Qualidade do cuidado em saúde e a iniciativa “Choosing Wisely” / Healthcare quality and “Choosing Wisely” initiative / /Calidad del cuidado en la salud y la iniciativa “Choosing Wisely”

A partir de uma campanha conduzida pela Fundação American Board of Internal Medicine (ABIM),teve início em 2011 a Iniciativa Choosing Wisely, quando várias associações norte-americanas de distintas especialidades médicas apresentaram listas de procedimentos utilizados de maneira excessiva e, consequentemente, inapropriada. Neste artigo, buscou-se destacar as relações entre a qualidade do cuidado, a variação injustificada na oferta de procedimentos e as iniciativas para redução da sobreutilização desses procedimentos. Além de uma metodologia adequada, alguns critérios devem ser levados em conta para se avaliar se o uso de determinados procedimentos é, ou não, recomendável. Entre os principais,encontram-se: a transparência e a participação de um grupo mais amplo de profissionais, incluindo diversas especialidades; a seleção de procedimentos de modo a evitar os que têm utilidade cientificamente questionável no tocante à melhora da saúde, além de custos impactantes, desproporcionais aos possíveis benefícios, para os serviços de saúde; a possibilidade de medir e avaliar esses procedimentos; ausência de conflito de interesses ou corporativismos...

From a campaign driven by the American Board of Internal Medicine (ABIM) Foundation, the ChoosingWisely Initiative began in 2011 when several US societies from different medical specialties presented listsof procedures that are used excessively and therefore inappropriate. In this article we sought to highlightthe relationship between healthcare quality, unjustified variation in supply of low-value procedures and theinitiatives to reduce the overuse of those procedures. In addition to appropriate methodology, one shouldtake account of criteria to evaluate whether or not the use of given procedures is recommended. The mostimportant criteria are: the transparency and participation of a broader group of professionals, includingdifferent specialties; selection of procedures whose utility with regard to improving health is scientificallyquestionable and its costs to health services are excessive relative to benefits; the possibilty to measure andevaluate these procedures; the absence of any conflict of interest or corporatism...

A partir de una campaña llevada a cabo por la Fundación American Board of Internal Medicine (ABIM),iniciada en 2011, la Iniciativa Choosing Wisely cuando distintas asociaciones norteamericanas dedistintas especialidades médicas presentaran listas de procedimientos utilizados de forma excessiva e, porconsiguiente, inapropriada. En este artículo hemos tratado de poner de relieve las relaciones entre la calidadde la atención, la variación injustificada en la oferta de los procedimientos y las iniciativas para reducir lasobreutilización de ellos. Además de una metodología adecuada, deben tenerse en cuenta ciertos criteriospara evaluar si es recomendado el uso de ciertos procedimientos. Entre los principales, están: la transparenciay la participación de un grupo más amplio de profesionales, incluyendo diversas especialidades; la selecciónde procedimientos con el fin de evitar aquellos que tienen utilidad científicamente cuestionable con relacióna la mejora de la salud, y los costes desproporcionados a los beneficios potenciales, impactantes para losservicios de salud; la posibilidad de mensurar y evaluar estos procedimentos; ausencia de conflicto deintereses o corporativismos...

Variação do desempenho hospitalar segundo fontes de pagamento nos estados de São Paulo e Rio Grande do Sul, Brasil / Variation in hospital performance according to payment sources in the states of São Paulo and do Rio Grande do Sul, Brazil / Variación del desempeño hospitalario según fuentes de pago en los estados de São Paulo y de Río Grande do Sul, Brasil

Resumo: No Brasil, a convivência público-privado no financiamento e na prestação do cuidado ganha nítidos contornos na assistência hospitalar. Os arranjos de financiamento adotados pelos hospitais (Sistema Único de Saúde - SUS e/ou planos de saúde e/ou pagamento particular) podem afetar a qualidade do cuidado. Alguns estudos buscam associar a razão de mortalidade hospitalar padronizada (RMHP) a melhorias na qualidade. O objetivo foi analisar a RMHP segundo fonte de pagamento da internação e arranjo de financiamento do hospital. Analisaram-se dados secundários e causas responsáveis por 80% dos óbitos hospitalares. A RMHP foi calculada para cada hospital e fonte de pagamento. Hospitais com desempenho pior que o esperado (RMHP > 1) foram majoritariamente públicos de maior porte. A RMHP nas internações SUS foi superior, inclusive entre internações no mesmo hospital. Apesar dos limites, os achados indicam iniquidades no resultado do cuidado. Esforços voltados para a melhoria da qualidade de serviços hospitalares, independentemente das fontes de pagamento, são prementes.

Abstract: In Brazil, the combined presence of public and private interests in financing and provision of healthcare services stands out clearly in hospital care. Financing arrangements adopted by hospitals (the public Brazilian Unified National Health System - SUS and/or health plans and/or out-of-pocket payment) can affect quality of care. Studies have analyzed the hospital standardized mortality ratio (HSMR) in relation to quality improvements. The objective was to analyze HSMR according to source of payment for the hospitalization and the hospital's financing arrangement. The study analyzed secondary data and causes that accounted for 80% of hospital deaths. HSMR was calculated for each hospital and payment source. Hospitals with worse-than-expected performance (HSMR > 1) were mostly large public hospitals. HSMR was higher in the SUS, including between admissions in the hospital. Despite the study's limitations, the findings point to inequalities in results of care. Efforts are needed to improve the quality of hospital services, regardless of the payment sources.

Resumen: En Brasil, la convivencia público-privada en la financiación y en la prestación del cuidado empieza a definirse nítidamente en la asistencia hospitalaria. Los acuerdos de financiación adoptados por los hospitales (Sistema Único de Salud - SUS y/o planes de salud y/o pago particular) pueden afectar a la calidad del cuidado. Algunos estudios buscan asociar la razón de mortalidad hospitalaria padronizada (RMHP) a mejorías en la calidad. El objetivo fue analizar la RMHP según la fuente de pago del internamiento y acuerdos de financiación del hospital. Se analizaron datos secundarios y causas responsables de un 80% de los óbitos hospitalarios. La RMHP se calculó para cada hospital y fuente de pago. Los hospitales con un desempeño peor que el esperado (RMHP > 1) fueron mayoritariamente públicos y con un mayor número de pacientes. La RMHP en los internamientos SUS fue superior, incluyendo internamientos en el mismo hospital. A pesar de los límites, los hallazgos indican inequidades en el resultado del cuidado. Son necesarios esfuerzos dirigidos a la mejoría de la calidad de servicios hospitalarios, independientemente de las fuentes de pago de los mismos.

The payment for performance model and its influence on British general practitioners' principles and practice / O modelo de pagamento por desempenho e sua influencia nos principios e pratica dos medicos generalistas britanicos / El modelo de pago por desempeno y su influencia en los principios y practica de los medicos generales britanicos

This article explores some effects of the British payment for performance model on general practitioners’ principles and practice, which may contribute to issues related to financial incentive modalities and quality of primary healthcare services in low and middle-income countries. Aiming to investigate what general practitioners have to say about the effect of the British payment for performance on their professional ethos we carried out semi-structured interviews with 13 general practitioner educators and leaders working in academic medicine across the UK. The results show a shift towards a more biomedical practice model and fragmented care with nurse practitioners and other health care staff focused more on specific disease conditions. There has also been an increased medicalisation of the patient experience both through labelling and the tendency to prescribe medications rather than non-pharmacological interventions. Thus, the British payment for performance has gradually strengthened a scientific-bureaucratic model of medical practice which has had profound effects on the way family medicine is practiced in the UK.

Este artigo explora alguns efeitos do modelo de pagamento por desempenho nos princípios e prática dos médicos generalistas britânicos, podendo contribuir para o debate sobre a relação entre modalidades de incentivos financeiros e qualidade dos serviços na atenção primária à saúde em países de moderada e baixa renda. Objetivando investigar o que os médicos generalistas têm a dizer dos efeitos do pagamento por desempenho britânico sobre seu ethos profissional, conduzimos entrevistas semiestruturadas com 13 médicos generalistas, educadores e líderes no meio acadêmico da medicina no Reino Unido. Os resultados apontam um modelo de prática mais biomédica e fragmentação do cuidado, com enfermeiras e outros profissionais mais focados em doenças específicas. Houve também um aumento da medicalização da vivência dos pacientes, pela rotulação e tendência a prescrever mais medicação e menor uso de intervenções não farmacológicas. Assim, o pagamento por desempenho britânico tem gradualmente fortalecido um modelo científico-burocrático de prática médica que teve efeitos profundos sobre a forma como a medicina de família vem sendo praticada no Reino Unido.

Este artículo explora algunos efectos del modelo británico de pago por desempeño en los principios y práctica de médicos generales que pueden contribuir a cuestiones relacionadas con modalidades de incentivos financieros y calidad de servicios de atención primaria en países de bajos y medios ingresos. La investigación tuvo por objetivo lo que los médicos tienden a decir sobre el efecto del pago por desempeño británico en su ethos profesional; se realizaron entrevistas semi-estructuradas con 13 médicos generales, educadores y líderes en medicina académica del Reino Unido. Los resultados muestran cambios hacia un modelo de práctica más biomédica y atención fragmentada con enfermeras y otros profesionales enfocados en enfermedades específicas. También produjo un aumento en medicalización de la experiencia del paciente a través de rotulaciones y tendencia a prescribir medicamentos en lugar de intervenciones no farmacológicas. Así, el pago por desempeño británico ha reforzado gradualmente un modelo científico-burocrático de práctica que ha tenido profundos efectos en la forma en la que la medicina familiar está siendo practicada en el Reino Unido.

Payment for performance in the Family Health Programme: lessons from the UK Quality and Outcomes Framework / Pagamento para desempenho no Programa Saúde da Família: lições do Quality and Outcomes Framework da Inglaterra

OBJECTIVE: Payment for performance financial incentive schemes reward doctors based on the quality and the outcomes of their treatment. In Brazil, the Ministry of Health is looking to scale up its use in public hospitals and some municipalities are developing payment for performance schemes even for the Family Health Programme. In this article the Quality and Outcomes Framework used in the UK since 2004 is discussed, as well as its experience to elaborate some important lessons that Brazilian municipalities should consider before embarking on payment for performance scheme in primary care settings.

OBJETIVO: Esquemas de pagamento para desempenho recompensam o médico baseado na qualidade e no resultado do tratamento dos seus pacientes. O Ministério da Saúde brasileiro analisa seu uso em hospitais públicos e alguns municípios estão desenvolvendo estratégias de pagamento por desempenho para o Programa de Saúde da Família. No artigo discute-se o Quality and Outcomes Framework - esquema de pagamento para desempenho usado no Reino Unido desde 2004, bem como sua experiência para elaborar algumas lições importantes que os municípios brasileiros devem considerar antes de empreender o esquema de pagamento por desempenho na atenção primária.

Satisfacción del paciente oncológico con la atención médica recibida en el Hospital General San Felipe y Hospital Escuela / Cancer patients satisfaction with the medical care received at the Hospital General San Felipe y Hospital Escuela

La satisfacción del paciente al recibir atención médica depende del cumplimiento de sus necesidades, expectativas y deseos con respecto al establecimiento de la relación médico-paciente, calidad y cantidad de información recibida y apoyo psicológico. Para conocer aspectos en el paciente oncológico, se realizó un estudio tipo transversal en 276 pacientes con cáncer atendidos en consulta externa y salas de hospitalización de Oncología en el Hospital General San Felipe (HGSF) y Hospital Escuela (HE). Objetivo: Medir el nivel de satisfacción de pacientes con cáncer al ser atendidos por médicos en los departamentos de Oncología. Material y Métodos: Previo consentimiento informado se aplicó a los pacientes un cuestionario por escrito de ocho preguntas relacionadas a la calidad de atención brindada a ellos por los oncólogos que laboran en los departamentos respectivos en el HGSF y HE. Resultados: El 44.9% de los pacientes tenía antecedentes de cáncer en su familia, 90.9% admitió tener una relación con su médico de buena a excelente, la calidad de información brindada fue satisfactoria en 82.7%, sin embargo, a los pacientes les gustaría que su médico fuera más amistoso, al 41.7% se le brinda apoyo psicológico y el 85.9% desean saber su pronóstico y que su familia esté enterada de éste; en caso de exámenes o tratamientos no disponibles desean se les informe al respecto y tratarían de obtenerlos. Conclusión: En este estudio los pacientes no están satisfechos con el nivel de atención médica brindada ya que desean cambiar algún aspecto en la relación con el médico, desean que dicha relación sea mejorada y la mayoría piensa que no se les brinda apoyo psicológico, con respecto a su pronóstico de vida la mayoría quieren enterarse del mismo y que sus familiares se enteren, por tanto el médico debería de explicar con detalle este aspecto...

Designing an Effective Pay-for-performance System in the Korean National Health Insurance / 예방의학회지

The challenge facing the Korean National Health Insurance includes what to spend money on in order to elevate the 'value for money.' This article reviewed the changing issues associated with quality of care in the Korean health insurance system and envisioned a picture of an effective pay-for-performance (P4P) system in Korea taking into consideration quality of care and P4P systems in other countries. A review was made of existing systematic reviews and a recent Organization for Economic Cooperation and Development survey. An effective P4P in Korea was envisioned as containing three features: measures, basis for reward, and reward. The first priority is to develop proper measures for both efficiency and quality. For further improvement of quality indicators, an electronic system for patient history records should be built in the near future. A change in the level or the relative ranking seems more desirable than using absolute level alone for incentives. To stimulate medium- and small-scale hospitals to join the program in the next phase, it is suggested that the scope of application be expanded and the level of incentives adjusted. High-quality indicators of clinical care quality should be mapped out by combining information from medical claims and information from patient registries.

Lessons From Healthcare Providers' Attitudes Toward Pay-for-performance: What Should Purchasers Consider in Designing and Implementing a Successful Program? / 예방의학회지

We conducted a systematic review to summarize providers' attitudes toward pay-for-performance (P4P), focusing on their general attitudes, the effects of P4P, their favorable design and implementation methods, and concerns. An electronic search was performed in PubMed and Scopus using selected keywords including P4P. Two reviewers screened target articles using titles and abstract review and then read the full version of the screened articles for the final selections. In addition, one reference of screened articles and one unpublished report were also included. Therefore, 14 articles were included in this study. Healthcare providers' attitudes on P4P were summarized in two ways. First, we gathered their general attitudes and opinions regarding the effects of P4P. Second, we rearranged their opinions regarding desirable P4P design and implementation methods, as well as their concerns. This study showed the possibility that some healthcare providers still have a low level of awareness about P4P and might prefer voluntary participation in P4P. In addition, they felt that adequate quality indicators and additional support for implementation of P4P would be needed. Most healthcare providers also had serious concerns that P4P would induce unintended consequences. In order to conduct successful implementation of P4P, purchaser should make more efforts such as increasing providers' level of awareness about P4P, providing technical and educational support, reducing their burden, developing a cooperative relationship with providers, developing more accurate quality measures, and minimizing the unintended consequences.

Korean National Health Insurance Value Incentive Program: Achievements and Future Directions / 예방의학회지

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poor-quality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.

Cost containment'adoption and its impact on quality of patient care 'commitment as perceived by middle - level nurse managers: a pilot exploratory study

Nowadays, the containment of health care costs and the improvement of quality of care are two essential concerns in a nation's health care system. For that, the nurse manager is accountable for quality of care and for containing costs of health care. Aim: To identify the impact of cost containment adoption on the commitment to quality of patient care as perceived by Military middle. - level nurse managers. Descriptive exploratory correctional design was used in carrying out this study. The study was conducted in a Military Institute, where'the participants were attending a continuing education program. Purposive sample consisted of thirty Military middle - level nurse managers who were in supervisory position, accepted to participate in the study and met the inclusion criteria were included in the study. Study tool: Modified questionnaire developed by Muehsam [1998] was adapted to measure cost containment and commitment to quality of patient care as perceived by middle - level nurse managers. indicated that a cost conscious behavior was found on the units' level than hospital as whole. On the whole, a strong level of commitment towards quality of patient care was found among nurse managers. No leaner relationship was found between cost containment and commitment to quality of patient care. This study can be replicated for other participants in the healthcare industry such as doctors who are contracted with organizations. Finally; middle - level nurse managers should participate in the selection of programs that influence nursing such as productivity programs, inventory management and documentation systems

[Total cost of services in diagnostic wards in Ghazvin medical university and health services based on activity based technique]

Challenges and obstacles in health system resources are the most important subjects in this area. Calculating the total cost of outputs [expenditures] by activity based technique is one step to improvement the performance. This study has performed for accounting the total cost of services in diagnostic wards in Ghazvin medical university and health services in 1386. This is a cross sectional and descriptive study. One hospital has been randomly selected from four hospitals in the city. Data was gathered by the ministry of health's standard forms. Data analyzed by activity based technique and total cost of each point [unit] were extracted. For each package of service, total cost was 57700R in Radiology and Sounography; and in Audiometry and EEG, 123800R. 68% of hospital activity expenditures were for personnel and the remained [32%] for nonpersonnel expenses. Extracting the total cost of expenditures with activity based technique helps hospital managers to prevent undesirable cost errors, to improve the services and to decrease the expenditures

[ effect of medical equipment maintenance management system implementation on Valie-Asr hospital costs situated in Arak 2006]

Medical equipment improvement and tremendous expenditure is allocated costs annually, so that optimum and proper maintenance management of equipment would have outstanding effects on health and treatment of medical training and research economies of the country. Present research was implemented aiming to examine effect of the medical equipment maintenance management systems on the hospital setting expenditures. In an interventional research, the model of medical equipment maintenance management system implemented in Imam Khomeini Hospital was examined precisely and based on appropriate software for Vali-e-Asr Hospital was designed. According to the model for all available medical instruments in Vali-e-Asr Hospital with usage of more than 5 years [240 medical equipment]; all costs were recorded in 2006 and compared with previous year [2005]. There wasn't any training for medical equipment operators and for its implementation necessity on 21.7% of equipment in the installation and start up phase with for 83.7% of equipments the operator was not fixed using of medical equipment maintenance management system, the repair events decreased from 78 events in 2005 to 58 events in 2006. Vali-e-Asr hospital recorded costs for maintenance and repair of medical equipment in 2006 was 801765375 Rials [Iran] which decreased to 513212912 Rials [Iran] according to accurate calculation of costs and auditing by medical equipment engineer and shows 36% saving in expenditures by medical equipment maintenance management system. Medical equipment computer-based maintenance, management system implementation and also using of medical engineers potentialities in hospital are necessary

Health seeking behavior, and financial access in Yemen

This paper presents the findings of a small health seeking behavior survey in two Governorates in Yemen, and provides guidelines for conducting larger surveys. The average per capita income in the sample was $ 485, while out-of-pocket health expenditure is $ 37. For 74% of the reported disease episodes the patients visited government health facilities, while 26% visited private clinics or hospitals. However, 71% of the respondents prefer attending private health facilities if they had the free choice. The main reason for this preference is the good perceived quality in the private sector. Further analysis showed that 73% of the visits to government health facilities were followed by visits to private pharmacies to buy drugs or private clinics to seek additional diagnostic and therapeutic care. Drug availability was considered problematic in all types of health facilities. Average waiting time was the longest in government hospitals with 5.3 hours and the shortest in private clinics with 3.1 hours. The average expenditure for the purchase of drugs in health facilities was $ 2.2 and $ 7.8 in private pharmacies. 54% of total out-of-pocket health expenditure was for buying drugs. Based on these data drug sales in Yemen would total $ 370 million per year. There is a need to further study the other elements of the minimum health care package such as birth spacing, malnutrition and chronic diseases. As far as the methodology for future health seeking behavior surveys is concerned much effort must be made to identify non-medical and female interviewers. After the selection of the interviewers good training is required to reduce interviewer bias. Such training can at the same time also be used to test the questionnaire to avoid bias due to its poor design. The surveys should be practically oriented in providing baseline data for future new programs for example in the context of the health reforms and reproductive health

Critical Appraisal of services of medical OPD of a tertiary care hospital of lahore

Patient satisfaction a component of quality of care has been given high priority in developed countries. It is an instrumental component in monitoring hospital's quality of care in relation to costs and services. Many problems are faced by the visitors of the health care facilities due to which they are unable to utilize these services to their entire satisfaction. Generally overcrowding of hospitals, shortage of staff, medicine and equipment and impatience by the patients are taken as the reasons for this unsatisfactory utilization. To pin point the specific reason of non satisfaction of clients in tertiary care hospital in our localities so that corrective measures could be adopted to improve client satisfaction and in turn the confidence on the local health care delivery system. Hospital based cross sectional survey Place and duration of the study: OPD of Mayo Hospital Lahore February 2005- May 2005 Respondents and 160 patients were selected randomly with their consent. These patients were interviewed on pre tested, structured questionnaire. 90 A, of the patients belong to young or middle age[12-40 yrs], 54% were female, 44% were under matric, 35% belong to poor families with family income <2000 Rs/month and 70% were attending it first time. 75% reach OPD early, 36% got registration easily. 21-22% were satisfied with waiting time and facilities. 21-34% were not satisfied because they were not made clear about diet, how to take medicine and further prevention of disease. Filter clinics should be established in the city waiting area facilities needs to be improved early start of OPD training of staff in preventive work and communication skills. In charge of the OPD must have good managerial skill

Consulta externa en instituciones de salud de Hidalgo, México, según la opinión de los usuarios / The quality of outpatient services in health facilities in Hidalgo, Mexico, from the users' perspective

OBJETIVO: Identificar y evaluar los factores asociados con la calidad de la atención en las consultas externas de los hospitales del sector público en el estado de Hidalgo, México, mediante la opinión que manifiestan los usuarios. MATERIAL Y MÉTODOS: Se aplicó un diseño transversal, comparativo y analítico en 15 hospitales públicos del estado de Hidalgo, México. La muestra, compuesta por 9 936 encuestados (con un poder de 85 por ciento y un nivel de significación de 95 por ciento), fue seleccionada mediante muestreo aleatorio simple entre las personas atendidas en las consultas externas de julio de 1999 a diciembre de 2000. Se analizó la calidad de la atención según la escala de Likert. Para el análisis estadístico se empleó la regresión logística no condicional. RESULTADOS: La calidad de la atención fue percibida como buena por 71,37 por ciento de los encuestados y como mala por 28,63 por ciento. La mala calidad se percibió mayormente en las instituciones de la seguridad social (39,41 por ciento frente a. 19,42 por ciento). Se observó satisfacción en 84,94 por ciento de los encuestados, de los cuales 49,2 por ciento esperaban una mejor atención. El 16 por ciento refirió que regresaría al mismo hospital por no tener otra opción para su atención y 2 por ciento manifestó que no regresaría. La mayor escolaridad y los ingresos económicos superiores se asociaron con la percepción de mala calidad y la desaprobación del tiempo de espera (razón de posibilidades [RP]: 2,3; IC95 por ciento: 2,02 a 2,82), del tiempo que duró la consulta (RP: 2,3; IC95 por ciento: 2,02 a 2,82) y del mal trato por parte del médico (RP: 4,22; IC95 por ciento: 3,6 a 4,8). CONCLUSIONES: Los principales elementos que definen la mala calidad de la atención, según los usuarios, son los largos tiempos de espera, las omisiones en las acciones de revisión y diagnóstico, la complejidad de los trámites de consulta y el maltrato por parte del personal que presta los servicios

Evaluación de una unidad de cirugía de día / Evaluation of a day surgery unit

Objetivos. Presentar una evaluación de la Unidad de Cirugía del Día (UCD) del Centro de Asistencia del Sindicato Médico del Uruguay (CASMU) de Montevideo, instalada en el Sanatorio 1 de esta institución, un hospital de 107 camas destinado antes a la actividad quirúrgica de mediana y baja complejidad. Se analizan los resultados del proceso de reorganización de la actividad quirúrgica bajo el régimen de la cirugía de día mediante indicadores estadísticos de utilización del servicio, costos y satisfacción del paciente. Métodos. Se utilizaron las estadísticas asistenciales para determinar la cobertura del nuevo régimen, los días de internación, los costos anteriores y posteriores a la puesta en funcionamiento de la UCD y la opinión de los pacientes sobre la calidad de la atención. Resultados. Tras los primeros 2 años de funcionamiento de la UCD (1998-1999), más de un tercio de las operaciones de las especialidades seleccionadas se realizaban en el régimen de cirugía de día. Dichas especialidades representan 84 por ciento del total de las actividades quirúrgicas realizadas por la UCD. Los días de estadía en las especialidades incluidas en el sistema disminuyeron en 26 por ciento. El análisis de costo-efectividad de esta modalidad muestra resultados dos veces y media más favorables que la forma convencional. En general, los pacientes manifestaron gran satisfacción con los servicios prestados por la UCD. Discusión. Los resultados obtenidos permiten recomendar definitivamente esta forma de atención, dado que es de buena calidad, logra la satisfacción del paciente y reduce radicalmente los costos, gracias a la disminución de la estadía y de los recursos necesarios en los servicios de internación. Existen posibilidades de expansión de este nuevo régimen mediante la incorporación de otros procesos patológicos y de las técnicas elegibles