Dimensiones que caracterizan la lealtad de los clientes internos en servicios de salud

Introducción: La satisfacción de los integrantes de una organización de cualquier tipo y, en particular, de aquellas que prestan servicios médicos es un tema de mucho interés e importancia si de lograr altos niveles de satisfacción y, por ende, de lealtad de los pacientes y sus familiares se trata. Objetivo: Determinar las dimensiones y atributos para la satisfacción y lealtad del cliente interno en instituciones de salud en Barranquilla durante el año 2021. Método: Se realizó un estudio exploratorio descriptivo en instalaciones relacionadas con los servicios de salud en Barranquilla en 367 funcionarios (n=367) aunado con la revisión de la literatura correspondiente. Se aplicó un cuestionario con el fin de conocer las dimensiones y atributos antes mencionados. Los atributos fueron agrupados por eje de acuerdo a su mayor peso y sobre la base de esto fue definida el nombre de las dimensiones considerando diversos estudios realizados y la experiencia. Se realizaron pruebas para determinar fiabilidad y validez para la encuesta, así como pruebas de adecuación muestral. Se aplicó el análisis factorial y componentes principales. Resultados: El 79 % de la varianza total abarcó las dimensiones: trabajo en equipo, reconocimiento laboral, condiciones de trabajo y beneficios laborales. Se mostró una distribución de los atributos en las dimensiones capaz de explicar la situación en un alto nivel. Conclusiones: El cliente interno es factor clave en una organización, considerándose adecuados los atributos propuestos para la satisfacción y lealtad del mismo en instituciones de salud.

Introduction: Satisfaction of internal members of any organization, in particular those which provide medical services, is of a great interest and importance when it comes to achieve high levels of satisfaction and, therefore, loyalty of both patients and their families. Objective: To determine dimensions and attributes to get internal customer satisfaction and loyalty in health institutions in Barranquilla, throughout 2021. Method: An exploratory descriptive study was carried out in healthcare facilities in Barranquilla. The study was conducted in 367 health officials (n=367). Also it was carried out a review of related literature. It was applied a questionnaire to determine the dimensions and attributes. The attributes were grouped by axis according to those with widest impact and, based on this assess, the name of the dimensions was defined taken into account various previous studies and experiences. Factor and principal component analyses were applied. Results: The 79 % of the total variance covered the following dimensions: teamwork, job recognition, working conditions and work benefits. The attributes distributed in the dimensions can certify the high level found. Conclusions: The internal customer is a key factor in any institution, and the proposed attributes for customer satisfaction and loyalty in health institutions are considered adequate.

Introdução: A satisfação dos membros de uma organização de qualquer tipo e, em particular, daqueles que prestam serviços médicos é um tema de grande interesse e importância se pretendemos alcançar elevados níveis de satisfação e, portanto, de fidelização dos pacientes e seus parentes são tratados. Objetivo: Determinar as dimensões e atributos para a satisfação e lealdade do cliente interno em instituições de saúde em Barranquilla durante o ano de 2021. Método: Estudo descritivo exploratório realizado em instalações relacionadas a serviços de saúde em Barranquilla em 367 funcionários (n=367) juntamente com a revisão da literatura correspondente. Aplicou-se um questionário para conhecer as dimensões e atributos mencionados. Os atributos foram agrupados por eixo de acordo com seu maior peso e com base nisso foi definido o nome das dimensões considerando diversos estudos e experiências. Foram realizados testes para determinar a confiabilidade e validade da pesquisa, bem como testes de adequação da amostra. Aplicou-se análise fatorial e componentes principais. Resultados: 79% da variância total cobriu as dimensões: trabalho em equipe, reconhecimento do trabalho, condições de trabalho e benefícios do trabalho. Foi apresentada uma distribuição dos atributos nas dimensões, capaz de explicar a situação em alto nível. Conclusões: O cliente interno é um fator chave em uma organização, considerando adequados os atributos propostos para a satisfação e fidelização do mesmo nas instituições de saúde.

La mejora continua y la formación de médicos en la Facultad "Manuel Fajardo" de La Habana / Continuous improvement and physician formation in Manuel Fajardo School of Medical Sciences of Havana

Introducción: El proceso de mejora continua constituye hoy la piedra angular de los esfuerzos para gestionar la calidad en la formación de los profesionales. Objetivo : Evaluar el estado actual de la Facultad "Manuel Fajardo" para el desarrollo del proceso de autoevaluación de la carrera de Medicina con fines de mejora continua. Métodos: El grupo de estudio estuvo integrado por 57 profesores y 143 estudiantes de primero hasta sexto años en el período enero-marzo de 2020. Se seleccionó, para los estudiantes, una muestra estratificada por conglomerado; y para los profesores, una estratificada simple. Además, se realizó una investigación observacional, descriptiva, de corte transversal. Resultados: La calidad del proceso de formación tuvo una percepción diferente entre profesores y estudiantes. Más del 20 por ciento de los encuestados consideró como no satisfactoria la preparación del personal no docente y administrativo, y su incidencia en la formación del profesional; acerca de la organización docente, estos la valoraron en más del 30 por ciento como no satisfactoria. Casi el 30 por ciento de los profesores manifestó como medianamente satisfactoria o insatisfactoria la actividad investigativa y laboral de los estudiantes; y más del 20 por ciento de los estudiantes estimó que había dificultades en la aplicación de las estrategias curriculares. Conclusiones: Se constataron insuficiencias que limitaban el continuo desarrollo del proceso de formación(AU)

Introduction: The continuous improvement process is nowadays the cornerstone of efforts made to manage quality in the training of professionals. Objective: To assess the current state of Manuel Fajardo School of Medical Sciences regarding the development of the self-evaluation process in the medical major for the purpose of continuous improvement. Methods: The study group consisted of 57 professors and 143 students from first to sixth academic years, in the period from January to March 2020. A sample stratified by cluster was selected for the students; while, for teachers, the sample was chosen by simple stratification. In addition, an observational, descriptive and cross-sectional research was carried out. Results: The quality of the training process had a different perception between professors and students. More than 20 percent of the respondents considered as unsatisfactory the preparation of nonteaching and administrative personnel and its impact on professional training. Regarding organization of teaching, more than 30 percent rated it as unsatisfactory. Almost 30 percent of the professors stated that research and work activity of the students was moderately satisfactory or unsatisfactory, while more than 20 percent of the students estimated that there were difficulties in the application of curricular strategies. Conclusions: Insufficiencies were found that limited the continuous development of the training process(AU)

Estrategias de enfermería para la prevención de errores programáticos en vacunatorio / Nursing strategies for the prevention of programmatic errors in vaccination

El Programa Nacional de Inmunizaciones (PNI) nace el año 1978 en Chile, considerando dentro de sus objetivos la prevención de la morbilidad, discapacidad y muertes secundarias a enfermedades inmunoprevenibles a lo largo de todo el ciclo vital. Dentro de los eventos asociados al proceso de inmunización y que el PNI contempla desde sus inicios, se encuentran los "Errores Programáticos en vacunación" (EPRO), definidos como eventos relacionados con los aspectos operativos de la vacunación, evitables, que no cumplen con las normas establecidas y que no causaron daño en el paciente. La gestión y prevención de los EPRO son vitales para asegurar la calidad y seguridad en la atención de pacientes durante todo su ciclo vital, debido a que a partir de estos se efectúan medidas correctivas y se puede realizar una evaluación de las razones de su ocurrencia pudiendo así evitar su futura aparición, a través de la elaboración de lineamientos para su prevención. Esta tarea ha sido liderada por los equipos de enfermería desde los inicios del proceso de inmunización en nuestro país y la cual se ha demostrado mediante estrategias como la estandarización de procesos, implementación de pautas de seguridad durante todo el proceso de vacunación, realización de reportes de errores con información detallada y veraz, programas de mejoras continua, evaluación de pautas de calidad de procesos, sistemas de gestión de control de stock, trabajo en equipo y metodologías de comunicación efectivas.

The Expanded Program on Immunization (EPI) in Chile, was born in 1978, considering within its objectives the prevention of morbidity, disability and deaths secondary to immunoprevenible diseases throughout the entire life cycle. Among the risks associated with the immunization process and that the EPI contemplates since its inception, there are the "Programmatic Errors in Vaccination" (EPRO), defined as attitudes or procedures that do not comply with the established norms of vaccination and that alone or in together they can generate serious and fatal adverse events. The management and prevention of events such as EPROs are vital for the assurance of quality and safety in patient care throughout their life cycle, a task that the Nursing team has been responsible for leading since the beginning of the immunization process in our country and which has been demonstrated through strategies such as process standardization, implementation of safety guidelines throughout the vaccination process, reporting of errors with detailed and truthful information, continuous improvement programs, evaluation of quality guidelines of processes, stock control management systems, teamwork and effective communication methodologies.

Percepción de los pacientes diabéticos tipo 2 acerca de la calidad y satisfacción con la atención médica en consulta / Perception of type 2 diabetic patients about quality and satisfaction with medical care at office

Introducción: Los indicadores de calidad de la atención y satisfacción percibida en la consulta de seguimiento por el paciente diabético tipo 2, son factores de especial importancia para comprender un fenómeno tan complejo como la adherencia terapéutica en las enfermedades crónicas no transmisibles. Objetivo: Valorar algunos indicadores de calidad de la atención médica en las consultas de seguimiento y el grado de satisfacción percibidos por los pacientes diabéticos tipo 2 adheridos y no adheridos al tratamiento. Métodos: Estudio descriptivo, transversal en 30 pacientes diabéticos tipo 2 del consultorio 3, Consejo Popular Cartagena, provincia Cienfuegos. Se emplearon los ítems 13 y 14 del Cuestionario para la Evaluación de la Adherencia Terapéutica en Pacientes con diabetes mellitus tipo 2 elaborado por investigadores de la Universidad Central Marta Abreu de las Villas en Cuba. Información procesada con SPSS versión 15.0. Resultados: Los pacientes cumplidores registraron mayores frecuencias absolutas y relativas en sentido positivo en más indicadores de calidad de la atención médica que los incumplidores y fue evidente que se encontraban satisfechos con la atención médica recibida a pesar de cumplir o no con el tratamiento. Conclusiones: Se demostró la necesidad de investigar con más profundidad el fenómeno de la adherencia terapéutica y de manera particular los determinantes relacionados con el equipo de salud-paciente, para de esta manera contribuir al desarrollo de este campo de estudio y optimizar la praxis médica(AU)

Introduction: Quality indicators for attention and satisfaction perceived in the follow-up consultation by the type 2 diabetic patient are factors of special importance to understand a phenomenon as complex as therapeutic adherence in chronic noncommunicable diseases. Objective: To assess some quality indicators of medical care in follow-up consultations and the degree of satisfaction perceived by type 2 diabetic patients with adherence or non-adherence to treatment. Methods: Descriptive, cross-sectional study with 30 type 2 diabetic patients from the family doctor's office 3, Cartagena Popular Council, Cienfuegos Province. We used items 13 and 14 of the Questionnaire for the Assessment of Therapeutic Adherence in Patients with type 2 diabetes mellitus prepared by researchers from Marta Abreu Universidad Central de Las Villas in Cuba. The information was processed with the SPSS version 15.0. Results: Disciplined patients registered higher absolute and relative frequencies positively in more quality indicators of medical care than undisciplined patients and they were evidently satisfied with medical care received despite complying or not with the treatment. Conclusions: The need was proved to investigate in depth the phenomenon of therapeutic adherence and particularly the determinants associated with the team health-patient, in order to contribute towards the development of this field of study and optimize medical practice(AU)

The factors influence the use of angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers (ACEI/ARB) in patients with acute myocardial infarction in Gansu, Ningxia, Qinghai and Xinjiang from 2001 to 2011 / 中华急诊医学杂志

Objective To investigate the rate of employing angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) therapy in patients with acute myocardial infarction (AMI) in Gansu,Ningxia,Qinghai and Xinjiang provinces from 2001 to 2011,in order to determine the factors affecting the use of ACEI/ARB.Methods The original data of this study were obtained from the China PEACE,a national retrospective study of AMI to evaluate clinical outcome of coronary heart disease from 31 provinces.A part of these data was selected from 8 cooperative hospitals (2 hospitals were tertiary class and 6 hospitals were secondary class) from Gansu,Ningxia,Qinghai and,Xinjiang provinces for further analyses.The clinical data of AMI patients in 2001,2006 and 2011 were collected to analyze the use of ACEI/ARB therapy in each of these years.Binary logistic regression analysis was used to identify factors influencing the use of ACEI/ARB.Results Of 311 eligible patients included,300 were categorized into Class Ⅰ AMI and 11 into Class Ⅱ a AMI according to Chinese guidelines.From 2001 to 2011,there wassignificant change in the use of ACEI/ARB in term of percentage in patients with Class Ⅰ AMI (69.57％,82.19％ and 60.77％,P =0.033),but such change did not occur in patients with Class Ⅱa AMI (40％,0％ and 60％,P =0.525).Among three specific years,the percentage of ACEIs employed was noticeably higher than that of ARBs.Binary logistic regression analysis showed that patients with hypertension (OR =2.3,95％ CI:1.3-4.1),heart failure (OR =1.95,95％ CI:1.7-5.8),smoking indulgence (OR =2.0,95％ CI:1.2-3.6) were more likely to be treated with ACEI/ARB,and patients with prior stroke (OR=0.3,95％CI:0.1-0.8),systolic blood pressure ＜90 mmHg (OR =0.1,95％CI:0-0.5)were less likely to be treated with ACEI/ARB.Conclusiorns In underdeveloped areas such as Gansu,Ningxia,Qinghai and Xinjiang provinces,the overall proportion of rational and necessary use of ACEI/ARB use in patients with AMI during hospitalization is still low.The rational use of ACEI/ARB lags behind the advance of medical condition progress,economic development and information availability,especially in patients with a history of stroke,low blood pressure.Patients with hypertension,heart failure,smoking indulgence were more likely to get ACEI/ARB therapy.The main reasons of this phenomenon were attributed to firstly the thorough understanding of standard medication guide to coronary heart disease to be lacking among some professionals,secondly,the side effects of these drugs to be unnecessary worried about among certain of doctors,and thirdly,low awareness of the pathogenesis of AMI disease and the lack of concerning for patients to be existent.

The factors influence the use of angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers (ACEI/ARB) in patients with acute myocardial infarction in Gansu, Ningxia, Qinghai and Xinjiang from 2001 to 2011 / 中华急诊医学杂志

Objective To investigate the rate of employing angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) therapy in patients with acute myocardial infarction (AMI) in Gansu,Ningxia,Qinghai and Xinjiang provinces from 2001 to 2011,in order to determine the factors affecting the use of ACEI/ARB.Methods The original data of this study were obtained from the China PEACE,a national retrospective study of AMI to evaluate clinical outcome of coronary heart disease from 31 provinces.A part of these data was selected from 8 cooperative hospitals (2 hospitals were tertiary class and 6 hospitals were secondary class) from Gansu,Ningxia,Qinghai and,Xinjiang provinces for further analyses.The clinical data of AMI patients in 2001,2006 and 2011 were collected to analyze the use of ACEI/ARB therapy in each of these years.Binary logistic regression analysis was used to identify factors influencing the use of ACEI/ARB.Results Of 311 eligible patients included,300 were categorized into Class Ⅰ AMI and 11 into Class Ⅱ a AMI according to Chinese guidelines.From 2001 to 2011,there wassignificant change in the use of ACEI/ARB in term of percentage in patients with Class Ⅰ AMI (69.57％,82.19％ and 60.77％,P =0.033),but such change did not occur in patients with Class Ⅱa AMI (40％,0％ and 60％,P =0.525).Among three specific years,the percentage of ACEIs employed was noticeably higher than that of ARBs.Binary logistic regression analysis showed that patients with hypertension (OR =2.3,95％ CI:1.3-4.1),heart failure (OR =1.95,95％ CI:1.7-5.8),smoking indulgence (OR =2.0,95％ CI:1.2-3.6) were more likely to be treated with ACEI/ARB,and patients with prior stroke (OR=0.3,95％CI:0.1-0.8),systolic blood pressure ＜90 mmHg (OR =0.1,95％CI:0-0.5)were less likely to be treated with ACEI/ARB.Conclusiorns In underdeveloped areas such as Gansu,Ningxia,Qinghai and Xinjiang provinces,the overall proportion of rational and necessary use of ACEI/ARB use in patients with AMI during hospitalization is still low.The rational use of ACEI/ARB lags behind the advance of medical condition progress,economic development and information availability,especially in patients with a history of stroke,low blood pressure.Patients with hypertension,heart failure,smoking indulgence were more likely to get ACEI/ARB therapy.The main reasons of this phenomenon were attributed to firstly the thorough understanding of standard medication guide to coronary heart disease to be lacking among some professionals,secondly,the side effects of these drugs to be unnecessary worried about among certain of doctors,and thirdly,low awareness of the pathogenesis of AMI disease and the lack of concerning for patients to be existent.

Ten Year Trend of Percutaneous Coronary Intervention in Central-western Urban Hospitals of China--Results From China PEACE-Retrospective CathPCI Study / 中国循环杂志

Objective: To assess the trends in clinical characteristics, treatment, and outcomes for hospitalized patients undergoing percutaneous coronary intervention (PCI) in central-western urban hospitals of China in 2001, 2006 and 2011. Methods: We used a 2-stage, random sampling strategy to create a Chinese central-western urban hospital representative sample of 2152 patients undergoing PCI at 26 hospitals in China PEACE- retrospective CathPCI study and calculated the weighted data of clinical information in each year. Results: Between 2001 and 2011, the admission rate for PCI increased by 46 folds. Compared with 2001, the patients undergoing PCI were more likely to be female, older than 80 years, and to have history of diabetes, dyslipidemia and PCI in 2011. The proportion of trans-radial PCIs increased from 3.5% in 2001 to 87.6% in 2011 (Ptrend < 0.0001); the proportion of drug eluting stents (DES) among all the implanted stents increased from 16.4% in 2001 to 95.7% in 2011 (Ptrend < 0.0001), largely due to increased use of domestic DES. Less than 5% of medical record of admission for PCI documented door time and balloon time. The median length of stay decreased from 13 days in 2001 to 10 days in 2011 (Ptrend < 0.0001). In-hospital mortality did not change signiifcantly, but both any bleeding and access bleeding events were decreased signiifcantly over time (Ptrend < 0.05). Conclusion: There has been a rapid increase in the volume and significant change in treatment patterns of PCI over the 10-year period from 2001 to 2011 in Chinese central-western urban hospitals. We identiifed quality gaps that represent opportunities to improve medical care.

<b>Hospital Information System and Quality of Medical Care </b> / 薬剤疫学

<p>We conducted a case-control study nested within a small cohort identified by using a hospital information system in Japan to examine the relationship of the use of calcium channel blockers (CCBs) to myocardial infarction. Although the crude odds ratio of myocardial infarction associated with CCBs was high, the ratio was reduced when adjusted by known confounding factors, suggesting a mechanism of confounding by indication. In addition, the results obtained in this study using records from a single hospital should not be generalized. Quality Indicators (QIs) are a tool for assessing healthcare quality, and QIs monitoring works to improve the quality of medical care. When QIs would be analyzed by using a hospital information, confounding factors should be removed if we measure QIs using the same method in the same hospital in chronological order. QIs analyzed by using a hospital information system are valuable and applicable to patients. It would be a driving force of the medical quality improvement that the number of the pharmaco-epidemiology experts would increase more and more. Because they can make the drug information conformed to Evidence-based Medicine using a medical database. Then, the medical quality improvement will decrease medical cost in Japan.</p>

Análisis de 7 años de la queja en gineco-obstetricia por la Comisión Estatal de Arbitraje Médico en Oaxaca, México / 7-year analysis of the complaint in gynecology-obstetrics by the State Commission of Medical Arbitration in Oaxaca, Mexico

ANTECEDENTES: Se realizó la revisión de 7 años del Sistema de Quejas Médicas en la Comisión Estatal de Arbitraje Médico del Estado de Oaxaca, México, entidad autónoma y calificada para dirimir el proceso de inconformidad durante el fenómeno de la atención médica. Se analizaron todas las quejas, formas de resolución y en especial se identifico la queja en gineco-obstetricia. OBJETIVO: Caracterizar la inconformidad en la queja del usuario en la especialidad de gineco-obstetricia. MÉTODO: Investigación documental, descriptiva, transversal, retrospectiva y sin implicaciones éticas, efectuada mediante el análisis de bases de datos del SAQMEDO de enero de 2008 a abril de 2015. Se seleccionaron todos los expedientes de quejas médicas de la especialidad, entre todas las presentadas. RESULTADOS: El Instituto Mexicano del Seguro Social fue la entidad más frecuente en quejas médicas seguida por la medicina privada. Por octavo año consecutivo la ginecología y obstetricia prevalece como líder en quejas de los usuarios, sumando en el actual análisis 100 de 438 quejas. El origen de las quejas resulta de la deficiencia en la otorgación del servicio institucional y privado que contabilizó el 69% de los casos. CONCLUSIONES: La falta en el proceso de la evaluación del desempeño ha sido fundamental en la repetición de la queja en gineco-obstetricia. A lo largo de 8 años se ha repetido el modelo vicioso, sin que las instituciones hagan algo a cambio. De continuar ignorando el problema de manera local conseguiremos que éste ciclo se perpetúe.

BACKGROUND: It has been made a complete analysis of 7 years in the State Commission of Medical Arbitration in Oaxaca, one of the southern states in México. This Commission is the legal entity to judge the process of malpractice. The study was aim to identify the obstetrics and gynecology complains. OBJECTIVE: Characterize the medical complain in the obstetrics and gynecology specialty. METHOD: It was conducted a documentary research, descriptive, transversal, retrospective and without ethical implications, through analysis of databases of the State Commission of Medical Arbitration of Oaxaca, corresponding to 2008 -2015 activity report; we selected records were medical complaints in the specialty of gynecology-obstetrics. RESULTS: The Mexican Institute of Social Security Services became the most demanded medical provider closely followed by the private practice. Obstetrics and gynecology was the most demanded medical specialty for 8th uninterrupted years. From 438 claims 100 accounted to this specialty. The failure to give or perform the service was the origin of the complains. CONCLUSION: Absence of risk assessment and supervision of competence in the performance of the medical process were the most forthcoming issues when malpractice were continue to identified. Eight in a row years of failure to amended these vicious process speaks for itself. Lots of hard work are to be consider as a reliability strategy.

A study of the triage function of referrals in an urban clinic / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : To promote disease management in the community, general physicians should refer their patients to specialists in a timely and appropriate manner. In this study, we propose an indicator for evaluation of such referrals.<br><b>Methods</b> : We analyzed all referrals in an urban clinic from September 1, 2011 to August 31, 2012. Symptoms and diagnoses documented by general physicians were collected from medical records, and the final diagnoses by specialists were collected from their reports. The symptoms and diagnoses were classified using the International Classification of Primary Care second edition (ICPC-2). Referral rates, hospitalization rates, and place of referral were analyzed.<br><b>Results</b> : The average number of encounters in the candidate clinic was 1402 per month, and the mean number of referrals was 23 (1.6% of encounters). Of patients who received a referral, 6.75 (29.1%) were admitted to hospitals. The symptoms and diagnoses of the referred patients were distributed across all chapters (A to Z) of ICPC-2. Diagnoses of admitted patients included pneumonia (R81) (24%), urinary tract infection (U70 and U71) (9%), and acute gastroenteritis with dehydration (D73 with T11) (9%).<br><b>Conclusion</b> : We identified the referral rates, hospitalization rates, and distribution of referral patients as indicators of the triage function of primary care physicians. These should be evaluated further as potential indicators of “the quality of medical care.”

Empirical Analysis the Competitive Effects of Profit-making Hospitals / 中国卫生经济

Objective: From the two prospective of hospital quantity and hospital market shares, to analyze the influences of profitmaking hospital’s competition on medical expenses and medical quality. Methods: The sample of provincial panel data from 2003 to 2011 is used, the fixed effect model is applied. Conclusion: For the competitive effect, the expanding of relative scale of profit-making hospitals increased outpatient expenses and reduced hospitalization expenses; for the quality effectiveness, the expand of relative scale of profit -hospitals improved the quality of outpatient service; the simple increase of the quantity of profit -making hospitals had no significant influences on medical expenses and quality of medical care.

Correlation between quality and expenditure of medical care:a review of international studies / 中国卫生政策研究

The health care system has always faced challenges from two competing fronts: rising costs and quality concerns. The common issue of debate confronted by various health care systems is whether or not rising medi-cal expenditure can lead to quality improvements. The key to addressing this issue is to figure out the correlation be-tween quality of care and medical expenditure. Based on Donabedian’s structure, process and outcome quality theory, this study reviews relevant international studies related to this topic in order to provide empirical evidence in a clearer way. Results show that the analysis of current studies have typically been based on the regional level, health provider level and patient level; the quality indicators used varied among studies while expenditure indicators had much in common;more studies were found to focus on the association between outcome quality and expenditure while less studies explored the link between structure or process quality and expenditure; additionally, the majority of relevant studies were located in the inpatient setting and studies from outpatient settings were found to be lacking. Overall, ac-cording to current knowledge, no inclusive conclusion could be obtained, but quality indicators, data and methods, and limitations revealed in these studies can be reviewed by future study to explore the correlation between quality and expenditure of medical care in a more objective way.

Comprehensive analysis on quality of clinical pathway for hospitalized patients with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze clinical data of hospitalized patients with age - related cataract treated through clinical pathway in our hospital, and to investigate the effectiveness of clinical pathway in standardizing medical behavior, advancing work efficiency, and improving quality of hospital management. METHODS:Data of patients with age-related cataract, who were treated with phacoemulsification combined with intraocular lens implantation in Xi'an North Hospital, were retrospectively analyzed. In clinical pathway group, 220 patients underwent cataract surgery from October 2012 to May 2013 in accordance with clinical pathway. For control group, 213 patients with cataract receiving surgery from October 2010 to June 2011, comply with conventional process. Effect of cataract surgery, average length of hospitalization, average cost of hospitalization, and degree of satisfaction of patients were comprehensive investigated. RESULTS: In 220 patients of clinical pathway group, 209 ( 95. 0%) got improved vision, the days of hospitalization was 4. 5 ± 1. 4d, and the average hospitalized consumption was 4 522. 3 ± 285. 1 Yuan. Whereas, in control group, visual acuity in 202 (94. 8%) out of 213 patients were improved, and the length and cost of hospitalization were 5. 1±1. 7d and 4 647. 7±271. 2 Yuan. The difference of the length and cost of hospitalization between these two groups were significant (P0. 05). CONCLUSION: Practicing of age - related clinical pathway is helpful in standardizing medical heavier, optimizing clinical process, reducing health cost, improving quality of medical care, and providing evidence for hospital management innovation.

Survey of medical care by oncologists for depression in breast cancer patients

<b>Objective:</b> To investigate the perception of the prevalence of mental diseases in breast cancer patients and the therapeutic approach to depression undertaken by oncologists. <b>Method:</b> Self-reported questionnaires were sent to 352 breast cancer specialists. The survey contains 11 categories to elicit the perception and identification of mental illnesses in patients, diagnostic procedure, and details of antidepressant prescribed. Logistic regression was used to explore the association of oncologists' characteristics and management of depression in breast cancer patients. <b>Results:</b> Survey response rate was 31.3%. Ninety percent of the oncologists perceived the prevalence of depression to be less than 20%, while half believed that the proportion was less than 5%. The most commonly-used medication for the treatment of depression was BZDs (41.5% [<i>n</i>=39]), followed by Selective Serotonin Reuptake Inhibitors (SSRIs) (30.9% [<i>n</i>=29]). Benzodiazepines (BZDs) were most frequently prescribed (41.5%) despite its known ineligible dependency, followed by Selective Serotonin Reuptake Inhibitors (SSRIs) (30.9%). Choice of BZDs was significantly associated with the career length of oncologists (Odds Ratio [OR]=8.20), and safety of drug (OR=5.57). Contrarily, prescription of SSRIs was associated with efficiency of drug (OR=7.07). Conclusion: Relative to anxiety and insomnia, a lower awareness regarding depression was common among study oncologists. In addition, the quality of care varied among these oncologists. It is necessary to improve both the awareness and management of mental illnesses in order to enhance the total clinical care of breast cancer patients.

Guía de evaluación de la atención médica en un centro oftalmológico de Venezuela, 2008 / Guide of assessment of the medical care in an Ophthalmology center in Venezuela, 2008

Se realizó la presente investigación con el objetivo de brindar una herramienta para la evaluación de un centro oftalmológico, con servicios de Misión Milagro implantados en Venezuela. La guía propuesta constó de 66 criterios e indicadores que servirían para evaluar las diferentes dimensiones. En estructura se tuvieron en cuenta las características de la planta física, la disponibilidad de recursos materiales, así como la cobertura, capacitación y competencia de los recursos humanos. Para el proceso se diseñaron guías de observación con el fin de evaluar las principales actividades realizadas por el equipo de salud y para los resultados se valorá la opinión de los trabajadores y la de los pacientes por los servicios recibidos. Para operacionalizar los criterios, indicadores y estándares se contó con la colaboración de varios expertos

A developmental research was carried out to offer a tool for assessment of an Ophthalmology center with Milagro's Mission service implemented in Venezuela. The guide proposed included 66 criteria and indicators allowing assessment of the different dimensions. As regards structure authors took into account the characteristics of the physical plant, the availability of human resources. For the process observational guides were designed that will allow the assessment of the main activities performed by the health staff and for results we considered the worker opinions and that of the service received by patients came to services. To make operative the criteria, indicators and standards we took into account the cooperation of some experts

Guías de práctica clínica "herramientas" para mejorar la calidad de la atención médica / Clinical guidelines "tools" for better medical care quality

Introducción: con el propósito de mejorar la calidad de la atención médica y garantizar la seguridad de los pacientes, en los últimos tiempos se han ido incorporando un grupo de "herramientas metodológicas", entre las que se encuentran las guías de práctica clínica. Objetivo: determinar el lugar que ocupan las guías de práctica clínica en la asistencia médica actual. Material y métodos: Se realiza una revisión de la literatura disponible sobre el tema, de donde se seleccionan de manera opinática, un conjunto de trabajos que se consideraron como los más importantes, así como se incluyen las opiniones recogidas por el autor de colegas relacionados con el tema en diversos intercambios formales e informales, a lo que se añade la experiencia y criterios propios del autor en más de 15 años. Resultados: se exponen las razones del surgimiento de las guías de práctica clínica, los requisitos que deben cumplir, los métodos para su elaboración, las etapas del proceso de su implementación y evaluación. Finalmente se brindan algunos consejos prácticos para uso, insistiendo que, aunque es común hablar de las buenas prácticas clínicas, la primera debe ser siempre la aplicación con excelencia del método clínico, del cual las guías son subsidiarias. Conclusiones: las guías de práctica clínica, como herramientas auxiliares de la atención médica, cuando son adecuadamente concebidas, elaboradas y utilizadas, pueden contribuir a mejorar la calidad de la asistencia médica que se brinda, aunque siempre como complemento de la aplicación con excelencia del método clínico.

Introduction: in order to improve the medical care quality and at the same time quarantee patients' safety,lately, it has been incorporated a group of methodological tools such as the clinical guidelines. Objective: Determine the role played by the clinical guidelines in present day medical practice. Methods: i was made a review of the available literature about this topic selecting a group of works considered as the most importants. There were also included different opinions of colleagues as well as the author's criteria based on the experience of more than 15 years. Results: the reasons of the appearance of clinical guidelines, their requirements to fulfill, the methods of elaboration and their implementation and assessment are exposed in this work. Finally, some practical advises are offered making emphasis on a good aplication of the clinical method playing the clinical guidelines a subsidiary role. Conclusions: when linical guidelines are conceived and used adequately they can contribute to improve the Quality of medical care as a complement of a clinical method of excelence.

The use of the tracer methodology to assess the quality of care for patients enrolled in Medical Insurance for a New Generation / El uso de la metodología de trazadores para la evaluación de la calidad de la atención en pacientes afiliados al Seguro Médico para una Nueva Generación

OBJECTIVE: To assess the quality of care provided at medical units that provide services to Medical Insurance for a New Generation (SMNG) enrollees. MATERIALS AND METHODS: The tracer methodology was used in a sample of 82 medical units selected in fifteen states of Mexico and data collected in November 2009. RESULTS: Problems were found to locate the minimal number of the 18 medical charts requested in three of the tracers. The first level of care on the average reports that the quality of the process of care is 6, in a 10 point scale. In the second level improves and the third level of care is better qualified. CONCLUSIONS: The tracer methodology has enabled us to assess the quality of care. There is room for improvement in the medical units of the state health services, to that end should be directed the efforts in the health system in Mexico.

OBJETIVO: Evaluar la calidad de la atención en unidades médicas que prestan servicios a afiliados al Seguro Médico para una Nueva Generación (SMNG). MATERIAL Y MÉTODOS: Se utilizó la metodología de trazadores en una muestra de 82 unidades médicas seleccionadas en quince estados de la República mexicana y los datos fueron recolectados en noviembre de 2009. RESULTADOS: En tres de los trazadores no se encontró el número de expedientes en las 18 unidades médicas. En el primer nivel de atención se reporta que la calidad del proceso de atención es de 6 en una escala de 0 a 10. La calidad mejora en el segundo nivel, y es la más alta en el tercer nivel. CONCLUSIONES: Se evaluó la calidad e identificaron oportunidades de mejora en la calidad de las unidades médicas del SMNG. Hacia ese objetivo deben ser dirigidos los esfuerzos en el sistema de salud en México.

Construction of risk early-warning system for medical quality / 中华医学科研管理杂志

Up to present,the research of the early-warning system for the risk of the medical quality has been carried out both at home and abroad.The majority of these researches aimed at providing theoretical guidance for the scientific decision-making of local health departments.In order to construct quality of medical care evaluation indicators system.On the bases of intelligence research,drawing on a series of internationally recognized quality of medical care evaluation system.The majority of these researches aimed at providing theoretical guidance for the scientific decision-making of local health departments.However,the hospital-related research is very limited.Therefore,hospitals were selected as objects in this study.33 experts from 6 three"A" hospitals were selected.And by using a series of internationally recognized quality health care system as a source of reference and focusing on process control and standardizing of management,the early-warning system for the risk of the medical quality has been constructed based on the combination of theory and practice.At the same time,Delphi method was used to verify the results repeatedly to form a set of early-warning system for the risk of the medical quality which is objective,scientific and approved by experts.

O grupo de trabalho de humanização e a humanização da assistência hospitalar: percepção de usuários, profissionais e gestores / The workgroups of humanization in the process of health care humanization: users', professionals' and managers' viewpoints

O artigo apresenta uma reflexão em torno da temática da humanização da assistência à saúde, trazendo também os resultados de uma pesquisa que objetivou diagnosticar a eficácia dos Grupos de Trabalho de Humanização no processo de humanização da assistência a partir da percepção de usuários, profissionais e gestores. Trata-se de uma pesquisa de caráter exploratório, uma vez que levantou aspectos da realidade, caracterizando- se por investigações de cunho bibliográfico, documental e investigativo. A pesquisa foi desenvolvida em dois hospitais públicos do estado de Santa Catarina, entre 2008 e 2009, e obteve-se como resultado que havia grande desconhecimento sobre a Política Nacional de Humanização e que os GTHs não estavam sendo eficazes no processo de humanização da assistência. Muitos dos limites apontados para que estes pudessem ser eficazes fugiam às possiblidades de atuação dos mesmos, pois relacionavam-se, principalmente, a questões de âmbito político-administrativo mais amplas, bem como a características próprias da sociabilidade capitalista.

This paper presents a discussion on health care humanization, bringing the results of a research aimed at diagnosing the effectiveness of Workgroups of Humanization in the process of heatlh care humanization from the users, professionalsand managersviewpoints. It is an exploratory research, in that it dealt with aspects of reality, and characterizes as a bibliographic, documental, and investigative study. The research was carried out from 2008 to 2009, and the data was collected at two public hospitals in the State of Santa Catarina. The results showed that the National Policy for Humanization was greatly unknown and that the Workgroups of Humanization were not effective in the process of health care humanization; many of the factors considered essential for the effectiveness of the process escaped their control, their possibility of implementing actions, since they were mainly related to issues within the broader political and administrative sphere, as well as the characteristics of the capitalist sociability.

Present Situation and Prospective Issues of Continuing Medical Education for Physicians / 医学教育

1) To improve the quality of medical care and to ensure patient safety, physicians have the professional duty and responsibility to constantly study the newest medical knowledge and technology.<BR>2) The terminology for “continuing education”for physicians differs in meaning from that generally used to refer to “life-long education.”<BR>3) Continuing medical education (CME) in Japan is independently carried out by medical associations and by numerous academic medical societies. Present CME activities in Japan are reviewed, and CME in the United States is explained.<BR>4) Continuing professional development is introduced as a new paradigm of CME for physicians, created to improve the health-care system in the United Kingdom.<BR>5) To further improve CME for physicians in Japan, prospective issues are discussed. Establishment of a third-party organization that discusses, manages, and operates the CME system for physicians, is strongly recommended.