Módulo Medios diagnósticos para el Sistema de Información Hospitalaria XAVIA HIS / Diagnostic Means Module for the XAVIA HIS Hospital Information System

El Sistema de Información Hospitalaria XAVIA HIS desarrollado por el Centro de Informática Médica (CESIM) está compuesto por módulos que aseguran la informatización de los procesos de las áreas de la institución hospitalaria. En la actualidad la gestión de los principales medios de diagnóstico se realiza de forma dispersa en diferentes módulos o sistemas. En este trabajo se presenta el módulo de Medios de Diagnóstico, desarrollo que permite la gestión de informes de solicitudes y resultados de forma configurable, así como la planificación de horarios y gestión de citas. Se analizó el proceso de negocio asociado a la gestión de información de medios de diagnóstico, se realizó un estudio de sistemas existentes con propósitos similares y se evaluaron tecnologías para su implementación. Se utilizó AUP-UCI como metodología de desarrollo, Java como lenguaje de programación y otras tecnologías libres y multiplataforma. El patrón arquitectónico implementado fue modelo-vista-controlador. El módulo de Medios de Diagnóstico del sistema XAVIA HIS, permite el soporte de los procesos de atención al paciente y la integración de la información sobre los medios de diagnóstico, además fomenta un aumento en la calidad del servicio. El módulo facilita la configuración de aspectos de solicitud e informe de las pruebas diagnósticas y la planificación de horarios y citas(AU)

Hospital Information System XAVIA HIS developed by the Medical Informatics Center (CESIM) is made up of modules that ensure the computerization of hospital institution areas processes. Currently, the management of the main diagnostic means is realized in a dispersed way in different modules or systems. This paper presents the Diagnostic Means module, development that allows the requests and results reports management in a configurable way, as well as the schedules planning and appointments management. The business process associated with the diagnostic means information management was analyzed, an existing systems study with similar purposes was carried out, and technologies for their implementation were evaluated. AUP-UCI were used as development methodology, Java as programming language and other free and multiplatform technologies. The architectural pattern implemented was model-view-controller. The XAVIA HIS system Diagnostic Means module, allows the patient care processes support and integration of information regarding diagnostic means, also encourages an increase in the service quality. The module facilitates the request and report aspects configuration of the diagnostic tests and the schedules and appointments planning(AU)

Estrategia para la implantación del Sistema XAVIA HIS en instituciones hospitalarias / Strategy to Implant the System XAVIA HIS in Hospital Institutions

El Centro de Informática médica (CESIM) de la Universidad de las Ciencias Informáticas (UCI) desarrolla el Sistema de Información Hospitalaria XAVIA HIS. El éxito en la implantación es de gran importancia para el CESIM, no obstante, los proyectos de implantación se han visto incididos por un conjunto de insuficiencias. El objetivo de la investigación es desarrollar una estrategia que contribuya a aumentar el éxito en la definición del alcance de los proyectos de implantación del sistema XAVIA HIS, en instituciones de salud. Se realizó un estudio descriptivo, que incluyó como escenario de aplicación el Centro Nacional de Cirugía de Mínimo Acceso, entre 2015 y 2017. Como resultado se obtuvo una estrategia para la implantación del sistema XAVIA HIS en instituciones de salud, que impacta positivamente en la disminución del tiempo necesario para este fin(AU)

University of Computer Sciences (UCI) develops the XAVIA HIS Hospital Information System. The implement success of the system is of great importance for CESIM, however, this stage have been affected by a set of insufficiencies. The objective of the research is to develop a strategy that contributes to increasing success in defining the scope of projects to implement XAVIA HIS system in health institutions. A descriptive study was carried out, which included as an application scenario the National Center for Minimally Access Surgery, between 2015 and 2017. As a result, a strategy to implement XAVIA HIS system in health institutions was obtained, which positively impacts the decrease of time necessary for this purpose(AU)

Integración de técnicas de Minería de procesos para la detección de la variabilidad en procesos hospitalarios desde sistemas automatizados / Integrating mining processes techniques in hospital procedures for the detection of variability from their information systems

Los sistemas de información hospitalaria cuentan con un volumen importante de datos, sin embargo, carecen de mecanismos que permitan analizar la ejecución de los procesos e identificar variabilidad. La variabilidad puede observarse en prácticamente cada paso del proceso asistencial y a varios niveles de agrupación: poblacional e individual. Desde el punto de vista poblacional se comparan tasas de realización de un procedimiento clínico, como pueden ser intervenciones quirúrgicas o ingresos hospitalarios en un período de tiempo. Las técnicas de minería de procesos analizan los datos reales de sistemas informáticos y son útiles para la detección de variabilidad en la ejecución de los procesos de negocio. La presente investigación propone la aplicación de técnicas de minería de procesos, seleccionadas a partir de un riguroso estudio del estado del arte, para el análisis de los procesos hospitalarios desde sus sistemas de información y materializadas en un modelo computacional. El Modelo para la Detección de Variabilidad (MDV) se instrumentó exitosamente en el sistema XAVIA HIS desarrollado por la Universidad de las Ciencias Informáticas UCI, donde fueron adaptadas e integradas las técnicas de minería de procesos. El modelo MDV contribuye al proceso de informatización de la salud en Cuba. La solución propicia la utilización de una tecnología emergente en áreas como la industrial y empresarial en el entorno sanitario. Esta beneficia importantes funciones gerenciales como la gestión, control y planificación de recursos y servicios sanitarios(AU)

The hospital information systems collect an important volume of data, however, they lack mechanisms to analyze the execution of the processes and identify variability. In practically every step of the care process and at various levels of grouping: population and individual the variability is present. From a population point of view, performance rates of a clinical procedure such as surgical interventions or hospital admissions, are compared over time. Process mining techniques analyze the real data of computer systems and are useful for the detection of variability in the execution of business processes. Based on a rigorous study of the state of the art, this research proposes the application of process mining techniques for the analysis of hospital processes from their information systems, providing a computational model. Model for Variability Detection (MDV) implemented successfully in the XAVIA HIS system developed by the UCI University of Informatics Sciences, where techniques of process mining were adapted and integrated. The MDV model contributes to the process of computerization of health in Cuba. The solution encourages the use of an emerging technology in areas such as industrial and business in the healthcare environment. This benefits important management functions such as control and planning of resources and health services(AU)

Barreras para la calidad de información en establecimientos de salud de la amazonía / Barriers For The Quality of Information in Health Facilities of Amazon Region

RESUMEN Objetivos . Identificar las barreras para la calidad de la información en establecimientos de salud de la Amazonía, explorando el caso de tres sistemas de información en salud: la vigilancia epidemiológica, el registro diario de atenciones y registro de defunciones vinculados al VIH/Sida, hepatitis B y sífilis congénita. Material y métodos . Se aplicó una metodología cuali-cuantitativa. Por un lado, se realizaron 57 entrevistas semi-estructuradas a personal administrativo y asistencial de establecimientos de salud; por otro, se aplicó una encuesta. Participaron 120 establecimientos de salud de las regiones Amazonas, Huánuco, Loreto, Madre de Dios, San Martín y Ucayali. Resultados . Se identificaron ocho barreras vinculadas principalmente al recurso humano, a aspectos socioculturales y a debilidades del propio sistema de salud. Conclusiones . Las barreras identificadas para la calidad de la información en los sistemas de información seleccionados, en establecimientos de salud de la Amazonía, reflejan un problema multidimensional, por lo que estrategias de mejora en el tema deberían ser consideradas.

ABSTRACT Objectives . To identify the barriers to the quality of information in health facilities in the Amazon region, exploring the case of three health information systems: the epidemiological vigilance, the daily recording of service, and the registry of deaths linked to HIV/AIDS, hepatitis B, and congenital syphilis. Materials and Methods . A quali-quantitative methodology was applied. On the one hand, 57 semi-structured interviews were conducted with administrative and assistance staff at health facilities; on the other hand, a survey was apyplied. One hundred and twenty health facilities in the regions of Amazonas, Huánuco, Loreto, Madre de Dios, San Martín, and Ucayali. Results . Eight barriers were identified, which were linked mainly to the human resource, to sociocultural aspects, and weaknesses of the health system. Conclusions . The barriers identified for the quality of the information in the selected information systems in health facilities in the Amazon region reflect a multidimensional problem, so strategies for improvement in the subject should be considered.

Barreras para la calidad de información en establecimientos de salud de la Amazonía: el caso de tres sistemas de información de VIH/SIDA, hepatitis B y sífilis congénita / Barriers for the quality of information in health facilities of amazon region: the case of three information systems of HIV/AIDS, hepatitis B, and congenital syphilis

Objetivos. Identificar las barreras para la calidad de la información en establecimientos de salud de la Amazonía, explorando el caso de tres sistemas de información en salud: la vigilancia epidemiológica, el registro diario de atenciones y registro de defunciones vinculados al VIH/Sida, hepatitis B y sífilis congénita. Material y métodos. Se aplicó una metodología cuali-cuantitativa. Por un lado, se realizaron 57 entrevistas semi-estructuradas a personal administrativo y asistencial de establecimientos de salud; por otro, se aplicó una encuesta. Participaron 120 establecimientos de salud de las regiones Amazonas, Huánuco, Loreto, Madre de Dios, San Martín y Ucayali. Resultados. Se identificaron ocho barreras vinculadas principalmente al recurso humano, a aspectos socioculturales y a debilidades del propio sistema de salud. Conclusiones. Las barreras identificadas para la calidad de la información en los sistemas de información seleccionados, en establecimientos de salud de la Amazonía, reflejan un problema multidimensional, por lo que estrategias de mejora en el tema deberían ser consideradas.

Objectives. To identify the barriers to the quality of information in health facilities in the Amazon region, exploring the case of three health information systems: the epidemiological vigilance, the daily recording of service, and the registry of deaths linked to HIV/AIDS, hepatitis B, and congenital syphilis. Materials and Methods. A quali-quantitative methodology was applied. On the one hand, 57 semi-structured interviews were conducted with administrative and assistance staff at health facilities; on the other hand, a survey was applied. One hundred and twenty health facilities in the regions of Amazonas, Huánuco, Loreto, Madre de Dios, San Martín, and Ucayali. Results. Eight barriers were identified, which were linked mainly to the human resource, to sociocultural aspects, and weaknesses of the health system. Conclusions. The barriers identified for the quality of the information in the selected information systems in health facilities in the Amazon region reflect a multidimensional problem, so strategies for improvement in the subject should be considered.

Qualidade das bases de dados hospitalares no Brasil: alguns elementos / Quality of hospital databases in Brazil: some elements

RESUMO: Introdução: O uso de bases de dados secundárias para o desenvolvimento de pesquisas sobre serviços de saúde tem sido cada vez mais frequente, tendo como vantagem a obtenção mais rápida e menos custosa das informações, além da maior amplitude populacional, temporal e geográfica. Objetivo: O objetivo deste estudo foi descrever problemas na qualidade das informações sobre a rede e a produção hospitalar no Brasil. Métodos: Foram analisados o Cadastro Nacional de Estabelecimentos de Saúde (CNES), o Sistema de Informações Hospitalares do SUS (SIH) e a Comunicação de Internação Hospitalar (CIH). Exploraram-se as dimensões "cobertura", "completitude", "consistência" e "validade". Resultados: Há preenchimento completo e consistente dos dados cadastrais básicos de hospitais, e a maioria deles enviou alguma informação sobre produção via CIH e SIH. Enquanto a CIH alcançou cobertura de 55% das internações, o SIH ultrapassou 100%. O preenchimento inadequado dos campos "procedimento realizado", "diagnóstico principal" e "secundário" é maior que o desejável, especialmente na CIH. Conclusão: As melhorias em bases de dados são necessárias para qualificar as análises e aumentar seu potencial uso, contribuindo para estudos estratégicos que subsidiem a tomada de decisões no planejamento de hospitais e redes de atenção à saúde.

ABSTRACT: Introduction: The use of secondary data for health service research has been increasingly common, having the advantage of acquiring information faster and cheaper, in addition to its larger population, temporal and geographical amplitude. Objectives: The aim of this study was to describe problems in the quality of information about hospitals characteristics and hospitalizations in Brazil. Methods: The National Database on Health Units (CNES), the Public Hospital Information System (SIH), and the Private Hospital Information System (CIH) were analyzed. We explored "coverage," "completeness," "consistency," and "validity" as quality dimensions. Results: There are complete and consistent basic registration data for hospitals, and most of them sent some information about the production of hospitalization. CIH covered 55% of admissions, and SIH exceeded 100%. The inadequate filling of the "procedure," "main," and "secondary diagnosis" fields is higher than expected, especially for CIH. Conclusion: Improvements in databases are required to qualify the analysis and increase its potential use, contributing with strategic studies that support decision-making in the planning of hospitals and health care networks.

Elementos clave en la implantación de sistemas de notificación de eventos adversos hospitalarios en América Latina / Key elements in implementing adverse event notification systems in Latin American hospitals

OBJETIVO: Elaborar recomendaciones para diseñar e implantar sistemas de notificación (SN) de eventos adversos en base a las experiencias de los países latinoamericanos. MÉTODOS: Mediante la metodología cualitativa Metaplán se recogieron propuestas a partir de la experiencia de 17 expertos nacionales en SN (de Argentina, Brasil, Chile, Colombia, Cuba, México y Perú) y 3 expertos de la Organización Panamericana de la Salud. Se analizaron las características, el alcance, las barreras y las limitaciones, el método de registro de datos, el tipo de análisis y el retorno de la información relacionada con los SN, y se discutió cómo involucrar a los profesionales en este proceso. Mediante el análisis de las respuestas y el discurso y la ponderación colectiva se priorizaron las propuestas. RESULTADOS: Se recogieron 73 recomendaciones sobre las características que deben poseer los SN y 90 sobre las barreras y limitaciones. Existió acuerdo en que la seguridad jurídica de los profesionales, la cultura de seguridad del establecimiento de salud, los incentivos, un sistema ágil para proporcionar resultados a los profesionales y una taxonomía unificada son temas clave para implantar con éxito un SN. Los SN deben dirigirse a generar mecanismos de seguridad para mejorar la atención sanitaria. CONCLUSIONES: Los SN deben ajustarse a las necesidades de cada centro. La oportunidad para aprender de la propia experiencia es la razón de ser de los SN. La confidencialidad, el anonimato, la voluntariedad, la taxonomía unificada y la seguridad jurídica de los profesionales son elementos cruciales de los SN.

OBJECTIVE: To develop recommendations for the design and implementation of adverse event notification systems based on the experiences of the Latin American countries. METHODS: Employing the qualitative Metaplán methodology, proposals were obtained from 17 experts on adverse event notification systems from Argentina, Brazil, Chile, Colombia, Cuba, Mexico, and Peru and three from the Pan American Health Organization. The characteristics, scope, barriers and constraints, data entry method, type of analysis, and information feedback on adverse event notification systems were reviewed and how to involve professionals in this process was discussed. The proposals were prioritized through an analysis of the responses, debate, and collective deliberation. RESULTS: A total of 73 recommendations were obtained on the characteristics that adverse event notification systems should have and 90 on barriers and constraints. There was agreement that legal security for professionals, a culture of safety in health facilities, incentives, a nimble system for providing professionals with results, and a single taxonomy are key to the successful implementation of adverse event notification systems, which must endeavor to protect patient safety in order to improve health care. CONCLUSIONS: Adverse event notification systems must be tailored to the needs of each health center. They exist to enable the health system to learn from experience. Confidentiality, anonymity, voluntary participation, a single taxonomy, and legal security for professionals are critical elements of adverse event notification systems.

Qualidade da notificação de anomalias congênitas pelo Sistema de Informações sobre Nascidos Vivos (SINASC): estudo comparativo nos anos 2004 e 2007 / Quality of birth defect reporting in the Brazilian Information System on Live Births (SINASC): a comparative study of 2004 and 2007

Este estudo comparou a validade dos diagnósticos de anomalias congênitas do Sistema de Informações sobre Nascidos Vivos (SINASC), em oito hospitais distribuídos em sete municípios do Brasil, totalizando 27.945 nascidos vivos em 2004 e 25.905 em 2007. Além disso, descreveu ações específicas realizadas para o aprimoramento da qualidade dos dados desse campo. Para a análise da validade, foi utilizado o Estudo Colaborativo Latino-Americano de Malformações Congênitas (ECLAMC) como padrão-ouro. Em 2004, pelo menos 40 por cento dos casos de anomalias congênitas eram subnotificados, situação que não foi modificada em 2007. Observou-se aumento significativo na sensibilidade somente em um hospital, de 56,9 por cento para 96,8 por cento. Em dois hospitais, houve diminuição significativa na sensibilidade, de 62,7 por cento para 41,7 por cento e de 66,5 por cento para 32,2 por cento. Os valores preditivos positivo e negativo e especificidade permaneceram acima de 80 por cento. Apenas duas secretarias municipais de saúde e quatro hospitais fizeram algum tipo de ação específica para a melhoria do campo 34. Os resultados apontam para a necessidade de se investir na qualidade da informação sobre anomalias congênitas no SINASC.

This study compared the validity of birth defect cases reported in the Brazilian Information System on Live Births in 2004 and 2007 in seven municipalities, out of a total of 27,945 live births in 2004 and 25,905 in 2007. The study also describes quality improvement measures in this area. The Latin American Collaborative Study on Congenital Malformations was used as the gold standard for analyzing the validity of birth defect diagnoses. In 2004, at least 40 percent of birth defects went unreported, and this situation persisted in 2007. Only one hospital showed a significant increase in reporting sensitivity, from 56.9 percent to 96.8 percent. Sensitivity decreased significantly in two hospitals (from 62.7 percent to 41.75 percent and from 66.5 percent to 32.2 percent, respectively). The positive and negative predictive values and specificity remained above 80 percent. Only two municipal health departments and four hospitals implemented measures to improve reporting of birth defects. The results indicate the need for investments in the quality of birth defect information on birth certificates.

[Comparative study of structure and activity of health information management association in selected countries, 2008]

Formation of professional associations is one point of inflection in the health care industry. Health Information Management Association in developed countries originally initiated its activities in the profession of medical records as Medical Records Librarians Association and later changed to Medical Record Association. This study aimed to compare structure, function and activities of Health Information Management Association in selected countries and Iran. This was a descriptive comparative study in cross-sectional method. The research sample included Health Information Management Association in Australia [HIMAA], United States of America [AHIMA] and Canada [CHIMA] as pioneer countries in initiation of Health Information Management Association and also Medical Record Association of Iran [IMRA]. Related data about structural and functional entities was collected through the library investigation, internet and communication with research sample associations via email according to collection forms. The structural and functional elements and entities of the Health Information Management Associations in the selected countries are mostly similar, although they had some differences. Canadian Health Information Management Association Board of Director's is communal with Canadian College of Health Information Management. Type of association memberships in Australia is different with other associations. Vision and values of HIMAA and IMRA have not been identified and written. In comparison with the other associations, AHIMA has various and multiple activities in provide services to its members. Continuing education and certification in various scope is one of major the activities of AHIMA. commensurate with done Changes in the Health Information Management Profession, the Association of this Profession in countries of Australia, United States and Canada has experienced a lot of change in the structure and activities of their associations accordingly. Position of inspector only existed in Iran's Medical Record Association. In comparison with other association, Iran Medical Record Association with fifteen years of history had not had a lot of systematic and integrated activities. Review of Structural and functional entities and activities of this association, seems necessary

[Statistical process control of medical record in Gharazi Hospital]

Utilization of information system in management is necessary. Statistical Process Control [SPC] is one of suggested tools in quality management system. In this study, processes of medical record unit in Gharazi Hospital [Isfahan] are studied using SPC tools. It is a descriptive, retrospective and trend study which was carried out by assembling indicators for some processes in medical record unit from 2003 to 2008. After Library studies, suggested indicators by experts [for Process controlling] were collected through 2 checklists. For quantitative indicators of medical records evaluation, all admitted patients during study period and for time assessing about 1500 patients were chosen randomly. Data were analyzed using Excel software. Findings showed that during study period, the average time for patient discharge order [by doctors] was at 9:54 a.m. and patients waiting time in discharge process decreased [with the average of 53 minutes]. In quantitative evaluation of medical records deficits, accepted fault rate [or the base line] consumed as about 6%. Gharazi Hospital tries to control tolerance of its processes by using SPC tools and maintaining some internal standards as baselines. These baselines may be shared with other hospitals and help to produce national and regional standards

Radiological reports: a comparison between the transmission efficiency of information in free text and in structured reports

Introduction: This work proposes to improve the transmission of information between requiring physicians and radiologists. Objectives: Evaluate the implementation of a structured report (SR) in a university hospital. Methods: A model of a structured report for thyroid sonography was developed according to information gathered from radiologists and endocrinologists working in this field. The report was based on a web platform and installed as a part of a Radiological Information System (RIS) and a Hospital Information System (HIS). The time for the report generation under the two forms was evaluated over a four-month period, two months for each method. After this period, radiologists and requiring physicians were questioned about the two methods of reporting. Results: For free text, 98 sonograms were reported to have thyroids with nodules in an average time of 8.71 (+/-4.11) minutes, and 59 sonograms of thyroids without nodules were reported in an average time of 4.54 (+/- 3.97) minutes. For SR, 73 sonograms in an average time of 6.08 (+/-3.8) minutes for thyroids with nodules and 3.67 (+/-2.51) minutes for thyroids without nodules. Most of the radiologists (76.2 percent) preferred the SR, as originally created or with suggested changes. Among endocrinologists, 80 percent preferred the SR. Discussion: From the requiring physicians' perspective, the SR enabled standardization and improved information transmission. This information is valuable because physicians need reports prepared by radiologists. Conclusions: The implementation of a SR in a university hospital, under an RIS/HIS system, was viable. Radiologists and endocrinologists preferred the SR when compared to free text, and both agreed that the former improved the transmission of information.

Qualidade da informação sobre causas externas no Sistema de Informações Hospitalares / Quality of external-cause data in the Hospitalization Information System

OBJETIVO: Analisar a cobertura e a qualidade das informações sobre internações por causas externas no Sistema de Informações Hospitalares do Sistema Único de Saúde. MÉTODOS: As internações ocorridas no Sistema de Informações Hospitalares de 11 hospitais, em 2004, em dois municípios (Londrina e Maringá, PR), foram comparadas com aquelas identificadas como conseqüências de causas externas por pesquisa em laudos médicos, complementadas por dados de mortalidade e de serviço pré-hospitalar. Foram calculados indicadores de concordância bruta, sensibilidade e valor preditivo positivo. Comparou-se o perfil de agrupamentos de causas das internações registradas no Sistema com o obtido na pesquisa. RESULTADOS: Foram registradas no Sistema 3.002 internações por causas externas em Londrina e 1.403 em Maringá, enquanto a pesquisa detectou 4.018 e 2.370, respectivamente. O Sistema apresentou alto valor preditivo positivo para internações por causas externas em ambos os municípios (97,7% em Londrina e 98,6% em Maringá). Porém, a sensibilidade foi baixa: 57,3% em Maringá e 73% em Londrina, denotando sub-registro dessas causas. A comparação dos perfis de tipos de causas externas revelou que há subestimação de algumas causas no Sistema, especialmente por acidentes por exposição a forças mecânicas inanimadas, agressões e lesões autoprovocadas. CONCLUSÕES: Há sub-registro de internações por causas externas e algumas distorções em relação aos tipos de causas no Sistema de Informações Hospitalares nos dois municípios estudados. A detecção dessas deficiências pode contribuir para o processo de qualificação da informação desse Sistema.

OBJECTIVE: To analyze the coverage and quality of the data on hospitalizations due to external causes in the Hospital Information System of the Brazilian National Health System. METHODS: Hospitalizations recorded in the Hospital Information System of 11 hospitals in two municipalities (Londrina and Maringá, Southern Brazil), in 2004, were compared with hospitalizations identified as consequences of external causes through investigating medical records, complemented with mortality and pre-hospital data. The crude agreement rate, sensitivity and positive predictive value were calculated. The profile of groups of hospitalization causes recorded in the System was compared with that obtained from investigations. RESULTS: In Londrina, 3,002 hospitalizations due to external causes were recorded in the System and, in Maringá, 1,403. The investigations found 4,018 and 2,370, respectively. The System presented high positive predictive values for hospitalizations due to external causes in both municipalities: 97.7% in Londrina and 98.6%in Maringá. However, the sensitivity was low: 57.3% in Maringá and 73% in Londrina, thus denoting underrecording of these causes. Comparison between the profiles of the types of causes revealed that there was underestimation of some causes in the System, especially regarding accidents due to exposure to inanimate mechanical forces, assaults and intentional self-harm. CONCLUSIONS: Underrecording of hospitalizations due to external causes and some distortions regarding the types of causes occurred in the Hospital Information System in both municipalities. Detection of these deficiencies may contribute towards the process of improving the quality of the information in this System.

OBJETIVO: Analizar la cobertura y la cualidad de las informaciones sobre internaciones por causas externas en el Sistema de Informaciones Hospitalares del Sistema Único de Salud. MÉTODOS:Las internaciones ocurridas en el Sistema de Informaciones Hospitalares de 11 hospitales, en 2004, en dos municipios (Londrina y Maringá, Sur de Brasil), fueron comparadas con aquellas identificadas como consecuencias de causas externas por pesquisa en laudos médicos, complementadas por datos de mortalidad y de servicio pre-hospitalar. Se calcularon indicadores de concordancia bruta, sensibilidad y valor predictivo positivo. Se comparó el perfil de agrupación de causas de las internaciones registradas en el Sistema con el obtenido en la pesquisa. RESULTADOS: Se registraron en el Sistema 3.002 internaciones por causas externas en Londrina y 1.403 en Maringá, mientras que la pesquisa detectó 4.018 y 2.370, respectivamente. El Sistema presentó alto valor predictivo positivo para internaciones por causas externas en ambos municipios (97,7% en Londrina y 98,6% en Maringá). Sin embargo, la sensibilidad fue baja: 57,3% en Maringá y 73% en Londrina, denotando sub-registro de tales causas. La comparación de los perfiles de tipos de causas externas reveló que hay subestimación de algunas causas en el Sistema, especialmente por accidentes por exposición a fuerzas mecánicas inanimadas, agresiones y lesiones autoprovocadas. CONCLUSIONES:Hay sub-registro de internaciones por causas externas y algunas distorsiones en relación a los tipos de causas en el Sistema de Informaciones Hospitalares en los dos municipios estudiados. La detección de esas deficiencias puede contribuir para el proceso de calificación de la información de dicho Sistema.

A comparative study of the quality and availability of health information used to facilitate cost burden analysis of diabetes and hypertension in the Caribbean / Estudio comparativo de la calidad y disponibilidad de la información sobre la salud usada para facilitar el análisis del nivel de costos de la diabetes y la hipertensión en el Caribe

OBJECTIVE: Non-communicable Diseases (NCDs) are leading threats to health and well-being in the Caribbean. A study was undertaken in the latter part of 2005 to compute the economic burden of diabetes mellitus and hypertension within the Caribbean Community and Common Market (CARICOM). This report critiques the quality and availability of health information which can be used to facilitate cost burden analysis of diabetes mellitus and hypertension. METHODS: A form was developed and disseminated to obtain epidemiological and health service utilization data. Subsequent visits were made to seven CARICOM member countries to collect the data. RESULTS: The results revealed (i) a number of deficiencies in the reliability and validity of the data received, in particular, those needed to facilitate the analysis of cost-specific complications such as ischaemic heart disease, cerebrovascular disease, chronic renal failure, hypertensive and diabetic retinopathy and peripheral circulatory complications; (ii) data management systems in hospitals were not linked to facilitate generation of cost-effectiveness estimates and other information required to compare options for health investment; (iii) despite repeated attempts by regional governments to develop/strengthen Health Information Systems within the Caribbean, sustainability has been significantly hampered by human, material and financial resource constraints and ongoing monitoring and evaluation is generally poor. CONCLUSION: There are deficiencies in the quality and availability of health information to facilitate cost burden analysis of hypertension and diabetes mellitus in the Caribbean. Strong commitment from CARICOM governments will be necessary to address these concerns if economic evaluations are to be undertaken more frequently as part of the effort to reduce the morbidity and mortality from these diseases.

OBJETIVO: Las enfermedades no comunicables (ENC) se cuentan entre las principales amenazas a la salud y el bienestar en el Caribe. Se llevó a cabo un estudio hacia finales de 2005, con el fin de computar la carga económica de la diabetes mellitus y la hipertensión dentro de la Comunidad y el Mercado Común del Caribe (CARICOM). Este reporte constituye un análisis crítico de la calidad y disponibilidad de información sobre la salud, que puede ser usada para facilitar el análisis del nivel de costos de la diabetes mellitus y la hipertensión. MÉTODOS: Se desarrolló y distribuyó un formulario para obtener datos acerca de la utilización de servicios de salud y servicios epidemiológicos. Posteriormente se realizaron visitas a siete países miembros de CARICOM con el propósito de recoger datos. RESULTADOS: Los resultados revelaron (i) algunas deficiencias en cuanto a la confiabilidad y la validez de los datos recibidos, en particular los necesarios para facilitar el análisis de las complicaciones costo-específicas, tales como la enfermedad cardíaca isquémica, la enfermedad cerebrovascular, el fallo renal crónico, la retinopatía hipertensiva y diabética, y las complicaciones circulatorias periféricas; (ii) los sistemas de administración de datos en los hospitales no estaban conectados para facilitar la producción de estimados de costo-efectividad y otras informaciones requeridas para comparar las opciones de inversión para la salud; (iii) a pesar de reiterados intentos de los gobiernos regionales por desarrollar y fortalecer los sistemas de información de salud en el área del Caribe, su sostenimiento ha sido obstaculizado significativamente a causa de restricciones en cuanto a recursos humanos, materiales y financieros, y por el hecho de que el monitoreo y la evaluación actuales son generalmente pobres. CONCLUSIÓN: Existen deficiencias en la calidad y disponibilidad de información sobre la salud, en cuanto a facilitar el análisis del nivel de la magnitud del costo de la hipertensión y la diabetes mellitus en el Caribe. Será necesario un fuerte compromiso por parte de los gobiernos del CARICOM para abordar estos problemas, si se ha de emprender evaluaciones económicas con mayor frecuencia, como parte del esfuerzo por reducir la morbilidad y la mortalidad por estas enfermedades.

A qualidade da informação sobre o parto no Sistema de Informações Hospitalares no Município do Rio de Janeiro, Brasil, 1999 a 2001 / Quality of childbirth data in the Hospital Information System in Rio de Janeiro, Brazil, 1999-2001

O objetivo deste estudo é avaliar o sub-registro e a confiabilidade dos dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS) no Município do Rio de Janeiro, Brasil. Comparam-se os dados do SIH/SUS sobre puérperas em hospitais conveniados ao SUS com dados de prontuários médicos e de um estudo de morbi-mortalidade e atenção perinatal e neonatal no Município do Rio de Janeiro. A concordância das informações sobre idade da puérpera e tipo de parto (medidas pelo coeficiente de correlação intraclasse e pelo índice kappa) foi quase perfeita: 0,95 e 0,94, respectivamente. A confiabilidade (kappa) da residência materna foi inversamente proporcional ao nível de agregação dos bairros (0,76 para áreas programáticas e 0,68 para região administrativa). Para o tipo de parto, a sensibilidade e especificidade das Autorizações de Internação Hospitalar (AIH) foram 98,6 por cento e 99,3 por cento, respectivamente. Das 6.835 internações em maternidades conveniadas ao SUS, 11,9 por cento não foram registradas no SIH/SUS. A alta proporção de cesarianas entre as AIH não emitidas sugere que o cumprimento de Portarias que limitam o pagamento deste tipo de parto induz à alteração intencional do procedimento.

This study aimed to assess the coverage and reliability of the Hospital Admissions Information System (SIH/SUS) in the Municipality of Rio de Janeiro, Brazil. Data for women who gave birth in hospitals belonging to the Unified National Health System (SUS) were compared with data from medical records and interviews from a morbidity and mortality survey. Reliability was almost perfect for age (intraclass correlation coefficient: 0.95) and mode of delivery (kappa = 0.94). The sensitivity and specificity of the SIH/SUS for cesarean section were 98.6 percent and 99.3 percent, respectively. Reliability of data on addresses was inversely related to level of data aggregation: 0.76 for programmatic areas and 0.68 for administrative regions. Of 6,835 hospital admissions covered by the SUS, 11.9 percent showed no records in the SIS-SUS. The high cesarean rate among admissions without prior authorization by the public system appears to be related to regulations setting limits on reimbursement according to mode of delivery.

Reclassificação dos grupos de causas prováveis dos óbitos de causa mal definida, com base nas Autorizações de Internação Hospitalar no Sistema Unico de Saúde, Estado do Rio de Janeiro, Brasil / Probable cause of death after reclassification of ill-defined causes on hospital admissions forms in the Unified National Health System, Rio de Janeiro, Brazil

Este artigo descreve características sócio-demográficas e clínicas dos óbitos classificados como de causa mal definida, ocorridos no Estado do Rio de Janeiro, Brasil, em 1998, e faz a reclassificação dos grupos de causas prováveis desses óbitos, com base nas informações contidas nas Declarações de Obito do Sistema de Informações de Mortalidade e do Sistema de Informações Hospitalares do Sistema Unico de Saúde (SIH-SUS) de 1997 e 1998. Para isso, foi necessário relacionar uma amostra aleatória de óbitos de causas definidas com o SIH-SUS. Foi utilizada técnica de relacionamento probabilístico de registros. Comparando com os óbitos de causa definida, os óbitos de causa mal definida ocorreram mais em indivíduos de cor da pele não branca e com menor escolaridade; foram mais frequentes na região metropolitana e os indivíduos internaram menos no SUS e morreram mais em domicílios, e sem assistência médica. Foi possível reclassificar cerca de 20 por cento dos óbitos de causa mal definida. A reclassificação apresentou pequeno impacto na mortalidade proporcional, por causa do tamanho deste grupo (10 por cento dos óbitos). No entanto, se os resultados pudessem ser aplicados ao total de óbitos de causa mal definida, poderiam ocorrer alterações de maior impacto na mortalidade proporcional.

Avaliação da qualidade de preenchimento das declarações de óbito em unidade terciária de atenção à saúde materno-infantil / Quality evaluation of the completeness of death certificates at a tertiary maternal-infant health care unit

Apesar de duas décadas e meia de implantação do Sistema de Informações sobre Mortalidade (SIM) no Brasil, as estatísticas de mortalidade ainda apresentam problemas de confiabilidade, pois, mesmo em unidades de saúde de referência, existem Declarações de Óbito (DO), que apresentam distorções nos registros. O objetivo do estudo foi avaliar a qualidade da DO quanto ao grau de preenchimento das variáveis e verificar o ganho de informação pós-resgate no prontuário médico em unidade de saúde terciária em Recife (Pernambuco- PE). Foram comparadas as DO originais com as corrigidas no primeiro semestre de 1999. Os resultados mostraram omissões no preenchimento das variáveis indispensáveis e essenciais entre 0,7 e 10,9%, com resgate completo de informação no prontuário. Para as variáveis exclusivas de menores de um ano, as omissões ficaram entre 27 e 47% e os ganhos de informação obtidos foram inferiores a 50%, chegando à total ausência, apesar de sua fundamental importância para análises clínico- epidemiológicas dos fatores de risco para a mortalidade infantil. As omissões no preenchimento das variáveis contidas na DO e o ganho pouco satisfatório de informações pós-resgate nos prontuários refletem o desconhecimento médico de seu papel, sendo prioritária a implementação dos núcleos de epidemiologia hospitalar, garantindo treinamento e educação continuada ao corpo clínico institucional

After more than two decades of use, the Mortality Information System in Brazil still has problems of credibility. Distortions in the registration of Death Certificates (DC) are observed even at reference health centers. The objective of this study was to evaluate the completeness of DC and the gain of recovering abscent data from medical records in a tertiary health care unit in Recife, Pernambuco-Brazil. The study was conducted during the first semester of 1999. Original DC were compared before and after they had been corrected. Essential variables of the DC were unfilled in 0.7 to 10.9%. Compared to those obtained all missing data were recovered from the medical records. The information for children under one year of age was absent in 27 to 47% and data could be recovered in less than 50% of the medical records, being absent in most cases despite of the clinical and epidemiological importance for the analysis of infant mortality risk factors. The uncompleteness of DC and the unsatisfactory recovery of missing data from medical records underscare the lack of recognition by doctors of their role in generating information. Hospital Epidemiology Units should be developed to offer training and continuing education to clinical staff.

Sistema de información hospitalaria integrada: una propuesta / Integral informaton system for hospital: a proposal

La existencia de sistemas de informacion integrales para los hospitales es una preocupacion constante para quienes deben tomar deciciones en forma oportuna. Este trabajo traduce la necesidad de desarrollar un sistema de informacion que cubra todos los elementos y actividades de un hospital como herramienta básica para una mejora continua de la calidad de la atención médica y como medio de contencion de costos.(au)

Compatibilizaçäo de bases de dados nacionais / Compatibilization of national data basis

Relatório de oficina de trabalho com o objetivo de elaborar propostas para a compatibilizaçäo dos principais elementos dos sistemas de informaçäo de abrangência nacional.

Compatibilizaçäo de sistemas e bases de dados(CBD) na Rede Integrada de Informaçöes para a Saúde(RIPSA); informe final / Compatibilization of systems and basis integrated network of health informations (RIPSA); final inform

Relatório de reuniäo com o objetivo de propor medidas consensuais, de caráter metodológico e operacional, facilitadoras da intercomunicaçäo das principais bases de dados nacionais.