SEARCHING FOR RESERVES TO IMPROVE THE QUALITY OF MEDICAL CARE FOR PATIENTS WITH UNDIAGNOSED CARDIOVASCULAR DISEASES DURING LIFETIME

Significance. The issue of discrepancy between clinical and forensic diagnoses in relation to undiagnosed cardiovascular diseases during lifetime is significant, as these conditions are the leading cause of morbidity and mortality worldwide. Additionally, the discrepancy between diagnoses, to a certain extent, reflects the quality of medical care provided to patients with cardiovascular diseases, as well as uncovers objective and subjective causes. Purpose. To analyze the causes of discrepancy between clinical and forensic diagnoses in relation to undiagnosed cardiovascular diseases during lifetime in the Russian Federation in 2018-2024, and to identify main measures to eliminate discrepancies between diagnoses in order to improve the quality of medical care delivery. Material and methods. The study analyzed data from the federal statistical observation form No. 14 “Information on performance of medical organization departments providing inpatient care” and information on cases of discrepancies between clinical and forensic diagnoses in relation to undiagnosed cardiovascular diseases during lifetime, obtained from 85 constituent entities of the Russian Federation in accordance with the letter the Ministry of Health of the Russian Federation to the constituent entities of the Russian Federation No. 13-2/72 as of January 28, 2025. Results. The most frequent cause of discrepancy between diagnoses was the latent course of the disease (42.0%), less frequently – other causes (33.8%) – short length of stay, admission of patients in extremely critical condition, insufficient examination data. Coding defects were noted in 17.8% of cases. Defects in medical care delivery were observed in 6.4% of cases. Main measures to eliminate discrepancy between diagnoses included clinical and anatomical conferences, examination of fatal cases by the commission for the investigation of fatalities, with the participation of the outpatient service, telemedicine consultations, professional development, increased control over medical documentation preparation, prescription of additional examinations and interpretation of their findings, and compliance of clinical specialists with basic rules for formulating a diagnosis. Conclusion. Analyzing the causes of discrepancy between diagnoses makes it possible to adopt a set of measures to eliminate or minimize them; main measures to eliminate the causes of discrepancy between diagnoses are reserves for improving the quality of medical care provided to patients. Keywords: discrepancy between clinical and forensic diagnoses; undiagnosed cardiovascular diseases during lifetime; cardiovascular diseases; diseases of the circulatory system; causes of discrepancy between diagnoses; latent course of diseases; coding errors; defects in medical care delivery; measures to eliminate discrepancies between diagnoses; quality improvement of medical care.