Стратегии управления проектом SFL   Важность аудита для мониторирования процесса   применения процедур и улучшения результ...
Несмотря на то, что в клинических исследованиях продемонстрировано, что первичныечрескожные коронарные вмешательства (пЧКВ...
шифрование данных и организовывать зашифрованные каналы передачи информации междулокальными центрами и центральным серверо...
дополнительно БОИК создает регулярные отчеты, в которых представляется информация одеятельности отдельных стационаров Вели...
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10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус
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10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус

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10 the importance of audit to monitor applications of procedures and imrove primary angioplasty results рус

  1. 1. Стратегии управления проектом SFL Важность аудита для мониторирования процесса применения процедур и улучшения результатов первичной ангиопластики Peter F. Ludman1*, MA, MD, FRCP, FESC; Mark A. de Belder2, MA, MD, FRCP; James M. McLenachan3, MD, FRCP; John S. Birkhead4, MA, MB, FRCP; David Cunningham5, BSc, PhD; Huon H. Gray6, MD, FRCP, FESC, FACC 1. Отдел аудита, Британское общество интервенционных кардиологов и Госпиталь королевы Елизаветы, г. Бирмингем, Великобритания (Audit Lead, British Cardiovascular Intervention Society (BCIS) and Queen Elizabeth Hospital, Birmingham, United Kingdom); 2. Группа мониторинга данных Национального проекта по проведению ангиопластики при инфаркте миокарда (NIAP) и госпиталь при университете Джеймса Кука, г.Мидлсбро, Великобритания (National Infarct Angioplasty Project (NIAP) Data Monitoring Group and The James Cook University Hospital, Middlesbrough, United Kingdom); 3. Программа совершенствования национальной системы здравоохранения Великобритании и Общий госпиталь г. Лидс, г. Лидс, Великобритания (NHS Improvement Programme, United Kingdom and Leeds General Infirmary, Leeds, United Kingdom); 4. Национальный проект аудита ишемии миокарда (MINAP), Национальный институт изучения клинических исходов, Университетский колледж, Лондон, Великобритания (Myocardial Ischaemia National Audit Project (MINAP), National Institute for Clinical Outcomes Research, University College, London, United Kingdom); 5. Центральная база данных аудита вмешательств на сердце, Национальный институт изучения клинических исходов, Университетский колледж, Лондон, Великобритания ( Central Cardiac Audit Database, National Institute for Clinical Outcomes Research, University College, London, United Kingdom); 6. Сопредседатель Национального проекта по проведению ангиопластики при инфаркте миокарда (NIAP) и госпиталь при Университете г. Саутгемптона, филиал Национальной службы здравоохранения, г. Саутгемптон, Великобритания ( Co-Chair, National Infarct Angioplasty Project (NIAP) and University Hospital of Southampton NHS Foundation Trust, Southampton, United Kingdom)*Автор для переписки: Отделение кардиологии, Госпиталь королевы Елизаветы, г. Бирмингем,Великобритания (Cardiology Department, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH,United Kingdom). E-mail: peter.ludman@uhb.nhs.ukРезюмеНесмотря на то, что в клинических исследованиях продемонстрировано, что первичныечрескожные коронарные вмешательства (пЧКВ) обеспечивают лучшие исходы при ИМСПST, чемтромболитическая терапия, невозможно ожидать, что похожие результаты могут быть получены вежедневной практике. Чтобы определить, выполняются ли требования стандартов, необходимнепрерывный аудит программ пЧКВ с надлежащей обратной связью с участвующими центрами испециалистами.Оба национальных аудиторских проекта, MINAP - Национальный проект аудита ишемии (ранееинфаркта) миокарда (Myocardial Ischaemia (formally infarction) National Audit Project) и проектБританского общества интервенционных кардиологов (БОИК), позволяют совершать электронныйсбор данных о пациентах, последовательно поступающих в каждый стационар, вовлеченный воказание экстренной помощи. Обеспечивается регулярная программируемая обратная связь сцентрами, проводящими первичное ЧКВ, что позволяет совершить попытку оценки статистическихвариаций и различий характеристик пациентов, поступающих в разные центры, путемиспользования воронкообразных графиков, графиков контроля статистического процесса имоделей выравнивания риска.Такое представление данных о процессе и результатах, как конфиденциальное, так и в открытыхисточниках, используется для совершенствования качества оказания помощи и ассоциируется спостоянным улучшением результатов и снижением дисбаланса в качестве оказанной помощи.Введение
  2. 2. Несмотря на то, что в клинических исследованиях продемонстрировано, что первичныечрескожные коронарные вмешательства (пЧКВ) обеспечивают лучшие исходы у большинствапациентов с ИМСПST, чем тромболитическая терапия (1), невозможно ожидать, что похожиерезультаты могут быть получены в ежедневной практике вне жестких рамок, в которых проводятсяклинические исследования. Улучшение исходов будет достигаться только, если пЧКВ проводитсяво временные сроки, соответствующие таковым в протоколах исследований, и если во всех пЧКВ-центрах будет показываться уровень положительных результатов, сопоставимый с достигнутым вцентрах-участниках исследований. В клинических исследованиях часто отмечаютсяограничивающие критерии включения и исключения, тогда как в национальных регистрах можноизучать генеральную популяцию в клинической практике. Чтобы определить, выполняются литребования стандартов, необходим непрерывный аудит программ пЧКВ с надлежащей обратнойсвязью с участвующими центрами и специалистами. Существуют преимущества подобного аудитана национальном уровне, поскольку это позволяет проводить централизованный обзор действий ирезультатов и сравнительный анализ центров. Централизованно проведенный аудит такжепозволяет улучшить процедуру сбора, анализа и представления данных об исходах. Дляэффективности аудита крайне важно осуществлять обратную связь с участвующими центрами.Клинический аудит должен оценивать состояние инфраструктуры, необходимой для проведенияизучаемых процедур, процессов, вовлеченных в предоставление услуги, корректностьвмешательства и клинические результаты. Любой сравнительный анализ должен принимать вовнимание статистические вариации и различия характеристиках пациентов, поступающих вразные центры. В Великобритании была разработана серия национальных регистров дляизучения стандартов оказания медицинской помощи при широком спектре кардиоваскулярныхзаболеваний и стратегий лечения.Разработка национальных программ аудита кардиоваскулярных вмешательств в ВеликобританииСбор национальных ЧКВ-данных в Великобритании начался, когда в 1988 г. было основаноБританское общество интервенционных кардиологов (БОИК) (British Cardiovascular InterventionSociety). Первоначально сбор данных представлял собой обычное фиксирование показателейклинической активности на бумажных носителях. Схожие процессы были предложены другимиобществами специалистов в области сердечно-сосудистой патологии, и в 1996 г. они совместносоздали Центральную базу данных аудита вмешательств на сердце (ЦБАВ) (Central Cardiac AuditDatabase), которая позволила проводить проспективный сбор информации о всех пациентах вэлектронном виде. Следуя за инициативой правительства по улучшению стандартов оказанияпомощи пациентам с коронарной патологией («Стандарты национальной службы помощи приишемической болезни сердца» («National Service Framework for Coronary Heart Disease»)) (2),ЦВАБ использовалась в качестве средства отслеживания исходов у пациентов с острыминфарктом миокарда при помощи массива данных Национального проекта аудита инфаркта(сейчас ишемии) миокарда (MINAP) (Myocardial Infarction (now Ischaemia) National Audit Project).Основанный в 1999 г., проект MINAP использовался в последующем всеми стационарами,принимающими пациентов с острым инфарктом миокарда. Со временем сбор данных и процессрепортирования результатов стали более сложными, и массивы данных изменились. Например,одной из первоначальных целей проекта MINAP являлся аудит качества проведениятромболитической терапии у пациентов с ИМСПST, тогда как сейчас он также отслеживаетпроцессы и результаты проведения процедур пЧКВ, а также таковые при других формах острогокоронарного синдрома (3). В массив данных БОИК собирается, в основном, информация опроцедурных аспектах вмешательства у всех пациентов, подвергающихся ЧКВ (4). И хотя имеетсянекоторое дублирование относительно когорты пЧКВ-пациентов, оно (дублирование) являетсяполезным для перекрестной проверки баз данных, и предпринимаются попытки объединить этибазы. ЦБАВ базируется сейчас в Национальном институте изучения клинических исходов(НИИКИ) (National Institute for Clinical Outcomes Research), Университетский колледж, Лондон, иосуществляет поддержку проведения национальных аудитов при различных кардиоваскулярныхзаболеваниях (рис. 1) (5).Общенациональное (для Соединенного королевства) участие в электронном сборе данных ЧКВпроводится с 2005 г. Несмотря на то, что специально разработанное программное обеспечениеопционально предоставляется ЦБАВ (сейчас под патронажем НИИКИ), каждый ЧКВ-центр может,если изъявляет желание, использовать собственные специально разработанные иликоммерчески доступные системы сбора информации. Какая бы электронная система сбораинформации не использовалась, все данные загружаются в локальные копии пакета программLotus Notes™, которые имеются в каждом ЧКВ-центре. Этот пакет программ позволяет проводить
  3. 3. шифрование данных и организовывать зашифрованные каналы передачи информации междулокальными центрами и центральным сервером данных. Он также запрограммированобеспечивать доступ к данным реальной практики конкретного центра в рамках всегонационального регистра (данные в рамках регистра представляются в обобщенном и анонимномвиде). Таким образом, каждый центр имеет возможность сравнить данные собственной практики собобщенными национальными результатами. Анализ данных позволяет суммироватьдемографическую информацию пациентов, их клинические характеристики, процедурные итехнические аспекты ЧКВ, а также клинические исходы, включая развитие нежелательныхявлений. Например, когда сравниваются данные локального центра с национальными данными,пользователь имеет возможность детализировать информацию: от раздела, где представленыданные обо всех ЧКВ-процедурах, он может перейти к разделу, где описаны первичныевмешательства или вмешательства с использованием стентов с лекарственным покрытием, и т.д.По каждой ЧКВ-процедуре суммарно собирается 113 единиц информации, включая уникальныйидентификатор пациента (номер в Национальной службе здравоохранения для проживающих вАнглии и Уэльсе), который позволяет отслеживать случаи смерти пациентов. Основной цельюсбора информации БОИК является помощь ЧКВ-центрам в улучшении качества проведения ЧКВ.Таким образом, акцент делается на аудите клинической практики вместо сравнительного анализастандартов и результатов. Большая часть вышеописанного зависит от обеспечения обратнойсвязи с тем, чтобы позволить центрам видеть, насколько хороши их результаты относительнодругих центров Великобритании, а также национальных и международных рекомендаций. Этаобратная связь от БОИК обеспечивается несколькими способами, и в рамках проекта MINAPпубликуется ежегодный отчет, в котором проводится обзор процессов и результатов, а такжеключевых показателей эффективности работы стационаров. Рисунок 1. Национальный аудит кардиоваскулярных вмешательств, проводимый Центральной базой данных аудита вмешательств на сердце (ЦБАВ) (Central Cardiac Audit Database (CCAD)), сейчас являющейся частью Национального института изучения клинических исходов (НИИКИ) (National Institute for Cardiovascular Outcomes Research (NICOR)). Обратная связь по результатам национального аудита с сетями, стационарами и отдельными врачам Отдельные центры могут использовать собственное программное обеспечение для виртуальной оценки каждого аспекта проведения процедур ЧКВ в данном центре, при этом
  4. 4. дополнительно БОИК создает регулярные отчеты, в которых представляется информация одеятельности отдельных стационаров Великобритании и ее результатах.Ежегодный национальный отчетОсновная обратная связь с участвующими центрами осуществляется относительнополноценности сбора информации в этих центрах, особенно касательно 12 ключевыхпараметров (рис. 2). Последние позволяют отслеживать исходы и создавать модели риска,которые БОИК использует для изучения результатов ЧКВ (см. ниже). Улучшение механизмовсбора информации год от года привело к тому, что большинство центров сейчас на 100%отвечают этим аспектам программы аудита. Более того, данные ЦБАВ сравниваются собобщенными статистическими данными, собранными отдельно от каждого центра, и в случаяхналичия несоответствий, стационары информируются (рис. 3).Каждый год база данных БОИК анализируется и представляется в качестве аудиторскогоотчета на одном из ежегодных съездов Общества. Этот отчет затем делается публичнодоступным (6), находки резюмируются и отдельно распространяются по всем сетям и центрамв виде короткого отчета. Для стимулирования предоставления данных в отчет включаетсяинформация о принадлежности клинического случая центру и полноте каждой записи (какописано выше). Идентифицируется эффективность отдельных ЧКВ-центров, что стимулируетулучшение процессов посредством сравнения с другими такими же центрамиВ ежегодном отчете БОИК (6) приводится широкий спектр выводов, детализирующих практикуЧКВ в Великобритании. Некоторые из этих данных, касающихся пациентов, которым быловыполнено пЧКВ, представлены ниже.Рисунок 2. Полнота внесения данных в ЦБАВ для 12 ключевых параметров в массиве данных БОИК. Участок таблицы полнотыданных, предоставленных стационарами, с акцентом, сделанным на тех полях, которые требуются для измерениястратифицированных по риску результатов. Там, где данные представлены менее, чем на 90%, поле выделяется розовым цветом, еслиданные представлены менее, чем на 50%, поле окрашено в красный цвет.
  5. 5. 53770ff953871ff9_3770fF953770ff9_3770bv=53770ff953770ff953770ff953770bf953770ff953770ff9u3670ff=53770ff953770ff953770gb953770ff953770ff953770ff_53570ff953770"f953770ff953770ff953770ff953770ff953770ff953771ff953770ff95s770fB953770ff913770ff953770ff953770ff95377pff952770ff953770ff953770ff953750ff953770ff;53774ff953770ff953770ff953770ff953?70ff)5376fff953730ff953770ff953770fd95367pff9537_0ff95і7?0fF953370ff95376fff95376fff953770ff953770ff953770ff953772fg=%3770ff953770ff953770fg9%3770ff953770ff953770ff953770ff953770ff953670ff953770ff953770ff953770ff953770dF95376gff953770gd953770ff953770ff953771ff953770ff957770ff953770ff95377pdf953750ff953770ff953760ff953770ff953770ff953770fg953770ff953770ff953772ff95s770fd 953730ff9_3770ff953770ff953_70ff953770ff95376vfb9537vfff953770vf953770ff953770ff9%3770ff9_3570ff953770ff953770ff953670ff953770ff953770f&)53770ff953770gf951770ff953770ff953770ff9%3770ff9u3770ff953770ff953771ff953770жf95376fnf953770ff953770ff951770ff953770ff953770ff953770ff953770ff9u3770ff953770ff953770ff95#_70ff953770fF953770ff953770fd953770ff953770ff953770ff952770`f953770ff953770ff953770ff953770ff95377ff953770ff953770ff953770ff9537_0df9_1770ff95377_ff953770ff9537_0жf953570fж953770ff953772ff953·70ff943770ff953570f&953770ff953772ff953770&f853772ff95377рff953770ff973770ff94356fff963b72ffe3cad6fffffffffffffffffffffffffffbffffffffbffffffffffffffffffffffffbfbfffffffffffdfffffffffffff_fffdffbffffffffffffffvfffffffffffffffdgffdfffffffffffffffvffffffffffffffbfffffffffbffff
  6. 6. fffffffffffvffffffffffffdfffffffffffffffffffffffffffffffdffffffdfff&bfffffffffffffffffffffffvffffffffffffffffffffffffffffffdffffffffffffbffffffffffdfvfffffgfffnffffffffffffffFffffffffffffff$fffffffffffffffffffffffffffffffffffffffgffffffffffffffffffbfffffffffffffffffffffffffffffffffffffdfffffffffffffffffffffFfffffffffffFffffffffffffFfffffffffffffffffffffffffffffffffffvffffff 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  7. 7. 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  8. 8. fжfffffffffffffffffffffffffffff&fffgffff&&&ffdffffffbffffffffffffffnffffffffffffffbffffffffffffffffffff&fffffffffffffffffffffffbfffffffdffffffffffffff&fffffffffffffffffffffffFfffffFffffffffffffffffжfffffFffffbffdffbffffffffffffff&ffffffffffffffffffffffffffffffffffffffffdffffffbfffffffb_fgffbff&ffffffFfffffffffffffffffffffffgffgffnffffffFffffffffffffdfffffffffFf&fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff&fffffffffffffffffffffffffffffffffffffffffffffffffffffdffffffff&fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffdfffffffffffffffffffffffvfffffffffffffffffdfffffffffffffffffffffffffffbffffffffffffffffffffffffffffffffffff454141ff3d393efffffffffffffffffffffffffffffffffffbffffffffffvfffffffffffffffffffffffffffffFffffffffffffffffffffffffffff&ffffffffffffffffffffffffffffffffffffdfdfffffgfffffffffffbffffffffffffffff&ffffffffffffgffffffffffffffffffffffvffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffddnfffvfffffffffffffffffffffffffffvffffffffffffffffffffffffffffffffffffffffffffffffff&ffffffffffffFffffffffffffffffffffff&gffffffff&ffffffffffffffbfffffff&fffffffffffffFfffffffffffffffffffffffffgffffffffffffffffffffffffffdffffffffffffbfffffffffffFbffffffffffffffffffffffffffnfffffffffffffffffffffffffffffffffffffffffff_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  9. 9. 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  10. 10. 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