And about. Health Committee Evgeny Yevdoshenko held a meeting on the implementation of Federal Law No. 256 in St. Petersburg Today, the Health Committee held a meeting with the heads of medical institutions who have reached the age of 65 and are seeing off for a well-deserved rest in connection with the implementation of Federal Law No. 256. Today, the Health Committee held a meeting with the heads of medical institutions who have reached the age of 65 and are seeing off...
The All-Russian Congress “Providing Assistance to Families with Seriously Ill Children. New Opportunities” On September 25, the IV All-Russian Congress dedicated to helping families with seriously ill children began its work in St. Petersburg. Acting President addressed the audience with a welcoming speech. Chairman of the Health Committee of St. Petersburg Evdoshenko Evgeny Petrovich. He thanked the congress participants for their work aimed at improving the quality of life of seriously ill children...
The Department of Radiation Occupational Pathology was opened at the Hospital for War Veterans On September 22, a solemn opening of a specialized department of radiation occupational pathology took place at the Clinical Hospital for War Veterans. The event was attended by the Governor of St. Petersburg G.S. Poltavchenko, Vice-Governor of St. Petersburg A.V. Mityanina, acting Chairman of the Health Committee E.P. Evdoshenko, Deputy Chairman of the St. Petersburg regional branch of Soyuz LLC "...
Evdoshenko Yevgeny Petrovich, who thanked the participants of the congress for the work aimed at improving the quality of life of seriously ill children. “The degree of involvement of such children in society is a reflection of the maturity of the whole society. This is a shared responsibility! And our task is to help children with incurable diseases and their relatives with our work,” Evgeny Petrovich noted, drawing attention to the fact that, based on the results of the work of the Congress, it is necessary to form the most effective...
Evdoshenko Evgeny Petrovich, acting on the basis of the Regulations on the Committee on Health, approved by the Decree of the Government of St. Petersburg of December 27, 2013 No. 1070 "On the Committee on Health", announces a competition for filling the vacant position of the state civil service of St. Petersburg - Chief Specialist of the Department of Economics and long-term planning of the Health Committee. Qualification requirements: higher education in one of the special...
Evdoshenko Evgeny Petrovich, acting on the basis of the Regulations on the Committee on Health, approved by the Decree of the Government of St. Petersburg dated December 27, 2013 No. 1070 "On the Committee on Health", announces a competition for inclusion in the personnel reserve of the Committee on Health for the position of the state civil service of St. Petersburg - chief specialist of the department for organizing outpatient medical care for the adult population of the Health Committee. Qual...
Evdoshenko Evgeny Petrovich was born on June 29, 1980 in Leningrad in a family of doctors. In 2003 he successfully graduated from the St. Petersburg State Pediatric Medical Academy as a doctor. He began his continuous medical experience in 1999 (at the age of 19) from the very first steps - a nurse of the neurosurgical department of the Polenov Russian National Institute of Chemistry, a paramedic of a specialized neuro-resuscitation ambulance team. Since 2000, he took subordination in neurology at the Mariinsky Hospital in St. Petersburg in the admissions department, the department of nervous diseases and neuroreanimation. From 2003 to 2005 he was trained in clinical residency in nervous diseases. After completing residency from 2005 to 2011, he worked as a neurologist at the Leningrad Regional Clinical Hospital at the Department of Neurology under the guidance of Professor Zaslavsky L.G. During his work as a neurologist, he showed his main interests in urgent neurology, cephalgia, autoimmune and neurodegenerative diseases of the central nervous system. He began to participate in international clinical trials as a physician co-investigator since 2005. Has a permanent GCP certificate (2005/2011). Since 2006, he has been trained in various certification cycles in the specialty of nervous diseases, immunology, laboratory diagnostics. Since 2006, under the guidance of Professor Zaslavsky L.G. on the basis of the Regional Hospital and the Department of Neurology and Neurosurgery with the clinic of the St. Petersburg State medical university named after A.P. Pavlov, work began on the dissertation topic for the degree of Candidate of Medical Sciences: “Changes in blood flow in the cerebral and middle cerebral arteries and options for their correction in patients with various types of tension headache”. In 2010 this work was successfully defended and Evgeny Petrovich was awarded the degree of Candidate of Medical Sciences.
Since 2007, Dr. Evdoshenko has been actively interested in autoimmune diseases. nervous system. He was trained in multiple sclerosis in 2007 and in 2010 at the Sheba Israel Clinic (under the guidance of Professor A. Achiron), a participant in 3 advanced training programs in multiple sclerosis (SSIF Barcelona, Gothenburg, St. Petersburg). Since 2007, under the guidance of Professor Zaslavsky L.G. organized medical care for patients with multiple sclerosis in Leningrad region(Leningrad Regional Center for Multiple Sclerosis).
In 2010, at the initiative of the Government of St. Petersburg, under the leadership of the chief neurologist of St. Petersburg, Academician of the Russian Academy of Medical Sciences, Professor Alexander Anisimovich Skoromets and the chief physician, MD Anatoly Yuryevich Ryvkin, Evgeny Petrovich created a city specialized medical center for multiple sclerosis and autoimmune diseases on the basis of the city clinical hospital №31. Since 2011, the Center began to work under the leadership of Dr. Evdoshenko. Currently, it is one of the largest Multiple Sclerosis Centers not only in the Russian Federation, but also in Europe. Every month, more than 1,000 patients with multiple sclerosis receive highly qualified medical care, including children. The Center has an integrated approach, unique for domestic medicine: a combination of practical health care, applied science and teaching. Such work of the Center attracted the attention of not only Russian, but also foreign colleagues. Currently, the Center has close scientific cooperation with leading hospitals and universities in Great Britain, Italy, Spain, the USA, Canada, Israel and other countries. Joint scientific work represented in prestigious international scientific journals and on international conferences. The staff of the Center and Dr. Evdoshenko regularly take advanced training courses in European clinics according to the experience exchange system. In June 2013, together with the Government of St. Petersburg, Academician Skoromets A.A. and Evdoshenko E.P. met at the RS Center in St. Petersburg Nobel laureates in biochemistry and molecular biology and major world-class scientists:
- Aaron Ciechanover– Nobel Prizĕ Laureate
- Jules Hoffmann– Nobel Prizĕ Laureate
- Richard Roberts– Nobel̆ Laureate
- Jack Szostak– Nobel̆ Laureate
- Susumu Tonegawa - Nobel laureate
- Richard Lerner - President of the Scripps Research Institute
- Michael Sela is Professor of Immunology at
- Ruth Arnon - Professor of Immunology at Weizmann Institute of Science
- Joseph Schlessinger - Director of Pharmacology at Yale
- Inda Abubakar - professor, director Molecular Physiology and Therapeutics Branch, The National Institutes of Health
- Skryabin K.G., Academician of the Russian Academy of Sciences
- Skoromets A.A., Academician of the Russian Academy of Medical Sciences
- Gabibov A.G., corresponding member. RAS
- Evdoshenko E.P., Associate Professor, Head of the RS Center St. Petersburg
Dr. Evdoshenko's one-hour lecture on personalized medicine, immunology in clinical application attracted the most great attention colleagues. The result of the meeting was an agreement on cooperation, the inclusion of the MS Center of St. Petersburg in a number of world projects on immunology, multiple sclerosis. Russia in this project presents Dr. Evdoshenko E.P.
It is important to note that thanks to Evdoshenko E.P. introduced into clinical practice scientific approaches and diagnostic tests, for example, in 2010, together with his friend and colleague, the head of the laboratory for the diagnosis of autoimmune diseases, Ph.D. Lapin Sergei Vladimirovich in the Russian Federation appeared a diagnostic test for antibodies to akvporin-4; In 2012, testing began on methods for detecting antibodies to interferon beta, a biological response study (MX pr) and a number of other important diagnostic tests that became available to patients and doctors in routine clinical practice. It is also important to note that major work was completed in 2013 to identify predictors of multiple sclerosis in collaboration with more than 20 countries. Amazing data has been obtained and accepted for publication in the Lancet Neurology.
One of the important components of the work of Dr. Evdoshenko is the conduct of clinical trials of new drugs. Having experience since 2005, Evgeny Petrovich began his participation as a research coordinator. Since 2011, he has been the principal investigator in more than 15 clinical trials. He is a member of many scientific councils for drug development and clinical trials. He is a consultant for more than 20 pharmaceutical companies in the EU, USA, RF on the development of dosage forms, support and safety.
Evgeny Petrovich began his teaching career in 2010 as an assistant at the Department of Neurology and Neurosurgery of the St. Petersburg State Medical University named after I.P. Pavlov under the guidance of Academician of the Russian Academy of Medical Sciences Professor Skoromets A.A. Currently, he has considerable experience as a lecturer, more than 20 presentations annually at various congresses in the Russian Federation, Europe and the CIS. Lectures for neurologists of practical health care in St. Petersburg, pediatric neurologists of the Russian Federation, neurologists of certification cycles of various major universities in St. Petersburg, training in residency, internship and advanced training. Since 2012, several groups of doctors from the EU and Canada have been trained on the basis of the City Center for Multiple Sclerosis.
Doctor, scientist and organizer - these are the three main components of the work of Evdoshenko Evgeny Petrovich. At 33 years old, the work schedule is 18 hours a day, 7 days a week, without holidays for 8 years.
On June 28, 2017, at the exit of my house, a treacherous attack two persons in civilian clothes, who, using special techniques and special equipment - handcuffs, placed me in a private car without identification marks of state bodies and, having picked up a third accomplice along the way, delivered me to the State Healthcare Institution without explaining the reasons and any documents confirming the legality of their actions " urban mental asylum No. 6" (hospital with a dispensary), where they illegally detained for 27 days without explanation.
Such criminal acts did not go unnoticed by the public and the necessary appeals were immediately sent to this fact, which can be found in my materials.
My resources report on the case of Rybakova N.F., who paid with her health for the revealed facts of fraud with warrants for residential premises in St. Petersburg. She was personally threatened by the head of the Main Directorate of the Ministry of Internal Affairs of Russia for St. Petersburg and the Leningrad Region, who was involved in the criminal prosecution against me on fabricated materials.
Nina Fedorovna sent the necessary report about the crimes committed against me to the authorities, after which she received the following "response" -
Suppose.
So, what did Valery Mikhailovich Kolabutin answer?
Nothing. He "hit the run", that is, he urgently went on vacation, and then quit ...
But his associates are still in office.
This is Pilipenko Vasily Viktorovich -
You can learn about all these comrades from publications in this LiveJournal and my other information resources.
The place of the escaped Kolabutin V.M. occupied by Acting Evdoshenko Yevgeny Petrovich -
In the Health Committee of the St. Petersburg government, power was changed according to the scenario previously described by the Spiritless. Chairman Valery Kolabutin left his post, in his place, for the time being, first deputy Yevgeny Yevdoshenko was appointed.
On Wednesday, May 23, the press secretary of the governor, Andrey Kibitov, announced the reshuffles that had taken place in the Health Committee. Valery Kolabutin, who has been chairman since 2012, left his post of his own free will. First Deputy Head of Department Yevgeny Yevdoshenko was appointed Acting Chairman. The fact that in the Health Committee in the summer, Spiritlessness was written back in May.
Andrey Kibitov also clarified that Valery Kolabutin is now enlisted as a staff adviser to Governor Georgy Poltavchenko on health issues.
Recall that Valery Kolabutin became the first chairman of the health committee who is not a doctor and does not have a medical education. It also never happened before that the head of the Territorial Compulsory Medical Insurance Fund, that is, the one responsible for financing the city health care system, also headed it. Since the creation of the CMI system and the formation of the St. Petersburg Terrfond, the financial and executive structures of power in the city health care have been in strained relations.
Kolabutin was replaced by his current first deputy Yevgeny Yevdoshenko. He, unlike the chairman, has medical education- in 2003 he graduated from the St. Petersburg State Pediatric Medical Academy as a doctor. “I started my continuous medical experience in 1999 (at the age of 19) from the very first steps - a nurse of the neurosurgical department of the Polenov Russian National Institute of Chemistry, a paramedic of a specialized neuro-resuscitation ambulance team,” says Evdoshenko's official biography.
Prior to his appointment to the health committee, Evdoshenko participated in the creation of a specialized Medical Center multiple sclerosis and autoimmune diseases at the city clinical hospital №31. Since 2011, the Center began to work under the leadership of Dr. Evdoshenko. Currently, it is one of the largest Multiple Sclerosis Centers not only in the Russian Federation, but also in Europe.
Note that the Health Committee is a wealthy department. Its budget for 2017 exceeded 73.5 billion rubles. Most of this money is spent on maintaining and subsidizing city hospitals.
Causes:
Valery Kolabutin has a bad relationship with the profile vice-governor Anna Mityanina, who was appointed to this position in February 2017. Rumors about his possible resignation appeared even before she joined the city government.
Consequences:
It can be expected that Yevgeny Yevdoshenko will soon become chairman of the Health Committee on a permanent basis.
It should also be noted that Alexander Rzhanenkov, chairman of the Committee on Social Policy, also has. However, he is a political long-liver in the city government, it will be more difficult for the vice-governor to achieve his dismissal than the dismissal of Kolabutin.
The new leadership promises big changes to the city's healthcare system. Evgeny Evdoshenko, head of the St. Petersburg Health Committee, explains why these changes are necessary and what they will be based on.
Evgeny Petrovich, despite the fact that your professional development took place in St. Petersburg, you worked in the capital for a long time and you are already connected with Moscow. Therefore, many believe that you were called to create a healthcare system similar to Moscow.
It is impossible to create a system similar to Moscow, Kazan or Tambov. Each regional system health care has its own characteristics associated with the size of the population and its structure, funding, regional policy. Therefore, it is wrong to say that we will create something similar to Moscow healthcare, we have many differences. In general, it is incorrect to take any, even a very successful healthcare system, and extrapolate it to St. Petersburg.
- You promised big changes to the healthcare system in St. Petersburg. Which?
Everyone says: "Something needs to be changed." But everyone means something different by changes: construction, modernization, cutting ribbons with the distribution of awards. And any problem must be considered comprehensively, therefore, before embarking on changes, it is necessary to clearly and clearly understand at what point of the coordinate system we are.
There is a strategy for the socio-economic development of the city, which outlines the general goal - a stable improvement in the quality of life of citizens, increasing the global competitiveness of St. Petersburg, ensuring economic growth and using the results of innovative and technological activities. It is impossible to achieve this without a person, and therefore without medicine. All participants in the process of achieving the goal must understand that they are not just tightening the nuts, the nut is part of the mechanism, and this mechanism will not work without it. Both the ordinary doctor and the main one in this process perform, as it were, a small task, but when it merges into one with other completed small tasks, this will lead to an improvement in the quality and standard of living of St. Petersburg residents. By 2025, a life expectancy of 80 years will be an indicator of achieving the goal. This means that we must consistently work to increase life expectancy, the birth rate, and reduce mortality from neoplasms and diseases of the circulatory system.
- But how can only the healthcare system be responsible for the life expectancy of the population?
In addition to mortality and fertility, no other factors can affect it. For us we are talking about mortality in the overall structure of mortality - health care can affect mortality.
We must set priorities in accordance with the strategy of socio-economic development until 2030. Active participation in this process will be medical organizations. Yes, there is an action plan for today. But if doctors and healthcare leaders want to change something, they need to come up with proposals, clearly arguing how this or that change will affect the achievement of their goals. In fact, there are many initiatives: I want to build, rebuild... Will this affect specific people? What will follow? The expected result should be obvious. Otherwise, there is no reason to spend public money. Proposals agreed with the Health Committee will be submitted for discussion by the government of St. Petersburg.
- What offers are you waiting for?
We must develop additional measures to reduce mortality from the main causes, increase labor productivity and modernize the system of remuneration of medical workers, taking into account an effective contract, lean production. We must establish e-health and approve the amount of data transfer in order to improve the system of care by developing and implementing a system for monitoring and evaluating medical technologies. These are the goals of the government of St. Petersburg.
To achieve them, at the level of the health committee, we need change, measurement and transparency.
We are back to the first question. What are these changes?
In 2017, new legislative requirements appeared that fundamentally change a lot. In connection with the introduction information technologies In the healthcare system, temporary disability certificates are issued differently, new quality assessment criteria have appeared, the Lean Polyclinic project ... These are federal standards and we must comply with them.
Petersburg healthcare is at a point that requires growth. And the state of medical institutions today is such that it will not allow us to achieve key indicators - the goals set by the government. My task is to prioritize and draw up a plan for their implementation. And then - we will gradually introduce changes, taking into account the opinion of medical institutions. That is, there will be changes, but they will be clearly linked to priorities and plans for their implementation. It won't work otherwise.
There are basic management principles that I am now declaring. This is transparency, patient focus, and a thrifty attitude to resources. What are these principles for? To evaluate the work of employees on the basis of these basic principles. They can do as they see fit, but I will evaluate the work that way. Because the entire quality management system must be permeated with the fact that the patient comes first. And when we begin to think in accordance with these principles, we will change the system from the inside.
- What do you mean by "measurement"? What and how are you going to measure?
Measurements are needed to understand what state medicine is in at any given moment. This is possible with the electronic healthcare system, with the transition to a single electronic document management system. Many indicators are subject to measurement, for example, lethality in the hospital - it is fixed in very specific numbers, the patient's waiting time in the clinic, or the volume of the patient's examination. In addition, an appointment with a doctor should be made electronically, then we will understand what kind of queues in clinics really are, what waiting lists they have. Research referrals and research results must be submitted electronically.
There is a need for a real transfer of doctors to an effective contract, which shows numbers that make it possible to objectively evaluate their work. Each employee of the clinic has his own functional responsibilities, but how to measure his contribution to the work of the clinic? Here, of course, there are difficulties - it is impossible to set unrealizable indicators, or, conversely, underestimated ones - in fear that too high ones will not be met. We already know what indicators we will measure in a number of areas.
- For example?
Example: oncology service. In order for a patient to be suspected of having a tumor in the clinic, he must undergo a medical examination or consult a doctor with a complaint. What criteria should be laid down to evaluate the work of an outpatient doctor? This is the proportion of patients in whom a neoplasm is suspected, and the proportion of actually confirmed diseases. Now there are two extremes. The first is that the doctor writes for every suspicion: “The tumor is questionable” and loads institutions of the second and third levels of medical care with examinations, but tumors are not detected. Second: the patient was at the doctor's office at the medical examination or at the reception in 2015, and in 2016 he was diagnosed with a volumetric neoplasm of III-IV degree. In these cases, we say that the system needs to be revised, and the doctor is not working effectively. So, you need to either send a doctor to study, or help him figure out the problem.
Here there is a need for changes regarding the main freelancers. They are responsible for quality - no one is going to load them with control functions, but they should be engaged in training personnel, improving their qualifications.
- How will you help the doctor?
There are clinical recommendations of the Ministry of Health, they are essentially descriptive, at the level of St. Petersburg, about 60% have already been developed linear algorithm their implementation in terms of providing medical care to patients with cancer. This guidelines with the scope of the survey for each level. For example, at the first level, the doctor opens the required page in the computer and sees the algorithm of actions in case, for example, melanoma is suspected. Its implementation is a criterion for assessing the quality of its work.
The second level of care is institutions that provide the fastest possible examination prescribed by a first-level doctor. And the criteria for measuring the effectiveness of its employees are the resources spent (if a patient has 5 ultrasound scans, this is an inefficient expenditure of funds) and the time of diagnosis. If cancer is not detected, it is a first-level problem. After the diagnosis is made, the patient is sent to a specialized hospital (third level), where he is no longer examined. An oncologist, a surgeon, a chemotherapist, a radiologist join in and draw up a treatment plan that cannot be broken: do something in one clinic, something in another. Sequence, duration, volume determine the quality of treatment, if something falls out or is performed in a different sequence, the end result suffers. Efficiency criteria - in-hospital mortality, and survival (1, 3, 5 years) and quality of life. All forces must be directed to this, and not to operate as best as possible more patients or prescribe targeted drugs.
On the one hand, the e-health system is a decision-making assistant for the doctor. On the other hand, it is also an assistant for monitoring medical appointments. If, according to their results, say, nothing was found in a patient, it is important for me, as a manager, to understand why? Where is the system error, at what stage was it made? There is no way to examine on certain equipment? The woman herself did not want to be examined completely? When I collect information from all polyclinics, I see that the mammograph is not loaded, the patient did not provide a detailed history, the doctor did not communicate with the patient enough ... A specific figure appears: for example, 80% of patients disappeared from the field of view of the polyclinic, and then they appeared in the hospital with the 4th stage. We see what we can do and what, in general, depends on management in this situation.
- What does the declared principle of "transparency" mean?
In medicine, it is very difficult to regulate everything. There are basic things that we regulate, we will bring them into line with federal requirements, but .... How can I make the healthcare system really better? To do this, it is necessary to have an objective picture of what is happening in the system and analyze it on the basis of primary data: CHI, MIS, financial and economic activities of institutions, personnel records. It is necessary to standardize the provision of medical care, centralize procurement, distribute institutions according to the levels of medical care and develop patient routing, and create a system for managing the quality of medical care. Then the picture is built not randomly, but on the basis of reliable information.
Medicine, like no other industry, is developing rapidly - new drugs, new methods are emerging. How to keep up with these rapid changes? How is the health committee - the holder of the industry's budget - to select and make decisions? How does he know what will help the patient and what will not? Be guided by the opinion of respected people? It's not possible because opinions change. I need analytics backed up by numbers and facts. They cannot be obtained without the creation of e-health.
The problem is that in the same oncology there is no second level, when a disease is detected, everyone is sent immediately to the third - to a specialized hospital.
Now we are working on grading medical institutions by levels. We need to understand what we have and what we don’t have in order to tell the government: we don’t have enough, because ...
But in fact, the city has already created a colossal infrastructure, in which everything is already there, you just need to set guidelines. Polyclinics, if a tumor is suspected, will be sent to the nearest hospital, where there is an outpatient department or to the CDC. For uniform and convenient routing from the first to the second level, we draw up a map of medical institutions. And the patient should not care what clinic he comes to, they must do everything that is prescribed by the doctor.
You talk about the need to prioritize. But we talk about almost every area in medicine as a priority - HIV, childhood, oncology, cardiology ... How to choose the most priority programs from priority programs and direct funding primarily to them?
Priorities today are cardiovascular diseases, oncology, and tuberculosis. But by the word "priority" I do not mean the redistribution of money in one of the branches of medicine, when other areas will be on the sidelines and they will be paid attention to as a residual. These are not financial priorities.
It is clear that now everyone is wondering where the financial flow will flow now. But whoever you give money to, you will always be guilty. In order not to be guilty, we need transparency in decision-making. And it can only be based on numbers. You can send money in one direction and show how wonderful things have changed. But the task is different - to understand the whole system, tie cash injections to the result, calculate and then say what we lack in order to achieve the main goal. We analyze the problem, conduct an audit and understand: here and there there are weaknesses, this needs to be changed.
With regard to priority areas, we will first of all deal with the creation of routing, distribution by levels, and the introduction of new modern technologies.
All over the world, healthcare absorbs a lot of money, it's like a bottomless pit into which no matter how much money you throw, only an echo is heard from there. And around the pit are people with varying degrees learning. And they all draw graphs, from which it should be clear that if you do not throw money now, it will be bad. And how much you need to throw in order to be good. And the regulator-official cannot understand what followed the spent penny. My task is just to tie all the costs to the result. At the same time, I have to change certain things without breaking or destroying anything. And this is a difficult task: they put me in front of a train rushing at great speed, in which there are many completely different cars that can flare up due to accumulated problems, they gave me a brush, a can of paint and said: “Paint the windows on the train on the go and make it beautiful — so that the train is the best in Russia.”
Dr. Peter
