[Evaluation of the performance of health services]

Quality assessment of adult intensive care services: application of a tool adjusted to the reality of low-income countries

Objective

To assess the quality of adult intensive care units.

Methods

This population-based, cross-sectional, observational, analytical study evaluated management type in Maranhão, Brazil. An assessment instrument was applied that assigned scores to each service (maximum 124 points). The units were categorized as insufficient (< 50% of the maximum score), typical (≥ 50% and <80% of the maximum score), or sufficient (≥ 80% of the maximum score).

Results

Of the 26 intensive care units in Maranhão, 23 were evaluated; 15 (65.2%) were located in the state capital, and 14 (60.9%) were public. The mean final score was 67.2 (54.2% of the maximum). The worst performance was observed with regard to processes (50.9%) in the units located outside the capital (p = 0.037) and for hospitals with 68 beds or fewer (p = 0.027). The result of the assessment categorized services as a function of the overall total points earned. Specifically, 8 (34.8%) services were assessed as insufficient, 13 (56.5%) were assessed as typical, and 2 (8.7%) were assessed as sufficient.

Conclusion

The majority of the intensive care units in this study were assessed as typical. These services must be better qualified. The priorities are the processes of the units located outside the capital and in small hospitals.

Auditoria em fisioterapia no Sistema Único de Saúde: proposta de um protocolo específico

INTRODUÇÃO: A auditoria no Sistema Único de Saúde (SUS) zela pela eficácia, eficiência e efetividade dos serviços que integram o sistema. Nos serviços de fisioterapia, as auditorias têm sido desempenhadas por profissionais sem os conhecimentos técnicos da área e inexistem protocolos de auditoria em fisioterapia específicos para o SUS, o que tem representado um entrave para a especificidade e qualidade das auditorias fisioterapêuticas realizadas. OBJETIVO: Este estudo teve como objetivo propor um modelo de protocolo específico de auditoria fisioterapêutica para os serviços públicos de fisioterapia. MATERIAIS E MÉTODOS: O presente trabalho trata-se de uma pesquisa exploratória por meio do levantamento de artigos publicados nas bases de dados LILACS, SciELO e portal Latin Science, além de documentos eletrônicos do Ministério da Saúde, Coffito e Associação Portuguesa de Fisioterapeutas, entre outros, entre 1991 a 2012. Respeitando as informações colhidas, o protocolo construído contempla uma auditoria sistemática e global sobre os mais variados aspectos dos serviços de fisioterapia em suas dimensões normativas, estruturais, processuais, bem como de resultados. RESULTADOS: Espera-se que o protocolo construído possa contribuir para aumentar a eficiência e acurácia da auditoria em fisioterapia no SUS, de modo que isso se traduza em melhorias na qualidade dos serviços prestados aos usuários.

[Effectiveness of a quality control program in mammography for the Brazilian National Health System]

OBJECTIVE

To assess the effectiveness of a quality control program in mammography services of the Brazilian National Health System (SUS).

METHODS

A prospective study using temporal analysis of a health surveillance action was conducted. A total of 35 service providers that had mammography equipment in operation and regularly performed exams between 2007 and 2009 in the state of Goiás, Central-Western Brazil, participated in this study. Services were assessed during three site visits by performance testing of mammography equipment, film processors, and other materials, and image quality and entrance surface dose in a phantom were also assessed. Each service was scored according to the percentage of tests that conformed to standards.

RESULTS

The mean percentage for compliance among the participating service providers were 64.1% (± 13.3%) in the first visit, 68.4% (± 15.9%) in the second, and 77.1% (± 13.3%) in the third (p < 0.001). The main improvements resulted from adjustments to the breast compression force, the automatic exposure control system, and the alignment of the compression paddle. The doses measured were within the conformity range in 80% of the services assessed.

CONCLUSIONS

The implementation of this program in the mammography services was effective at improving the operational parameters of the mammography machines, although 40% of the services did not reach the acceptable level of 70%. This result indicates the need to continue this health surveillance action.

[Evaluation of health service providers by consumers through the Analytic Hierarchy Process Method]

OBJECTIVE

To assess the quality of services offered by health service providers, according to the perception of consumers.

METHODS

A cross-sectional study with 360 consumers from seven health service providers in the metropolitan area of Curitiba, PR, in 2008, was performed. An individual questionnaire measuring the consumers' preferences in relation to six attributes (location of service points; effectiveness of doctors, clinics and hospitals; promptness and kindness when caring for patients and family members; ease of access to the authorization forms for consultations; price; diversity of available doctors, clinics and hospitals) for each one of the analyzed health service providers was carried out. The Analytic Hierarchy Process (AHP), a multiple criteria tool for decision analysis and planning, was used to analyze the responses.

RESULTS

The attribute most valued by the consumers was "price". The companies were grouped into two sets, regarding the mentioned attributes: two had lower preference (between 19% and 23%) and five, higher preference (around 10% each).

CONCLUSIONS

With this type of research, health service providers could reshape their structures, processes, prices and accredited networks, in order to improve their market strategy.

Percepções sobre qualidade de serviços que atendem à saúde da mulher

O objetivo deste trabalho é identificar as características relacionadas à qualidade em serviços que atendem à saúde da mulher na perspectiva de profissionais de vigilância sanitária (Visa) e de coordenadores de saúde da mulher (CSM) de municípios. Trata-se de um estudo de abordagem qualitativa, efetuado por meio de entrevistas semiestruturadas. Foram selecionadas três capitais brasileiras e entrevistados três sujeitos de cada capital - um responsável e um técnico da área de Visa em serviços de saúde e um CSM. A análise das entrevistas foi realizada pela técnica de análise de conteúdo, organizando as respostas em categorias temáticas baseadas no modelo de avaliação dos serviços de saúde de Donabedian: estrutura, processos e resultados. Os técnicos de Visa relataram com maior frequência aspectos relacionados à estrutura dos serviços de saúde, como equipamentos e recursos humanos qualificados. Os responsáveis pela Visa citaram aspectos relacionados à estrutura e aos processos como priorização no atendimento. Os CSM abordaram as três categorias, com destaque para os processos. As entrevistas apontam para um possível prejuízo na avaliação por resultados. O estudo reforça a necessidade de atuação conjunta entre os setores de vigilância e assistência, a fim de promover a qualidade nos serviços.

Pesquisa avaliativa e epidemiologia: movimentos e síntese no processo de avaliação de programas de saúde

Este artigo enfoca alguns antecedentes da avaliação de programas de saúde e aponta a diversidade de teorias e métodos que informam o campo. Com o objetivo de fornecer subsídios para pesquisas avaliativas em HIV/AIDS, discutem-se alguns pressupostos clássicos da epidemiologia, em especial da teoria de inferência causal e seus limites na abordagem de enfermidades infecciosas. Argumenta-se que os debates recentes acerca da lógica e aplicabilidade dos estudos de tipo ecológico marcam interesses convergentes entre a epidemiologia e a pesquisa avaliativa, preocupada na incorporação de variáveis contextuais nos modelos de análise. Explicitam-se preceitos e tipologias da pesquisa avaliativa contemporânea com vistas à defesa de um modelo de análise de processos de saúde-doença na perspectiva da avaliação de ações e programas. Por fim, sublinham-se os propósitos comuns e movimentos convergentes da epidemiologia e da pesquisa avaliativa, que servem de referência à discussão sobre os limites e potencialidades do modelo proposto.

[Cardiorespiratory arrest in the intensive care unit: theoretical considerations on factors related with iatrogenic events]

The attendance of Cardiopulmonary Resuscitation (CPR) demands rapidity, efficiency, scientific knowledge and technical ability. Still, an adequate infra structure is vital as well as the accomplishment of an harmonic and synchronized work and team performance, in order to promote the patient's backup. Iatrogenic factors related to attendance of CPR in the Intensive Care Unit may be due to professional inexperience, insufficient staff and problems with material or equipments. Thus, the team must be prepared to assist the patient efficiently, as resuscitation should restore the life process and not prolong the death process.

[Iatrogenic episodes at the ICU and the quality approach]

Regarding iatrogenic occurrences in ICUs as events that interfere with the quality of the care given to critical patients, the author contextualizes such occurrences by taking into account the principles of Total Quality Management as a theoretical framework.

[Nursing process and structure for cancer patients]

This study aimed at evaluating the structure for cancer patient assistance and antineoplasic chemotherapy assistance process. It has been performed at six internation units and one out-patient unit at a university hospital. Systematized observation and semistructured interview were used from January to June, 1996. It was noticed the there were some deficiencies in the physical area and installations of the studied units. Generally, nursing team had no formal training in Oncology, except for Chemotherapy Sector. The absence of a systematized nursing assistance and differences among the studied units as for technical organizational aspects for antineoplasic administration as well as patients and staff interaction has been observed. Inadequations observed could be minimized with such a politics which would be able to increase public sector financing, planting of systematized care and inclusion of Oncology in the permanent nursing team education.