Conventional units of labor intensity in dentistry. Performance indicators of a dentist-therapist and a dental clinic
MODULE 3.3. METHODOLOGY FOR CALCULATION AND ANALYSIS OF STATISTICAL INDICATORS OF ACTIVITY OF DENTAL ORGANIZATIONS
MODULE 3.3. METHODOLOGY FOR CALCULATION AND ANALYSIS OF STATISTICAL INDICATORS OF ACTIVITY OF DENTAL ORGANIZATIONS
Purpose of studying the module: emphasize the meaning statistical indicators to evaluate and analyze the performance of dental organizations.
After studying the topic, the student must know:
Basic forms of primary accounting medical documentation dental service institutions;
Statistical indicators of the work of organizations providing dental care;
Methodology for calculating and analyzing statistical indicators of the work of dental organizations.
The student must be able to:
Calculate, analyze and interpret statistical indicators of the work of dental organizations;
Use the information obtained in the management of dental organizations and in clinical practice.
3.3.1. Information block
Dental care is one of the most widespread types of medical care. More than 90% of patients receive general and specialized dental care in outpatient clinics. Patients receive inpatient specialized dental care in the departments maxillofacial surgery multidisciplinary hospitals.
The main forms of primary medical records of dental service institutions are:
Daily record sheet for the work of a dentist (dentist) dental clinic, department, office (f. 037/u-88);
Summary record of the work of a dentist (dentist) of a dental clinic, department, office
(f. 039-2/u-88);
Medical record of a dental patient (f. 043/u), etc. There are no special reporting forms for dentistry, the data is included
in the form of various tables in “Information about the medical institution” (f. 30).
Based on these and other forms of medical documentation, statistical indicators are developed that are used to analyze the activities of dental organizations. These statistical indicators, methods for calculating them, recommended or average values are presented in section 5 of chapter 16 of the textbook.
3.3.2. Tasks for independent work
1. Study the materials of the corresponding chapter of the textbook, module, recommended literature.
2.Answer security questions.
3. Analyze the standard problem.
4.Answer questions test task module.
5. Solve problems.
3.3.3. Security questions
1.Name the main forms of primary medical records used to analyze the activities of dental organizations.
2.What are the features of statistics dental care?
3. List 4 groups of performance indicators of dental organizations.
4.Name the indicators of population satisfaction with dental care. Provide formulas for their calculation and recommended values.
5.What indicators can be used to judge the workload of staff in dental organizations? Provide formulas for their calculation and recommended values.
6.List the quality indicators of dental care. Provide formulas for their calculation and recommended values.
7.Name the indicators of clinical examination of dental patients.
3.3.4. Reference task
Table.
End of table.
Exercise
1. Based on the initial data given in the table, calculate statistical performance indicators dental organization.
2.Analyze the data obtained, comparing them with the recommended or average values given in the textbook and recommended literature.
Solution
To analyze the work of a dental organization, we calculate the following indicators.
1. Indicators of population satisfaction with dental care 1.1. Provision of population with dental care =
1.2. Provision of population with dentists (dentists) =
We calculate similarly: provision of population with dentists - 1.3 0 / 000
2. Personnel workload indicators
2.1. Average number of visits per day per 1 dentist (dentist) =
2.2. Average number of sanations per day per 1 dentist (dentist) =
2.3. Average number of teeth treated per day per 1 dentist (dentist) =
2.4. Average number of teeth removed per day per 1 dentist (dentist) =
3. Indicators of quality of dental care
3.1. Ratio of number of teeth treated to teeth removed =
3.2. Share of complicated caries =
3.3. Proportion of complications after tooth extraction =
3.4. Removal rate permanent teeth in children =
4. Indicators of clinical examination of dental patients
4.1. Efficiency of clinical examination =
We calculate similarly: with deterioration - 8.0%; without change in condition - 57.0%.
4.2. Share of sanitized persons =
We enter the results of calculating statistical indicators into a table and compare them with the recommended values or the existing average statistical indicators given in Section 5 of Chapter 16 of the textbook and recommended literature, after which we draw appropriate conclusions.
Table. Comparative characteristics of dental organization indicators
Conclusion
An analysis of the performance indicators of the dental organization showed that the provision of the population with dental care attached to this clinic, 872.7 visits per 1000 population, is below the recommended value, at the same time, the indicator of the provision of the population with dentists and dentists meets the standards.
Indicators of staff workload, quality of dental care, and the effectiveness of clinical examination (using the example of periodontal diseases) in this dental organization correspond to the recommended ones. At the same time, the low value of the Kollegov index is noteworthy - 0.85, which indicates an insufficient level of prevention of oral diseases in children in organized groups. Serious problems were identified in the organization of medical examinations of the population, as evidenced by the extremely low percentage of sanitized persons - 31.7%.
3.3.5. Test tasks
Choose only one correct answer.1. Name 4 groups of indicators characterizing the activities of a dental organization:
1) duration of treatment of the patient in the clinic; staff workload; quality of dental care; medical examination of dental patients;
2) population satisfaction with dental care; staff workload; quality of dental care; medical examination of dental patients;
3) duration of treatment of the patient in the clinic; staff workload; quality of dental care; continuity of outpatient and inpatient treatment;
4) employment of dentists in dental organizations; staff workload; quality of dental care; continuity of outpatient and inpatient treatment;
5) employment of dentists in dental organizations; staff workload; incidence of complications; indicator of continuity of outpatient and inpatient treatment.
2. Name the primary statistical accounting form used to calculate the workload of personnel in a dental organization:
1) medical card of a dental patient (form 043/u);
2) information on the number of diseases registered in patients living in the service area medical institution
(f. 12);
3) coupon outpatient(f. 025-12/у);
4) summary record of the work of a dentist (dentist) of a dental clinic, department, office
(f. 039-2/u-88);
5) Voucher for an appointment with a doctor (f. 025-4/u-88).
3. What statistical reporting form is used to calculate performance indicators for a dental organization?
1) medical card of an inpatient (f. 003/u);
2) information about the activities of the hospital (form 14);
3) a sheet of daily accounting of the movement of patients and hospital beds (f. 007/u-02);
4) information on the number of diseases registered in patients living in the service area of the medical institution (form 12);
5) information about the medical institution (form 30).
4. Indicate the data necessary to assess the workload of one dentist (dentist) in a dental organization:
1) number preventive examinations per day; number of sanitizations per day; number of teeth treated; number of patients admitted per day;
2) the number of preventive examinations per day; number of patients served per day; number of teeth treated; number of patients admitted per day;
3)number of visits per day; number of sanitizations per day; number of teeth treated; number of patients admitted per day;
4) number of visits per day; number of sanitizations per day; number of teeth treated; number of teeth removed;
5) the average number of patients referred for hospitalization; number of registered patients per day; number of sanitizations per day; number of teeth treated.
5. Indicate the data necessary to calculate the rate of complications after tooth extraction:
1) the number of complications after tooth extraction; the total number of patients whose teeth were removed;
2) the number of complications after tooth extraction; total number of teeth removed;
3) total number of teeth removed; total number of all complications;
4) the number of complications after tooth extraction; total number of all complications;
5) total number of teeth removed; the total number of patients whose teeth were removed.
6. Name the indicator characterizing the workload of a dentist in a dental organization:
1) average number X-ray studies by referral from one dentist;
2) the average number of patients referred for tooth extraction by one dentist;
3) average number of visits per day per dentist;
4) average number laboratory tests per dentist;
5) the average number of dispensary patients per dentist.
7. The quality of dental care is characterized by the following indicator:
1) provision of population with dental care;
2) shares of sanitized persons;
3) the ratio of the number of treated teeth to those removed;
4) the effectiveness of clinical examination;
5) the average number of visits per day per dentist.
8. The peculiarity of dental care statistics is to take into account:
1) both visits and conventional units of labor intensity (CUT);
2) conventional units of labor costs (UET);
3) visits and discharged patients;
4) visits and conventional units of employment (UET);
5) visits and conventional units of labor costs (UCET).
9. Name an indicator characterizing the state of clinical examination of patients in need of dental care:
1) indicator of the share of sanitized persons;
2) the indicator of implementation of the visit plan by patients registered at the dispensary;
3) indicator of the distribution of visits to dispensary patients among all patients of the dental organization;
4) the rate of repeat visits to the clinic for dispensary patients;
5) indicator of population satisfaction with dental care.
10. What does the Kollegov index characterize?
1) distribution of visits to sick children attending preschool institutions;
2) implementation of the plan of visits for patients who are registered at the dispensary;
3) the level of prevention and treatment of oral diseases in children in organized groups;
4) the ratio of the number of teeth treated in children to those removed;
5) prevention and treatment of oral diseases in the population.
3.3.6. Problems to solve independently
Problem 1
The work of a certain dental organization is analyzed. The table presents the initial data for calculating statistical indicators.
Table. Initial data for calculating performance indicators of a dental organization
End of table.
Problem 2
The work of a certain dental organization is analyzed. The table presents the initial data for calculating statistical indicators.
Table. Initial data for calculating performance indicators of a dental organization
End of table.
“Please tell me who sets the UET standards?” - this question came from an employee of one of the Samara dental clinics.
Let's first figure out what UET is. UET stands for “conventional unit of labor intensity”. Also by Order of the USSR Ministry of Health dated January 25, 1988 No. 50 “On the transition to new system accounting for the work of dental doctors and improving the form of organizing dental appointments" for dentists and dentists, for the first time, the transition to a new meter of labor costs was determined: instead of the accepted method of measuring labor in minutes, UET was proposed, and instead of the indicator of labor volume, which is generally accepted for doctors in outpatient appointments , expressed in visits, are individual labor operations. At the same time, in dentistry, 1 UET at a therapeutic or surgical appointment was taken to be the amount of doctor’s work required to apply a filling for moderate caries. All other types of work (individual labor operations) were expressed as a whole or fractional number UET. The main reason for the transition to a new labor cost meter was to ensure the provision of maximum care in one visit and the interest of doctors in the final results of labor.
Currently in different medical institutions different standards UET, and this raises many questions. Let's figure it out.
Basic regulations according to conventional units of labor intensity (UCL) at the federal level:
1. Instructions for calculating cost medical services(temporary) NN 01-23/4-10, 01-02/41 (approved by the Ministry of Health of the Russian Federation and Russian Academy Medical Sciences November 10, 1999);
2. Order of the Ministry of Health and social development RF dated February 17, 2012 N 139n “On approval of the methodology for determining the amount of payment for the provision of necessary and mandatory services for medical examination with the issuance of a certificate for the purpose of providing public services federal executive authorities and maximum fees for its provision."
Further, in accordance with the Regulations on the Ministries of Health of the constituent entities of the Russian Federation, these ministries approve the recommended coefficients for recalculating the number of UET into the number of medical visits, and also approve the list and values in conventional units of labor intensity (hereinafter - UET) of the main dental therapeutic and diagnostic procedures performed by dentists and dentists for the adult population in the compulsory health insurance system, etc. Based on the above documents, the manager medical organization It is recommended to approve specific workload standards in the institution.
Thus, ultimately, UET standards in an institution are established by the chief physician, but not arbitrarily, but on the basis of existing federal recommended standards. If they contradict federal regulations and common sense, this issue should be raised with the employer - up to and including complaints to supervisory authorities (Roszdravnadzor, prosecutor's office) and even a lawsuit.
The consultation with a lawyer from the “Action” trade union was held as part of the project “Legal support for workers medical organizations V Russian Federation and monitoring current problems in the field of social and labor relations in the context of reforming the public health sector” using funds from a grant from the President of the Russian Federation for the development of civil society.
calculated as the load per 1 hour * number of working hours per day * number of working days per year (284-287) therapist 3 visits per hour, surgeon 5. for orthopedists 2100 units 6 days, then 21, 5-25.
Organization of the work of a dentist-orthopedist.
Orthopedic care in the Russian Federation is provided in orthopedic departments district dental clinics, departmental clinics, extra-budgetary clinics, as well as private practitioners doctors, orthopedist 2 visits for 30 minutes and performs 2100 units of labor intensity. 1 nurse for 2 orthopedists.
17. Organization of the work of a dentist during a surgical appointment:
main sections of work, reception workload, assessment of the amount of work in
UET, documentation
The surgeon has 5 visits of 12 minutes each, for 1 surgeon there is 1 nurse. Documents - card, work record sheet, summary sheet, operation sheet, coupon. Tooth extraction (UET includes labor costs for os-| |
| |simple | 0.75 |
| |complicated | 1.5 |
| |lara |
18. Organization of the work of a dentist at an orthopedic appointment:
main sections of work, assessment of the amount of work in UET, documentation.
Orthopedic care in the Russian Federation is provided in the orthopedic departments of district dental clinics, in departmental clinics, non-budgetary clinics, as well as by private practitioners, with an orthopedist 2 visits for 30 minutes and 2100 units of labor intensity performed. For 2 orthopedists 1 nurse. The orthopedic doctor fills out accounting documents, this is a patient’s certificate, a medical card, and carries out tertiary prophylaxis.
Organization of the work of a dentist during a therapeutic appointment:
main sections of work, reception workload, assessment of the amount of work in
UET, documentation. 1 nurse for 2 therapists, 3500 people are assigned to each therapist. 3 visits for 20 minutes. 6 days - 21 days, 5 days - 25 minutes. Fills out accounting documents - outpatient card, medical card, statement. Conducts primary and secondary prevention.
Polyclinic
Orthopedic care in the Russian Federation is provided in the orthopedic departments of district dental clinics, in departmental clinics, non-budgetary clinics, as well as by private practitioners, with an orthopedist 2 visits for 30 minutes and 2100 units of labor intensity performed. For 2 orthopedists 1 nurse. The orthopedic doctor fills out accounting documents, this is a patient’s certificate, a medical card, and carries out tertiary prophylaxis.
20. . Contents of the work of a dentist-therapist in a dental clinic
Polyclinic.
1 nurse for 2 therapists, 3500 people are assigned to each therapist. 3 visits for 20 minutes. 6 days - 21 days, 5 days - 25 minutes. Fills out accounting documents - outpatient card, medical card, statement. Conducts primary and secondary prevention.
Dental clinic
5 visits 12 min. os-| |
| |examination of the patient, anesthesia, filling out documentation):| |
| |simple | 0.75 |
| |complicated | 1.5 |
| |with peeling of the mucoperiosteal flap, you-| 3.0 |
| | sawing a fragment of the cortical plate of the alveo-| |
| |lara |
for 1 surgeon 1 nurse.
documents - card, work record sheet, summary sheet, sheet of operations, coupon
Performance indicators during surgery
Patients admitted per day
Number of tooth extractions per day
Number of tasks completed per day
admitted primary patients per day
hir. Activity
complications
22. Organization of the work of a dentist at children's reception: basic
sections of work, assessment of the amount of work in UET, documentation,
Performance indicators.
30 minutes are allocated per child. :due to a large number schoolchildren and institutions, the method of a decentralized organization - a dentist works in a school office and has the possibility of systemic treatment; centralized - schoolchildren come to a clinic and covers children under 18 years old. There should be 1 therapist per 800 students. The centralized method of sanitation of the oral cavity is carried out in regular inpatient rooms, clinics with patients called there, all types of treatment are provided, consultation with specialists, but the planned work of the clinic and school is disrupted.
The doctor is engaged in primary and secondary prevention, sanitation of the oral cavity. He gives a medical card and a sick certificate. Children are examined at 6-8 years old, 16-18 years old.
MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
In order to increase the efficiency of dental institutions and improve the quality of dental care for the population, as well as to comply with uniform approaches to calculating conventional units of labor intensity and financing for budgetary dental institutions
I order:
Approve the Instructions (application).
Minister
Yu.L.Shevchenko
Application. Instructions for calculating conventional units of labor intensity for the work of dentists and dentists
Application
APPROVED
By order of the Russian Ministry of Health
dated November 15, 2001 N 408
This instruction provides for the medical and economic feasibility of using conventional units of labor intensity (hereinafter referred to as UET) when introducing new technologies for providing dental care to the population, taking into account budget financing and financing under compulsory health insurance programs.
Financing of state dental institutions according to the principle of “conventional units of labor intensity (UCL)” provides for the following opportunities for intensifying the activities of budgetary dental institutions:
- reducing the number of visits to the patient to provide dental care, which in turn provided each patient with savings in his personal and working time spent on receiving this care in the amount of 30% to 60% due to the reduction in time for travel, registration, and waiting for an appointment ;
- providing the patient with a larger volume of assistance in one visit: treatment of 2-3 teeth for caries in one visit, treatment of pulpitis - in one visit, etc.;
- saving the doctor’s working time by reducing the time spent on non-productive elements of the labor process (calling a patient, preparing the workplace, preparing the surgical field, working with documentation, etc.);
- reduction in the number of executions of such auxiliary elements labor process, such as the selection of instruments necessary to perform work, their sterilization (reducing the number of directions for sterilization of instruments from 2-5 times, corresponding to the number of visits, to 1);
- increase in the number of fillings per shift from 6 (according to standard assessment-oriented visits) to 10-12 due to rational use real working hours of dental doctors.
- increasing the overall productivity of dental doctors by 15-20%, and in some regions by 25%.
Health authorities of the constituent entities of the Russian Federation and dental institutions must use a method that is uniform for a given administrative territory: the timing method or the method of expert assessments.
A. Timing method
When calculating UET using the timing method, the following must be taken into account:
1. Organization of the workplace
1.1. The doctor’s office, whose work is being studied for the purpose of calculating UET, must be organized taking into account the requirements and regulations sanitary rules devices, equipment, operation of outpatient dental clinics, labor protection and personal hygiene of personnel.
1.2. Additionally, bring the organization of the doctor’s workplace into compliance with the requirements of the technology for providing dental care, for which the UET is calculated. For example, when calculating UET for filling a tooth with light-curing materials workplace must be equipped with an installation that has an oil-free compressor, a “gun” that provides treatment of the tooth cavity with compressed air and water, a saliva ejector, a lamp that does not distort color perception, and a turbine handpiece with a water supply.
1.3. A list of medications, materials, and instruments provided for by a specific technology for providing dental care is compiled. And on the basis of this list, they appropriately provide the volume of labor necessary to provide the type of assistance under study. In these lists, based on the results of completing elements of the labor process, the amount of consumable materials and medications is noted, on the basis of which, after research, the consumption rates for materials and medications for UET for a specific type of dental care are determined. (Consumption of instruments is determined taking into account existing standards or according to the deadlines established by the instructions and certificate for a specific type of instrument).
1.4. Creating conditions for the personal protection of the doctor and assistant from the possibility of infection (viral, etc.), as well as from other harmful contaminants in the personnel area of activity (for example, saliva, “tooth dust”) by using a mask, glasses, gloves, etc.
2. Research staffing
2.1. The doctor must be provided with a specially trained assistant if this is provided for by the requirements of the technology for which the UET is being calculated. For example, when using light-curing materials, it is necessary to organize a “4-handed” workflow. Failure to comply with this and other requirements provided for by the technology leads to a sharp reduction in the preservation time of the filling and reduces the guarantee of the quality of dental care.
2.2. Only those personnel who have undergone special training in a specific technology should be included in the research process.
2.3. The optimal age limit for doctors whose work is being studied is set between 30 and 50 years. Work experience in the specialty - at least 5 years, in the technology being studied - at least 1 year. Having a certificate of completion of training to work on the technology being studied is mandatory.
3. The study must include the results of the work of at least 3 doctors (3 working groups on the “4 hands” technology). For each doctor, a “Chronological Observation Card” is created for the type of dental care being studied (Appendix 1 to the Instructions).
4. Patient preparation.
General preparation of the patient includes the following stages of work: calling, sitting in a chair, putting on a sanitary napkin, taking an anamnesis, examination, interview (after diagnosis), discussion of the patient’s wishes, treatment plan and possible results after it has been carried out. According to indications: conducting an X-ray examination, training in the skills of maintaining personal oral hygiene, hygienic cleaning teeth, carried out by the patient before providing him with assistance.
5. Other requirements:
5.1. Preparation of the “operative field” of the doctor’s actions is carried out taking into account the technology requirements for a specific case.
5.2. Before conducting a study, there must be a clear and detailed description all elements of the work process of a doctor (or group: doctor and assistant), provided for in accordance with the technology of providing care for a specific case. (Appendix 2 to the Instructions).
5.3. A general estimate of working time costs is established based on 30 completed cases (for all doctors included in the study)
- provision of dental care for a specific nosology of the disease;
- execution certain type work, manipulation, process;
- final result(for example, making a pin tooth using a standard pin and light-curing materials).
5.4. The calculation of UET, as the economic equivalent of resource costs, is determined for one specific completed case and is carried out using the formulas:
- where T is the total time spent on 30 completed cases;
- T is the time spent on 1 completed case.
- where T, time spent on 1 completed case;
- 20 min - time set for completing 1 UET;
n is the number of conventional units of labor intensity that determine the resource costs of performing one completed case: providing assistance according to the nosology of the disease, performing a type of work, manipulation, process, manufacturing a product of activity (clause 5.3).
5.5. Rounding of digital values to 0.05 UET is carried out according to generally accepted methods.
6. To conduct a study, the health care management body of a constituent entity of the Russian Federation issues an appropriate order, on the basis of which this work is financed from budget funds.
7. This order is duplicated by the management of the dental institution, on the basis of which the research and calculation of UET using new technologies is carried out.
8. The study and calculations are carried out according to a protocol (Appendix 3), signed by the person conducting the study when using the timing method, the doctor participating in the study and his assistant, as well as the heads of the institution: the chief physician (or his deputy) and the chief accountant.
9. The protocol is approved by the healthcare management body of the constituent entity of the Russian Federation, establishing the terms of its validity (at least 5 years) and mandatory execution everyone legal entities related to the provision and receipt of dental care.
10. In order to simplify timing studies, the calculation of the time spent on all types of actions that are associated with the reception of a patient can be determined in total for a specific case, and not for individual elements of the labor process.
11. When calculating the UET in the budget of working time for the provision of dental care for the case under study, time should be taken into account in the appropriate proportion: for rest - 10 minutes, for personal needs - 10 minutes, morning conferences - 10 minutes, sanitary educational work - 11 min. (based on 4 hours per month).
So, if a dentist must perform work in the amount of 25 UET during a shift (6 hours and 36 min.), then, accordingly, when performing the type of dental care under study in the amount of, for example, 5 UET, the proportion of rest time will be 2 minutes ., personal needs - 2 min., morning conferences - 2 min., sanitary educational work - 2.2 min.
B. Method of expert assessments.
1. The organization of a permanent workplace for medical experts must comply with the requirements of section 1 (see A. Timing method) of this Instruction.
2. Staffing.
2.1. The study must include at least 10 doctors working in dental institutions in the region and having appropriate certificates of completion of advanced training courses in a specific type of work or technology.
2.2. Doctors' work experience in their specialty is at least 5 years, in a specific technology - at least 1 year.
2.3. An independent expert (a representative of the certification commission of the health care management body of a constituent entity of the Russian Federation or a representative from a regional dental association) must be included in the group.
3. Conducting research.
3.1. Medical experts are provided with a clear description of the case being studied (type of work, technology, etc.). Medical experts agree on this description with personal experience providing assistance with this case. They make their own adjustments.
3.2. Expert doctors, based on their experience, determine the amount of working time required to provide assistance in a particular case. The data is entered into the study protocol (Appendix 4).
3.3. An independent expert analyzes the adjustments made by medical experts and calculates the UET using the formulas specified in clause 5.4. and subject to the provisions set out in paragraph 11 (see A. Timing Method) of these Instructions. And he also draws up a general research protocol (Appendix 5).
3.4. The protocol is signed by an independent expert, the chief physician (or his deputy) and the chief accountant of the institution.
4. To conduct a study, the health care management body of a constituent entity of the Russian Federation issues an appropriate order, on the basis of which this work is financed from budget funds.
5. This order is duplicated by the management of the dental institution, on the basis of which the research and calculation of UET using new technologies is carried out.
6. The protocol is approved by the health care management body of the constituent entity of the Russian Federation, establishing the duration of its validity (at least 5 years) and mandatory execution by all legal entities associated with the provision and receipt of dental care.
Appendix No. 1 to the Instructions... Map of timing observations
Appendix No. 1
to the Instructions
according to the calculation of conventional units of labor intensity
work of dentists and dentists
Current time | Duration | Name of the element of the labor operation (what was observed?) | Number outpatient card sick |
||
Calling a patient | |||||
sitting in a chair, putting on a sanitary napkin and other elements of the labor operation | |||||
Appendix No. 2 to the Instructions... Description of the actions of the doctor (working group) to determine the volume of UET
Appendix No. 2
to the Instructions
by calculating conventional units of labor intensity of work
dentists and dentists
Example: Treatment of moderate dental caries using light-curing materials
Preliminarily carried out:
A. Compliance with the requirements of the Instructions under paragraphs 1-9.
B. Checking the technical condition of equipment, photopolymerizer (using a tester), tips, etc.
Actions of the doctor and his assistant
1. Calling the patient, sitting in a chair, putting on a sanitary napkin.
2. Preparing the doctor’s and assistant’s workplace: preparing documentation, laying out instruments, putting on gloves (or processing them after a preliminary appointment), masks, glasses, adjusting the patient’s position in the chair.
3. Clarification of the patient’s complaints (or wishes). Anamnesis collection.
4. Inspection. Probing. Percussion. (According to indications: electrical odontometry, determination hygiene indices, viewing the radiograph).
5. Making a diagnosis.
6. Interview with the patient regarding the possibilities of providing dental care in a particular case.
7. Additional preparation of the workplace taking into account the diagnosis (selection of the necessary tools, materials, etc.).
8. Conducting anesthesia (according to indications).
9. Preparation of the surgical field, isolation with a rubber dam, installation of a saliva ejector, removal of dental plaque.
Determination of tooth surface color.
10. Preparation of handpieces for work, selection of burs, their fixation in the handpiece (or the total number of burs and other instruments fixed in the handpiece used when receiving a patient is indicated).
11. Cavity preparation. Control examinations of the cavity being treated.
12. Flushing the cavity.
13. Stop bleeding (according to indications). Repeated rinsing.
14. Drying the cavity.
15. Acid etching. Repeated flushing of the cavity from acid exposure.
16. Application of therapeutic and/or insulating pads (as indicated).
17. Application of a matrix and/or wedge (as indicated).
18. Application of a filling, taking into account the requirements of the instructions for using a specific filling material (use of primer, adhesive, re-determination of color, layer-by-layer application of filling material).
19. Removal of rubber dam.
20. Checking occlusion and its correction.
21. Changing grinding and polishing tools in the handpiece. Grinding and polishing of the filling.
22. Final illumination of all surfaces of the filling with a photopolymerizer.
23. Advice to the patient.
24. Filling out documentation.
25. Collapse of the workplace. Collection of used material and instruments for subsequent processing and sterilization, processing of tips, changing the saliva ejector.
26. Preparation of the workplace to an adequate extent general requirements to see the next patient.
Note 1. This description does not determine the need for strict adherence to the sequence of actions, but characterizes only the completeness of the description of the actions included in the process of providing assistance using technology. The sequence of actions is determined only by the technological requirements set out in the instructions for using filling materials.
Note 2. General resource costs associated with organizing the work of the office, workplace and support staff, disinfection and sterilization of instruments, preparation of dressings, etc. are determined based on the annual consumption of resources (according to UET) for the provision of dental care in a specific institution (office, department, clinic).
Note 3. A similar description of all the doctor’s actions is compiled for other cases of dental care for which the study is being conducted.
Appendix No. 3 to the Instructions...Protocol
Appendix No. 3
to the Instructions
according to the calculation of conventional units of labor intensity
work of dentists and dentists
I APPROVED
healthcare of the subject
Russian Federation
/Signature/
Protocol N
dated __________2001 | /Timekeeping method/ |
_________________________________________________________________________ |
|
(a clear definition of the case: nosology of the disease, type of work, technology, process, etc., on which the study is carried out using the timing method) |
|
Data on doctors and other personnel included in the study:
Medical experience in specialty | Availability of a certificate for the case being studied (disease nosology, type of work, etc.) | ||||
The organization of the study is carried out taking into account the requirements of the Instructions of the Ministry of Health of Russia dated........ __ N ......
The study included the results of data on |
_________________________________________________________________________ |
(indicate the number of cases of dental care) |
Total time time spent on all cases of dental care __________ min. |
Number of conventional units of labor intensity per case _____ |
Spent: |
List of medications | Unit of measurement | |||
List of materials | Unit of measurement | Costs for all cases of assistance | Average cost per case of care | Cost per UET for the case of care being studied |
Chief physician (Signatures) Full name
Chief accountant
Doctors participating in the study:
2.
Timing was carried out by (full name)
Appendix No. 4 to the Instructions...Protocol
Appendix No. 4
to the Instructions
according to the calculation of conventional units of labor intensity
work of dentists and dentists
dated ________________2001 __ | /Expert assessment method/ |
Expert assessment data for calculating conventional units of labor intensity (UCU) according to |
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_________________________________________________________________________ |
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_________________________________________________________________________ |
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(a clear definition of the case: nosology of the disease, type of work, technology, etc., on which the study is carried out using the method of expert assessments) |
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Information about the expert doctor and his assistant:
Experience in specialty | Work experience in a specific technology | Name of the institution where the doctor works |
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The organization of the study is carried out taking into account the requirements of the Instructions of the Ministry of Health of Russia dated..... N ....
1. The study included the results of the work experience of a doctor-expert in |
_________________________________________________________________________ |
_________________________________________________________________________ |
(indicate the approximate number of cases of dental care provided by an expert doctor in one year) |
2. Expert assessment of the time spent by an expert doctor to perform one case of dental care ___ min.
3. The total time spent by the expert doctor on providing dental care for the case under study during the year __ min. (multiply the data in point 1 by the indicators in point 2).
4. Spent:
List of medications | Unit of measurement | Costs for all cases of assistance |
List of materials | Unit of measurement | Costs for all cases of assistance |
Doctor-expert | /Signature/ |
Appendix No. 5 to the Instructions...Protocol
Appendix No. 5
to the Instructions
according to the calculation of conventional units of labor intensity
work of dentists and dentists
I CONFIRM:
Head of the governing body
healthcare of the subject of the Russian
Federation
/Signature/
Protocol N
dated _______ 2001 | /Expert assessment method/ |
Calculation of conventional units of labor intensity (CUT) according to |
_________________________________________________________________________ |
_________________________________________________________________________ |
(a clear definition of the case: nosology of the disease, type of work, technology, etc., on which the study is carried out using the method of expert assessments) |
Information about the independent expert: _______
Represents (specify body: qualification commission or association) | Specialty experience | Availability of a certificate for the case being studied (nosology of the disease, type of work, etc.) | Work experience in a specific technology | Name of the institution where the independent expert works |
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Organization of the study taking into account the requirements of the Instructions of the Ministry of Health of Russia dated...... 2001 N .....
1. The study included the results of the work experience of 10 doctors in
_________________________________________________________________________ |
(indicate the approximate total number of cases of dental care provided by experts in one year) . |
2. The total time spent by medical experts on providing dental care for the case under study during the year ____ min. (The total amount of time indicated by medical experts for all cases of dental care).
3. The time spent by one expert doctor to perform one case of dental care ___ min. (indicate the arithmetic average obtained by dividing the indicator for 2 points by the indicator for 1 point).
4. Number of conventional units of labor intensity (UCU) per
5. Spent:
List of medications | Unit of measurement | Costs for all cases of assistance | Average cost per case of care | Cost per UET for the case of care being studied |
List of materials | Unit of measurement | Costs for all cases of assistance | Average cost per case of care | Cost per UET for the case of care being studied |
Chief accountant
Independent expert
/Note: All protocols compiled by each medical expert are attached to this protocol. The protocols are numbered in order and are integral part general protocol.
N.I. Leiman
economist
Tariff for payment of medical care in in rare cases covers the costs of its provision. Officials of the Ministry of Health and Social Development advise learning to live within your means, municipal customers insist on increasing production standards. Using the example of dentistry, one can see that even in such conditions, changing the algorithm for recording labor costs can be one of the ways to increase the motivation of doctors.
Regulatory framework
The direct relationship between the improvement of dental care and the accounting system in the institution was first announced in the decision of the board of the USSR Ministry of Health dated April 17, 1987. The first attempt to eliminate the imperfections of the accounting system was an order from the USSR Ministry of Health dated January 25, 1988 No. 50(hereinafter referred to as Order No. 50), which determined the transition to a new system for recording the work of doctors according to the so-called conventional units of labor intensity - UET. At the same time, a list of 183 types of work was determined with their corresponding assessment in UET. These works were, in their way, the economic equivalent of labor costs for performing dental care activities.
The transition of dental institutions to the UET system became a harbinger of results-based budgeting. The performance indicator for the UET system is the provision of the maximum amount of assistance in one visit. Physicians are now motivated to reduce wasted time associated with repeat visits:
UET directly depends on the intensification of the work of doctors (the use of new technologies and materials). In this regard, an order was issued by the Russian Ministry of Health dated 02.10.1997 No. 289(hereinafter referred to as Order No. 289), which allowed the heads of healthcare authorities of the constituent entities of the Russian Federation to independently develop and approve the UET. The main condition for independence is the use of new production technologies dental work, not provided for by Order No. 50.
Instructions for calculating conventional units of labor intensity for the work of dentists and dentists were approved by order of the Russian Ministry of Health dated November 15, 2001 No. 408(hereinafter referred to as Instruction No. 408).
