Marina Ferreira de Noronha

Algoritmo para a composição de dados por internação a partir do sistema de informações hospitalares do sistema único de saúde (SIH/SUS) - Composição de dados por internação a partir do SIH/SUS

The authorization form for hospital admittance (AIH), an observation unit under the Hospital Information System of the Unified Health System (SIH/SUS), may represent a short-term hospital admittance or a longer hospital stay. This study presents an algorithm for composing admittance data based on the AIH forms, allowing for a proper assessment of hospital mortality, costs under the Unified Health System (SUS), and longer hospital stays, typical of chronic, terminal, and psychiatric patients.

Potenciais usos dos AP-DRG para discriminar o perfil da assistência de unidades hospitalares

The All Patient Diagnosis Related Groups (AP-DRG) provide a classification system for general hospital inpatients, aggregating hospitalizations based on resource use and clinical criteria. The different versions of the AP-DRG have been applied to inpatient care management and reimbursement. This paper aimed to describe the classification and explore the potential for generating information on inpatient care management based on data from the Ribeirao Preto region (Sao Paulo State, Brazil) in 1997, including public, private, and charity hospitals. We compared average length of stay related to DRGs in the Ribeirao Preto region and the United States. Using the relative cost weights of the AP-DRGs constructed for New York State, we verified the profile of inpatient care provided by 30 hospitals in the Ribeirao Preto region, and reimbursement for hospital care provided to patients referred from other municipalities and covered by the Unified National Health System (SUS). Our findings indicate the applicability of the classification to inform the decision-making process on inpatient care regionalization and organization in levels of complexity, as well as for improvement of inpatient care monitoring and reimbursement.

O desenvolvimento dos "Diagnosis Related Groups"- DRGs. Metodologia de classificação de pacientes hospitalares

The history of Diagnosis Related Groups (DRGs), a system for classifying patients in acute care hospitals, developed by researchers at Yale University, USA, is reviewed. DRGs are an instrument for measuring the hospital product, primarily from a management viewpoint. Starting with a review of the definitions of hospital product, the article follows the course from the first DRGs through the most recent revision, providing a summary of potential and current applications of the system in several countries, which range from payment mechanism to uses in quality control.

Proposta de indicadores e padrões para a avaliação de qualidade da atenção hospitalar: o caso da asma brônquica

The objectives of this article are to propose indicators for evaluation of the quality of hospital management of bronchial asthma patients, based on explicit criteria from literature reviews. The central problem identified in the literature review is the erroneous evaluation of severity of asthma crises, either by patients and their relatives, or by health professionals at all levels of care, causing serious consequences not only for the patient, but for society as a whole. Mortality figures indicate that from 1980 to 1990, an average of 2000 deaths per year from asthma occurred in Brazil, of which 70% occurred in hospital. Asthma was the fourth cause of hospitalization (hospital admissions), in the state of Rio de Janeiro in 1993. Only 12% of the admissions that resulted in death made use of the ICU. The above information highlights the need for a thorough evaluation of hospital care of bronchial asthma in Brazil, including a review of all admissions resulting in death and reviews of a sample of all bronchial asthma admissions. Proposed criteria are for this evaluation include: severity of the crise, treatment prescribed, information given to the patient and their relatives, and follow-up appointments made after discharge from hospital.

Óbitos por asma nos hospitais do Sistema Único de Saúde

Os obitos por asma sao raros e considerados ‘eventos-sentinela’ da qualidade da assistencia, uma vez que grande parte deles poderia ser evitada se houvesse assistencia adequada. Regularmente, nas ultimas decadas, de todos os obitos por asma notificados no Brasil, cerca de 70% ocorreram em hospitais. Neste estudo, os autores procuraram analisar as mortes hospitalares por asma. Foram analisados a mortalidade proporcional, a mortalidade hospitalar, a taxa de mortalidade e o uso de UTI por asma ocorridos nos hospitais publicos e privados conveniados ao Sistema Unico de Saude (SUS) de todo o pais, no ano de 1996. Naquele ano, foram registrados 1033 casos de morte com o diagnostico de asma, o que representou 2% dos obitos por doencas respiratorias. A mortalidade hospitalar por asma foi mais elevada entre os menores de 1 ano de idade e os com idade superior a 40 anos, e nos estados de Sao Paulo, Espirito Santo, Bahia, Santa Catarina e Distrito Federal. Os autores consideraram que houve sub-utilizacao de leitos de UTI e que ha indicios de comprometimento na qualidade da assistencia hospitalar a pacientes com crise grave de asma. Possivelmente, houve 1) falhas na interpretacao da gravidade da crise tanto por parte dos pacientes e familiares quanto por parte dos profissionais de saude, resultando em demora na procura dos servicos de saude ou em retardo na adocao de medidas intensivas de tratamento; 2) escolha inadequada da unidade hospitalar; 3) prescricao de terapia inadequada e 4) atendimento em unidades sem os recursos tecnologicos necessarios para as condicoes do paciente. Baseado no levantamento realizado, sao feitas recomendacoes para reduzir os obitos por asma.

Arrependimento após a esterilização feminina no Brasil

OBJECTIVES: to identify socio-demographic factors associated with regret following sterilization. METHODS: a cross-cutting study was carried out using data from the National Population and Health Survey conducted in Brazil in 1996. The sample comprised 3233 women of child-bearing age who had been sterilized at least one year prior to the interview. The logistic regression model was employed. RESULTS: the proportion of women regretting sterilization was 10.5% and the main reason reported was the desire to have another child (62.7%). The likelihood of a sterilized woman aged 35 years or over regretting sterilization was less than that for women aged below 25 years (p<0.01). Women with more than nine years of schooling are less likely to regret sterilization than women with three years of schooling or less (RC=0.75; 95%CI: 0.51-1.03). CONCLUSIONS: young women with a low level of education are the group that is most likely to have regrets following sterilization. These results may aid family planning program managers, restating the need for orientation regarding the irreversibility of the method and the changes that may occur in the lives of women in the course of the reproductive cycle, thereby minimizing the possibility of a woman coming to regret the decision.

Differences in disease burden related to condition of maternity among women ages 15-44 in the State of Minas Gerais, Brazil, 2004-2006

Although maternal mortality is one of the most commonly used indicators for evaluating women’s health, it is inefficient for describing actual health status since it fails to take into account years lived with a given incapacity. To make up for this deficiency, the present article analyzes maternal conditions based on the Disability-Adjusted Life Years (DALY) Indicator used in studies on disease burden. DALY has been considered a broad and accurate indicator of the health status of a population because it incorporates the dimensions of mortality and morbidity simultaneously. The aim of the present study was to estimate and assess the differential of the impact of the burden of maternal-condition-related diseases in the State of Minas Gerais, Brazil, and in the state’s 13 macro health regions between 2004 and 2006, among women in child-bearing age, defined here as being women between ages 15 and. Among other findings, a very high disparity was seen in DALY rates among the different macro-regions of the state. The three poorest macro regions (Jequitinhonha, Northeast, and North of Minas) showed the highest DALY rates, corresponding to 44% of the entire estimated maternal-condition disease burden for Minas Gerais. This indicates how maternal morbidity and mortality are sensitive to income inequities, which, in turn, generate unequal status regarding the distribution of health services.

Diferenciais da carga de doença das condições maternas entre mulheres de 15 a 44 anos no Estado de Minas Gerais, 2004-2006

Although maternal mortality is one of the most commonly used indicators for evaluating women’s health, it is inefficient for describing actual health status since it fails to take into account years lived with a given incapacity. To make up for this deficiency, the present article analyzes maternal conditions based on the Disability-Adjusted Life Years (DALY) Indicator used in studies on disease burden. DALY has been considered a broad and accurate indicator of the health status of a population because it incorporates the dimensions of mortality and morbidity simultaneously. The aim of the present study was to estimate and assess the differential of the impact of the burden of maternal-condition-related diseases in the State of Minas Gerais, Brazil, and in the state’s 13 macro health regions between 2004 and 2006, among women in child-bearing age, defined here as being women between ages 15 and. Among other findings, a very high disparity was seen in DALY rates among the different macro-regions of the state. The three poorest macro regions (Jequitinhonha, Northeast, and North of Minas) showed the highest DALY rates, corresponding to 44% of the entire estimated maternal-condition disease burden for Minas Gerais. This indicates how maternal morbidity and mortality are sensitive to income inequities, which, in turn, generate unequal status regarding the distribution of health services.

Diferenciales de la carga de enfermedad de las condiciones maternas entre mujeres de 15 a 44 años en el Estado de Minas Gerais, 2004-2006

Although maternal mortality is one of the most commonly used indicators for evaluating women’s health, it is inefficient for describing actual health status since it fails to take into account years lived with a given incapacity. To make up for this deficiency, the present article analyzes maternal conditions based on the Disability-Adjusted Life Years (DALY) Indicator used in studies on disease burden. DALY has been considered a broad and accurate indicator of the health status of a population because it incorporates the dimensions of mortality and morbidity simultaneously. The aim of the present study was to estimate and assess the differential of the impact of the burden of maternal-condition-related diseases in the State of Minas Gerais, Brazil, and in the state’s 13 macro health regions between 2004 and 2006, among women in child-bearing age, defined here as being women between ages 15 and. Among other findings, a very high disparity was seen in DALY rates among the different macro-regions of the state. The three poorest macro regions (Jequitinhonha, Northeast, and North of Minas) showed the highest DALY rates, corresponding to 44% of the entire estimated maternal-condition disease burden for Minas Gerais. This indicates how maternal morbidity and mortality are sensitive to income inequities, which, in turn, generate unequal status regarding the distribution of health services.