On approval of the rules for the organisation and conduct of internal and external quality reviews of health services (care)

New Unofficial translation

Order of the Minister of Healthcare of the Republic of Kazakhstan dated 3 December 2020 No. KR DSM-230/2020. Registered with the Ministry of Justice of the Republic of Kazakhstan on 4 December 2020 under No. 21727

      Unofficial translation

      In obedience to paragraph 5 of Article 35 of the Code of the Republic of Kazakhstan of 7 July 2020 “On Public Health and the Healthcare System”, I HEREBY ORDER:

      1. That the attached rules for the organisation and conduct of internal and external quality reviews of health services (care) shall be approved.

      2. That certain orders in the field of healthcare shall be deemed to have lost force pursuant to the Annex hereto.

      3. That, in the order established by the legislation of the Republic of Kazakhstan, the Committee for Medical and Pharmaceutical Control of the Ministry of Healthcare of the Republic of Kazakhstan shall ensure:

      1) state registration hereof with the Ministry of Justice of the Republic of Kazakhstan;

      2) posting hereof on the website of the Ministry of Healthcare of the Republic of Kazakhstan after its official publication;

      3) within ten working days after the state registration hereof, submission to the Legal Department of the Ministry of Healthcare of the Republic of Kazakhstan of information on the implementation of the measures stipulated in sub-paragraphs 1) and 2) of this paragraph.

      4. That the supervising Vice-Minister of Healthcare of the Republic of Kazakhstan shall be charged with control over this order.

      5. That this order shall be enforced ten calendar days after the date of its first official publication.

      Minister of Healthcare
of the Republic of Kazakhstan
      A. Tsoy

  Approved by order
of the Minister of Healthcare
of the Republic of Kazakhstan
No. KR DSM-230/2020
dated December 3, 2020

Rules for the organisation and conduct of internal and external quality reviews of health services (care)
Chapter 1. General provisions

      1. The rules for organization and and conduct of internal and external quality reviews of health services (care) (hereinafter referred to as Rules) have been developed pursuant to paragraph 5 of article 35 of Code of the Republic of Kazakhstan of July 7, 2020 “On Public Health and Healthcare System” (hereinafter referred to as Code) and determine the order of organization and carrying out of internal and external expertise of quality of healthcare services (care), rendered by healthcare entities regardless of ownership form and departmental affiliation.

      2. The following basic concepts shall be used in these Rules:

      1) social medical insurance fund (hereinafter referred to as Fund) - a non-profit organization, which accumulates contributions and fees, as well as performs procurement and payment for services of health care entities, providing medical care in the volumes and on terms, which are provided by contract for procurement of healthcare services, and other functions, determined by the laws of the Republic of Kazakhstan;

      2) subject matter expert- a medical worker with higher medical education, certified in the field of healthcare;

      3) authorized body in the field of health care (hereinafter referred to as authorized body) - central executive body, carrying out management and inter-sectoral coordination in the field of health care of citizens of the Republic of Kazakhstan, medical and pharmaceutical science, medical and pharmaceutical education, sanitary and epidemiological welfare of population, circulation of medicines and medical devices, quality of healthcare services (assistance);

      4) clinical protocol - scientifically proven recommendations on prevention, diagnostics, treatment, medical rehabilitation and palliative medical care for a certain disease or condition of a patient;

      5) independent expertise of the quality of healthcare services (care) - a procedure conducted by independent experts within the framework of internal and external expertise in order to make a conclusion on the quality of healthcare services (care) provided by health care entities, using indicators reflecting the indicator of effectiveness, completeness and compliance of healthcare services (care) provided with the Standards;

      6) standard in health care (hereinafter - the Standard) - a normative legal act establishing rules, general principles and characteristics to ensure standardization in health care in the field of medical, pharmaceutical activities, educational and scientific activities in the field of health care, digital healthcare;

      7) healthcare services (care) - actions of health care entities having preventive, diagnostic, therapeutic, rehabilitation and palliative orientation towards a particular person;

      8) quality reviews of healthcare services (care) - a set of organizational, analytical and practical activities carried out to make a conclusion on the quality of healthcare services provided by individuals and legal entities, using indicators reflecting the indicator of efficiency, completeness and compliance of healthcare services with the Standards;

      9) state body in the sphere of healthcare services (care) (hereinafter referred to as state body) - state body exercising management in the sphere of healthcare services (care), control over quality of healthcare services (care);

      10) independent expert - a natural person who meets the requirements defined by the authorised body and is on the register of independent experts.

      3. The stages of internal and external quality reviews of healthcare services (care) shall be:

      analysis of accounting and reporting documentation;

      clinical audit;

      generalization of the results of the quality reviews of healthcare services (care).

      4. During analysis of accounting and reporting documentation the organization's activity indicators for a certain period of work shall be compared with the indicators of the previous similar period, as well as with national and regional indicators of public health.

      5. During the clinical audit the following shall be assessed:

      1) quality of anamnesis collection, which is evaluated according to the following criteria:

      absence of anamnesis collection;

      the completeness of the anamnesis;

      data on past, chronic and hereditary diseases, haemotransfusions, drug tolerance, allergological status;

      the development of complications due to tactical errors in therapeutic and diagnostic measures due to poor anamnesis collection;

      2) completeness and validity of diagnostic tests, which are evaluated according to the following criteria:

      absence of diagnostic measures;

      incorrect medical conclusion or lack of conclusion on the results of diagnostic examinations, which led to incorrect diagnosis and errors in treatment tactics;

      performance of diagnostic tests in compliance with clinical protocols;

      conducting diagnostic investigations with high, unreasonable risk to the patient's health, validity of diagnostic investigations not included in the clinical protocols;

      diagnostic tests that are uninformative for a correct diagnosis and result in unreasonable prolongation of the treatment period and higher treatment costs;

      3) correctness, timeliness and validity of the clinical diagnosis with due regard for the results of the tests (in case of planned hospitalisation, the tests performed at the pre-hospital stage shall be taken into account), which shall be assessed according to the following criteria:

      the diagnosis is absent, incomplete or incorrect, does not comply with the international classification of diseases;

      the leading pathological syndrome that determines the severity of the disease is not identified, or comorbidities and complications are not recognised;

      the diagnosis is correct, but incomplete, the leading pathological syndrome is not identified with the complications highlighted, the comorbidities affecting the outcome are not recognised;

      the diagnosis of the underlying disease is correct, but the comorbidities affecting the outcome are not diagnosed.

      objective reasons for incorrect and/or untimely diagnosis (atypical course of the underlying disease, asymptomatic course of comorbidities, rare complications and co-morbidities) are reflected in the results of the examination. The impact of incorrect and/or untimely diagnosis on the subsequent stages of health services (care) shall be assessed;

      4) timeliness and quality of consultations of subject matter experts, which are evaluated according to the following criteria:

      lack of consultation, resulting in misinterpretation of symptoms and syndromes, negatively affecting the outcome;

      timely consultation, failure to take into account the consultant's opinion in making the diagnosis partially affected the outcome;

      the consultation is timely, the consultant's opinion has been taken into account in the diagnosis, failure to follow the consultant's treatment recommendation partially affected the outcome;

      the consultant's opinion is wrong and has affected the outcome.

      In cases of late consultations, the objectivity of the reasons for the late consultation and the impact of the late diagnosis on the subsequent stages of health services (care) shall be assessed;

      5) scope, quality and validity of treatment measures, which shall be assessed pursuant to the following criteria:

      absence of treatment in the presence of indications;

      prescription of treatment in the absence of indications;

      prescription of ineffective treatment measures without taking into account the course of the disease, concomitant diseases and complications;

      implementation of therapeutic measures not in full, without taking into account the functional state of organs and systems, the prescription of drugs without proven clinical efficacy;

      non-compliance with the requirements of the Standards, unreasonable deviation from the requirements of clinical protocols, polypragmasy leading to the development of a new pathological syndrome and deterioration of the patient's condition;

      6) absence or development of complications after medical interventions, all complications are assessed, including those caused by surgical interventions (delayed surgical intervention, inadequate scope and method, technical defects) and diagnostic procedures;

      7) the result achieved, which is assessed according to the following criteria:

      achievement of the expected clinical effect while complying with the technology of health services (care);

      absence of clinical effect of treatment and preventive measures due to poor anamnesis and diagnostic tests;

      lack of expected clinical effect due to ineffective treatment, preventive measures without taking into account the specifics of the disease, related diseases, complications, prescribing drugs without proven clinical efficacy;

      the presence of polypragmasy, which led to the development of undesirable effects;

      8) the quality of medical documentation which is assessed by the availability, completeness and quality of records in the primary medical documentation designed to record data on the health status of patients, reflecting the nature, scope and quality of medical care provided in conformity with the forms of reporting and accounting documentation in the field of healthcare according to sub-paragraph 31) of Article 7 of the Code.

      at the outpatient care level, dispensary care, preventive, rehabilitative measures and screening examinations shall be additionally assessed.

      6. When summarizing the results of the quality review of healthcare services (care), a decision shall be made on the compliance (non-compliance) of the provided medical care with the requirements of Standards and clinical protocols.

      7. Expert evaluation of the quality of healthcare services (care) shall be carried out with the participation of the patient, if necessary.

      8. For fatal cases, the comparison of the results of retrospective analysis, autopsy and (or) forensic medical examination shall be considered as a full and complete review.

      Medical records and electronic health information resources shall be used as a source of information in the expert evaluation.

Chapter 2: Procedure for organising and conduct of internal quality review of health services (care)

      9. In order to organise and conduct internal review, a Patient Support and Internal Expertise Service (hereinafter referred to as the Service) shall be established in the medical organisation.

      The structure and composition of the Service shall be approved by the head of the medical organisation with allowances made for the volume of healthcare services, profile, capacity (number of beds) for organisations providing inpatient care, number of attached population for organisations providing outpatient-polyclinic care.

      10. The Service shall carry out a review of:

      1) in organizations providing inpatient or inpatient-substituting care, not less than 15% of treated cases per month, as well as all cases of:

      lethal outcomes;

      complications, including post-operative complications;

      hospital-acquired infections;

      repeated hospital admissions for the same disease within the same month due to poor previous treatment;

      prolongation or reduction of the duration of treatment;

      diagnosis discrepancies;

      unjustified hospitalization;

      2) in organizations providing outpatient and polyclinic care:

      not less than 10% of reviews per month:

      treated cases, outpatient records of persons subject to immunisation against infectious diseases;

      as well as any cases:

      maternal deaths;

      deaths at home of children from 0 to 5 years of age inclusive;

      deaths at home of persons of working age due to diseases;

      hospital-acquired infections;

      late vaccination or lack of vaccination against infectious diseases;

      neglected forms of cancer and tuberculosis;

      premature disability of persons of working age;

      complications of pregnancy managed at the level of primary health-care organizations;

      observations of patients after discharge from hospital (children, women in the postpartum period), patients with circulatory system diseases (after strokes and heart attacks);

      3) in emergency medical aid organizations examination of quality of healthcare services (care) for at least 20 % of served calls during a quarter as well as any cases;

      repeated calls to the same patient for the same disease within a day from the date of the first call;

      fatalities in calls: death before the arrival of the team, death in the presence of the team;

      discrepancies between the diagnoses of the ambulance team and the in-patient department in the case of hospitalization;

      4) in rehabilitation and medical rehabilitation organizations - any cases:

      lethal outcomes;

      transfer to hospital organizations;

      increase or decrease of duration of treatment;

      hospital injuries;

      hospital-acquired infections;

      5) in palliative care and nursing organizations - any cases:

      fatalities;

      nosocomial infections;

      hospital traumatism;

      6) blood service organisations shall carry out a quality assessment of at least 20% of donor medical records per quarter, as well as monitoring compliance with the rules of procurement, processing, quality control, storage, sale of blood, its components, and the rules of transfusion of blood, its components according to paragraph 84 of Article 7 of the Code.

      11. The Service shall also conduct monthly review of at least 10% of treated cases on the quality of completion of medical records by mid-level medical workers.

      12. The Service shall clarify with the medical workers who have committed violations of the procedure of medical care, therapeutic and diagnostic measures, expressed in unjustified deviation from the Standards and clinical protocols (hereinafter - defects), the reasons for their occurrence, explanations of the requirements of the Standards, and joint development of recommendations for the prevention of defects and errors.

      Cases of defects requiring management decisions (referral for additional training, refresher courses for medical staff, purchase of medicines, medical devices, medical equipment) shall be submitted to management for consideration.

      13. The Service shall evaluate the activity of the structural subdivisions and the medical organization as a whole based on the evaluation of internal indicators in pursuance of Annex 1 to these Rules. Heads of structural subdivisions of the medical organization shall submit to the Service monthly, pursuant to the schedule approved by the head of the medical organization the results of monitoring by the indicators of assessment of the quality of healthcare services (care).

      14. The Service shall determine the degree of patient satisfaction with the level and quality of healthcare services (care) by questioning patients and/or their relatives and analysing justified complaints on the quality of healthcare services (care) provided, analysing medical incidents in conformity with the rules for determining cases (events) of medical incidents, their recording and analysis, in accordance with sub-paragraph 11 of Article 7 of the Code.

      15. The Service shall consider appeals from patients regarding medical care provided, with the establishment of a commission. In this case the appeal shall be considered within a period not exceeding five calendar days.

      16. Internal quality review of healthcare services (care) shall also be carried out through self-control at the level of:

      each medical worker;

      structural subdivision;

      head nurse and (or) deputy head of nursing;

      deputy head of nursing; deputy head for treatment.

      17. The health care worker's self-assessment shall be carried out by the doctor, each nurse on the ward for all cases treated. The result of the self-monitoring shall be the signature of the health care worker in the medical documentation.

      18. The review at the level of a structural subdivision shall be carried out by its head for all treated cases.

      19. The performance appraisal of nurses at the level of a structural subdivision shall be performed by a head nurse. The quality review of the work of auxiliary medical workers of structural subdivisions shall be determined by completeness and timeliness of filling of medical documentation, as well as by completeness, timeliness and quality of fulfillment of medical prescriptions;

      20. The review at the level of the head nurse or deputy head of nursing of a medical organization shall be carried out by examining and analysing at least 10% of cases treated for the quality of completion of medical documentation by nursing staff.

      21. The review on the level of deputy head for treatment shall be conducted by reviewing and analysing at least 15% of cases treated per month.

      22. The Service shall draw up an opinion based on the results of the internal review, which shall include:

      1) the total number of identified irregularities, their structure, possible causes and remedies;

      2) the number of detected irregularities that caused the deterioration of the health status;

      3) the number of detected deviations which resulted in increase of costs for medical care.

      23. The results of the internal review shall be considered at the meeting of the Service and be documented in the minutes.

      Based on the results of the internal review the Service shall make monthly proposals to the head of the medical institution to eliminate the identified causes and conditions of deterioration of the quality of healthcare services.

Chapter 3: Procedures for organising and conducting external quality review of health services (care)

      24. The external review of the quality of health services (care) shall be carried out by:

      1) a state body;

      2) by a fund;

      3) independent health care experts;

      4) department of the Office of the President of the Republic of Kazakhstan in relation to subordinated organizations.

      25. Based on the results of an external review, an analysis shall be made of:

      the result of the internal review for compliance with the principles of review;

      compliance and effectiveness of the measures taken by the Service;

      compliance with the threshold values in the dynamics of external indicators in pursuance of Annex 2 to these Rules;

      quality of health services (care) provided.

      26. The state body shall conduct an external review, including with the involvement of independent experts and (or) subject matter experts in the field of health care.

      27. The external review of any cases of maternal mortality (except for accidents) shall be conducted by the state body.

      28. If defects are identified based on the results of the external review, the public authority shall send information to the Fund, the local public health authorities of the regions, cities of republican status and the capital, as well as the health care entities, for taking response measures according to competence.

      29. In case of revealing of defects which resulted in health damage in the form of invalidity, including with loss of working capacity or lethal outcome, the state body shall direct materials of external review to bodies of internal affairs for acceptance of the procedural decision pursuant to article 179 of the Criminal Procedure Code of the Republic of Kazakhstan.

      30. Based on the results of the external review of the quality of healthcare services (care) conducted by the state body and the Fund, the state body shall conduct an analysis to develop proposals to improve the provision of healthcare services (care).

      31. When carrying out a review of healthcare entities, a specialist of the state body shall provide the expert with the materials that are the scope of the review. If necessary, he/she shall arrange a meeting with the applicant (with the consent of the applicant).

      32. At the end of the review the state body shall draw up a conclusion in the form in compliance with Annex 3 to these Rules.

      33. The external review by the Fund shall be conducted within the framework of monitoring the performance of contractual obligations on the quality and scope of healthcare services including the involvement of independent experts and (or) specialized health care specialists in the manner determined in pursuance of sub-paragraph 99) of Article 7 of the Code.

      34. The Fund shall provide to the independent expert the materials that are the scope of the review.

      35. At the end of the review, the Fund shall draw up an opinion and (or) an act in the form determined in accordance with sub-paragraph 99) of Article 7 of the Code.

      36. Independent experts in the field of health care shall carry out external review if they are engaged by natural or legal persons on a contractual basis.

      Information on independent experts shall be contained in the Register of Independent Experts formed by the state body in compliance with sub-paragraph 18) of Article 8 of the Code. The Register of Independent Experts shall be placed on the website of the state body.

      37. When carrying out an independent review, natural or legal persons hiring independent experts on a contractual basis (hereinafter - the customer) shall provide the independent expert with the materials which are the subject matter of the review.

      If the questions raised are beyond the scope of special knowledge of the independent expert or the materials provided are not sufficient for giving the expert opinion, the independent expert shall refuse to give the opinion.

      The independent expert shall conduct an independent review of the quality of medical activity in accordance with the current legislation in the field of health care and shall ensure legality, competence and impartiality of the independent review, as well as scientific validity of means and methods of investigation for completeness and objectivity of the independent review.

      In the course of the review, the independent expert shall comply with the confidentiality of official information and principles of professional ethics, shall not disclose information on the investigation activity carried out with his/her participation and circumstances that emerged in the course thereof, data of the closed court session as well as the information obtained on the circumstances that affect privacy, constitute state secrets, trade or other legally protected secrets.

      38. Review conducted by independent experts engaged by a public authority shall be divided into the following categories:

      (1) review of the quality of healthcare services (care) rendered with an adverse outcome:

      review of pathological and anatomical examinations;

      review of medical records of no more than two health care organisations (according to the patient's itinerary of care);

      review of medical records of three or more health care organisations (according to the patient's itinerary of care);

      2) review of the quality of healthcare services (care) rendered with a favourable outcome with examination of the patient (if necessary):

      review of pathological and anatomical examinations;

      review of medical records of not more than two health care organizations (pursuant to the route of the patient's medical care);

      review of the medical records of three or more health-care organizations (according to the patient's itinerary of care).

      Healthcare services (care) rendered with an adverse outcome shall include poor-quality healthcare services (care), non-compliance with the Standards and Rules for Medical Care, which resulted in death, life-threatening condition, significant permanent loss of general capacity for work, full loss of professional capacity for work.

      Healthcare services (care) rendered with a favourable outcome shall include substandard provision of healthcare services (care), non-compliance with the Standards and Rules of Medical Care, which did not result in harm to human life and health.

      39. At the end of the review, the independent expert shall submit an expert opinion in the form according to Annex 3 to these Rules.

      The expert opinion of the independent expert shall be drawn up in three copies. One copy shall be delivered to the healthcare entity, the second copy shall be delivered to the Customer, the third copy shall be kept by the independent expert.

      40. Comments and (or) objections on the results of the external review shall be stated in writing and attached to the conclusion of the external review. Based on the results of the external review of the quality of healthcare services (care) the head of the medical organization shall take management measures, including determining the need and focus of training programs for doctors and nursing staff.

      41. A repeated review shall be carried out in cases of disagreement with the conclusions of an external review based on requests from healthcare entities, natural or legal persons.

      Experts who have not participated in the initial review shall be involved in a repeated review.

      42. Complaint on disagreement with the conclusions of the external review shall be submitted to the superior state body (superior official) or to the court in accordance with the legislation of the Republic of Kazakhstan.

  Annex 1 to the rules
for the organisation and conduct of
internal and external quality reviews
of health services (care)

Internal indicators

Name of indicators

Calculation formula/Unit of measure

Frequency of information

Information source
 

Threshold value

1

2

3

4

5

6

Assessment indicators for inpatient care providers

1

Mortality rate for planned hospital admissions

Proportion (%) of inpatient deaths (excluding patients receiving oncological and palliative care) out of the total number of patients discharged (discharged, died) in the reporting period

Monthly

Reporting data, IPMR, ERI IS

The indicator value tends towards zero

2

Daily inpatient mortality rate

Proportion (%) of inpatients who died within the first 24 hours of admission in the reporting period

Quarterly

IPMR, DISC, ERI IS

Indicator value does not exceed 4%

3

Post-surgery mortality rate for planned hospital admissions

Proportion (%) of post-surgery inpatient deaths out of the number of patients who underwent elective surgery in the reporting period

Monthly

Reporting data, IPMR , ERI IS

The indicator value tends towards zero

4

Rate of intraoperative complications

Proportion (%) of intraoperative complications to the total number of operations in the reporting period

Quarterly

Reporting data, IPMR, transaction and manipulation form

Indicator value does not exceed 5%

5

Rate of post-operative complications

Proportion (%) of post-operative complications to the total number of operations in the reporting period

Quarterly

Reporting data, IPMR, transaction and manipulation form, ERI IS

Indicator value does not exceed 3 %

6

Number of maternal deaths, of which: obstetric haemorrhage, gestosis, abortion, extragenital pathology

Absolute number

Daily

Monitoring data on pregnant and postpartum women in the health centre, maternal mortality chart, ERI IS

The indicator value tends towards zero for reasons that are manageable

7

Rate of birth trauma among women

Proportion (%) of birth injuries to the total number of births in the reporting period

Quarterly

IPMR, Transaction and manipulation record form, ERI IS

The indicator value tends towards zero

8

Rate of emergency caesarean sections

Proportion (%) of emergency caesarean sections out of the total number of caesarean sections

Quarterly

IPMR, Transaction and manipulation record form, ERI IS

Indicator value does not exceed 20%

9

Admission rate of pregnant women admitted to hospital within 24 hours of refusal of admission

Proportion (%) of pregnant women admitted to hospital within 24 hours of refusal of admission as a proportion of all pregnant women admitted

Quarterly

IPMR, ERI IS

The indicator value tends towards zero

10

Number of infant deaths, of which: respiratory diseases, intestinal infections, congenital malformations, perinatal diseases

Absolute number

Monthly

IPMR, APR IS

Decrease in the value of the indicator for the reporting period compared to the previous period by 5%

11

Injury rate for newborns

Proportion (%) of newborn injuries to the total number of newborns in the reporting period

Quarterly

IPMR, ERI IS

The indicator value tends towards zero

12

Indicator of intrapartum fetal death

Proportion (%) of intrapartum fetal deaths per 100 live and stillbirths

Quarterly

IPMR, ERI IS

Decrease in the value of the indicator for the reporting period compared to the previous period by 10%

13

Early neonatal mortality rate (up to 7 days of life)

Proportion (%) of early neonatal deaths per 1,000 live births

Quarterly

IPMR, APR IS

Decrease in the value of the indicator for the reporting period compared to the previous period by 5%

14

Rate of purulent-septic processes after surgical interventions

Proportion (%) of purulent-septic processes after surgical interventions from the total number of operations in the reporting period

Monthly

IPMR, ERI IS

Indicator value not exceeding 1%

15

Indicator of purulent-septic processes in newborns

Proportion (%) of cases of neonatal septicaemia as a proportion of live births

Monthly

IPMR, ERI IS

The indicator value tends towards zero

16

Re-admission rate within a month for the same condition

Proportion (%) of hospital admissions for the same disease within a month of the number of admissions in the reporting period (excluding patients with cancer, haematological diseases and patients receiving substitution therapy)

Monthly

OPMR, DISC, ERI IS

The indicator value tends towards zero

17

Number of discrepancies between clinical and pathological diagnoses

Absolute number

Monthly

Pathology protocol, ERI IS

The indicator value tends towards zero

18

Indicator of justified complaints about the quality of health services

Number of substantiated complaints per 1,000 patients treated

Monthly

Logbook of appeals

The indicator value must not exceed 1.0

19

Indicator of epidemiological investigation of nosocomial infections

Proportion (%) of cases of nosocomial infections with epidemiological investigation from the total number of reported cases

Monthly

Minutes of the meeting of the infection control committee

The indicator value tends to 100%

20

Indicator for identifying causes and factors of nosocomial infections and the spread of nosocomial infections

Proportion (%) of cases of nosocomial infections with identified causes and factors of nosocomial infections from the total number of reported cases

Monthly

Minutes of the meeting of the infection control committee

The value of the indicator tends to 80%

Evaluation indicators for outpatient care providers

1

Number of first-time disability cases among people of working age

Absolute number

once a year

Data from the Territorial Department of the Committee for Labour, Social Protection and Migration

Decrease in the value of the indicator for the reporting period compared to the previous period by 1%

2

Maternal mortality rate, with deficiencies in the provision of health services at primary care level

Proportion (%) of maternal deaths among attached residents with confirmed defects (experts) at primary health care level, for the reporting period, per number of attached women of childbearing age

Quarterly

Maternal mortality scorecard (results of external evaluation)

The indicator value tends towards zero

3

Rate of recovered women with extragenital pathology among women of fertile age

Proportion (%) of healthy women of childbearing age per total number of women of childbearing age in the assigned population

Quarterly

OMR, outpatient statistical card, MIS, DPER IS

Increase of 5% compared to previous period

4

Contraceptive coverage rate for women with absolute contraindications to pregnancy

Proportion (%) of contraceptive prevalence among women with absolute contraindications to carry a pregnancy out of the total number of women with absolute contraindications to carry a pregnancy

Quarterly

OMR, RPWWFA IS

Indicator value tends towards 100%

5

Abortion rate in relation to childbirth

Proportion (%) of abortions to births

Quarterly

DISC, ERI IS

Decrease in the value of the indicator for the reporting period compared to the previous period by 5%

6

Hospital admission rate for pregnant women with regionalisation disorder (based on 24-hour inpatient unit)

Proportion (%) of pregnant women hospitalised with regionalisation as a proportion of all hospitalised pregnant women

Quarterly

DISC (International Classification of Diseases diagnosis with indication of delivery), RPWWFA IS

Decrease in the value of the indicator for the reporting period compared to the previous period by 5%

7

Infant mortality rate, with deficiencies in the provision of health services at PHC level

Proportion (%) of deaths of children aged 0 to 1 year prevented at PHC level per number of children aged 0 to 1 year in the attached population

Quarterly

Registration chart of live births, stillbirths and deaths of children under the age of 1 year

Decrease in the value of the indicator for the reporting period compared to the previous period by 5%

8

Indicator of training of health workers (doctors, nurses) of PHC under the IMCI programme

Proportion (%) of PHC medical staff (doctors, nurses) trained under the IMCI programme out of the total number of PHC medical staff

once a year

Human resources report

Indicator value of at least 70%

9

Doctor attendance rate for newborns in the first 3 days after discharge from hospital (patronage)

Proportion (%) of newborns seen by a doctor in the first 3 days after discharge from hospital (patronage) per number of newborns in the reporting period

Quarterly

OMR, MIS

Indicator value tends towards 100%

10

Rate of emergency hospital admissions for children under 5 years of age with AEI, ARI

Proportion (%) of hospital admissions of children under 5 with AEI, ARI to total hospital admissions of children under 5

Quarterly

DPER IS

Decrease in the value of the indicator for the reporting period compared to the previous period by 1%

11

Indicator of parental education of children under 5 years of age on the danger signs according to the principles of the IMCI programme

Proportion (%) of parents of children under 5 years of age who have been taught the danger signs according to the principles of the IMCI programme per number of children under 5 years of age

Quarterly

Healthy child's room log

Indicator value tends towards 100%

12

Number of congenital malformations in newborns undiagnosed in utero

Absolute number

Quarterly

OMR, individual card for pregnant women, women in labour and childbirth, MIS

The indicator value tends towards zero

13

Indicator of obtaining exclusive breastfeeding of children at 6 months of age

Proportion (%) of children aged 6 months who are exclusively breastfed out of all children aged 6 months, excluding abandoned foundlings and children born to HIV-positive mothers, mothers taking cytostatics

Quarterly

OMR, MIS

Indicator value tends towards 100%

14

Breastfeeding rate for children under 2 years of age

Proportion (%) of children breastfed up to age 2 out of all children up to age 2, excluding abandoned foundlings and children born to HIV-positive mothers and mothers taking cytostatics

Quarterly

OMR, MIS

Indicator increase of 5 % compared to the previous period

15

The rate of neglected cases among newly diagnosed patients with pulmonary tuberculosis

Proportion (%) of first-time pulmonary tuberculosis cases detected in the attached population per first-time pulmonary tuberculosis cases detected in the attached population

Quarterly

DPER IS

Decrease in the value of the current period compared to the previous period by 5%

16

Fluorography screening coverage rate for populations at high risk of tuberculosis as determined by the responsible authority

Proportion (%) of populations at high risk of tuberculosis covered by fluorography out of the total population at high risk of tuberculosis

once a year

Plan for fluorography examinations, fluorography logbook, MIS reporting forms

Indicator value tends towards 100%

17

Mandatory fluorography screening coverage rate

Proportion (%) of compulsory population covered by fluorography examinations of the total compulsory population

once a year

Plan for fluorography examinations, fluorography logbook, MIS reporting forms

Indicator value tends towards 100%

18

Tuberculosis case detection rate by fluorography among populations at high risk of tuberculosis as determined by the responsible authority

Proportion (%) of tuberculosis patients detected by fluorography among populations at high risk of tuberculosis per 1,000 population at high risk of tuberculosis

Quarterly

Logbook for fluorography examinations, MIS

The value of the indicator is at least 2

19

Detection rate of patients with suspected tuberculosis among persons examined by microscopy

Proportion (%) of TB cases detected by microscopy out of the total number of patients with suspected TB referred for microscopy

Quarterly

Laboratory logbook for PHC laboratories, referral for laboratory testing services, consultation services, hospital admission, transfer to another hospital, MIS, NRTP IS

The indicator value is 5-10%

20

Number of tuberculosis patients who interrupted therapy at primary care level

Absolute number

Quarterly

OMR, MIS

The indicator value tends towards zero

21

Rate of patients with first-time malignant neoplasms stage 3-4

Proportion (%) of first-time detected patients with malignant neoplasms of stage 3-4 from the total number of first-time detected malignant neoplasms in the reporting period

once a year

ERCP IS

Decrease of 5% compared to previous period

22

Rate of patients with first-time malignant neoplasms of stage 1-2

Proportion (%) of first-time malignant tumour patients at stages 1 and 2 of the total number of malignant tumour patients detected in the reporting period

once a year

ERCP IS

Increase of 1% compared to previous period

23

5-year survival rate of patients with malignant neoplasms

Proportion (%) of 5-year survival rate of patients with malignant neoplasms per total number of patients with malignant neoplasms

once a year

ERCP IS

Indicator value is at least 50%

24

Indicator of justified complaints about the quality of health services

Number of substantiated complaints per 1,000 outpatient cases

Monthly

Logbook for enquiries

The indicator value must not exceed 3.0

25

Hospitalisation rate for patients with complications of cardiovascular diseases (arterial hypertension, myocardial infarction, stroke)

Proportion (%) of inpatients treated for complications of cardiovascular diseases (arterial hypertension, myocardial infarction, stroke) per population

Quarterly

DISC, ERCP IS

Decrease in the value of the indicator for the reporting period compared to the previous period by 10%

26

Indicator of epidemiological investigation of nosocomial infections

Proportion (%) of cases of nosocomial infections with epidemiological investigation out of the total number of reported nosocomial infections

Monthly

Minutes of the meeting of the infection control committee

Indicator value tends towards 100%

27

Indicator for identifying causes and factors of nosocomial infections and the spread of nosocomial infections

Proportion (%) of cases of nosocomial infections with identified causes and factors of nosocomial infections from the total number of reported cases of nosocomial infections

Monthly

Minutes of the meeting of the infection control committee

Indicator value tends towards 80%

28

Immunization coverage rate for children under 5 years of age against targeted infections

Proportion (%) of immunised children in the target group

Monthly on an incremental basis

Reporting Form No. 4, approved by Order No. 415 of the Minister of National Economy of 30 May 2015, Preventive Immunisation Logbook, MIS

Indicator value aims at 95% for the year (at least 7.9% each month)

29

Medical rehabilitation coverage rate - 3 stages

Proportion (%) of patients covered by medical rehabilitation to the total number of patients eligible for medical rehabilitation

Monthly on an incremental basis

OMR, MIS

Indicator value tends towards 85% for the year

      Explanation of abbreviations and acronyms:

      1. IPMR – In-Door Patient Medical Record

      2. ERI IS -Electronic Register of Inpatients Information System

      3. DISC - Discharged Inpatients Statistical Chart

      4. APR IS – Attached Patient Register Information System

      5. PHC - Primary Health Care

      6. OMR - Outpatient Medical Record

      7. MIS - Medical Information Systems

      8. DPER IS - Dispensary Patients Electronic Register Information System

      9. RPWWFA IS - Register of Pregnant Women and Women of Fertile Age Information System

      10. IMCI programme - Integrated Management of Childhood Illnesses Programme

      11. AEI - Acute Enteric Infection

      12. ARI - Acute Respiratory Infection

      13. NRTP IS – National Registry of Tuberculosis Patients Information System

      14. ERCP IS - Electronic Registry of Cancer Patients Information System

  Annex 2 to the rules
for the organisation and conduct of
internal and external quality reviews
of health services (care)

External indicators

Name of indicators

Measurement unit

Frequency of information

Source of information

Threshold value

1

2

3

4

5

6

Assessment indicators for inpatient care providers

1

Mortality rate for planned hospital admissions

Proportion (%) of inpatient deaths (excluding patients receiving oncological and palliative care) out of the total number of patients discharged (discharged, died) in the reporting period

Monthly

Reporting data, IPMR

The indicator value tends towards zero

2

Post-operative mortality rate for planned hospital admissions

Proportion (%) of post-operative inpatient deaths out of the number of patients who underwent elective surgery in the reporting period

Monthly

Reporting data, IPMR

The indicator value tends towards zero

3

Number of maternal deaths, of which: obstetric haemorrhage, gestosis, abortion, extragenital pathology

Absolute number

Monthly

Monitoring data of pregnant and postpartum women, maternal mortality record card, ERI IS

The value of the indicator tends towards zero for reasons that can be managed

4

Number of infant deaths, of which: respiratory diseases, intestinal infections, congenital malformations, perinatal diseases

Absolute number

Monthly

Registration card of live births, stillbirths and deaths of children under 5 years of age, Attached Patient Register information system

Decrease in the value of the indicator for the reporting period compared to the previous period by 5%

5

Re-admission rate within a month for the same condition

Proportion (%) of hospital admissions for the same disease within a month of the number of admissions in the reporting period (excluding patients with cancer, haematological diseases and patients receiving substitution therapy)

Monthly

Reporting data, IPMR, DISC

The indicator value tends towards zero

6

Number of discrepancies between clinical and pathological diagnoses

Absolute number

Monthly

Postmortem examination protocol
 

The indicator value tends towards zero

7

Indicator of justified complaints about the quality of health services

Number of substantiated complaints per 1,000 patients treated

Monthly

Logbook for enquiries

The indicator value must not exceed 1.0

8

Indicator of epidemiological investigation of nosocomial infections

Proportion (%) of cases of nosocomial infections with epidemiological investigation from the total number of reported cases

Monthly

Minutes of the meeting of the infection control committee

Indicator value tends towards 100%

9

Indicator for identifying causes and factors of nosocomial infections and the spread of nosocomial infections

Proportion (%) of cases of nosocomial infections with identified causes and factors of nosocomial infections from the total number of reported cases

Monthly

Minutes of the meeting of the infection control committee

Indicator value tends towards 80%

Evaluation indicators for outpatient care providers

1

Maternal mortality rate, with deficiencies in the delivery of health services at primary care level

Proportion (%) of maternal deaths among attached residents with confirmed defects (experts) at PHC level, for the reporting period, per number of attached women of childbearing age

Quarterly

Maternal mortality scorecard (results of external evaluation)

The indicator value tends towards zero

2

Infant mortality rate, with deficiencies in the provision of health services at PHC level

Proportion (%) of deaths of children aged 0 to 1 year prevented at PHC level per number of children aged 0 to 1 year in the eligible population

Quarterly

Registration card of live births, stillbirths and deaths of children under 1 year of age

Decrease in the value of the indicator for the reporting period compared to the previous period by 5%

3

Pregnancy rate of WFW with extragenital abnormalities who are absolutely contraindicated in pregnancy

Proportion (%) of antenatal pregnancies of WFW with extragenital pathology who are absolutely contraindicated among attached residents per total number of WFW among attached residents

Quarterly

DISC, Register of Pregnant Women and Women of Fertile Age Information System
 

The indicator value tends towards zero

4

The rate of neglected cases among newly diagnosed patients with pulmonary tuberculosis

Proportion (%) of first-time pulmonary tuberculosis cases detected in the attached population per first-time pulmonary tuberculosis cases detected in the attached population

Quarterly

NRTP IS – National Registry of Tuberculosis Patients Information System

Decrease in the value of the indicator for the reporting period compared to the previous period by 5%

5

Rate of patients with first-time malignant neoplasms stage 3-4

Proportion (%) of first-time detected patients with malignant neoplasms of stage 3-4 from the total number of first-time detected malignant neoplasms in the reporting period

Quarterly

ERCP IS - Electronic Registry of Cancer Patients Information System

Decrease in the value of the indicator for the reporting period compared to the previous period by 5%

6

Indicator of justified complaints about the quality of health services

Number of substantiated complaints per 1,000 outpatient cases

Monthly

Logbook for enquiries

The indicator value must not exceed 3.0

7

Hospitalisation rate for complications of cardiovascular diseases (arterial hypertension, myocardial infarction, stroke)

Proportion (%) of inpatients treated for complications of cardiovascular diseases (arterial hypertension, myocardial infarction, stroke) per population

Quarterly

DISC, ERCP IS

Decrease in the value of the indicator for the reporting period compared to the previous period by 5%

8

Indicator of epidemiological investigation of nosocomial infections

Proportion (%) of cases of nosocomial infections with epidemiological investigation from the total number of reported cases

Monthly

Minutes of the meeting of the infection control committee

The indicator value must not exceed 3.0

9

Indicator for identifying causes and factors of nosocomial infections and the spread of nosocomial infections

Proportion (%) of cases of nosocomial infections with identified causes and factors of nosocomial infections from the total number of reported cases

Monthly

Minutes of the meeting of the infection control committee

The value of the indicator tends to 80%

10

Immunization coverage rate for children under 5 years of age against targeted infections

Proportion (%) of children in the target group who were immunised

Monthly on an incremental basis

Reporting form No. 4, approved by Order No. 415 of the Minister of National Economy of 30 May 2015, logbook of preventive vaccinations

Indicator value tends towards 95% for the year (monthly at least 7.9%)

      Explanation of abbreviations and acronyms :

      1. IPMR – In-Door Patient Medical Record

      2. ERI IS -Electronic Register of Inpatients Information System

      3. DISC - Discharged Inpatients Statistical Chart

      4. PHC - Primary Health Care

      5. WFW - Women of Fertile Age

  Annex 3 to the rules
for the organisation and conduct of
internal and external quality reviews
of health services (care)

Expert judgement

      1. Surname, first name, patronymic (if any) of the person who carried out the review, indicating specialisation, position, academic degree.

      2. Name of health care entity (facility) where the review has been conducted

      3) Basis for the review, or information on the customer

      4. Timeframe of expert evaluation

      5. Period of the review

      6. Scope of the review

      7. Information on the results of the review, including the detected violations and their nature

      8. Conclusions.

      9. Recommendations

      _________________________________________________ ________________________

            Surname, first name, patronymic (if any), signature of the person who carried out the review


      Date "____" ___________ 20 ___

  Annex to order
of the Minister of Healthcare
of the Republic of Kazakhstan
No. KR DSM-230/2020
dated December 3, 2020

List of certain repealed orders in the field of healthcare

      1) Order of the Minister of Healthcare and Social Development of the Republic of Kazakhstan No. 173 of 27 March 2015 "On Approval of the Rules for Organising and Conducting Internal and External Quality Assurance Reviews of Healthcare services" (registered with the Register of State Registration of Regulatory Legal Acts under No. 10880, published on 1 October 2015 in the newspaper "Kazakhstanskaya Pravda" No. 187);

      2) Order No. 568 of the Minister of Healthcare and Social Development of the Republic of Kazakhstan of 28 June 2016 "On Amendments to Order No. 173 of the Minister of Healthcare and Social Development of the Republic of Kazakhstan of 27 March 2015 "On Approval of the Rules for Organising and Conducting Internal and External Quality Assurance Reviews of Healthcare services" (registered with the Register of State Registration of Regulatory Legal Acts under No. 14026, published in the Control Reference Bank of Regulatory Legal Acts of the Republic of Kazakhstan on 15 September 2016 in electronic form);

      3) Order of the Minister of Healthcare of the Republic of Kazakhstan No. KR DSM-3 of 11 February 2019 “On Amendments and Additions to Order of the Minister of Healthcare and Social Development of the Republic of Kazakhstan No. 173 of 27 March 2015 “On Approval of the Rules for the Organisation and Conduct of Internal and External Quality Reviews of Healthcare Services” (registered with the Register o of State Registration of Regulatory Legal Acts under No. 18300, published in the Control Reference Bank of Regulatory Legal Acts of the Republic of Kazakhstan in electronic form on 15 February 2019).

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