Patient’s model for the surgical treatment and rehabilitation of diabetic foot syndrome

Object. Create a patient’s model with a neuro-ischemic form of diabetic foot syndrome in the stage of purulo-necrotic changes and calculate the completed case of treatment according to the profile of surgery in order to change the payment system by compulsory medical insurance.
Materials and methods. On the basis of the FSBO “A. V. Vishnevsky National Medical Research Center of Surgery” Ministry of Health of Russia has carried out a preliminary calculation of the average cost the complex surgical treatment by patients with neuroischemic form of DFS in the stage of purulo-necrotic changes (Wagner II-IV). The formation of the clinic and statistic group (CSG) is based on a set of basic and additional classification criteria that determine the relative cost of patients treatment. The main criteria are: diagnosis (ICD code 10), applied medical technology (code in accordance with the Nomenclature of Medical Services, approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 27, 2011 No. 1664n), as well as methodological recommendations for the CSG, approved by the Mandatory Medical Insurance Fund and the Ministry of Health for 2018. Additional classification criteria are: age category of the patient, concomitant diagnosis or complications of the disease, gender, duration of treatment. Expensive medications as additional classification criteria is possible to include if there are specific indications defined by clinical guidelines (treatment protocols). This rule applies only to drugs that are included in the List of vital and essential drugs for medical use. Differentiating signs in such subgroups can be services for the use of specific drugs. The level of costs is determined on the basis of the prevailing average level of purchase prices for these drugs in a constituent entity of the Russian Federation or in accordance with the registered maximum selling prices.
Results. The direct costs of treating a surgical patient with a neuroischemic form of DFS are 300,679 rubles 97 kop. and include: medical services for diagnosing the disease; medical services for treating and controlling a disease for a specified duration of treatment; medications; dressings and medical devices implanted into the human body. Overhead costs are 90,224 rubles 56 kop., and the preliminary total cost of a completed case of treatment is 390,904 rubles 47 kop.
Conclusion. Preliminary calculations clearly demonstrate the apparent lack of funding for the treatment of DFS. The existence of the needs of the clinical community for the formation of new or updated CSG based on the clinical recommendations of specialists (and not on the minimum services from medical and economic standards (MES)), using principles and methodological approaches for patient models, will help make it clear providing quality personalized care to patients.

1. Dedov I. I., Shestakova M. V. diabetes mellitus. Guide for doctors. Moscow: Universum publishing.

2. Suntsov I., Dedov I., Shestakova M. V. screening of complications of diabetes mellitus as a method of assessing the quality of medical care for patients. According to the results of 5 years of scientific and practical project. Moscow: Mobile Diabetes Center, 2008.

3. International Consensus on the Diabetic Foot and Practical Guidelines on the Management and the Prevention of the Diabetic Foot. International Working Group on the Diabetic Foot, 2007, www.iwgdf.org

4. Klonoff D. C., Schwartz D. M. An Economic Analysis of Interventions for Diabetes. Diabetes Care. 2000; 23: 390–404.

5. International Diabetes Federation, Diabetes Atlas, 6th edition. 2012. www.diabetesatlas.org

6. Dedov I. I., Shestakova M. V., Vikulova O. K. Epidemiology of diabetes in the Russian Federation: clinical and statistical analysis according to the Federal register of diabetes. Diabetes = Saxarny`j diabet. 2017; 20 (1): 13-41 (in Russ.).

7. Komeliagin E. Yu., Antsiferov M. B. risk Factors and prevention of diabetic foot syndrome. Russian medical journal = Russkij medicinskij zhurnal. 2003; 11 (27): 1514 (in Russ.).

8. The resolution adopted by the UN General Assembly, 20.12.2006].

9. Suntsov Yu. I., Dedov I. I., Bolotskaya L. L. Economic effect of the use of modern technologies in the treatment of diabetes. Diabetes = Saxarny`j diabet. 2006; 2: 60-62 (in Russ.).

10. Dedov I. I., Udovichenko O. V., Galstyan G. R. the Diabetic foot. Moscow: Practical medicine, 2005.

11. Dedov I. I. Diabetes mellitus is a global medical and social problem of our time. Federal reference book "health care In Russia". 2011. Vol. 11.

12. Cavanagh P., Attinger C., Abbas Z. et al. Cost of treating diabetic foot ulcers in five different countries. Diabetes Metabolism Research and Reviews. 2012; 28 (1): 107–111.

13. Hunt N. A., Liu G. T., Lavery L. A. The economics of limb salvage in diabetes. Plastic and Reconstructive Surgery. 2011; 127 (1): 289–295.

14. Ragnarson-Tennvall G., Apelqvist J. Health-economic consequences of diabetic foot lesions. Clinical Infectious Diseases. 2004; 39 (2): 132–139.

15. Kalashnikova M. F., Maksimova N. V., Udovichenko O. V., Suntsov Y. I. Pharmacoeconomic aspects of treatment of diabetic foot syndrome. Diabetes = Saxarny`j diabet. 2010: (2): 113-119 (in Russ.).

16. Boulton А., Connor H., Cavanagh P. The foot in diabetes. Thirdedition, 2002.

17. Winter G. D. Formation of scab and the rate of epithelialisation of superficial wounds in the skin of the domestic pig. Nature, 2000; 377–378.

18. Jurczak F., Dugré T., Johnstone A. et al. Randomised clinical trial of Hydrofiber dressing with silver versus povidone-iodine gauze in the management of open surgical and traumatic wounds. International Wound Journal. 2007; 4 (1): 66–76.

19. Meaume S., Teot I., Lasareth I. et al. The importance of pain reduction through dressing selection in routine wound management: the MAPP study. J Wound Care 2004; 13 (10): 409–413.

20. Udovichenko O. V., Galstyan G. R. Algorithms of choice of dressing material for the treatment of diabetic foot syndrome (on the example of Paul Hartmann bandages). Diabetes = Saxarny`j diabet. 2006; 46-52 (in Russ.).

21. Resolution of the Government of the Russian Federation of December 08, 2017 № 1492 " on the Program of state guarantees of free provision of medical care to citizens for 2018 and the planning period of 2019 and 2020.

22. Guidelines for methods of payment for medical care at the expense of CHI, approved by the Ministry of Health and the Federal Compulsory health insurance Fund of 22.12.2016, document from the website https://www.rosminzdrav.ru/.

23. Changes to the Guidelines on methods of payment for medical care at the expense of CHI, approved by the Ministry of Health and the Federal Compulsory health insurance Fund, a joint letter dated November 21, 2017, the document from the website https://www.rosminzdrav.ru/.

24. The nomenclature of medical services approved by the order of the Ministry of health and social development of the Russian Federation of December 27, 2011 № 1664n.

25. Galstyan G. R., Tokmakova A.Yu., D.N. Egorova D. N. et al. Clinical guidelines for diagnosis and treatment of diabetic foot syndrome. Wounds and Wound Infections. The Prof. B. M. Kostyuchenok Journal = Rany` i ranevy`e infekcii. Zhurnal im. prof. B. M. Kostyuchyonka. 2015, 3 (2): 63–83 (in Russ.).