"3DT" concept as a model for integrating trauma and orthopedic services into priority areas of development and national projects of the Russian Federation

Introduction In the year of anniversaries of two leading national centers for traumatology and orthopedics, the authors analyzed the main problems and current challenges in specialized trauma and orthopedic care (TOC). Historical parallels in the development of TOC in our country and its problems and trends abroad motivated the authors to conduct an analysis while the need for their comparative assessment determined the purpose of the work which is a brief analysis of the organizational model of TOC and substantiation of a "3DT" concept as a contemporary organizational model of trauma and orthopedic service in the Russian Federation. Results and discussion The analysis of current trends in the trauma and orthopedic (TO) service showed its variability over the past three decades. However, the original organizational structure of specialized TO care remained almost the same. A comparative assessment of organizational models has shown that the models for providing specialized care in developed countries are extremely diverse. The availability of assistance does not depend on the population density and tariffs even in the regions of developed countries. In addition, the monetary assessment of treatment of spinal pathology, as an example, has not been standardized and harmonized across countries and regions. It is also important to evaluate the steady increase in high technology care with the use of more developed systems of diagnosis, treatment, rehabilitation and, accordingly, its growing costs. The challenges that our specialty faces may be conditionally divided into technical, socio-economic and organizational ones with the need to create a clear vertical structure of organization, control and referral of patients with organizational decisions for selection of patients with a TO profile according to flows within various areas of subspecialties, the need for justification and feed-back control of financing systems for various types of TO assistance. The challenges described above motivated us to propose a new “3DT” organizational concept as a basis for a more stable and understandable model for the functioning of the national trauma and orthopedic service. The proposed basic model includes 4 direction sectors: D1 (pediatric diseases of the musculoskeletal system and their outcomes); D2 (degenerative and involuntary pathology of the musculoskeletal system); D3 (destructive diseases of the musculoskeletal system of tumor or infectious origin); T (trauma of the