Validation of Outcomes Through the Analysis of the Process-Outcome Relation: Limitations

Silva, Letícia Krauss

doi:10.1093/intqhc/9.2.101

Cited by 2 publications

(4 citation statements)

References 22 publications

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“…O fato da posição dessas unidades na classificação dos escores (obtidos na análise fatorial) não ter se modificado após o procedimento metodológico de padronização, permite-nos levantar uma primeira hipótese relacionada à adequação das estruturas dessas unidades em relação ao perfil de risco extremo das gestantes e fetos. Uma segunda hipótese aponta para possíveis falhas existentes no processo da assistência hospitalar, como o uso inapropriado de tecnologias médicas, 12 que não puderam ser aprofundadas no presente estudo. Por outro lado, os escores bastante elevados, relativos ao fator "Perfil de Risco Materno" encontrado para estas unidades, permite-nos inferir que o desempenho desses hospitais é superior quando comparado ao das outras unidades hospitalares, que embora com resultados semelhantes, mostraram um perfil de risco bem menor, sobretudo considerando o ponto de corte referente ao terceiro quartil.…”

Section: Discussionunclassified

Assistência obstétrica e risco de internação na rede de hospitais do Estado do Rio de Janeiro

2002

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OBJETIVO: Estudar a variação das taxas de mortalidade neonatal precoce, natimortalidade e de um conjunto de indicadores da rede de hospitais que prestaram atenção obstétrica ao Sistema Único de Saúde, visando o monitoramento das unidades hospitalares a partir do Sistema de Informações Hospitalares (SIH/SUS) e do Sistema de Nascidos Vivos (SINASC). MÉTODOS: Em 1997, 135 hospitais do Estado do Rio de Janeiro foram estudados por meio da análise estatística fatorial, pelo método de componentes principais. Estabeleceu-se a distribuição dos escores dos estabelecimentos nos dois primeiros componentes, o que permitiu classificar os hospitais segundo o perfil de risco materno das internações e os resultados da assistência. RESULTADOS: Observou-se que a rede obstétrica do Sistema Único de Saúde no Estado, responsável por cerca de 77,8% dos partos, possui 23% dos hospitais que realizam menos de 100 partos/ano. Entre os hospitais com perfil de internação de extremo risco materno e baixo desempenho encontram-se unidades consideradas referência para gestação de alto risco. Observou-se que 5% dos hospitais possuidores de estruturas de baixa complexidade apresentaram um perfil de risco materno alto e resultados da assistência questionáveis. CONCLUSÕES: O SIH/SUS mostrou ser uma importante fonte de dados para monitorar a natimortalidade e a mortalidade neonatal precoce hospitalares e para o planejamento das ações de vigilância das unidades hospitalares obstétricas e neonatais.

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Section: Discussionunclassified

Assistência obstétrica e risco de internação na rede de hospitais do Estado do Rio de Janeiro

2002

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“…it is linked to severity of conditions (if health status related); 9. it takes into account co-morbidity; 10. it accounts for patient/client-related factors, including compliance with treatment/therapy/management regime; and 11. the standards the indicator measures or is based upon are affordable and feasible. (Banta 1992;Boyce 1996;Donabedian 1966;Mant and Hicks 1996;Scrivens 1995;silva 1997) Some common outcome indicators used in health services are:…”

Section: Processmentioning

confidence: 99%

“…the outcome measure tells how the practice, intervention or process worked, not why; and 6. clients, managers and organisations are interested in structure and process as well as outcomes. (Banta 1992;Boyce 1996;Donabedian 1966; Mant and Hichs 1996;Scrivens 1995;Silva 1997) This does not mean that outcomes should not be measured; one must recognise the difficulties in measurement. To assist in developing outcome indicators there are some guidelines that make it easier, more valid and reliable, as well as affordable, to collect and analyse data.…”

Section: Processmentioning

confidence: 99%

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Towards Strategic Quality Management of Health Care

Whittaker¹

1999

Journal of Health Management

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This paper briefly explores the history of quality management principles and their application to health care. Defining some of the principles that have evolved in quality management, especially in health care management, the paper discusses the analysis of and means used to improve quality using structure, process and outcome variables, with special focus on examples of the use of these in developing countries' health care systems. Finally, the paper describes some of the measurement and implementation challenges for those interested in quality management in health care. IntroductionThe search for and value of quality in health care is not new. The concepts of quality of care in health are firmly embedded in the spirit of the Hippocratic Oath, and in the regulation of medical practices in Indian, Chinese and Greek medicine (Kols and Sherman 1998), where quality is defined as the responsibility of the individual practitioner. In these models, and until recently in most health systems, quality in health care was seen as a product of highly skills-based training and selection of candidates, and a self-regulation process by the individual and the professional body (Harvey 1996). Interests in quality of care have been revived in recent years for a number of reasons. These include:1. increased attention to resource allocation, cost-effectiveness and efficiency; 2. increase in community participation and consumer activism in health;at University of Birmingham on June 14, 2015 jhm.sagepub.com Downloaded from 216 3. changes in management attitudes and culture in the private sector, especially manufacturing, which has influenced management practices in health; 4. reforms in health services, especially public sector, including user payment schemes; 5. increased professionalism in health care; 6. a focus on standard setting; 7. a recognition that there were quality problems in many primary health care settings; 8. an expansion of the private sector and its role in health care delivery in many developed and developing countries; and 9. a realisation of the need for systematic analysis and improvement of problems.Recently, the process of quality improvement in health care (and in management in all sectors), has moved towards a more proactive, systematic and continual process. Client (patient) satisfaction and management (service) efficiency are more likely to happen when an organisation focuses upon quality. Improvements in the process and systems, and a transformation of management to strategic quality management is a long-term process requiring commitment of time, resources and all staff.Benefits of quality improvement in health care reflect those found and demonstrated in industry and include:.

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Validation of Outcomes Through the Analysis of the Process-Outcome Relation: Limitations

Cited by 2 publications

References 22 publications

Assistência obstétrica e risco de internação na rede de hospitais do Estado do Rio de Janeiro

Assistência obstétrica e risco de internação na rede de hospitais do Estado do Rio de Janeiro

Towards Strategic Quality Management of Health Care

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