Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC88710.15690/vramn887HEALTH CARE MANAGEMENT: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ОРГАНИЗАЦИИ ЗДРАВООХРАНЕНИЯTHE PROBLEM OF KNOWLEDGE TRANSLATION IN HEALTHCARE: TOOLS FOR ITS SOLUTION IN THE AREA OF PATIENT SAFETYПРОБЛЕМА ТРАНСЛЯЦИИ ЗНАНИЙ В ЗДРАВООХРАНЕНИИ: ИНСТРУМЕНТЫ ДЛЯ ЕЕ РЕШЕНИЯ В ОБЛАСТИ БЕЗОПАСНОСТИ ПАЦИЕНТОВhttps://orcid.org/0000-0002-8745-6195KleymenovaE. B.КлейменоваЕлена Борисовна
Russian Federation

Moscow

Доктор медицинских наук, заведующая отделом управления качеством медицинской помощи.

117593, Москва, Севастопольский пр., д. 66, тел.: +7 (495) 676-80-11.

SPIN-код: 2037-7164

e.kleymenova@gmail.comhttps://orcid.org/0000-0002-0026-7720NazarenkoG. I.НазаренкоГерасим Игоревич

Moscow

Доктор медицинских наук, академик РАН, директор.

119333, Москва, ул. Вавилова, д. 44/2, тел.: +7 (499) 135-12-46.

SPIN-код: 2362-1001

gerasimnazarenko@gmail.comhttps://orcid.org/0000-0003-1357-0056PayushchikS. A.ЯшинаЛюбовь Петровна

Moscow

Кандидат биологических наук, консультант отдела управления качеством медицинской помощи.

117593, Москва, Севастопольский пр., д. 66, тел.: +7 (495) 676-80-12.

SPIN-код: 1910-0484

lyashina1@yandex.ruhttps://orcid.org/0000-0002-7350-0423YashinaL. P.ПающикСветлана Александровна

Moscow

Кандидат медицинских наук, заместитель заведующего отделом управления качеством медицинской помощи.

117593, Москва, Севастопольский пр., д. 66, тел.: +7 (495) 676-83-91.

SPIN-код: 1367-6633

svetlanapay@gmail.comGeneral Medical Center of the Bank of RussiaМногопрофильный медицинский центр Банка РФInstitute of Modern Information Technologies in Medicine, Federal Research Center «Computer Science and Control» of the Russian Academy of SciencesИнститут современных информационных технологий в медицине ФГУ «Федеральный исследовательский центр «Информатика и управление» РАН160520187321051142808201715032018Copyright ©; 2018, "Paediatrician" Publishers LLCCopyright ©; 2018, Издательство "Педиатръ"2018"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/article/view/887

Adherence to evidence-based clinical guidelines enhances patient safety, but the level of knowledge implementation into routine practice remains unsatisfactory. The concept of knowledge translation (KT) was proposed as a «process that includes the synthesis, dissemination, exchange, and ethically sound application of knowledge» to define the framework of knowledge transfer from research to practical activities aimed at improving the quality and safety of healthcare. Although Russian authors pay much attention to translational medicine, the problem of implementation research is poorly discussed. Modern information technologies including clinical decision support systems (CDSS) play a crucial role in KT, but the evidence of their effectiveness is poor. The authors describe a systematic approach to the practical implementation of knowledge imbedded in clinical guidelines based on the use of CDSS. CDSS implementation was accompanied by organizational measures that ensured the overall success: creation of standard operating protocols and quality register, clinical audit with feedback, and staff training. The effectiveness of this approach in reducing the risk of inhospital complications in Moscow general hospital is illustrated by the example of hospital-acquired venous thromboembolism (HA-VTE) prevention. Implementation of a comprehensive program for HA-VTE prevention in 2014−2016 helped to increase the coverage with VTE and bleeding risk assessment from 15% to 80% (p<0.0001), to reduce the frequency of pharmacological prophylaxis defects from 50.6% to 23% (p=0.01), to increase the compliance with anticoagulant use from 50% to 76% (p=0.0005), without increasing the rate of hemorrhagic complications. The HA-VTE rates decreased from 10 to 4.25 cases per 1000 overall hospital admissions (p=0.001), from 8 to 1.27 cases per 1000 operations in surgical patients (p=0.001) and from 12 to 6.38 cases per 1000 hospitalizations in therapeutic patients (p=0.06; with a statistically significant downward linear trend for HA-VTE rate, p=0.038).

Соблюдение научно обоснованных клинических руководств способствует повышению безопасности медицинской помощи, однако уровень использования научных знаний в повседневной практике остается неудовлетворительным. Для процесса систематического внедрения научных достижений в практическую деятельность, нацеленную на повышение качества и безопасности медицинской помощи, была предложена концепция трансляции знаний как процесса синтеза, распространения, обмена и этически корректного применения знаний. Хотя в отечественной литературе трансляционной медицине посвящено немало внимания, проблема внедренческих исследований обсуждается недостаточно. Современные информационные технологии, включая системы поддержки принятия решений (СППР), играют важнейшую роль в трансляции знаний, однако доказательства их эффективности малочисленны. Авторы описали подход к практическому внедрению знаний, содержащихся в клинических руководствах, основанный на использовании СППР. Внедрению СППР сопутствовал ряд организационных мероприятий, обеспечивших общий успех программы: создание стандартных операционных протоколов, регистра по качеству, обратной связи, а также обучение персонала. На примере профилактики внутригоспитальных венозных тромбоэмболических осложнений (ВГ-ВТЭО) продемонстрирована эффективность данного подхода в снижении риска внутрибольничных осложнений в многопрофильном стационаре г. Москвы. Внедрение комплексной программы профилактики ВГ-ВТЭО в течение трех лет (2014−2016 гг.) позволило статистически значимо повысить охват первичной и повторной оценкой риска тромбозов и кровотечений с 15 до 80% (p<0,0001), снизить частоту дефектов фармакологической профилактики ВГ-ВТЭО с 50,6 до 23% (p=0,01), повысить адекватность применения антикоагулянтов с 50 до 76% (р=0,0005) без увеличения числа геморрагических осложнений. Показатели распространенности ВГ-ВТЭО снизились с 10 до 4,25 случаев на 1000 госпитализаций в целом по стационару (р=0,001), с 8 до 1,27 ― у хирургических (р=0,001) и с 12 до 6,38 ― у терапевтических (p=0,06; с достоверным линейный трендом в снижении частоты ВГ-ВТЭО, p=0,038) пациентов.

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