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RESUMO - Contexto: Diariamente entram no serviço de urgência doentes com patologias, que
estão associados a episódios de urgências potencialmente evitáveis por Ambulatory
Care Sensitive Condition (ACSC), que geram desperdícios em saúde. Identificar estes
episódios, estudar as variáveis que explicam este fenómeno, observando o desperdício
associado e compreender os fatores preditivos na admissão são os objetivos desta
investigação. O elevado número de urgências associado a falta de estudos em Portugal
sobre as ACSC e o serviço de urgência, leva ao desenvolvimento desta investigação.
Metodologia: As urgências potencialmente evitáveis por ACSC foram identificadas,
seguindo a metodologia do Canadian Institute for Healthcare Information. Após a
identificação, foram desenvolvidas três análises: 1) Estudo e caracterização dos
episódios de urgência, comparando os resultados entre os episódios com e sem ACSC,
2) Estudo dos fatores preditivos de urgências evitáveis por ACSC, utilizando o método
de regressão logística e 3) Estudo dos custos decorrentes das urgências evitáveis por
ACSC, tendo como base o custo de tratamento no Serviço de Urgência Polivalente face
ao custo de acompanhamento e monitorização nos cuidados de ambulatório.
Resultados: Foram identificadas 2346 urgências evitáveis por ACSC. Ambos os grupos
apresentam resultados semelhantes para as variáveis, faixa etária, origem da admissão,
triagem de Manchester e destino após alta. A doença pulmonar obstrutiva crónica foi
responsável por 44,29% dos episódios de urgência evitáveis por ACSC. O risco de
urgência evitável aumenta quando o doente se encontra na faixa etária entre os 70 e os
75 anos em 2,627 e proveniência na admissão através do INEM em 1,896 vezes. O
desperdício gerado para o tratamento dos episódios evitáveis foi de 154 601,40€.
Conclusão: As urgências potencialmente evitáveis por ACSC devem constituir um
indicador para a medição do desempenho dos cuidados de ambulatório e serviços de
urgência a nível nacional. Com os resultados encontrados, é possível sedimentar uma
cultura para a reorganização do modelo de prestação de cuidados, controlo das
condições agudas e gestão efetiva das doenças crónicas, minimizando assim o número
de admissões no futuro promovendo a sustentabilidade financeira dos serviços de
urgência e a redução do desperdício em saúde.
ABSTRACT - Background: Daily in the emergency department there are patients with pathologies that are associated with episodes of potentially avoidable emergencies for Ambulatory Care Sensitive Condition (ACSC). These situations generate waste in health. Identify these episodes, studying the variables that explain this phenomenon, calculate the waste associated and understand the predictive factors in the admission are the goals of this research. The high number of attendances to the emergency department associated with the lack of studies in Portugal on the ACSC leads to the development of this research. Methods: Potentially avoidable emergencies for ACSC were identified, following the methodology of the Canadian Institute for Healthcare Information. After identification three analyses were developed: 1) characterization of emergency episodes, comparing the results between episodes with and without ACSC, 2) identify predictive factors of avoidable emergencies for ACSC, using logistic regression method and 3) analyze the costs of avoidable emergency for ACSC, based on the treatment costs in the emergency department comparing with follow-up costs and monitoring in outpatient care. Results: 2346 avoidable emergencies were identified by ACSC. Both groups had similar results for the variables: age, origin of admission, color in Manchester triage and destination after discharge. Chronic obstructive pulmonary disease was responsible for 44.29% of the episodes of avoidable emergencies for ACSC. The risk of avoidable emergencies increases when the patient is in the age range between 70 and 75 years in 2.627 and provenance on admission through the INEM in 1.896 times. The waste generated for the treatment of preventable episodes was 154 601.40€. Conclusions: Potentially avoidable emergencies for ACSC must be an indicator to measuring the performance of outpatient care and emergency department at national level. With these results, it is possible to settle a culture for the reorganization of the model of care, control of acute pathologies and effective management of chronic diseases, thereby minimizing the number of emergency admissions in the future promoting the financial sustainability of emergency department and reduction of waste in health.
ABSTRACT - Background: Daily in the emergency department there are patients with pathologies that are associated with episodes of potentially avoidable emergencies for Ambulatory Care Sensitive Condition (ACSC). These situations generate waste in health. Identify these episodes, studying the variables that explain this phenomenon, calculate the waste associated and understand the predictive factors in the admission are the goals of this research. The high number of attendances to the emergency department associated with the lack of studies in Portugal on the ACSC leads to the development of this research. Methods: Potentially avoidable emergencies for ACSC were identified, following the methodology of the Canadian Institute for Healthcare Information. After identification three analyses were developed: 1) characterization of emergency episodes, comparing the results between episodes with and without ACSC, 2) identify predictive factors of avoidable emergencies for ACSC, using logistic regression method and 3) analyze the costs of avoidable emergency for ACSC, based on the treatment costs in the emergency department comparing with follow-up costs and monitoring in outpatient care. Results: 2346 avoidable emergencies were identified by ACSC. Both groups had similar results for the variables: age, origin of admission, color in Manchester triage and destination after discharge. Chronic obstructive pulmonary disease was responsible for 44.29% of the episodes of avoidable emergencies for ACSC. The risk of avoidable emergencies increases when the patient is in the age range between 70 and 75 years in 2.627 and provenance on admission through the INEM in 1.896 times. The waste generated for the treatment of preventable episodes was 154 601.40€. Conclusions: Potentially avoidable emergencies for ACSC must be an indicator to measuring the performance of outpatient care and emergency department at national level. With these results, it is possible to settle a culture for the reorganization of the model of care, control of acute pathologies and effective management of chronic diseases, thereby minimizing the number of emergency admissions in the future promoting the financial sustainability of emergency department and reduction of waste in health.
Descrição
Trabalho Final do Curso de Especialização em Administração Hospitalar
Palavras-chave
Urgências potencialmente evitáveis Ambulatory Care Sensitive Conditions Desperdício hospitalar Fatores preditivos Potentially avoidable emergencies Hospital waste Predictive factors
Contexto Educativo
Citação
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública