Comparative analysis of functional and organizational models of regional centers for the care of large joint diseases in Central and Eastern European countries and Ukraine

Abstract

Purpose is to conduct a comparative analysis of the functional and organizational models of regional centers for the provision of care for diseases of large joints in the countries of Central and Eastern Europe and to determine the organizational mechanisms suitable for integration into the health care system of Ukraine in the conditions of its post-war recovery. Materials and Methods. The research is comparative descriptive-analytical. Four countries (Poland, the Czech Republic, Slovakia, and Slovenia) were selected for analysis based on common historical prerequisites for the development of the health care system and the presence of specialized centers. Scientific publications in open access, regulatory and legal documents, data from national arthroplasty registers, information resources of official web pages of institutions, materials of previous studies served as materials. The comparative analysis was carried out according to five parameters: the organizational structure of the center, the patient’s route, the system of registration and monitoring of treatment results, the financial model of operation and the mechanisms of intersectoral interaction. The bibliosemantic method, the method of structural and logical analysis, comparative analysis and the modeling method were used. Results. Significant differences have been established between the models of the countries under study in terms of the level of integration, the presence of registers of results and mechanisms of intersectoral interaction. The Czech model is the most developed: it implements the “single window” concept, combining preoperative preparation, surgical treatment and rehabilitation in a single structure; The National Joint Replacement Registry (NJRR) has been operating since 2002 and publishes annual reports with public placement of institutions. The Slovak model is distinguished by the legally required participation of all institutions in the arthroplasty register (SAR, since 2003), which ensures 100 percent coverage of operations throughout the country. The Polish experience is valuable primarily as a cautionary example. The three-level system of care organization (district hospitals, regional departments, university centers) is supplemented by high-tech private clinics. However, the reform of centralized electronic waiting lines mostly failed to achieve its goals due to the inherited weakness of primary care and staff shortages. The Slovenian case confirmed that structural reforms without simultaneous work with a culture of inter-organizational cooperation and elimination of macro-level barriers remain ineffective. The system of orthopedic and trauma care in Ukraine is characterized by the following indicators: the presence of a basic digital infrastructure (EHCS, electronic queue, centralized procurement), but in the absence of a register of results; functioning of the electronic queue for endoprosthesis in the absence of long-term structured postoperative supervision; legislative consolidation of the Medical Guarantee Program with undeveloped financial models of individual centers. These data indicate a significant scale of activity, but without recording the results, it is impossible to assess its quality. Conclusions. According to the results of the comparative analysis, four priority elements for adaptation in Ukraine have been identified: introduction of the arthroplasty register with a legislative basis based on the EHCS; closing the patient’s route through mandatory follow-up examinations 6 and 12 months after surgery; integration of surgery and rehabilitation under one roof; introduction of public quality reporting.