Optimization of Medical and Organizational Aspects of Dental Center Activities as Structural Components of the Territorial Healthcare System

The dissertation addresses the problem of optimizing medical and organizational aspects of the activities of ambulatory dental centers as structural components of the territorial healthcare system. The research is based on a social-hygienic approach and is aimed at developing pathways for improving the quality of dental services through the enhancement of management of factors determining the effectiveness of specialized centers of different forms of ownership. The work takes into account modern socio-economic conditions of healthcare development and current epidemiological trends of dental pathology in Russia.

During the research, the resultative and structural components of dental care quality, the medico-social environment of institutions, and comprehensive portraits of consumers and producers of dental services are analyzed. Special attention is given to the influence of organizational culture, personnel potential, medical informedness, and patient activity on the quality of services provided. The obtained results allow the use of the developed models and methodologies in the practical activities of healthcare authorities and educational institutions.

Relevance of the research. The social significance of dental pathology is determined by the widespread prevalence of diseases in this profile among the population. Epidemiological studies conducted in various regions of Russia in the late 1990s showed an increase in the prevalence of dental diseases. This situation testifies to the insufficient effectiveness of dental service activities and serves as one of the justifications for further investigation of the problems of effective management of factors determining it. A significant number of studies have been devoted to various problems of dentistry. Studies on lifestyle have been conducted, including in rural and urban areas, medical-biological factors have been identified, and the role of socio-economic and housing conditions has been substantiated. Studies on improving medical and organizational approaches to dental care have been carried out, including work with risk groups, prediction of the risk of pathology development, treatment schemes and standards for various forms of pathology. Against the backdrop of the growing dental pathology in recent years, special attention is being paid to the development and implementation of modern principles of diagnosis and treatment, as well as preventive dentistry. Several studies have proposed approaches to improving organizational forms and technologies for quality assessment of medical services, based on the use of expert assessment of medical documentation, quality assessment of medical services in the consumer rights protection department of territorial compulsory medical insurance funds, analysis of patient complaints regarding cases of medical services provided, the use of automated programs, standards, patient opinion surveys, and healthcare worker opinions. A limited number of studies have been conducted on the baseline condition of patients, in terms of their informedness and medical activity, as well as on the baseline condition of healthcare workers and their role in the formation of the quality of medical care. However, despite the large number of scientific studies conducted on the problems of quality of medical care, there are no works addressing the justification of differentiated approaches to quality assessment of dental medical services, based on the definition of medical care quality (WHO) as a set of properties that allows for an integral assessment, determination of the intensity of property violations, and justification of pathways for improving medical and organizational approaches. The significance of the social portrait characteristics and personal qualities of consumers and producers of services in this profile for the success of specialized dental center activities has not been studied. Therefore, it appears appropriate to conduct a comprehensive social-hygienic study of the quality of dental services, which would provide information on the social portrait of consumers and producers of these services, the influence of their characteristics on the state of individual quality properties, as well as information on defects in services provided, differentiated by quality properties. Furthermore, there are no studies on the comprehensive study of the structural component of dental center quality activity, the relationship between its organizational culture, social-psychological climate, informational support of service delivery, and interaction with other organizational units of the territorial healthcare system. Among the studies conducted, works aimed at solving these tasks have been practically absent.

The aim of the work was: on the basis of a social-hygienic study of the effectiveness of activities of ambulatory dental centers of different forms of ownership, to develop pathways for optimizing the management of medical and organizational factors determining the quality of dental services.

To achieve the stated aim, the following tasks were resolved:

1. To analyze the indicators of resultative quality of activities of ambulatory dental centers of different forms of ownership, including the quality of dental services by their properties, the final results of activities, the volume of financing, and the physical volume of services.

2. To study the indicators of the structural component of quality of dental services, including the material and technical base, organizational culture, social-psychological climate, informational support of the service delivery process, provided by ambulatory dental centers of different forms of ownership as structural components of the territorial healthcare system, and to establish factors determining the quality of services.

3. To determine the social portrait, medical activity, medical informedness, and personal qualities of consumers of dental services provided by a private ambulatory dental center as a structural component of the territorial healthcare system, in comparison with a municipal center, and to establish factors influencing the quality of services provided.

4. To determine the social portrait, medical activity, medical informedness, and personal qualities of producers of dental services, including those with different levels of education, working in a private ambulatory dental center as a structural component of the territorial healthcare system, in comparison with a municipal center, and to establish factors influencing the quality of services provided.

5. To scientifically substantiate and develop a complex of proposals for optimizing the management of medical and organizational factors determining the quality of dental services provided by ambulatory specialized centers.

The scientific novelty of the research results lies in the fact that:

- for the first time, social-medical and social-psychological portraits of consumers and producers of dental services as structural components of their quality have been determined, and the influence of their characteristics on the quality of services in this profile has been established;

- for the first time, an expert assessment of the quality of dental services has been provided using a methodology differentiated by quality properties, and a model for integral quality assessment on a quantitative basis has been developed;

- for the first time, a comprehensive quantitative assessment of the organizational culture of ambulatory dental centers of different forms of ownership has been conducted, and the influence of its components on the quality of services in this profile has been established;

- the optimization of medical and organizational approaches to managing factors determining the quality of dental services has been scientifically substantiated and developed, including a quality assessment methodology for medical services in this profile, differentiated by quality properties and their parameters, the use of basic assessment standards, a model for integral quality assessment of dental services, a methodology for predicting the quality of these services at the individual and social levels, a model of the volume of work for providing ambulatory dental services to the population at the territorial level, and the selection of management decisions regarding the use of factors preventing the decline in quality of dental services, taking into account the ranks of their properties by frequency of violations.

The practical significance of the obtained research results lies in the fact that the data identified during the study on the ranking of quality properties of dental services by frequency of violation, the model for integral quality assessment, and the model for the volume of dental services to the population at the territorial level can be used by practical healthcare in the formation of territorial programs "Quality Management in Healthcare."

Implementation of research results in practice. 1. Factors identified during the study that prevent the decline in quality of dental services, and scales for predicting the effectiveness of their action, have been included in the information letter "Scientific Justification for the Optimization of Medical and Organizational Aspects of the Quality of Ambulatory Dental Services" (2005) for healthcare organizers and dental physicians. 2. The features of medical informedness and medical activity of consumers of dental services identified during the study, along with proposals for their correction in the conditions of a specialized center, have been included in the information letter "Medical Activity and Informedness of Consumers of Dental Services on Issues of Prevention and Rehabilitation in the Case of This Pathology" (2004). 3. The scales for predicting the action of factors reducing the quality of ambulatory dental services, developed during the study, have been implemented in the practice of a specialized dental center in the city of Ivanovo. 4. The quality assessment methodology for dental services, differentiated by quality properties, is used in the educational process at the Department of Public Health and Healthcare of the State Educational Institution of Higher Professional Education "Ivanov State Medical Academy" of Roszdrav.

Acquaintance with research results. The main provisions of the work were reported at: the regional "School of Healthcare Organizers" (Ivanovo, 2004); the All-Russian Scientific and Practical Conference "Current Problems of Regional Healthcare" (Ivanovo, 2003), the inter-departmental conference of the State Educational Institution of Higher Professional Education "Ivanov State Medical Academy" (2005), and the Ivanov State Medical Academy Science Week (2005). The materials of the dissertation are published in works.

Main provisions for defense:

1. The effectiveness of a specialized ambulatory dental center as a structural component of territorial healthcare can be determined using the proposed models of the volume of work and the model for assessing final results.

2. The scientific justification for optimizing the management of medical and organizational factors determining the quality of dental services provided by ambulatory specialized centers can be the identified relationship of the ranks of quality properties by frequency of their violation, the identified directions of decline in medical activity and informedness among consumers of dental services, the identified role of the organization's culture, the personnel potential of producers of these services, as well as the identified medical and organizational risk factors for the decline in quality of dental services.