ORDER OF THE MINISTER OF HEALTH OF THE REPUBLIC OF KAZAKHSTAN

of March 24, 2011 No. 152

About approval of Rules of the organization and conducting internal and external examinations of quality of medical services

According to Item 5 of article 58 of the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system", I ORDER:

1. Approve Rules of the organization and conducting internal and external examinations of quality of medical services according to appendix to this order.

2. To committee of control of medical and pharmaceutical activities of the Ministry of Health of the Republic of Kazakhstan (Beysen N. E.) provide state registration of this order in the Ministry of Justice of the Republic of Kazakhstan in the procedure established by the legislation.

3. To provide to legal department of the Ministry of Health of the Republic of Kazakhstan official publication of this order after its state registration.

4. Declare invalid:

1) the order of the Minister of Health of the Republic of Kazakhstan of January 20, 2009 No. 32 "About approval of Rules on enhancement of quality management system of delivery of health care in the organizations of health care of the Republic of Kazakhstan" (registered in the Register of state registration of regulatory legal acts at No. 5545, No. 35 published in the Yuridicheskaya Gazeta newspaper of March 6, 2009 (1632);

2) order of the deputy. The Minister of Health of the Republic of Kazakhstan of November 10, 2009 No. 677 "About approval of Rules of the organization and conducting internal and external examinations of quality of medical services" (registered in the Register of state registration of regulatory legal acts at No. 5878, No. published in the Yuridicheskaya Gazeta newspaper of December 24, 2009 195).

5. I reserve control of execution of this order.

6. This order becomes effective after ten calendar days after its first official publication.

 

Appendix

to the order of the Minister of Health of the Republic of Kazakhstan of March 24, 2011 No. 152

Rules of the organization and conducting external and internal examinations of quality of medical services

1. General provisions

1. These rules determine procedure for the organization and conducting internal and external examinations of quality of medical services and extend to the organizations of health care, irrespective of patterns of ownership and departmental accessory, and the physical persons practising private medicine (further - subjects of health care).

2. In these rules the following basic concepts are used:

1) indicators of quality evaluation of medical services the performance indicators, completeness and compliance of medical services to standards in the field of health care including:

indicators of structure indicators of security with human, financial and technical resources;

process indicators indicators of assessment of accomplishment of technologies of prevention, diagnostics, treatment and rehabilitation;

indicators of result of medical services indicators of assessment of effects for health as a result of rendering or non-rendering of medical care by subjects of health care;

2) medical documentation the documents intended for data recording about the state of health of the patient, reflecting amount and quality of the provided medical care;

3) quality management of medical care systematic, independent and documentary process of the continuous, interconnected actions including the planning, the organization, motivation, internal audit of the activities, and also other actions providing quality of medical care and safety for patients and directed to the prevention and remedial action in the activities at the level of the medical organization;

4) the intrahospital commissions - the commissions created in the medical organization for the different directions of medical activities;

5) service of internal control (audit) - structural division of the medical organization, the performing activities for quality management of medical care at the level of the medical organization and given appropriate authority;

6) clinical audit - the detailed retrospective and/or current analysis of the held medical and diagnostic events regarding their compliance to the established standards the approved authorized body in the field of health care;

7) internal indicators - indicators which characterize efficiency, completeness and compliance of medical activities of each structural division of the medical organization to standards in the field of health care for the purpose of carrying out the analysis and quality evaluation of medical activities;

8) external indicators - indicators which characterize efficiency, completeness and compliance of medical activities of the medical organization to standards in the field of health care for the purpose of carrying out the analysis and quality evaluation of medical activities;

9) threshold indicator value - the value established as target for the indicators characterizing the favorable phenomenon or admissible for the indicators characterizing the adverse phenomenon;

10) self-assessment - process which is carried out by health workers and the head of each structural division of the medical organization for assessment of the medical activities according to internal indicators.

3. Examination of quality of medical services is subdivided on internal and external.

4. Internal expertize of quality of medical services (daleevnutrenny examination) is carried out by the service of internal control (audit) created in each medical organization. The structure and structure of this service affirm the head of the medical organization depending on amount of the rendered medical services.

5. External examination of quality of medical services (further - external expertize) is carried out within implementation of the state control in the field of rendering medical services of control of medical and pharmaceutical activities by state body, and also with involvement of the independent experts accredited according to the Rules of accreditation of health care approved by the order of the Government of the Republic of Kazakhstan of October 12, 2009 No. 1559.

6. Examination of quality of medical services by independent accredited experts in the field of health care is performed according to the Rules of involvement of independent experts approved by the order of the deputy. The Minister of Health of the Republic of Kazakhstan of November 9, 2009 No. 672 (registered in the Register of state registration of regulatory legal acts at No. 5870).

7. During conducting examination of quality of medical services assessment is carried out:

1) actions of specialists regarding observance of standards of diagnostics and treatment;

2) compliance of material resources of subjects of health care to standard rates of equipment.

8. Basic principles of examination of quality of medical services:

1) systemacity of examination of quality of medical services is performed in interrelation of indicators of structure, process and result;

2) objectivity of examination of quality of medical services is performed with use of standards in the field of health care;

3) openness of examination of quality of medical services is performed with participation of independent experts in the presence of health workers.

9. Determination of the quality level of medical services in specific case is carried out regarding compliance of quality of medical care to standards in the field of health care.

10. Determination of the quality level of medical services in general in the subject of health care is carried out by mathematical modeling.

2. Organization of internal examination of quality of medical services

11. Internal expertize is carried out by the service of internal control (audit) created in each medical organization.

12. The service of internal control (audit) carries out the analysis of the organization of delivery of health care, clinical activities of the medical organization, identification of the facts of violation of procedure for delivery of health care and standards in the field of health care, and also consideration in time which is not exceeding five days, addresses of the patients who are on treatment. By results of the booked internal audit the service of internal control (audit) makes to the head of the medical organization offers on elimination of the established reasons and conditions of decline in quality of the rendered medical services.

13. Internal examination is performed with respect for the principles of conducting examination of quality of the medical services established by these rules.

14. Internal examination consists of mnogourovny nature: self-checking, control at the level of division managers, the control exercised by service of internal control (audit).

Internal examination at the level of self-checking is performed by the doctor of department, the nurse of department.

At the level of department internal examination is performed by the manager of department and the senior nurse.

At the level of the medical organization internal examination is performed by service of internal control (audit) which determines structural approach to help quality assurance in general in the medical organization.

15. Internal expertize is carried out by quality evaluation of medical care retrospectively and at the time of receipt of medical care by patients.

16. When conducting internal examination in the medical organization giving stationary help all cases are analyzed:

lethal outcomes;

facts of emergence of intrahospital infections;

complications, including postoperative;

repeated hospitalization on the same disease within one month owing to low-quality previous treatment;

lengthenings or shortenings of terms of treatment;

discrepancies of diagnoses.

17. When conducting internal examination in the organization giving ambulatornopoliklinichesky help all cases are analyzed:

maternal death rate;

death at home children from 0 to 5 years inclusive;

death at home persons of working-age from diseases;

pregnancy complications;

primary exit to disability of persons of working-age;

observations of citizens after the statement from hospital;

the started forms of oncological diseases and tuberculosis;

lengthenings or shortenings of terms of treatment;

discrepancies of diagnoses.

18. When conducting internal examination in the organizations of health care performing activities in the field of service of blood, examination medical records of all donors who took blood test on paid and free basis are subject.

19. When conducting internal examination in general on the organization of emergency medical service all cases are subject to internal examination:

repeated challenges on the same disease within a day;

lethality by challenges: death before arrival of crew, death in the presence of crew;

discrepancies of diagnoses of ambulance crew and hospital in case of hospitalization of patients.

20. All cases of delivery of health care have identical opportunity to be subjected to internal examination that is provided with the statistical technique of random check.

Within a month the manager of department of hospital carries out expertize at least 50% of the finished cases, the deputy manager concerning medical work of 5% of the finished cases within every quarter.

Within a month the manager of department of the out-patient and polyclinic organization carries out expertize at least 10% of the finished cases, experts of intrahospital control at least 30 examinations a quarter.

21. During conducting internal examination at all its levels:

1) completeness and timeliness of diagnostic actions, adequacy of the choice and observance of medical actions, correctness and accuracy of diagnosis is estimated;

2) variations and their reasons are established;

3) recommendations about elimination and the prevention of the revealed shortcomings are developed.

22. Following the results of the carried-out assessment of activities of the specific doctor, structural division and by the subject of health care for the analysis and acceptance of management decisions it is determined:

1) total quantity of the revealed variations, their structure, the possible reasons and ways of their elimination;

2) quantity of the revealed variations which entailed deterioration in the state of health;

3) quantity of the revealed variations which led to increase in costs for delivery of health care.

23. Results of internal examination are used and compared with results of external examination based on what conclusions about quality and objectivity of work of service of internal control (audit) are drawn.

24. Results of internal examination, including their comparison to results of external examination, are taken out and deal at meetings of the intrahospital commissions, at medical conferences with the subsequent acceptance of organizational conclusions, for the purpose of increase in level of knowledge of health workers and development of optimum approaches to medical diagnostic process.

25. The system of quality evaluation and efficiency of medical care functions continuously and provides operational obtaining necessary for information directorate.

26. The self-assessment of quality of work of average health workers is performed for the purpose of enhancement of the organization and rendering modern types of the sisterly help to patients and implementation of standards of medical care in activities of average health workers.

27. Conducting internal examination includes assessment according to the following Sections of activities:

1) organization of workplace of the nurse, maintaining medical documentation;

2) fulfillment of requirements of the regulatory legal acts regulating the anti-epidemic mode and infectious safety;

3) the organization of work on observance of storage conditions of medicines in department;

4) knowledge and fulfillment of requirements of labor protection and fire safety;

5) assessment of condition of the medical equipment, its readiness for work;

6) knowledge and accomplishment of the basic principles of ethics and deontology;

7) accomplishment of job responsibilities.

28. The chief nurse of organization estimates work of nurses of departments. This assessment includes:

1) quality evaluation of work of senior nurses;

2) selective job evaluation of average health workers.

For quality evaluation of work of each senior nurse of each department in month it shall be carried out at least 1 expertize.

29. Conducting one examination includes quality evaluation of work of the senior nurse on 4 indicators:

1) organization of work on human resources planning, rational arrangement and use of average and associate health workers;

2) organizational actions for advanced training, retraining, assessment of qualification of average health workers;

3) control of anti-epidemic actions in department;

4) organization of medical process.

30. Selective expert appraisal of work of average health workers of departments is carried out for job evaluation of the senior nurse of department on examination of quality of work of medical personnel of department.

31. The chief nurse carries out the analysis of the obtained data on quality evaluation of work of average health workers of departments and quality of work of senior nurses.

32. The obtained data and the conclusion are reported on the head of the medical organization and (or) his deputy supervising service of internal control (audit), once a month for the analysis and development of organizational and management decisions.

3. Organization of external examination of quality of medical services

33. External examination is performed with respect for the principles of conducting examination of quality of the medical services established by these rules.

34. External expertize is carried out, both with visit of the subject of health care, and without its visit.

35. When conducting external examination in general on the subject of health care, the results of internal examination for the analyzed period which are carried out by the organization regarding respect for the principles of examination of quality of medical services and adequacy of the taken measures are analyzed. First of all results of internal examination of the cases which are subject to obligatory examination and on consideration of addresses of patients are analyzed.

Is subject to external examination on the subject of health care giving stationary help:

1) at least 50% of cases of total number of the registered cases:

lethal outcomes;

emergence of intrahospital infections;

complications, including postoperative;

repeated hospitalization on the same disease within one month owing to low-quality previous treatment;

2) at least 10% of medical records of the inpatient on each department of hospital from number of the treated patients for the analyzed period.

36. To external examination on the subject of health care giving ambulatornopoliklinichesky help:

1) 100% of cases of total number of the registered cases:

maternal death rate;

death at home children from 0 to 5 years inclusive;

death at home persons of working-age;

the started forms of oncological diseases and tuberculosis;

2) at least 50% of cases of total number of the registered cases:

pregnancy complications: gestoz of heavy degree, childbirth which were complicated by obstetric bleedings, hysterectomies;

primary exit to disability of persons of working-age;

observations of citizens after the statement from hospital on diseases on which medical care is priority, by determination of authorized body in the field of health care;

3) at least 10 medical records of the outpatient from each department and (or) profile of specialists.

37. To external examination on the organization of emergency medical service:

1) at least 50% of cases of total number of the registered cases:

repeated challenges on the same disease within a day;

lethality by challenges: death before arrival of crew, death in the presence of crew;

discrepancies of diagnoses of ambulance crew and hospital in case of hospitalization of patients;

2) at least 10 medical records of departures of all-profile and specialized crews;

3) in the organizations performing activities in the field of service of blood at least 50 medical records of the donors who took blood test on paid and free basis.

38. In case of establishment of non-objective conducting internal examination, external examination covers 100% of the above-stated cases.

39. In case of examination according to the address expertize of quality of medical services of specific case is carried out.

40. By results of examination the conclusion in which variations of quality of delivery of health care in specific cases are specified is constituted and conclusions are drawn:

1) about compliance (discrepancy) to the provided medical care to requirements of the current legislation in the field of health care;

2) about provision to the patient of free medical care in the amount guaranteed by the state;

3) about availability of the bases for application of measures of disciplinary and (or) administrativnogopravovy impact with indication of particular persons.

41. In case of identification of the variations which are subject to application of measures of economic impact, the revealed variations are classified according to the legislation of the Republic of Kazakhstan and go to territorial subdivisions of state body on payment of medical services.

42. With results of earlier carried out external expertize by state body on control of medical and pharmaceutical activities and (or) independent experts, external expertize is not carried out. Repeated expertize is carried out in case of disagreement with results of earlier carried out expertize.

43. When carrying out by state body on control of medical and pharmaceutical activities of external examination, in cases of detection of variations of rendering medical services using measures of economic impact, results of external examination go to the administrator of budget programs.

44. At the request of territorial subdivisions of state body on payment of medical services, external expertize is carried out by state body on control of medical and pharmaceutical activities.

45. Results of the external expertize which is carried out at the request of state body on payment of medical services are provided by state body on control of medical and pharmaceutical activities, during 30 request, calendar from the date of obtaining.

46. In case of disagreement with results of external examination subjects of health care can appeal them according to the procedure, established by the current legislation of the Republic of Kazakhstan.

4. Stages of examination of quality of medical care

47. Stages of examination of quality of medical services:

1) the analysis of accounting and reporting documentation of the subject of health care is carried out for the purpose of comparative analysis of indicators of activities of the subject of health care for certain period of work, with national average and regional average indicators of the state of health of the population in comparison with the same period of last year;

2) carrying out clinical audit by studying of the detailed retrospective and/or current analysis of the held medical and diagnostic events regarding their compliance to the established standards.

The analysis of internal indicators and external indicators is performed by means of assessment of threshold values in dynamics according to appendices 1, 2 to these rules.

Threshold indicator values are calculated based on statistical data for the last three years and their values can vary in process of improvement of situation.

Results of internal examination are used and compared with results of external examination based on what conclusions about quality and objectivity of work of service of internal control (audit) are drawn.

In the presence of critical variations (negative) from threshold values are the basis for acceptance of the adjusting and warning actions for the purpose of elimination of discrepancies.

Variations of threshold values of internal indicators are registered in the magazine of monitoring in form according to appendix 3 to these rules;

3) the analysis and generalization of results of examination of quality of medical services, conclusions are introduced in the inspection statement;

4) determination of degree of satisfaction of citizens with level and quality of the provided medical care is carried out by questioning of patients and (or) their relatives and on number of reasonable addresses of citizens on activities of the subject of health care;

5) acquaintance with the conclusion of results of examination of quality of medical services is represented to the head of the structural unit, the subject of health care and (or) person them replacement.

In case of availability of notes and (or) objections by results of examination of quality of medical services the division manager, the subject of health care or person them replacement state them in writing.

Notes and (or) objections are attached to the conclusion by results of examination of quality of medical services about what the corresponding entry is made.

48. Examination of quality of medical services is performed by carrying out (clinical audit):

1) the current analysis during which medical documentation of the patients receiving medical care at the time of conducting examination of quality of medical services, if necessary with survey of the patient is studied;

2) the retrospective analysis during which are studied medical documentation of the patients who received medical care at the time of conducting examination of quality of medical services.

49. When carrying out the analysis of medical documentation it is estimated:

1) quality of collection of the anamnesis;

2) completeness and justification of conducting diagnostic testings;

3) correctness, timeliness and justification of the exposed clinical diagnosis during the first 3 days taking into account results of the conducted researches at pre-hospital stage;

4) justification of stay on treatment, receipts of medical care in this form (out-patient and polyclinic, stationary, hospital-replacing);

5) timeliness and quality of consultations of specialists;

6) amount, quality and justification of holding medical actions, including dispensary, preventive and rehabilitation;

7) development of complications after medical interventions;

8) the achieved result;

9) satisfaction with quality of the provided medical care;

10) quality of maintaining medical documentation.

At the level of the out-patient and polyclinic help dispensary, preventive and rehabilitation actions are in addition estimated.

50. Quality of collection of the anamnesis is estimated by four criteria:

1) lack of collection of the anamnesis;

2) lack of systemacity of collection with partial or complete omissions on the main components (allergologichesky part, haemo transfusion part, the postponed diseases, medicinal part, the burdened heredity);

3) in case of complete collection lack of allocation of the essential details which are important in interpretation of this case;

4) low-quality collection of the anamnesis was the reason of the tactical mistakes which entailed emergence of complications.

In cases of extreme weight of condition of the patient or its stay in unconsciousness quality of collection of the anamnesis is not considered.

51. In case of assessment of conformity of diagnostic testings five criteria are considered:

1) diagnostic actions and examinations were not conducted;

2) diagnostic actions have the wrong treatment or is absent that leads to the wrong diagnosis and matching of tactics of treatment;

3) the diagnostic testings provided by protocols of diagnostics and treatment of diseases are not conducted;

4) there is excessive set of diagnostic procedures and additional researches with high, unjustified risk for the state of health of the patient;

5) there is excessive set of diagnostic procedures and additional researches which led to unreasonable lengthening of terms of treatment, rise in price of cost of treatment, and did not bring information for statement of the correct diagnosis.

The objective reasons of not holding the diagnostic procedures and actions necessary according to requirements of protocols of diagnostics and treatment of diseases, such as lack of the equipment, insufficient qualification of the doctor, difficulty of conducting diagnostic testings because of extreme weight of condition of the patient and the emergency indications to resuscitation actions or operational benefit, are reflected in results of examination of quality of medical services. The impact assessment of failure to carry out of the standard on inspection on the subsequent stages of implementation of medical care is carried out.

52. Assessment of correctness and accuracy of statement of the clinical diagnosis is carried out by four criteria:

1) the diagnosis is made incorrectly or is absent, including the diagnosis incomplete, does not correspond to the international classification of diseases or the commonly accepted classifications;

2) the leading pathological syndrome determining weight of course of disease is not allocated, associated diseases, and also complications are not distinguished;

3) the diagnosis correct, but incomplete, is not selected the leading pathological syndrome though complications are allocated, but associated diseases, important for outcome, are not distinguished;

4) the diagnosis of the main disease correct, however, the associated diseases important for result of treatment are not diagnosed.

The objective reasons of the wrong and (or) untimely diagnostics, such as atypical course of the main disease, the veiled availability of serious associated disease, seldom found complications and associated diseases, are reflected in results of examination of quality of medical services. The impact assessment of the wrong and (or) untimely diagnosis on the subsequent stages of implementation of medical care is carried out.

53. Assessment of timeliness and quality of consultations of specialists is performed by four criteria:

1) consultations are not held that resulted in wrong interpretation of symptoms and syndromes which negatively affected disease outcome;

2) consultations are held in time, but the opinion of the consultant is not considered in case of statement of the correct diagnosis that partially affected disease outcome;

3) consultations are held in time, the opinion of the consultant is considered in case of determination of the correct diagnosis, but recommendations of the consultant for treatment are not implemented what partially affected disease outcome;

4) the opinion of the consultant is wrong, except for consultants from other medical organization.

Carrying out consultations with delay on absence reason of specialists of this profile in the organization, assessment of objectivity of the reasons of untimely, low-quality consultation and influence of the wrong and (or) untimely diagnosis on the subsequent stages of implementation of medical care is carried out.

54. Assessment of the appointed medical actions is carried out by the following criteria:

1) lack of treatment in the presence of indications;

2) treatment is appointed without indications;

3) in case of treatment ineffective medical actions without features of course of disease at this patient, associated diseases, complications are appointed;

4) medical actions are executed not completely, without functional insufficiency of bodies and systems, features of the mechanism of effect of medicinal substances;

5) the premature termination of treatment in case of underestimation of clinical effect and/or weighting of course of disease, except documentary drawn up cases of the termination of treatment at the initiative of the patient;

6) considerable variation from requirements of regulatory legal acts in the field of health care, including protocols of diagnostics and treatment of diseases, polypragmasy availability without heavy side effect of drugs and development of new pathological syndrome;

7) complete variation from requirements of regulatory legal acts in the field of health care, including protocols of diagnostics and treatment of diseases, the polypragmasy availability which led to development of new pathological syndrome and deterioration in condition of the patient.

In case of assessment of medical actions availability of the circumstances creating difficulty or impossibility of holding effective medical actions is considered and reflected in results of examination of quality of medical care and exerted or could exert impact on disease outcome.

55. When conducting examination of quality of medical care at the level of hospital assessment of justification of refusals in hospitalization, quality evaluation of delivery of health care in receptions of hospitals, succession availability with stations (departments) of ambulance, availability of the population to the stationary help is carried out. At the level of the out-patient and polyclinic help assessment of availability of medical care to patients, the organization of work of registry is carried out.

56. The arisen complications and complications caused by low technical workmanship of transaction, the postoperative complications which are consequence of accomplishment of surgical manipulations and applications of other methods of research are subject to quality evaluation of medical care.

57. Quality of maintaining medical documentation is determined by availability, completeness and quality of records in compliance by the forms of primary medical documentation of the organizations of health care approved by the order the deputy. The Minister of Health of the Republic of Kazakhstan of July 8, 2005 No. 332, including on quality of vypisny epikriz, interpretations of the held medical and diagnostic events, completeness of recommendations.

During conducting examination of quality of medical services execution of the informed consent of the patient on carrying out invasive interventions, refusal of the offered treatment, and also justification of not carrying out pathoanatomical opening, except as specified, stipulated in Item 2 articles 56 of the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system" is estimated.

58. Dispensary actions are estimated, proceeding from their influence on the patient's condition, frequency of emergence of exacerbations of disease, their weight and duration from the point of view of timeliness, regularity of medical examinations, the conducted laboratory and tool examination, purpose of preventive treatment, by the following criteria:

1) frequency rate of dispensary observation;

2) quality of inspection and compliance of types of inspections to the approved protocols of diagnostics and treatment of diseases, justification of conducting the laboratory diagnostic testings which did not enter protocols;

3) quality of treatment and compliance of the appointed treatment according to the approved protocols of diagnostics and treatment of diseases of the approved order of the Minister of Health of the Republic of Kazakhstan for December 28, 2007 No. 764, the justification of prescription of medicines and procedures which are not included in protocols;

4) in case of the direction on hospitalization availability of indications to hospitalization;

5) observation after the statement from hospital;

6) treatment continuation availability if the patient was directed to hospitalization, but in hospital did not arrive;

7) statistical data of reliability of removal from accounting in connection with recovery.

59. Preventive (routine inspections, vaccination, observation of children of the first year of life, of pregnant women, questions of planning of family) and rehabilitation actions are estimated taking into account availability of indications to their carrying out, timeliness of carrying out, level of primary detection of diseases, the taken measures for results of medical examination, accomplishment of complex of improving actions, results of improvement.

60. Assessment of preventive actions for children up to 5 years is carried out by the following criteria:

1) adherence to deadlines of observation of children and completeness of surveys by specialists;

2) timeliness of recommendations about leaving and feeding;

3) adequacy of recommendations about leaving and feeding, according to the principles of the integrated maintaining diseases of children's age and development of children of early age;

4) observance of calendar of preventive inoculations;

5) availability of control of the state of health of the child after carrying out inoculation;

6) justification of medical branches.

61. Assessment of preventive actions for expectant mothers is carried out by the following criteria:

1) capture terms on accounting and dynamics of observation on pregnancy;

2) completeness and efficiency of inspection, including availability of prenatal screening;

3) timeliness of diagnostics of complications of pregnancy and ekstragenitalny pathology, including availability of consultations of profile specialists for the purpose of detection of ekstragenitalny pathology;

4) compliance of risk group of the expectant mother to the planned hospitalization level;

5) providing expectant mothers with medicines on free and (or) preferential basis.

62. Assessment of the achieved result is carried out by the following criteria:

1) achievement of the expected clinical effect in case of respect for technology of delivery of health care;

2) lack of clinical effect of medical and preventive actions owing to low-quality holding diagnostic actions (incomplete collection of the anamnesis, absence or the wrong interpretation of results of inspection, establishment of the wrong or inexact diagnosis);

3) will not reach the expected clinical effect owing to holding ineffective medical, preventive actions without features of course of disease at this patient, associated diseases, complications, features of the mechanism of effect of medicinal substances;

4) the polypragmasy availability which caused development of undesirable effects.

63. On completion of examination of quality of medical services, in case of variation of delivery of health care conclusions are classified and drawn:

1) about compliance (discrepancy) to the provided medical care to requirements of the current legislation in the field of health care of the Republic of Kazakhstan;

2) about provision to the patient of free medical care in the amount guaranteed by the state;

3) about availability of the bases for application of measures of disciplinary and (or) administrativnogopravovy impact with indication of particular persons.

64. In case of identification of variations, cases not of subjects to payment, the revealed variations are classified according to Rules of payment for the rendered amount of the medical services within the guaranteed amount of free medical care performed at the expense of means of the republican budget approved by the order the deputy. The Minister of Health of the Republic of Kazakhstan of January 6, 2011 No. 26 also go to territorial subdivisions of state body on payment of medical services.

65. Service of internal control (audit) quarterly to the 5th of the following behind the accounting period represents to Territorial Department of the state control in the field of rendering medical services the variance report of threshold values of target indicators according to appendix 4 to these rules.

66. The territorial department of the state control in the field of rendering medical services quarterly to the 10th of the following behind the accounting period submits the summary report on variations of threshold values of target indicators in authorized body of the state control in the field of rendering medical services.

Appendices 1-4

to Rules of the organization and conducting external and internal examinations of quality of medical services

See Appendices 1-4 (0.27Mb In original language)

Disclaimer! This text was translated by AI translator and is not a valid juridical document. No warranty. No claim. More info