Сonceptual model and system of performance indicators for medical rehabilitation in the Russian Federation

Vollständiger Abstract

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Background. Although regulatory requirements for assessing the efficiency of medical rehabilitation have been established in the Russian Federation, a unified, conceptually structured system of indicators consistent with international frameworks still needs to be developed. Due to the disparity of indicators across departments, regional data become difficult to compare and further integrate into international monitoring. Objective: To develop a conceptual model and matrix of basic indicators that evaluate the performance of the medical rehabilitation system in the Russian Federation by integrating the Donabedian model, the International Classification of Functioning, Disability, and Health (ICF), and framework documents from the World Health Organization (WHO). Material and methods. A targeted documentary and literature review was conducted that examined the Russian regulations (GOST R 58258-2018 and GOST R 58259-2018); the 2024 methodological recommendations of the Federal Bureau of Medical and Social Expertise; the 2019 WHO documents “Rehabilitation in Health Systems: Guide for Action” and “Rehabilitation Indicator Menu” (RIM). Fifteen key publications on conceptual frameworks for assessing the quality of rehabilitation were also examined. Content analysis and coding were conducted according to Donabedian model, ICF domains, and system level. Results. While the Russian healthcare regulatory framework has structural and effective elements, it lacks process indicators and planned monitoring of rehabilitation coverage. Three critical gaps were identified in the comparison with RIM, including the absence of patient-centered outcomes as a mandatory component, economic indicators, and national-level coverage monitoring. A conceptual, three-layer model was developed based on the Donabedian model, the ICF domain, and the system level. A matrix of 20 basic indicators was proposed, involving 5 structural, 7 process, and 8 outcome indicators. Сonclusion. The proposed conceptual model creates a systematic basis for monitoring the efficiency of medical rehabilitation in the Russian Federation and provides conditions for harmonizing national data with international WHO standards.