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RESUMO - INTRODUÇÃO: Tempos e listas de espera têm merecido especial atenção por parte de cidadãos e políticos. Longos tempos de espera podem implicar resultados negativos pelo impacto na saúde, pelo risco de ocorrência de eventos adversos, por exemplo, e por questões de natureza económica. Esta realidade pode, ainda, transformar situações reversíveis/curáveis em irreversíveis, potenciar incapacidades permanentes ou, no limite, pôr em causa a vida dos doentes. Uma resposta atempada às necessidades de saúde, bem como, a continuidade de cuidados tem-se revelado uma característica chave dos sistemas de saúde fortes, demonstrando ter efeitos na saúde dos cidadãos associada à redução de taxas de mortalidade, taxas de internamento e reinternamento e redução dos custos com cuidados de saúde.
METODOLOGIA: Trata-se de um estudo quantitativo classificado como observacional, retrospetivo, transversal e ecológico, com dados referentes ao periodo de 2017 e 2018, que tem por objetivo analisar a associação entre as primeiras consultas em tempo adequado e inscritos em Lista de Inscritos em Cirurgia (LIC) dentro do Tempo Máximo de Resposta Garantida (TMRG), ao nível das instituições hospitalares do SNS, na atividade de internamento de agudos adultos em Portugal Continental. Os dados da produtividade de cada instituição foram obtidos através da BDMH e do Portal da Transparência do SNS e serão analisados em 3 etapas: Análise Descritiva Univariável, Análise de Correlação e Análise Multivariável (regressão linear simples).
RESULTADOS: No período em análise, a proporção de primeiras consultas em tempo adequado era de cerca de 75%, enquanto que a proporção de incritos em LIC dentro do TMRG era de 87%. No departamento médico foi possivel constatar associação inversa, embora fraca, entre a resposta a pedidos de 1ª consultas e o número de internamentos. Já no departamento cirúrgico, a associação entre pedidos de inscritos em LIC e a DM é mais evidente, com uma correlação de cerca de 54%. Os resultados para a regressão linear demonstraram que a demora média era menor nos centros hospitalares que tinham mais inscritos em LIC dentro TMRG (β=-0.443, p<0.001).
CONCLUSÃO: Do ponto de vista da Administração Hospitalar, ficaram evidentes vários aspetos que poderão contribuir para a melhoria de desempenho de diversas instituições, sugerindo-se uma partilha de conhecimento e modelos de organização de meios e recursos das instituições que revelaram melhores resultados para com as restantes.
ABSTRACT - INTRODUTION: Times and waiting lists have received special attention from citizens and politicians. Long waiting times can imply negative results due to the impact on health, the risk of adverse events, for example, and economic reasons. This reality can also transform reversible/curable situations into irreversible ones, potentiate permanent dis-abilities or, at the limit, jeopardize the lives of patients. A timely response to health needs, as well as continuity of care, has proved to be a key feature of strong health systems, demonstrating to have effects on the health of citizens associated with reduced mortality rates, hospitalization and readmission rates and reduced of health care costs. METHODOLOGY: This is a quantitative study classified as observational, retrospective, cross-sectional and ecological, with data for the period 2017 and 2018, which aims to analyze the association between the first consultations in an adequate time and enrolled in the Surgery Enrollment List (SEL) within the Maximum Guaranteed Response Time (MGRT), at the level of NHS hospitals, in the activity of inpatient acute care adults in mainland Portugal. The productivity data of each institution were obtained through BDMH and the SNS Transparency Portal and will be analyzed in 3 stages: Univariate Descrip-tive Analysis, Correlation Analysis and Multivariable Analysis (simple linear regression). RESULTS: In the period under review, the proportion of timely first consultations was around 75%, while the proportion of SEL enrollees within the MGRT was 87%. In the medical department, it was possible to observe an inverse, albeit weak, association be-tween the response to requests for 1st consultations and the number of hospitalizations. In the surgical department, the association between requests for SEL enrollments and DM is more evident, with a correlation of around 54%. The results for linear regression showed that the mean delay was shorter in hospital centers that had more SEL enrollees within TMRG (β=-0.443, p<0.001). CONCLUSION: In view of the Hospital Management, several aspects were evident that could contribute to the improvement of the performance of several institutions, suggest-ing a sharing of knowledge and models of organization of means and resources of the institutions that showed better results for the others.
ABSTRACT - INTRODUTION: Times and waiting lists have received special attention from citizens and politicians. Long waiting times can imply negative results due to the impact on health, the risk of adverse events, for example, and economic reasons. This reality can also transform reversible/curable situations into irreversible ones, potentiate permanent dis-abilities or, at the limit, jeopardize the lives of patients. A timely response to health needs, as well as continuity of care, has proved to be a key feature of strong health systems, demonstrating to have effects on the health of citizens associated with reduced mortality rates, hospitalization and readmission rates and reduced of health care costs. METHODOLOGY: This is a quantitative study classified as observational, retrospective, cross-sectional and ecological, with data for the period 2017 and 2018, which aims to analyze the association between the first consultations in an adequate time and enrolled in the Surgery Enrollment List (SEL) within the Maximum Guaranteed Response Time (MGRT), at the level of NHS hospitals, in the activity of inpatient acute care adults in mainland Portugal. The productivity data of each institution were obtained through BDMH and the SNS Transparency Portal and will be analyzed in 3 stages: Univariate Descrip-tive Analysis, Correlation Analysis and Multivariable Analysis (simple linear regression). RESULTS: In the period under review, the proportion of timely first consultations was around 75%, while the proportion of SEL enrollees within the MGRT was 87%. In the medical department, it was possible to observe an inverse, albeit weak, association be-tween the response to requests for 1st consultations and the number of hospitalizations. In the surgical department, the association between requests for SEL enrollments and DM is more evident, with a correlation of around 54%. The results for linear regression showed that the mean delay was shorter in hospital centers that had more SEL enrollees within TMRG (β=-0.443, p<0.001). CONCLUSION: In view of the Hospital Management, several aspects were evident that could contribute to the improvement of the performance of several institutions, suggest-ing a sharing of knowledge and models of organization of means and resources of the institutions that showed better results for the others.
Descrição
Trabalho Final do Curso de Especialização em Administração Hospitalar
Palavras-chave
Avoidable Hospitalization Healthcare appointments access Healthcare access barriers
Contexto Educativo
Citação
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública