of medical organizations. With effective performance of the medical organization, expenses under the enlarged items "Remuneration and payroll accruals" and "Other expenses" will gradually increase, while expenses and under the enlarged items "Acquisition of services, total" and "Acquisition of non-financial assets" will decrease.

Keywords: inpatient care to the elderly; nursing care units; nursing beds; expenditure structure optimization; static optimization mathematical model; optimization criterion.

References

1. Almazova E.G., Mikshina V.S. Matematicheskaya model' otsenki effektivnosti profilakticheskikh osmotrov naseleniya [Mathematical model for assessing the effectiveness of preventive examinations of population]. Fundamental'nye issledovaniya 2007; (7): 79-83. (In Russian).
2. Devyatkova G.I. Matematicheskoe modelirovanie v upravlenii deyatel'nost'yu khirurgicheskoy kliniki. Preprint [Mathematical modeling in the management of surgical clinic. Preprint]. Perm': Izdatel'stvo Permskogo universiteta; 2000. 110 p. (In Russian).
3. Kumratova A.M., Popova E.V., Bidzhiev A.Z. Ekonomiko-matematicheskoe modelirovanie riska v zadachakh upravleniya resursami zdravookhraneniya [Economic and mathematical risk modeling in health care resource management]. Krasnodar: Kubanskiy gosudarstvennyy agrarnyy universitet; 2014. 168 p. (In Russian).
4. Lebedev N.V., Roldugin G.N. Optimizatsiya raspredeleniya material'nykh resursov na urovne mnogoprofil'nogo LPU [Optimization of material resources distribution at a level of multidisciplinary health facility]. Sistemnyy analiz i upravlenie v biomeditsinskikh sistemakh 2006; 5(2): 384-385 (In Russian).
5. Novikov G.A., Rudoy S.V., Vaysman M.A., Samoylenko V.V., Prokhorov B.M., Efimov M.A. Sovremennoe sostoyanie i perspektivy razvitiya palliativnoy pomoshchi v Rossiyskoy Federatsii [Current state and prospects for development of palliative care in the Russian Federation]. Palliativnaya meditsina i reabilitatsiya 2008; (3): 5-11. (In Russian).
6. Ob utverzhdenii poryadka okazaniya palliativnoy meditsinskoy pomoshchi vzroslomu naseleniyu [On approving the procedure for providing palliative medical care to the adult population]. Prikaz Minzdrava Rossii ¹187n ot 14 aprelya 2015 g. [Online]. 2015 [cited 2018 Mar 17]. Available from: http://base.garant.ru/71014388/ (In Russian).
7. Perkhov V.I., Grechko A.V., Yankevich D.S. Metamorfozy standartizatsii meditsinskoy pomoshchi [Metamorphosis of medical care standardization]. Menedzher zdravookhraneniya 2017; (6): 6-12. (In Russian).
8. Ponomareva I.P. Organizatsionnye aspekty palliativnoy pomoshchi litsam pozhilogo i starcheskogo vozrasta s somaticheskoy progressiruyushchey patologiey [Organizational aspects of palliative care for the elderly people with progressive somatic pathology]. Sovremennye problemy nauki i obrazovaniya [serial online] 2012 [cited 2017 Mar 17]; (3). Available from: http://science-education.ru/ru/article/view?id=6251 (In Russian).
9. Sboeva S.G., Ryazhenov V.V. Kharakternye cherty postareniya naseleniya i sovremennye gerontotekhnologii [Characteristic features of population aging and modern gerontology technologies]. Zdravookhranenie 2003; (4): 13-18. (In Russian).
10. Sviridova T., Orlova T. Sravnitel'nyy analiz modeley zdravookhraneniya v mire [Comparative analysis of healthcare models in the world]. Vrach 2012; (4): 112-115. (In Russian).
11. Sokolov E.V. Sistema effektivnogo upravleniya byudzhetnymi poliklinikami Moskvy i instrumenty rosta ekonomiki Rossii [System of effective management of Moscow's budget polyclinics and instruments of economic growth in Russia]. Ekonomika i upravlenie: problemy, resheniya 2017; 1(10): 55-64. (In Russian).
12. Sokolov E.V., Samoylov D.I. Ekonomiko-matematicheskaya model' upravleniya finansovym rezul'tatom raboty strukturnykh podrazdeleniy i polikliniki v tselom [Economic and mathematical model of managing financial result in work of structural divisions and polyclinics in general]. Ekonomika i upravlenie: problemy, resheniya 2015; 2(8): 22-32. (In Russian).
13. Stepkina Yu.A. Analiz modeley i sposobov finansirovaniya zdravookhraneniya i ikh razvitiya v sovremennykh usloviyakh [Analysis of models and methods of financing health care and their development in modern conditions]. Vestnik Leningradskogo gosudarstvennogo universiteta im. A.S. Pushkina 2012; 6(1): 135-144. (In Russian).
14. Shchitikova O.B., Ivanov S.V. Organizatsiya okazaniya statsionarnoy meditsinskoy pomoshchi bol'nym pozhilogo i starcheskogo vozrasta v Moskve [Organization of providing inpatient medical care for elderly patients in Moscow]. Sotsial'nye aspekty zdorov'ya naseleniya [serial online] 2016 [cited 2017 Mar 17]; 47(1). Available from: http://vestnik.mednet.ru/content/view/736/30/lang,ru/ (In Russian).
15. Edeleva A.N., Fedotkin M.A. Postroenie matematicheskoy modeli i izuchenie resursnogo obespecheniya i struktury zatrat meditsinskikh uchrezhdeniy [Development of a mathematical model and study of resource provision and the structure of health facility expenditures]. Glavnyy vrach: khozyaystvo i pravo 2014; (4): 15-21. (In Russian).
16. Edeleva A.N., Fedotkin M.A. Optimizatsiya kolichestva prolechennykh bol'nykh dlya meditsinskikh uchrezhdeniy pri vydelennykh ob"emakh finansirovaniya [Optimization of the number of patients treated in health facilities in condition of dedicated funding]. Glavnyy vrach: khozyaystvo i pravo 2014; (6): 29-36. (In Russian).
17. Edeleva A.N., Fedotkin M.A. Effektivnoe raspredelenie resursov meditsinskikh uchrezhdeniy [Effective resources allocation in health care facilities]. Glavnyy vrach: khozyaystvo i pravo 2015; (1): 30-39. (In Russian).
18. Edeleva A.N., Fedotkin M.A. Analiz resursov meditsinskikh uchrezhdeniy s tsel'yu povysheniya kachestva okazaniya meditsinskoy pomoshchi litsam pozhilogo i starcheskogo vozrastov [Analysis of resources of health care facilities in order to improve the quality of medical care for elderly people]. Glavnyy vrach: khozyaystvo i pravo. 2015; (6): 39-42. (In Russian).

Write Comment

Please keep the topic of messages relevant to the subject of the article. Personal verbal attacks will be deleted. Please don't use comments to plug your web site. Such material will be removed. Just ensure to *Refresh* your browser for a new security code to be displayed prior to clicking on the 'Send' button. Keep in mind that the above process only applies if you simply entered the wrong security code.
Name:
E-mail
Comment:
Code:*