Panorama da acreditação (inter)nacional no Brasil / Panorama de la acreditación (inter) nacional en Brasil / Overview of (inter)national accreditation in Brazil

RESUMO Objetivo delinear o panorama da Acreditação nacional e internacional no Brasil. Método estudo descritivo, de abordagem quantitativa e fonte documental. Os campos de inquérito foram as páginas online de acesso irrestrito das seguintes metodologias acreditadoras: Organização Nacional de Acreditação (ONA), Joint Commission International (JCI), Accreditation Canada International (ACI) e QMentum Internacional, além da página do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e/ou sites institucionais. Foram extraídas as variáveis: tipo de instituição/estabelecimento de saúde; regime de gestão setorial; localidade; nível de certificação (em caso de selo concedido pela ONA) e porte (para hospitais). Empregou-se análise estatística descritiva. Resultados apuraram-se os dados de 1.122 certificações, especialmente da ONA (77,2%) e QMentum International (13,2%). Os hospitais prevaleceram na adesão à Acreditação (35,3%), principalmente os de grande porte (60,3%) e do setor privado (75,8%). Houve concentração dos selos de qualidade na região Sudeste do Brasil (64,5%), e a região Norte apresentou menor proporção de estabelecimentos certificados (3%). Conclusões e implicações para a prática as certificações de Acreditação no Brasil remetem à metodologia nacional, com enfoque na área hospitalar privada e na região Sudeste do país. O mapeamento delineado pode sustentar assertividade em políticas de incentivo à gestão da qualidade e avaliação externa no Brasil.

RESUMEN Objetivo delinear el panorama de la Acreditación nacional e internacional en Brasil. Método estudio descriptivo, con enfoque cuantitativo y fuente documental. Los campos de consulta fueron las páginas en línea de libre acceso de las siguientes metodologías de acreditación: Organización Nacional de Acreditación (ONA), Joint Commission International (JCI), Accreditation Canada International (ACI) y QMentum Internacional, además del Registro Nacional de Establecimientos Salud (CNES) y/o sitios web institucionales. Se extrajeron las variables: tipo de institución/establecimiento de salud; régimen de gestión sectorial; localidad; nivel de certificación (en caso de sello otorgado por la ONA) y tamaño (para hospitales). Se utilizó análisis estadístico descriptivo. Resultados se recogieron datos de 1.122 certificaciones, especialmente de ONA (77,2%) y QMentum International (13,2%). Los hospitales prevalecieron en la adhesión a la Acreditación (35,3%), en especial los hospitales grandes (60,3%) y el sector privado (75,8%). Hubo concentración de sellos de calidad en la región Sudeste de Brasil (64,5%), y la región Norte tuvo la menor proporción de establecimientos certificados (3%). Conclusiones e implicaciones para la práctica las certificaciones de acreditación en Brasil se refieren a la metodología nacional, con foco en el área hospitalaria privada y la región Sudeste del país. El mapeo esbozado puede apoyar la asertividad en las políticas de fomento de la gestión de la calidad y la evaluación externa en Brasil.

ABSTRACT Objective to outline the panorama of national and international Accreditation in Brazil. Method a descriptive study, of quantitative approach and documental source. The survey fields were the unrestricted access online pages of the following accrediting methodologies: National Accreditation Organization (ONA), Joint Commission International (JCI), Accreditation Canada International (ACI), and QMentum International, besides the page of the National Registry of Health Establishments (CNES) and/or institutional sites. Variables were extracted: type of institution/health care facility; sector management regime; location; level of certification (in case of a seal granted by ONA), and size (for hospitals). Descriptive statistical analysis was used. Results data from 1,122 certifications was obtained, especially from ONA (77.2%) and QMentum International (13.2%). Hospitals prevailed in the Accreditation adherence (35.3%), mainly the large ones (60.3%) and from the private sector (75.8%). There was a concentration of quality seals in the Southeast region of Brazil (64.5%), and the North region presented the lowest proportion of certified establishments (3%). Conclusions and implications for practice the Accreditation certifications in Brazil refer to the national methodology, focusing on the private hospital area and the Southeast region of the country. The mapping outlined can support assertiveness in incentive policies for quality management and external evaluation in Brazil.

Quality of care in accredited and nonaccredited hospitals: perceptions of nurses in the Eastern Province, Saudi Arabia

Background: Although Saudi Arabia is one of the first countries in the Eastern Mediterranean Region to implement healthcare accreditation standards, little is known about its impact on nurse assessment of the provision of healthcare

Objective: The main objectives of this study were to determine the quality of healthcare services provided by accredited and nonaccredited hospitals on the basis of the views of nurses. In addition, this study aimed to explore the potential contributing factors affecting the quality of care

Methods: A cross-sectional study was carried out at one accredited and another nonaccredited hospital at Al-Khobar city, Saudi Arabia. A questionnaire was used to assess nurses' perceptions of the quality of healthcare provided in the target hospitals on a five-point Likert scale tool. A total of 164 nurses were surveyed

Main outcome measures: Quality of healthcare services and the potential contributing factors affecting the quality of care

Results: The most highly rated scales by nurses were 'education and training' [mean=4.09], followed by [quality management] [mean=3.96] at the accredited hospital compared with 'use of data' [mean=3.56] and 'strategic quality planning' [mean=3.56] at the nonaccredited hospital. For both hospitals, the lowest scores were assigned to the 'reward' [mean=2.78 and 3.06 by nurses at accredited and nonaccredited hospitals, respectively]. Nurses' rating for all scales was higher in the accredited compared with the nonaccredited hospital, except for the reward scale. The difference was statistically significant for all scales, except human resource utilization [P?0.02]. In accredited hospitals and for different scales, nurses with 4-6 years of experience, Saudi nurses, and those aged 30-35 years had significantly higher agreement scores than their counterparts. For the accredited hospitals, the predictors of good-quality results were leadership, commitment and support [P=0.019], and strategic quality planning [P=0.007]. For nonaccredited hospitals, predictors of good quality results were leadership, commitment, and support [P=0.001]

Conclusion: As perceived by nurses in study hospitals, accredited hospitals perform favorably compared with nonaccredited hospitals in almost all quality scales. Thus, accreditation can be considered a tool for improving hospital quality. The most important determinants of quality in healthcare were leadership, commitment and support, and strategic quality planning

Estado actual de las especialidades médicas en Chile: realidad en el sistema público no municipalizado / Present status of medical specialties in the Chilean public health system

To adequately plan the post graduate training of physicians, we need to know the needs for specialists in the country and the most prevalent diseases and causes of consultations. In 2004, the National System of Health Services assessed the number of hours and types of specialities available, their regional distribution and calculated an approximate number of physicians in charge of those specialities, determining an equivalent per 44 weekly hours of physician. This number of hours is the maximum that a physician is allowed to work per week. Fifty six percent of specialists correspond to basic specialities (3,688 physicians equivalent to 44 hours, 33 percent to primary specialities (2,205 physicians) and 10 percent to subspecialties (666 physicians). The regional distribution of basic specialties is proportional to the population of each region. However, there are gaps in the distribution of primary specialties and subspecialties. The demand for specialists, assessed measuring the yield in minutes of each hired hour, determined that 54 percent of specialist hours are delicated to the new health program that guaranties the access to certain specialties in a predefined lapse, to all beneficiaries (AUGE). Moreover the demand for attentions to cover this health system has a gap of 30 percent in hours or 800 specialists. This motivated the creation of new posts for specialties during 2005 and 2006, equivalent to 250 physicians hired for 44 hours per week.

Autorización para el ejercicio profesional médico en Chile: experiencia de la comisión de reválida de la Escuela de Medicina de la Universidad de Chile período 1984-1999 / Medical practice licensing in Chile: experience of the re-valuation committee of the medical school of Universidad de Chile, 1984-1999

We report the experience of the re-valuation committee of the University of Chile Medical School, in the period 1984-1999. This experience is relevant to the licensing processes in Latin America. We report the political, legal and regulatory backup and the academic criteria used to esatblish different evaluation methodologies. We also communicate the main results obtained. Factors such as the country and University conferring a title, nationality and length of service of the applicant, influence in the percentage of licensure exammination approval. Some modifications to the licensure process should be incorporated but, the overall results obtained, fully justify the existence of this licensure committee

Fisiopatología de los programas de Residencia de Cirugía General / Physiopathology of the Residence programs in general surgery

Antecedentes: Dificultades para implantar un Sistema de Residencias apto en la República Argentina. Objetivo: Analizar la tarea y los procedimientos de la Comisión de Residencias de la AAC. Lugar de aplicación: 67 Programas de Residencia en Cirugía General registrados en la Comisión. Diseño: Revisión de la información recogida en 96 evaluaciones efectuadas sobre 54 programas. Población: Muestra consecutiva de los 54 programas evaluados. Método: Determinación del procedimiento de acreditación, criterios para el tratamiento de los indicadores y estudio de las formas de distorsión. Resultados: Con las limitaciones expuestas en el texto, resulta un número de Programas con Acreditación Completa no significativo ante la desproporción de programas con Acreditación Parcial crónica y de un grupo fuera de control. Se describen los modelos de distorsión. Conclusiones: Se define un Programa Básico apto para la realidad nacional que resulta accesible a todos los programas con Acreditación Parcial

Perfil del nuevo socio activo de la Sociedad Chilena de Pediatría / Profile of the new active member of the Sociedad Chilena de Pediatría

Se describen las características principales de 102 recientes socios activos de la Sociedad Chilena de Pediatría, destacando una tardanza postítulo de alrededor de 10 años (mediana) en ingresar, período en el cual asisten a cursos cortos de perfeccionamiento, realizan actividades de investigación en menor grado y adquieren formación como pediatras, estando certificado el 78,4 por ciento por universidad o CONACEM