The purposes of this article are to review the concepts of health services access and utilization and to analyze how these concepts interrelate. Access is a complex concept (often used inaccurately) which changes over time and according to the context. Health services utilization is at the core of health systems functioning. Despite some disagreement, according to this review the prevailing perspective is that access is related to characteristics of services supply. Health care services utilization can be applied as a measure of access, but use of services depends on other factors. Individual and contextual factors influence the use of services. The article shows that the concept of access is becoming more comprehensive and is changing its focus from entry into the health system to outcome of care. Access is valued in relation to its impact on health and depends on the effectiveness of care delivered. As an outcome measure, access becomes multidimensional and difficult to operationalize. Finally, the article discusses how health determinants differ from those of health services utilization, which impacts directly on illness, but only indirectly on health.

The incidence of patients with adverse events at the three hospitals was similar to that in international studies. However, the proportion of preventable adverse events was much higher in the Brazilian hospitals.

A segurança do paciente como dimensão da qualidade do cuidado de saúde -um olhar sobre a literatura Patient safety as a dimension of the quality of health care -a look at the literature

The evaluation of the culture of patient safety in hospitals is nowadays considered as a management too, since it helps to identify problem areas and provide valuable information for planning improvements. This study explored the reliability and validity of the Brazilian version of the Hospital Survey on Patient Safety Culture, an instrument that evaluates characteristics of patient safety culture among hospital staff. The reliability of the instrument was evaluated by analyzing the internal consistency of each dimension. The validity of the tool was carried out by means of exploratory and confirmatory factor analysis. The sample was made up of 322 questionnaires that were collected in two Brazilian hospitals in 2012. Cronbach's alpha ranged from 0.52 to 0.91 for the different dimensions, with the exception of two, for which it was much lower. After excluding four items, the exploratory factor analysis presented adjusted indices that were appropriate for a 10 factor model.

Este artigo é uma síntese de alguns dos principais resultados das discussões realizadas ao longo de 18 meses entre pesquisadores de diversas instituições, afiliadas à Abrasco, e procura contribuir para a formulação de uma metodologia que permita: a) compreender quais são e como se inter-relacionam os fatores que influenciam a eficiência, a efetividade e a eqüidade no desempenho do SUS; b) melhorar a formulação de políticas e c) monitorar as desigualdades no acesso e na qualidade dos serviços recebidos pelos diferentes grupos sociais no Brasil. A metodologia desenvolvida nutre-se de elementos utilizados nas propostas de avaliação de desempenho dos sistemas de saúde canadense, australiano, inglês e a da OPS e tem o formato de um painel de controle (dashboard), onde podem ser visualizadas simultaneamente diferentes dimensões da avaliação. O artigo descreve a experiência na adaptação e desenvolvimento da metodologia e fornece sugestões no sentido de aplicá-la para melhorar a formulação da política de saúde no Brasil.

A cultura de segurança, aspecto específico da cultura organizacional geral, é definida como o produto de valores, atitudes, competências e padrões de comportamento individuais e de grupo, os quais determinam o compromisso, o estilo e a proficiência da administração de uma organização saudável e segura 2 . Organizações com uma cultura de segurança positiva são caracterizadas pela comunicação fundada na confiança mútua, pelas percepções partilhadas da importância da segurança e pela confiança na efetividade de ações preventivas 3 .Avaliar cultura de segurança permite identificar e gerir prospectivamente questões relevantes de segurança nas rotinas e condições de trabalho. Esta abordagem permite acessar informações dos funcionários sobre suas percepções e comportamentos relacionados à segurança, identificando pontos fracos e fortes de sua cultura de segurança e as áreas mais problemáticas para que se possa planejar e implementar inter-NOTA RESEARCH NOTE

The HAI is the major preventable AEs, as observed in other developing countries. Despite the limitations of the study, the characterization of preventable AEs indicates that known and effective actions available to reduce HAI, such as hand hygiene, to prevent pressure ulcers, to encourage adherence to protocol and clinical guidelines and to create continuing education programs for health professionals, should compose the list of priorities of hospital managers and health professionals involved in the care of hospitalized patients.

This article presents data from a study on quality of information from the data bank on the form used in the Brazilian health care system to authorize hospital admittance (AIH). The form pertains to the Unified Health System (SUS) and is used by hospitals to be reimbursed for the health care provided to patients, with public funds. The AIH data bank is the largest source of information in Brazil on production by hospitals. This study analyzes a sample of forms filled out by private hospitals under contract with the city of Rio de Janeiro in 1986. Study design was based on reliability between interviewers, and agreement was analyzed utilizing the kappa test. Agreement was analyzed between data from AIH forms filled out by administrative personnel and information from medical files for patients, focusing on demographic, administrative, and clinical variables. The first two types of variables were generally more reliable than the third. Reliability for the principal diagnosis was worse than for the prescribed procedure, despite the latter being the reference for unit reimbursement by the Unified Health System. Furthermore, where there was disagreement, hospitals were more likely to adopt a procedure with higher reimbursement value as compared to the data derived from the clinical file. The article proposes measures to improve data quality.