Methodological aspects of the study of the organization, quality and effectiveness of specialized medical care for patients with traumatic eye injuries

Abstract

This article presents a comprehensive analysis of methodological approaches to studying the organization, quality, and effectiveness of specialized ophthalmological care for patients with traumatic eye injuries in the Zakarpattia region of Ukraine. The relevance of this research is underscored by the significant burden of eye trauma globally and regionally, with the Zakarpattia region presenting unique challenges due to its geographical features, mountainous terrain, population distribution patterns, transportation accessibility issues, and socio-economic development factors that impact the healthcare system’s capacity to deliver specialized care.The study investigated regional peculiarities of medical care organization, analyzed information and statistical data, and identified key problems and shortcomings in the specialized care delivery system. The research was conducted from 2019 to 2023 across healthcare facilities in the Zakarpattia region that provide specialized ophthalmological care, utilizing multiple data sources including official statistics from the Medical Statistics Center of the Ministry of Health of Ukraine, healthcare facility documentation, medical records, patient questionnaires, and expert assessments of care quality. Aim – to develop and substantiate methodological approaches for studying the organization, quality, and effectiveness of specialized medical care for patients with traumatic eye injuries in the Zakarpattia region.Materials and methods. The research employed a systematic approach with multiple complementary methods including bibliosemantic analysis, medical-statistical analysis, epidemiological assessment, sociological surveys, expert evaluation, organizational modeling, and systems analysis. The study examined the structure and organization of the ophthalmological trauma service, evaluated the timeliness and completeness of medical care provision, and assessed the quality indicators through an integrated coefficient of medical care quality (IMCQ) calculated using a 5-point scale across multiple criteria.Results. The research developed an integrated methodology for assessing the quality and effectiveness of specialized ophthalmological care for eye trauma, incorporating criteria for accessibility, timeliness, adequacy, and effectiveness of medical interventions. Key findings revealed a three-tiered system of care delivery (primary, secondary, and tertiary levels) with significant resource disparities. The study identified that 35.7% of the region’s population lived beyond 60 minutes from the nearest ophthalmological facility, while 18.3% faced travel times exceeding 120 minutes for emergency eye trauma care. The analysis showed the highest quality indicators at the tertiary level (IMCQ = 0.92±0.04) compared to lower scores at primary (0.67±0.08) and secondary (0.78±0.06) levels. The epidemiological analysis revealed a trauma incidence rate of 2.78 cases per 100.000 population, 18.3% higher than the national average. Household injuries comprised 56.7% of cases, with contusions representing 44.8% of traumatic injuries. The research identified critical factors affecting care effectiveness, including delayed access to specialized treatment, inadequate equipment at primary care facilities, and suboptimal patient routing systems, with 47.3% of severe trauma patients initially presenting to primary care facilities lacking appropriate resources.Conclusions. The proposed methodology enables comprehensive assessment of ophthalmological trauma care organization and identification of optimization pathways. The developed structural-functional model for care optimization incorporates organizational, resource, medical, educational, and analytical components. Implementation of these approaches, including the multi-level prevention system and quality indicators, will enhance treatment effectiveness for patients with traumatic eye injuries and improve functional outcomes. The research establishes a foundation for regional healthcare policy improvements and provides a framework for monitoring and evaluating specialized ophthalmological care quality and accessibility.