EFFICACY ASSESSMENT OF MODERNIZATION OF CHILDREN’S POLYCLINIC OPERATION ACCORDING TO DALY CRITERION

Terletskaya R.N.¹, Sukhinin M.V.², Shcherbakova S.V.¹

¹The Centre of science of health of children of RAMS, Moscow

²The Russian National Research Medical University after N.I. Pirogov,

Moscow

Introduction. By present time a concept of avoidable losses of population health has been developed. This concept reflects an idea of concentration of the efforts on those issues of health and healthcare which could be solved at the current level of health protection. The index of avoidable losses of population health could serve as efficacy measure of medical, social, economical and political activities aimed to community health care. DALY (Disability-Adjusted Life Years) criterion [1, 4] is suggested for quantitative assessment of burden of healthy life years loss.

Main purpose of health care modernization in our country is to provide most favorable conditions for preservation and improvement of children’s health. Great practical importance belongs to analysis of changes of child population health, which will allow taking differentiated measures to enhance ambulatory-policlinic care of different age kids [2].

Materials and methods. Analysis of morbidity and disability of child population, residing in health service zone of Moscow Children’s Policlinic No.118, based on official statistic data (Form 12, 19; demographic collections), had been executed within 2007 – 2011 period. The process tendency was determined by trends modeling with application programs help.

Scheduling of chronic pathologies emergence and disability formation within different disease classes had been done based on data from Compulsory Medical Insurance System personified bases.

Calculation of number of life years per person with correction to activity limitation caused by health damages (DALY) was made. The index is a linear sum of potentially lost years of life.

Results. The researches had provided all data necessary for DALY calculation relating to different diseases of child population from the medico prophylactic institution service area. Thus, population aged up to 17 y.o. inclusive was known along with number of disease cases, as well as most significant (in terms of disability and mortality) ones. Average age of disease emergence in general and related disability had been calculated. Life expectancy had been calculated on base of life expectancy at birth in Moscow. Two extreme years of observation were compared. The mentioned indexes with respect to Moscow for 2007 and 2011 are shown in Table 1.

Table 1.

Basic characteristics necessary for DALY calculation

Characteristics	2007	2011
Population 0-17 y.o.	9761	11113
Life expectancy at birth in Moscow, years [3]	72,50	73,61
Life expectancy at 17 y.o. in Moscow, years	55,51	56,62

DALY criterion had been calculated for different diseases. Significant (by 30.1%) decrease of quantity of lost life years connected with morbidity and disability in general was revealed both for absolute value and recalculation in 100,000 child population. This happened mainly at the expense of diseases of derma and hypoderm, blood circulation system, respiratory system, infections. At the same time losses increased at diabetes mellitus, injuries and intoxications. An absolute increase of health life years loss, caused by digestive apparatus, urogenital system, anemia diseases, did not accompanied by increase of DALY criterion as per 100,000 of child population. In view of different directions of DALY criterion changes at different pathology we had compared them with morbidity and disability rates dynamics (Table 2).

Table 2

Morbidity, disability and DALY criterion rates at different diseases

(per 100,000 child population)

Health loss reasons	Rates per 100,000 of children population
	morbidity		disability		DALY criteria
	2007	2011	2007	2011	2007	2011
Total diseases, incl.	1758.7	1200.6*	148.55	119.68*	8374189.99	5850005.76*
infectious and parasitic diseases	44.0	30.1*			219356.52	153340.05*
neoplasm	1.9	1.8	5.12	4.5	8235.73	7814.27
blood and blood-forming organs diseases	8.0	8.0	2.05	-	42034.42	43022.41
anemia	7.5	7.6	-	-	40093.54	41853.68
endocrine system diseases	56.3	42.7*	17.42	13.5*	255643.89	198245.12*
diabetes mellitus	4.3	6.3*	11.27	11.7	19754.33	29617.57*
obesity	24.1	13.1*	-	-	113178.47	63218.93*
nervous system diseases	51.2	29.3*	23.56	29.69	251032.68	147357.33*
eye diseases	138	137.1	8.2	9.0	673454.26	684460.36
myopia	62.8	47.7	-	-	279527.00	217570.41*
ear diseases	75.6	43.3*	12.29	6.3*	355514.60	208320.17*
blood circulation system diseases	12.0	5.5*	-	-	51074.38	23998.20*
respiratory system diseases	1078.1	631.0*	15.37	7.2*	5024480.38	3010821.92*
asthma	16.3	14.2	15.37	7.2*	76348.63	68440.21*
digestive apparatus diseases	56.1	52.0*	2.05	27.0*	250411.64	237309.10*
derma and hypoderm diseases	20.4	9.8*	1.02	-	105604.86	51905.70*
musculoskeletal system diseases	106.0	111.6	7.17	5.4	459140.97	495572.75*
urogenital system diseases	66.2	64.6	7.17	6.3	329471.98	328831.64
congenital anomalies	25.1	21.5	46.1	35.09*	128208.69	112319.63
trauma, intoxication	6.7	7.5	1.02	-	32429.57	37209.21*

* reliable differences 2011 vs. 2007, p<0.05

Decrease of health loss took place both owing to both morbidity and disability. Similar tendencies were registered in dynamics of neoplasm, endocrine system, ear and respiratory system diseases as well as congenital anomalies. DALY criterion increase due to morbidity and disability was registered at diabetes mellitus; due to morbidity only – at anemia, musculoskeletal system diseases, trauma and intoxications; due to disability only – at nervous system diseases, eye and its supplementary apparatus diseases.

It’s determined that decrease of morbidity and disability provided by urogenital system diseases had not resulted in DALY criterion reduction.

Conclusion. Thus, during period of modernization of pediatric polyclinic operation positive trends in children health conditions had been registered. As morbidity and disability rates usually are analyzed separately, they cannot provide such children health characteristic that would help to optimize application of granted resources and assess efficacy of health care system. DALY criterion usage allows determining real health loss even at differently directed dynamics of morbidity and disability rates caused by different diseases. It also makes possible to evaluate effectiveness of taken actions. The research had revealed reserves for improvement of children polyclinic operation while caring of different aged children.

Literature:

1. Baranov А.А., Аl’bitsky V.Yu., Terletskaya R.N., Zelinskaya D.I. Concept of reduction of avoidable children health losses // Contemporary Pediatrics Issues. 2010, No. 5, pp.8-12.

2. Burdeiny N.N. Effectiveness of state social policy in modernization terms (by the example of health care system) // People’s Friendship University of Russia Bulletin. Series: Sociology. 2012. No. 1. pp. 59-65.

3. Russian Demography Annual. 2011. М.: Rosstat. 2012. p.104.

4. Terletskaya R.N., Babkina L.M. DALY criterion application for evaluation of children’s health loss at respiratory system diseases // Contemporary Pediatrics Issues. 2010. No. 6. pp.16-18.

EFFICACY ASSESSMENT OF MODERNIZATION OF CHILDREN’S POLYCLINIC OPERATION ACCORDING TO DALY CRITERION

Terletskaya R.N.¹, Sukhinin M.V.², Shcherbakova S.V.¹

¹The Centre of science of health of children of RAMS, Moscow

²The Russian National Research Medical University after N.I. Pirogov,

Moscow

SUMMARY: The research has been conducted in accordance with the concept of reduction of avoidable health loss among children. First results of DALY criterion application for evaluation of health life years loss burden in childhood had been represented. It’s been shown that this criterion usage allows to determine real health losses at multidirectional dynamics of morbidity and disability rates in connection with different diseases, as well as to evaluate efficacy of pediatric polyclinic’s operation modernization. During the research period positive tendencies in children’s health conditions have been registered and reserves for further enhancement of medical care provided by polyclinics revealed.

KEY WORDS: children population, morbidity, disability, DALY criterion, modernization of health care.