ABSTRACT
Background: The economic impact associated with the treatment strategies of coronavirus disease-2019 (COVID-19) patients by hospitals and health-care systems in Brazil is unknown and difficult to estimate. This research describes the investments made to absorb the demand for treatment and the changes in occupation rates and billing in Brazilian hospitals. Methods: This research covers the initial findings of "COVID-19 hospital costs and the proposition of a bundled reimbursement strategy for the health-care system," which includes 10 hospitals. The chief financial officer, the chief medical officer, and hospital executives of each participating hospital provided information regarding investments attributed to COVID-19 patient treatment. The analysis included variations in occupation rates and billing from 2019 to 2020 observed in each institution, and the investments for medical equipment, individual protection materials and building construction per patient treated. Results: The majority of hospitals registered a decrease in hospitalization rates and revenue from 2019 to 2020. For intensive care units (ICUs), the mean occupancy rate ranged from 88% to 83%, and for wards, it ranged from 85% to 73%. Monthly average revenue decreased by 10%. The mean hospital investment per COVID-19 inpatient was I$6800 (standard deviation 7664), with the purchase of ventilators as the most common investment. For this item, the mean, highest and lowest acquisition cost per ventilator were, respectively, I$31â¯468, I$48â¯881 and I$17â¯777. Conclusion: There was significant variability in acquisition costs and investments by institution for responding to the COVID-19 pandemic. These findings highlight the importance of continuing microeconomic studies for a comprehensive assessment of hospital costs. Only with more detailed analyses, will it be possible to define and drive sustainable strategies to manage and reimburse COVID-19 treatment in health-care systems.
ABSTRACT
OBJECTIVES: To identify the nursing diagnoses through reports in the medical records of patients monitored in a specialized ischemic heart disease outpatient clinic. METHODS: Cross-sectional study with retrospective data collection in the medical records. From the data collected, the nursing diagnoses were proposed by the researchers and submitted for validation by specialist cardiology nurses. RESULTS: A total of 13 nursing diagnoses were evaluated from the medical records of 50 outpatients with the following validation agreements among the specialists: Ineffective health management (100%), Noncompliance (100%), Sedentary lifestyle (100%), Activity intolerance (100%), Decreased cardiac output (88%), Risk of decreased cardiac tissue perfusion (65%), Risk of intolerance to activity (65%), Acute pain (76%), Ineffective health maintenance (65%), Risk-prone health behavior (65%), Risk for decreased cardiac output (65%), Risk for intolerance to activity (65%), Ineffective respiratory pattern (53%), Impaired memory (29%). CONCLUSIONS: In this study, the nursing diagnoses validated for stable heart disease patients were linked to adherence to treatment and to the cardiovascular responses of the patients, reinforcing the importance of early intervention. These results allow the multidisciplinary team to individualize the goals and interventions proposed for ischemic heart disease patients.
Subject(s)
Ambulatory Care Facilities , Myocardial Ischemia/diagnosis , Nursing Diagnosis , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Myocardial Ischemia/therapy , Patient Care Team/organization & administration , Patient Compliance/statistics & numerical data , Retrospective StudiesABSTRACT
Abstract Objective. To identify the nursing diagnoses through reports in the medical records of patients monitored in a specialized ischemic heart disease outpatient clinic. Methods. Cross-sectional study with retrospective data collection in the medical records. From the data collected, the nursing diagnoses were proposed by the researchers and submitted for validation by specialist cardiology nurses. Results. A total of 13 nursing diagnoses were evaluated from the medical records of 50 outpatients with the following validation agreements among the specialists: Ineffective health management (100%), Noncompliance (100%), Sedentary lifestyle (100%), Activity intolerance (100%), Decreased cardiac output (88%), Risk of decreased cardiac tissue perfusion (65%), Risk of intolerance to activity (65%), Acute pain (76%), Ineffective health maintenance (65%), Risk-prone health behavior (65%), Risk for decreased cardiac output (65%), Risk for intolerance to activity (65%), Ineffective respiratory pattern (53%), Impaired memory (29%). Conclusion. In this study, the nursing diagnoses validated for stable heart disease patients were linked to adherence to treatment and to the cardiovascular responses of the patients, reinforcing the importance of early intervention. These results allow the multidisciplinary team to individualize the goals and interventions proposed for ischemic heart disease patients.
Resumen Objetivo. Identificar los diagnósticos de enfermería a partir de los registros en el seguimiento de los pacientes que acuden a un centro ambulatorio especializado en cardiopatía isquémica en la ciudad de Porto Alegre, Brasil. Métodos. Estudio transversal con toma de información retrospectiva de la historia clínica. A partir de los datos recolectados, los diagnósticos de enfermería identificados por los investigadores se sometieron a valoración de enfermeros especialistas en cardiología. Resultados. Se identificaron 13 diagnósticos de enfermería en las historias clínicas de 50 pacientes ambulatorios, con la siguiente concordancia de validación entre los especialistas: control ineficaz de la salud (100%), falta de adherencia (100%), estilo de vida sedentario (100%), Intolerancia a la actividad (100%), Débito cardíaco disminuido (88%), Riego de perfusión tisular cardíaca disminuida (76%), Dolor agudo (76%), Mantenimiento ineficaz de la salud (65%), Comportamiento de salud propenso a riesgo (65%), Riesgo de débito cardíaco disminuido (65%), Riesgo de intolerancia a la actividad (65%), Patrón respiratorio ineficaz (53%), Memoria perjudicada (29%). Conclusión. En este estudio los diagnósticos de enfermería validados para los pacientes cardiópatas estables están relacionados con la adherencia al tratamiento y a la respuesta cardiovascular a las intervenciones, reforzando la importancia de intervención precoz. Esos resultados permiten, en equipos multiprofesionales, individualizar las metas e intervenciones para los pacientes con cardiopatía isquémica.
Resumo Objetivo. Identificar os diagnósticos de enfermagem através dos registros no seguimento dos pacientes que vão a um centro ambulatório especializado em cardiopatia isquêmica na cidade de Porto Alegre, Brasil. Métodos. Estudo transversal com toma de informação retrospectiva da história clínica. A partir dos dados recolhido, os diagnósticos de enfermagem identificados pelos investigadores foram submetidos a valoração de enfermeiros especialistas em cardiologia. Resultados. Foram identificados 13 diagnósticos de enfermagem nas histórias clínicas de 50 pacientes ambulatórios, com a seguinte concordância de validação entre os especialistas: controle ineficaz da saúde (100%), falta de aderência (100%), estilo de vida sedentário (100%), Intolerância à atividade (100%), Débito cardíaco diminuído (88%), irrigação de perfusão tissular cardíaca diminuída (76%), Dor agudo (76%), Manutenção ineficaz da saúde (65%), Comportamento de saúde propenso a risco (65%), Risco de débito cardíaco diminuído (65%), Risco de intolerância à atividade (65%), Padrão respiratório ineficaz (53%), Memória prejudicada (29%). Conclusão. Neste estudo os diagnósticos de enfermagem validados para os pacientes cardiopatas estáveis estão relacionados com a aderência ao tratamento e à resposta cardiovascular às intervenções dos pacientes, reforçando a importância de intervenção precoce. Esses resultados permitem em equipes multiprofissionais
