ABSTRACT
Introducción. La ausencia de hospitalización domiciliaria (HD) de niños y adolescentes con necesidades especiales en salud de alta complejidad (NANEAS) genera hospitalizaciones prolongadas en la atención cerrada (AC). Objetivo: Comparar el gasto estimado de HD de NANEAS de alta complejidad versus costo real del mismo paciente en AC y su impacto en la producción hospitalaria. Métodos: Estudio descriptivo y comparativo entre costos de ambas modalidades de hospitalización de NANEAS de alta complejidad. De enero a diciembre 2016 se registraron hospitalizaciones NANEAS no oncológicos del Servicio de Pediatría (SP) según norma del Ministerio de Salud-Chile (MINSAL). Se clasificó para grupos clínicos y consumos similares de recursos según grupos relacionados al diagnóstico (GRD). Para evaluar el impacto en la producción hospitalaria la estancia fue ajustada y se realizó un análisis financiero de ambas modalidades (AC) y (HD). Resultados: De 3690 egresos, 126 (3,4%) se relacionaron a 27 NANEAS, la edad promedio fue 4,6 años (± 5 DS) con dependencias tecnológicas para vivir. La estancia media NANEAS fue 16 días, comparada con 5,9 de los pacientes sin necesidades especiales en salud. Las estancias NANEAS llegaron a 2017 días (8,6%). Prescindir de los egresos NANEAS hubiera aportado 320 egresos adicionales y su HD habría ahorrado US $15/día por paciente, que para el total de estancias consumidas habría sido un ahorro anual de US $ 29 170. Conclusiones: La HD tiene un costo estimado menor a la AC de NANEAS de alta complejidad, mejora la productividad hospitalaria y libera camas críticas con inversión financieramente viable.
Introduction. The absence of home hospitalization (HH) of children and youth with special health care needs (CYSHCN) generates prolonged hospitalizations in closed care (CC). Objective: To compare the estimated cost of HH of high complexity CYSHCN versus the actual cost of the same patient in CC and its impact on hospital production. Methods: Descriptive and comparative study between costs of both hospitalization modalities of high complexity CYSHCN. From January to December 2016, non-oncological CYSHCN hospitalizations were registered by the Pediatric Service (PS) according to the Ministry of Health-Chile (MINSAL) norm. It was classified for clinical groups and similar consumption of resources according to groups related to diagnosis (DRG). The stay was adjusted, and financial analysis of both modalities (CC) and (HH) was performed to evaluate the impact on hospital production. Results: Of 3690 discharges, 126 (3.4%) were related to 27 CYSHCN, the average age was 4.6 years (± 5 SD) with technological dependencies to live. The mean CYSHCN stay was 16 days, compared with 5.9 for patients without special health needs. CYSHCN stays reached 2017 days (8.6%). Disregarding the CYSHCN discharges would have contributed 320 additional discharges, and his HH would have saved US $ 15 / day per patient, which for the total number of stays consumed would have been an annual saving of US $ 29170. Conclusion: HH has an estimated cost lower than the CA of high complexity CYSHCN, improves hospital productivity, and frees critical beds with financially viable investment.
ABSTRACT
Webinar N° 10 del ORAS-CONHU, realizado el 09 de julio de 2020, se realizó un webinar con el objetivo de analizar los avances y desafío que tiene la región andina en cuanto a las acciones y medidas multi e intersectoriales tomadas para garantizar educación para todos en tiempos de covid-19. Al reconocer que la educación es uno de los determinantes sociales de la salud, nos vemos en la necesidad de analizar tanto la dimensión global de esta relación, como cada una de las interacciones que se producen con otras variables del desarrollo humano, para dar respuesta a la Agenda Mundial en materia de salud y educación AL 2030. Conferencistas del webinar: Fernando Berríos, Coordinador de Unesco Perú, Luis Jorge Hernández Flores, Profesor Universidad de los Andes de Colombia, Fabián León Tamariz, Decano de la Facultad de Ciencias Químicas de la Universidad de Cuenca, Ecuador y José Ferrer Vicerrector de la Universidad de las Ciencias de la Salud de Venezuela.
Subject(s)
Social Determinants of Health , Peru , Venezuela , Bolivia , Chile , Colombia , Coronavirus Infections , Ecuador , COVID-19ABSTRACT
It has been hypothesized that ecosystem health describes the state in which all processes operating within an ecosystem are functioning at a level of optimum efficiency to maximize system empower. In this study, systems analysis of networks and information flows is used within this definition of ecosystem health to assess the condition of the benthic ecosystems in three coastal bays in northern Chile. These highly productive ecosystems are characterized by the inflow of cold, nutrient-rich waters of low oxygen concentration derived from coastal upwelling of deep waters and the interruption of upwelling flow during El Niño events when warmer waters with higher oxygen and lower nutrient concentrations enter these coastal systems. Also, these ecosystems support important artisanal benthic fisheries and are affected by industrial activities in the coastal zone. Energy Systems Theory (EST) and Emergy Analysis (EA) were applied to quantify the health of these benthic ecosystems and evaluate differences in their structure, organization and functional capacities, which are related to their emergy signatures. The marked dominance of these benthic ecosystems by nitrate from upwelling resulted in unbalanced emergy signatures, suggesting less development and system diversity compared to other coastal ecosystems with more balanced emergy signatures. Macro-descriptors and network properties, such as emergy-based ascendency and the quality-adjusted Shannon diversity index were highest for Mejillones Bay, followed by Antofagasta and then Tongoy Bay. The Average Mutual Information (AMI) index adjusted for energy quality and the emergy-based A/C (ascendency to capacity) ratio, were higher for Tongoy Bay, suggesting functional differences in health among the three ecosystems. Thus, the emergy-based macro descriptors and other indicators used in our analysis indicate that the benthic networks examined have different structural and functional characteristics that lead to different characterizations of their states of health. As a result of this complexity, management policies should be implemented within a systemic context for analysis that considers all the factors determining the relative health of each ecosystem.
