Bielorus A. Medical and social substantiation of the model for detection and prevention of occurrence of adverse events in perinatal practice.

The thesis addresses a relevant and important task of modern social medicine - improving the safety of mothers and infants during the perinatal care by developing a model for detection and prevention of adverse events in perinatal practice, the central element of which is the woman-child-family triad, and the innovative elements are the detection of adverse events and reporting, ranked by level, multidisciplinary approach to the root cause analysis of an adverse event by means of high-quality evidence of new and efficient technologies, and management of existing and new risks to prevent adverse events and medical errors in the future. The model was developed based on the results of a critical analysis of existing evidence-based organizational technologies for improving the level of safety of medical care, as well as the author's own findings concerning the following data: the absence of a declining dynamics of fetus and neonate losses in Ukraine, the establishment of the share of preventive lethal cases at the institution level, the identification of the frequency of diseases and events related to the safety of patients in the neonatal intensive care unit, proving their relationship with mortality and duration of treatment. The effectiveness of introducing certain elements of the proposed model at the perinatal center level over the period of 2014-2017 has been proved, which is confirmed by the improvement of epidemiological situation in the neonatal intensive care unit, and the reduction of intra-ventricular hemorrhages of III-IV grades by 51% and bronchopulmonary dysplasia by 62.5% among infants weighing up to 1500 g at birth; the decrease in re-hospitalization of infants by 19.6%, infant mortality at the department by 62.3%, infant mortality at the perinatal center by 51.6%; the decrease neonatal mortality in the region by 47.2%.