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Estudo de fatores preditivos das diferenças nos resultados de duração de internamento e de mortalidade em doentes com enfarte agudo do miocárdio
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Orientador(es)
Resumo(s)
RESUMO - Contexto: O uso apropriado dos recursos hospitalares é importante para o controlo da
despesa e para a melhoria dos resultados. Compreender os fatores que explicam os
resultados na duração de internamento (DI) e mortalidade no enfarte agudo do
miocárdio (EAM) observando o desperdício associado, através da variação não
justificada e identificar os fatores preditivos na admissão são os objetivos desta
investigação. O EAM foi escolhido pela elevada morbilidade e mortalidade, elevada
variabilidade (DI/mortalidade) e elevados custos de tratamento a nível global.
Metodologia: Desenvolveram-se duas análises: 1) estudo do EAM na DI e mortalidade
ao nível do hospital nos doentes internados com alta dos hospitais SNS entre
2011/2013 com recurso a dados administrativos (DA) e 2) estudo dos fatores
preditivos de DI e mortalidade no EAM na admissão de doentes internados com alta
num hospital entre 2010/2011 recorrendo a DA e dados laboratoriais (DL).
Resultados: No primeiro estudo observaram-se diferenças na DI e mortalidade,
correspondendo a um desperdício de 2392 dias de internamento e 137 mortes
evitáveis. No segundo foram identificados um conjunto de fatores preditivos
constituídos por DA e DL com excelentes resultados na validação.
Conclusão: Existe variabilidade de práticas com particular relevância na mortalidade,
defendendo-se que é necessário mudar a gestão do fluxo do doente no tratamento do
EAM a diversos níveis. Os modelos encontrados a partir do estudo dos fatores
preditivos permitem melhorar essa gestão. São identificados para futura investigação
a avaliação do desperdício noutras doenças, implementação de sistema de apoio à
decisão e generalização dos fatores preditivos.
ABSTRACT - Background: Appropriate hospital resource use is an important factor to control the expenditure and improve the results. The aim of this study is to understand the factors that explain the length of hospital stay (LOS) and the mortality results in acute myocardial infarction (AMI) by observing the associated waste through unjustified variability and identify the predictive factors for those measures. Methods: To pursue the objectives, the following analysis were performed: 1) the study of AMI in LOS and mortality at hospital level with the inpatient discharged from NHS hospitals between 2011/2013, based on administrative data (AD) and 2) the study of the predictive factors on LOS and mortality in AMI patients at the time of inpatient admission, discharged from one hospital between 2010/2011 based on AD and laboratory data (LD). Results: In the first study, there were differences identified in LOS and mortality, with a total waste of 2392 days of stay and 137 avoidable deaths. In the second study, predictive factors with both DA and DL variables were identified, showing excellent validation results. Conclusions: There is variability in AMI treatment practices and this fact has particular incidence in mortality. We defend that is necessary to do more in the inpatient management at AMI treatment in several domains to reduce associated hospital waste and the models generated from the predictive factors study contribute to that improvement. Emerging topics for future investigation are the evaluation of waste in other diseases, implementation of a disease support system and predictive factors generalization studies.
ABSTRACT - Background: Appropriate hospital resource use is an important factor to control the expenditure and improve the results. The aim of this study is to understand the factors that explain the length of hospital stay (LOS) and the mortality results in acute myocardial infarction (AMI) by observing the associated waste through unjustified variability and identify the predictive factors for those measures. Methods: To pursue the objectives, the following analysis were performed: 1) the study of AMI in LOS and mortality at hospital level with the inpatient discharged from NHS hospitals between 2011/2013, based on administrative data (AD) and 2) the study of the predictive factors on LOS and mortality in AMI patients at the time of inpatient admission, discharged from one hospital between 2010/2011 based on AD and laboratory data (LD). Results: In the first study, there were differences identified in LOS and mortality, with a total waste of 2392 days of stay and 137 avoidable deaths. In the second study, predictive factors with both DA and DL variables were identified, showing excellent validation results. Conclusions: There is variability in AMI treatment practices and this fact has particular incidence in mortality. We defend that is necessary to do more in the inpatient management at AMI treatment in several domains to reduce associated hospital waste and the models generated from the predictive factors study contribute to that improvement. Emerging topics for future investigation are the evaluation of waste in other diseases, implementation of a disease support system and predictive factors generalization studies.
Descrição
Palavras-chave
Desperdício hospitalar Enfarte agudo do miocárdio Duração de internamento Mortalidade Modelos preditivos Hospital waste Acute myocardial infarction Length of hospital stay Mortality Predictive model