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RESUMO - Introdução: A acreditação em saúde é utilizada diversas vezes como ferramenta de
garantia e regulação da qualidade e segurança dos cuidados de saúde, uma vez que
são esperados melhores processos e, consequentemente, melhores resultados nas
organizações acreditadas. Apesar de diversos estudos apontarem no sentido do
impacto positivo que a acreditação tem nos resultados, a literatura não é consensual.
Desta forma torna-se pertinente desenvolver um estudo em que se analise a potencial
relação entre ambos, nomeadamente conhecer o impacto da acreditação nos resultados
ao nível da eficiência e da efectividade.
Metodologia: Considerando o agrupador All Patient Refined versão 31 e os dados
existentes na Base de Dados de Morbilidade Hospitalar, determinaram-se as
probabilidades de óbito, de readmissões a trinta dias e de exceder a demora média pura
nos hospitais acreditados e não acreditados, nos diagnósticos correspondentes aos
GDH de EAM e AVC, utilizando o teste-T para amostras independentes. Foram
analisados os anos de 2014, 2015 e 2016, ajustando-se os resultados pelo risco através
das variáveis idade, sexo, risco de mortalidade e grau de severidade. De modo a
comparar hospitais semelhantes, os mesmos foram agregados em grupo I, II e III de
acordo com os critérios definidos na Portaria n.º82/2014 de 10 de Abril.
Resultados: No período em análise verificou-se que no grupo I os hospitais acreditados
apresentam melhores resultados, no grupo II os hospitais acreditados têm melhores
resultados no diagnóstico de AVC e os hospitais não acreditados no diagnóstico de
EAM, no grupo III os hospitais não acreditados têm melhores resultados.
Conclusão: Existe impacto da acreditação na efectividade e na eficiência nos hospitais
em análise e para os diagnósticos em estudo. O referido impacto é maior nos hospitais
menos complexos (grupo I) e tende a diminuir nos hospitais de maior complexidade
(grupos II e III). É necessário que sejam desenvolvidos estudos para investigar o
impacto da acreditação nas restantes dimensões da qualidade.
ABSTRACT - Introduction: Health accreditation is used several times as a tool for improving and regulating the quality and safety of health care, since better processes and, consequently, better outcomes are expected in accredited organizations. Although several studies point to the positive impact that accreditation has on outcomes, the literature is not consensual. Therefore, it is pertinent to develop a study that analyses the potential relationship between both, namely to know the impact of accreditation on outcomes in terms of efficiency and effectiveness. Methodology: By applying the All Patient Refined to the Hospital Morbidity Data, the probability of death, readmissions to thirty days, and exceed the length of stay in accredited and non-accredited hospitals were determined, for the diagnoses corresponding to the DRG of acute myocardial infarction (AMI) and stroke, using the Ttest for independent samples. We analysed the years 2014, 2015 and 2016, riskadjusting outcomes with the variables age, sex, risk of mortality and degree of severity. In order to compare similar hospitals, they were grouped in groups I, II and III in accordance with the criteria defined in Portaria n.º82/2014 de 10 de Abril. Results: In the period under analysis, it was verified that in group I the accredited hospitals present better results, in group II accredited hospitals have better results in the diagnosis of stroke and hospitals not accredited in the diagnosis of AMI, in group III the non-accredited hospitals have better results. Conclusion: There is an impact of accreditation on effectiveness and efficiency in the hospitals under analysis and for the diagnoses under study. This impact is greater in less complex hospitals (group I) and tends to decrease in hospitals of greater complexity (groups II and III). It is necessary to develop studies to investigate the impact of accreditation on the remaining dimensions of quality
ABSTRACT - Introduction: Health accreditation is used several times as a tool for improving and regulating the quality and safety of health care, since better processes and, consequently, better outcomes are expected in accredited organizations. Although several studies point to the positive impact that accreditation has on outcomes, the literature is not consensual. Therefore, it is pertinent to develop a study that analyses the potential relationship between both, namely to know the impact of accreditation on outcomes in terms of efficiency and effectiveness. Methodology: By applying the All Patient Refined to the Hospital Morbidity Data, the probability of death, readmissions to thirty days, and exceed the length of stay in accredited and non-accredited hospitals were determined, for the diagnoses corresponding to the DRG of acute myocardial infarction (AMI) and stroke, using the Ttest for independent samples. We analysed the years 2014, 2015 and 2016, riskadjusting outcomes with the variables age, sex, risk of mortality and degree of severity. In order to compare similar hospitals, they were grouped in groups I, II and III in accordance with the criteria defined in Portaria n.º82/2014 de 10 de Abril. Results: In the period under analysis, it was verified that in group I the accredited hospitals present better results, in group II accredited hospitals have better results in the diagnosis of stroke and hospitals not accredited in the diagnosis of AMI, in group III the non-accredited hospitals have better results. Conclusion: There is an impact of accreditation on effectiveness and efficiency in the hospitals under analysis and for the diagnoses under study. This impact is greater in less complex hospitals (group I) and tends to decrease in hospitals of greater complexity (groups II and III). It is necessary to develop studies to investigate the impact of accreditation on the remaining dimensions of quality
Descrição
Trabalho Final do Curso de Especialização em Administração Hospitalar
Palavras-chave
qualidade em saúde acreditação eficiência efectividade resultados health care quality accreditation efficiency effectiveness outcomes
Contexto Educativo
Citação
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública