A new 3DT-paradigm of management of traumatological and orthopedic care in three age groups

Abstract

The interests of society and the modern rhythm of life have shifted the focus towards early rehabilitation, including surgical rehabilitation, and predetermined requirements of functional activity and quality of life in all age groups.The purpose of study – search for ways to optimize the organization of the traumatological and orthopedic service, taking into account the age continuity of nosologies and the inclusion of subgroups of orthopedic diseases of childhood, degenerative diseases, destructive, incl. tumor and traumatic in the model proposed by the authors.Material and methods. Forms of Federal Statistical Observation. The evaluation criteria were data on the prevalence of musculoskeletal diseases for 2019.Results and discussion. An analysis of the primary diagnosis of the orthopedic pathology by regions of the Russian Federation showed extreme variability, and the availability of care does not depend on the population and billing in the regions. The monetary value of the treatment of both planned and urgent pathology has shortcomings in standardization and harmonization between regions. The authors substantiate the new “3DT” organizational concept as the basis for a stable and understandable model of the country’s traumatology and orthopedic service for administrators and the population. The model identifies four areas of directions for assessing the pathology of the musculoskeletal system: “D1” (“children’s” diseases and their outcomes); “D2” (degenerative and involutive pathology); “D3” (destructive diseases of tumor or infectious pathology); “T” (trauma of and its consequences), which have fundamentally different approaches to the organization and planning of medical care.Conclusion. The directions of the “3DT” model require different approaches to the organization of medical care. Groups “D1” and “D2” must be implemented through national (federal) programs, for groups “D3” and “T” the approach of payment for the completed case is applicable. In each sector, it is necessary to indicate the basic, additional and optional amount of assistance. The target indicator for the stability and effectiveness of the model for organizing specialized assistance should be considered to be the provision of a basic level, and the possibility of financing additional assistance cannot be at the expense of providing basic assistance.