Pol De Vos

The functioning of the Cuban home hospitalization programme: a descriptive analysis

BackgroundOver the last decades hospital at home (HaH) programmes have been set up in many, mainly European, countries. The Cuban HaH programme is not hospital driven, but the responsibility of the first line health services, and family doctors play a pivotal role.MethodsWe analyse the structure and functioning of the Cuban programme. In this descriptive study, information was prospectively collected on HaH patients admitted between July 1st 2001 and June 30th 2002.ResultsAdmission rates varied between areas from 0.014 to 0.035 per person per year (ppy). The < 1y and 1–4y age groups had the highest admission rates. In one area the follow-up of pregnancy problems led to high 15–24y and 25–49y female admission rates (0,070 and 0,058 respectively). Respiratory affections were the most frequent reason for admission (32,6%), followed by early hospital discharge (16,0%) and gynaeco-obstetrical problems (10.8%). The median length of stay varied from 5 to 7 days between regions and from 5 days (early discharge) to 7 days (gynaeco-obstetrical problems) in function of the reason for admission. On average an HaH episode entailed 1.4 and 1.6 contacts per patient-day with the family doctor and nurse respectively.ConclusionDifference in admission criteria in function of geography, distance to the hospital, transport facilities, and staff factors, as well as differences in hospital policy on early discharge explain the observed variability. The programme plays an important role in the integrated approach to quality care in the Cuban health system, but could benefit from more uniform admission criteria.

La relación entre los niveles de atención constituye un determinante clave de la salud

Basandose en ejemplos concretos de sistemas de salud, se aportan elementos y argumentos al debate internacional sobre la importancia de los niveles de atencion y de la relacion optima entre niveles. El primer nivel tiene tres funciones esenciales: ser el punto de entrada al sistema, facilitar y coordinar el itinerario de su paciente en el sistema, y asegurar la integracion y la sintesis de la informacion de salud de cada paciente. Describiendo los diferentes obstaculos y problemas posibles, en primer lugar la logica comercial que se ha ido introduciendo en muchos sistemas, los autores definen puntos de atencion y proponen ajustes para asegurar el acceso universal, la equidad, la eficacia y eficiencia, y la sostenibilidad de un sistema de salud.

El ingreso en el hogar y su costo directo en Cuba

OBJECTIVE: To analyze home care services in Cuba and determine how length of stay, per-day cost, and per-patient cost vary by diagnosis and by the area of the country in which the services are rendered. METHODS: Patient information was analyzed for 837 individuals who were enrolled in home care services between July 2001 and June 2002 in the following four municipalities: (1) Playa municipality (a metropolitan urban area) in the province of the City of Havana; Cruces municipality (an urban, but not metropolitan, area) in the province of Cienfuegos; Union de Reyes municipality (a rural area) in the province of Matanzas; and Fomento municipality (a mountainous rural area) in the province of Sancti Spiritus Analysis of the mean length of stay for home care services was conducted using the Kaplan-Meier survival curve method. The impact of the following criteria on the probability and timing of discharge was also assessed: diagnosis at time of enrollment (respiratory, gastrointestinal, obstetrical/gynecological, hospital discharge follow-up, and other causes), area in which services were rendered, and patient gender and age. The total service, per-patient, and per-day costs were determined for each municipality. Adjusted multilinear regression models were used to determine how length of stay, diagnosis upon enrollment, and service area affected cost. RESULTS: The diagnoses most frequently requiring home care were respiratory illness (31.4%), hospital follow-up of acute condition (15.5%), obstetrical/ gynecological illness (10.8%), and gastrointestinal disorder (8.1%). The mean length of stay was 6 days (95% confidence interval: 5.75 to 6.25). In Fomento, the probability of patients enrolling in home care was 66% lower than in Cruces and 30% lower than in Playa and Union de Reyes. The total direct cost of home care in the municipalities studied ranged, in Cuban pesos, from

La regionalización de los servicios de salud como una estrategia de reorganización sanitaria

3,983.54 to

Costos del subsistema de urgencias en la atención primaria de salud en Cuba, 1999-2000

9,624.87. The per-day cost ranged from

Diferenciales de salud y una aproximación mediante el empleo del coeficiente de Gini y el índice de concentración en las provincias cubanas, 2002-2008

2.57 to

Empoderamiento comunitario en salud en tres municipios cubanos

6.88, and the per-patient cost from

Utilización de los servicios del nivel primario de atención por los ancianos en tres policlínicos de Cuba

23.04 to

Percepción sobre el análisis de situación de salud en un Consejo Popular de Centro Habana

42.78. The length of stay had a direct impact on per-patient cost (P < 0.0001). CONCLUSIONS: A longer length of stay was observed in the mountainous rural area; however, this was where the lowest per-patient and per-day costs were incurred. Length of stay can be used as an indicator for measuring the quality of home care services. From a cost perspective, length of stay must be evaluated based on diagnosis and geographic area.OBJETIVOS: Analizar el tiempo de estadia en ingreso en el hogar (IH) y su costo diario y por paciente en Cuba, segun el diagnostico al ingreso y la zona donde se brinda el servicio. METODOS: Se analizo la informacion de los 837 pacientes en IH entre julio de 2001 y junio de 2002 en un area del municipio Playa, en Ciudad de La Habana (zona urbana metropolitana), una del municipio Cruces, en Cienfuegos (zona urbana no metropolitana), otra del Municipio Union de Reyes, en Matanzas (zona rural) y una de Fomento, en Sancti Spiritus (zona rural montanosa). Se analizo la mediana del tiempo del IH mediante curvas de supervivencia Kaplan Meier y se evaluo el efecto del diagnostico al ingreso (afecciones respiratorias, gastrointestinales, ginecobstetricas, egreso hospitalario precoz y otras causas), la zona del IH, el sexo y la edad, sobre la posibilidad de egresar del IH. Para cada municipio se calculo el costo directo del servicio, el costo por paciente y el costo por dia de estadia. Se ajustaron modelos de regresion lineal multiple para identificar el efecto que sobre el costo por paciente tienen el tiempo de estadia, el diagnostico al ingreso y el area donde se presta el servicio de IH. RESULTADOS: La causa mas frecuente de IH en los municipios estudiados fueron las afecciones respiratorias (31,4%), seguidas del egreso hospitalario precoz (15,5%), las afecciones ginecobstetricas (10,8%) y los trastornos gastrointestinales (8,1%). La mediana del tiempo de estadia fue de 6 dias (IC95%: 5,75 a 6,25). En Fomento los pacientes tuvieron 66% menos probabilidad de egresar que en Cruces y 30% menos que en Playa y Union de Reyes. El costo directo del IH en los municipios estudiados medido en pesos cubanos (

Evidencias actuales en las propuestas de intervención local para el estudio y manejo de los determinantes sociales de la salud en la población cubana

) vario entre