Development and validation of a Composite Index of Dispensary Follow-up Effectiveness in the Russian Federation

Le résumé fourni par la source

Aim . To develop and validate a Composite Index of Dispensary Follow-up Effectiveness (CIDFE) for the adult population based on compulsory health insurance (СHI) data for the comparative assessment of 85 constituent entities of the Russian Federation and prioritisation of management interventions. Material and methods. A population-based observational study was conducted (unit of observation: constituent entity of the Russian Federation, n = 85, period 2023–2024). The index comprises 7 sub-indices grouped into two domains based on Donabedian’s model: “Process” (60%: DF coverage, enrolment activity, intensity, and completeness of follow-up) and “Outcome” (40%: hospitalisation rate, emergency medical service call rate, mortality among DF patients). Normalisation was performed using the min-max method (0–100 points); aggregation used a weighted sum in accordance with OECD methodology. Robustness was assessed by Monte Carlo simulation (10,000 iterations, ±20% weight perturbation); criterion validity was evaluated by correlation with Rosstat 2024 mortality data. Regions were stratified into 4 quadrants based on median CIDFE and mortality values. Results . The mean CIDFE for 2024 was 65.65±9.77 points (Me=67.55; range 31.60-84.33; coefficient of variation 14.9%). Class I (≥75 points) was assigned to 10.6% of regions, Class II (55-75) to 75.3%, and Classes III-IV to 14.1%. Robustness was confirmed by a high intraclass correlation coefficient (ICC=0.994; p <0.001); temporal stability by the correlation between CIDFE 2023 and 2024 (r=0.671; p <0.001). Quadrant analysis revealed that mortality in Quadrant A (high CIDFE + low mortality; n = 25) was 4.4‰ lower than in Quadrant D (low CIDFE + high mortality; n=19): 11.1±2.6‰ versus 15.4±1.1‰ (U=0; p <0.001; Cohen’s d=2.06). For a typical region with a population of approximately 1.5 million, this difference corresponds to roughly 660 preventable deaths per year. Conclusion . The CIDFE is the first Russian composite instrument for monitoring the quality of dispensary follow-up at the regional level, based on routine СHI data. The index demonstrates high robustness and stability, ensuring its suitability for annual monitoring. Quadrant analysis enables the identification of regions requiring priority systemic interventions and the selection of benchmark entities for disseminating best DF practices.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.