Open AccessAnalysis of medical records in a specialized osteopathic clinic in Moscow
Author(s) -
L. V Tumbinskaya,
Тумбинская Лидия Викторовна,
Olga V. Yashchina,
Ящина Ольга Владимировна,
M Yu Gerasimenko,
Герасименко Марина Юрьевна
Publication year - 2019
Publication title -
fizioterapiâ, balʹneologiâ i reabilitaciâ
Language(s) - English
Resource type - Journals
eISSN - 2413-2969
pISSN - 1681-3456
DOI - 10.17816/1681-3456-2019-18-1-28-32
Subject(s) - documentation , quality (philosophy) , control (management) , medical record , task (project management) , medical care , set (abstract data type) , medicine , medical emergency , computer science , family medicine , engineering , artificial intelligence , philosophy , systems engineering , epistemology , radiology , programming language
. In clinics, hospitals, public and private hospitals, it is necessary to ensure that documentation meets all the requirements of the industry regulator. Registration, maintenance, systematization, storage of medical documentation is a specific and difficult task, it serves as a means of proving the conduct of medical, diagnostic and other specialized procedures. Medical documents serve as a tool for monitoring the quality of medical services provided, confirming the fact of assistance and revealing its essence.
The goal is to conduct internal quality control of medical documentation and develop a set of measures to improve quality control of medical care.
Methods. The research uses statistical methods of data processing (calculation of shares, average) and analysis of literature data .
Conclusion. As one of the main indicators of the effectiveness of the chief physician, it is necessary to consider quality control of medical documentation, the most complete registration of it by specialists of the clinic and regular training of clinicians.