Assessment of the activities of regional blood systems in Ukraine, 2016–2020

Abstract

The activities of regional blood systems (RBS) of each region determine the stability and quality of transfusion care in medical institutions. During 2016–2020, unfavorable dynamics of key indicators of the national blood system were revealed: the number of donors decreased by 22.4%, donations – by 19.1, and the volume of erythrocyte-containing components issued to hospitals – by 14.8%.Under these conditions, there was a need to create strategic monitoring based on a comparative rating assessment of the RBS. Rating indices, built according to unified criteria, are able to quickly reflect gaps and allow objectively comparing regions with each other in dynamics.Purpose of the scientific study. Using the rating assessment methodology, to determine the status of the activities of the RBS of Ukraine and form an information basis for management decisions.Materials and methods. The activities of 22 RCCs were analyzed according to official data of the Ministry of Health of Ukraine and the National Academy of Medical Sciences for 2016–2020. The list of indicators was formed using the Delphi method. Each indicator reflects the final result of the work of the subjects of the blood system. The indicators are grouped into two blocks: Block 1. “Provision of the population with blood components” contains four indicators calculated per 1000 population: “number of donors”, “doses of erythrocytes issued to hospitals”, “doses of apheresis platelet concentrate”, “volume of plasma for fractionation”.Block 2. “Efficiency of activity” covers six relative values, in particular the volume of plasma and the number of doses of CTA prepared by apheresis per one separator, as well as the ratio of the components obtained to the number of personnel; this reflects labor productivity and the use of technological equipment.Characteristics of indicators. Indicators of block 1 cover the status of donation, the volume of erythrocytes, platelets and plasma suitable for fractionation, while block 2 assesses personnel productivity (doses/employee) and technological capacity (liter of plasma or doses of CTA per separator), which allows for a correct comparison of regions with different material and technical bases.Ranking mechanism. The ranking place was determined in three stages. First, each system was ranked by the value of each indicator; the obtained points (from 1 to 22) were summed within the block, forming an intra-block rank. At the third stage, the results of the two blocks were summed, which gave an integral indicator of the activity of the RCC for each year. Statistical processing was performed in Microsoft Excel. The ranking procedure is transparent and reproducible in regional statistics centers.Results. In block 1, the highest indicators (90.6–108.8 points) were demonstrated by the regional blood banks of Dnipropetrovsk, Zaporizhzhia, Volyn, Poltava, Mykolaiv, Sumy and Khmelnytskyi regions. In block 2, the leaders were Mykolaiv (131.0 points), Dnipropetrovsk (126.6), Kyiv (118.2), Sumy (117.0), Vinnytsia (110.8), Kharkiv (98.8) and Khmelnytskyi (90.8). Another six regional blood systems scored 69.6–90.5 points, while ten received 42.8–69.5 points, which indicates a significant unevenness of provision between regions. High transfusion activity was recorded in Mykolaiv, Volyn, Dnipropetrovsk, Zaporizhzhia and Khmelnytskyi regions.The Zakarpattia, Chernivtsi, Luhansk, Cherkasy, Ternopil, Kirovohrad, Kherson, Odesa and Ivano-Frankivsk regions remain in the risk zone (<150 points).Additional results. According to the aggregate rating (both blocks), the first seven places on average over five years were occupied by the Dnipropetrovsk (235.4 points), Mykolaiv (224.2), Sumy (208.2), Kyiv city (192.0), Vinnytsia (187.4), Volyn (186.4) and Kharkiv (182.2) regions. Six regions formed the “average” group (150–180 points), and nine – the “control zone” (<150 points). This allows for targeted planning of resources and support.The ratings obtained annually provide the Ministry of Health with the opportunity to promptly direct financial support, adjust the state order for the procurement of blood components, and also plan training programs for blood service personnel.Conclusions. The ranking analysis revealed the strengths and weaknesses of each RCC, forming the basis for targeted measures to increase the availability of blood components and work efficiency. The proposed set of indicators, especially the “Effectiveness of activity” block, can be used as a basis for continuous strategic monitoring. The developed methodological approaches form an information base for operational and strategic decisions at the regional and national levels.