"3DT" concept as a model for integrating trauma and orthopedic services into priority areas of development and national projects of the Russian Federation

Gubin A.V., Khan N.V., Ryabykh S.O., Ovchinnikov E.N., Burtsev A.V., Vetrile M.S., Pulyatkina I.V., Solomyannik I.A.

Abstract


Introduction
In the year of anniversaries of two leading national centers for traumatology and orthopedics, the authors analyzed the main problems and current challenges in specialized trauma and orthopedic care (TOC). Historical parallels in the development of TOC in our country and its problems and trends abroad motivated the authors to conduct an analysis while the need for their comparative assessment determined the purpose of the work which is a brief analysis of the organizational model of TOC and substantiation of a "3DT" concept as a contemporary organizational model of trauma and orthopedic service in the Russian Federation.
Results and discussion
The analysis of current trends in the trauma and orthopedic (TO) service showed its variability over the past three decades. However, the original organizational structure of specialized TO care remained almost the same. A comparative assessment of organizational models has shown that the models for providing specialized care in developed countries are extremely diverse. The availability of assistance does not depend on the population density and tariffs even in the regions of developed countries. In addition, the monetary assessment of treatment of spinal pathology, as an example, has not been standardized and harmonized across countries and regions. It is also important to evaluate the steady increase in high technology care with the use of more developed systems of diagnosis, treatment, rehabilitation and, accordingly, its growing costs. The challenges that our specialty faces may be conditionally divided into technical, socio-economic and organizational ones with the need to create a clear vertical structure of organization, control and referral of patients with organizational decisions for selection of patients with a TO profile according to flows within various areas of subspecialties, the need for justification and feed-back control of financing systems for various types of TO assistance. The challenges described above motivated us to propose a new “3DT” organizational concept as a basis for a more stable and understandable model for the functioning of the national trauma and orthopedic service. The proposed basic model includes 4 direction sectors: D1 (pediatric diseases of the musculoskeletal system and their outcomes); D2 (degenerative and involuntary pathology of the musculoskeletal system); D3 (destructive diseases of the musculoskeletal system of tumor or infectious origin); T (trauma of the musculoskeletal system and its consequences), that all have fundamentally different approaches to organization and planning. The main requirement for the model is its simple application by all participants directly or indirectly involved in the provision of care: orthopedic and trauma specialists, doctors of other specialties, authorities and financial institutions, patients, their relatives and patient communities.
Conclusion
The advantages of the 3DT model lie in the possibility of extrapolating this concept to any region of the Russian Federation, taking into account the difference in their resources. The integral criterion of its effectiveness may be the assessment of the development of these areas as a whole, rather than separate types of assistance. In each sector, it is necessary to indicate the basic, additional and optional amount of assistance. All regions must have the basic level, while the state funding of additional and, moreover, optional assistance should not be carried out without providing the basic one.

Keywords


orthopedics, traumatology, organizational issues, amount of care, stages, care grading, socio-economic problems, patient routes

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DOI: http://dx.doi.org/10.18019/1028-4427-2021-27-2-146-152

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