ABSTRACT
The 'Seguro Médico Siglo XXI' (SMSXXI), a universal coverage medical insurance programme for children under 5 years of age, started in 2006 to help avoid catastrophic health expenditures in poor families without social security in Mexico. The study used information from the National Health Information System for the 2006-14 period. An ecological approach was followed with a panel of the 2457 municipalities of Mexico as the units of analysis. The outcome variables were the municipality-level neonatal mortality and infant mortality rates in population without access to social security. The programme variable was the coverage of the SMSXXI programme at the municipality level, expressed as a proportion. Demographic and economic variables defined at the municipality level were included as covariates. Impact was estimated by fitting a fixed-effects negative binomial regression model. Results reveal that the SMSXXI significantly reduced both infant and neonatSal mortality in the target population, although in a non-linear fashion, with minimum mortality levels found around the 70% coverage range. The effect is mostly given by the transition from the first quintile to the fourth quintile of coverage (<13% vs 70.5-93.7% coverage), and it is attenuated significantly at coverage levels very close to or at 100%. The observed risk reduction amounted to an estimated total of 11 358 infant deaths being avoided due to the SMSXXI during the 2006-14 period, of which 48% were neonatal. In conclusion, we found a significant impact of the SMSXXI programme on both infant mortality and neonatal mortality. An attenuation of the effect of the insurance on mortality rates at levels close to 100% coverage may reflect the saturation of health units in detriment of the quality of care.
Subject(s)
Infant Mortality , Insurance Coverage/statistics & numerical data , Insurance, Health/statistics & numerical data , Humans , Infant , Infant, Newborn , Mexico/epidemiologyABSTRACT
OBJECTIVE: Develop and pilot indicators of quality of care to neonates with relevant conditions in Mexico (prematurity, neonatal sepsis, perinatal asphyxia, and intrauterine hypoxia). MATERIALS AND METHODS: Own indicators were built based on key recommendations of national clinical practice guidelines and indicators found in international repositories. With previous search, selection and prioritization, the indicators were piloted within two hospitals. The feasibility of measuring, (kappa index) reliability and usefulness was analyzed to detect quality problems. RESULTS: 23 indicators were selected and piloted, 12 are compounds, of the total, nine were feasible and reliable. The quality of the hospital's information was diverse and often poor, limiting both the feasibility and the reliability of the indicators. Improvement opportunities were identified thorough the compliance levels. CONCLUSIONS: A set of nine indicators valid, reliable, feasible and useful indicators is proposed in order to monitor the quality of care of pathological neonates.
OBJETIVO: Desarrollar y pilotar indicadores de calidad de la atención a neonatos con padecimientos relevantes en México (prematuridad, sepsis neonatal, asfixia perinatal e hipoxia intrauterina). MATERIAL Y MÉTODOS: Se construyeron indicadores propios a partir de recomendaciones clave de las guías de práctica clínica nacionales e indicadores encontrados en repositorios internacionales. Previa búsqueda, selección y priorización, los indicadores fueron pilotados en dos hospitales. Se analizó la factibilidad de medición, fiabilidad (índice kappa) y utilidad para detectar problemas de calidad. RESULTADOS: Se seleccionaron y pilotaron 23 indicadores; 12 eran compuestos. Del total, nueve fueron factibles y fiables. La calidad de la información en los hospitales fue diversa y frecuentemente deficiente, limitando tanto la factibilidad como la fiabilidad de los indicadores. Los niveles de cumplimiento identificaron oportunidades de mejora. CONCLUSIONES: Se propone un set de nueve indicadores válidos, factibles, fiables y útiles para la monitorización de la calidad en la atención a neonatos patológicos.
Subject(s)
Asphyxia Neonatorum/epidemiology , Fetal Hypoxia/epidemiology , Neonatal Sepsis/epidemiology , Quality Indicators, Health Care , Data Accuracy , Female , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/epidemiology , Male , Mexico/epidemiology , Pilot Projects , Practice Guidelines as Topic , Quality Improvement , Quality of Health Care , Reproducibility of ResultsABSTRACT
Resumen: Objetivo: Desarrollar y pilotar indicadores de calidad de la atención a neonatos con padecimientos relevantes en México (prematuridad, sepsis neonatal, asfixia perinatal e hipoxia intrauterina). Material y métodos: Se construyeron indicadores propios a partir de recomendaciones clave de las guías de práctica clínica nacionales e indicadores encontrados en repositorios internacionales. Previa búsqueda, selección y priorización, los indicadores fueron pilotados en dos hospitales. Se analizó la factibilidad de medición, fiabilidad (índice kappa) y utilidad para detectar problemas de calidad. Resultados: Se seleccionaron y pilotaron 23 indicadores; 12 eran compuestos. Del total, nueve fueron factibles y fiables. La calidad de la información en los hospitales fue diversa y frecuentemente deficiente, limitando tanto la factibilidad como la fiabilidad de los indicadores. Los niveles de cumplimiento identificaron oportunidades de mejora. Conclusiones: Se propone un set de nueve indicadores válidos, factibles, fiables y útiles para la monitorización de la calidad en la atención a neonatos patológicos.
Abstract Objective: Develop and pilot indicators of quality of care to neonates with relevant conditions in Mexico (prematurity, neonatal sepsis, perinatal asphyxia, and intrauterine hypoxia). Materials and methods: Own indicators were built based on key recommendations of national clinical practice guidelines and indicators found in international repositories. With previous search, selection and prioritization, the indicators were piloted within two hospitals. The feasibility of measuring, (kappa index) reliability and usefulness was analyzed to detect quality problems. Results: 23 indicators were selected and piloted, 12 are compounds, of the total, nine were feasible and reliable. The quality of the hospital's information was diverse and often poor, limiting both the feasibility and the reliability of the indicators. Improvement opportunities were identified thorough the compliance levels. Conclusions: A set of nine indicators valid, reliable, feasible and useful indicators is proposed in order to monitor the quality of care of pathological neonates.
Subject(s)
Humans , Male , Female , Infant, Newborn , Asphyxia Neonatorum/epidemiology , Quality Indicators, Health Care , Fetal Hypoxia/epidemiology , Neonatal Sepsis/epidemiology , Quality of Health Care , Infant, Premature , Pilot Projects , Reproducibility of Results , Practice Guidelines as Topic , Quality Improvement , Data Accuracy , Infant, Premature, Diseases/epidemiology , Mexico/epidemiologyABSTRACT
OBJECTIVE: To describe the relation between risk perception of people with relatives who have been hospitalized with diabetes mellitus, and also their modifiable risk factors. MATERIAL AND METHOD: We applied a validated questionnaire to a hundred of people who have any relatives with diabetes mellitus, because we wanted to know their perception for risk of this disease and their modifiable risk factors, as obesity, sedentary life style and meals. We think that the relatives who have two or more modifiable risk factors have a higher probability to develop diabetes mellitus than the relatives who have only one of them. RESULTS: The risk perception to develop diabetes in patients' relatives could be 87%; 67% has fat, and 73% has a sedentary life style. So, the relation among the modification of risk factors and the risk perception towards diabetes mellitus was not really significant (p = 0.399, RR 0.94, IC 0.80-1.10 to 95%), but there is a statistical relation among high risk for diabetes mellitus acquisition and gender (chi2 5.0, p < 0.05, RR 1.61, IC 1.00 < Rr -2.58), when we associate the variable age and obesity (chi2 7.9, p < 0.05, RR 0.59, IC 0.37-0.93). CONCLUSIONS: More of 50 % patients' relatives are in a high risk to develop diabetes mellitus because they have a similar life style than the patient had before getting the illness. For this reason, we suggest a different educational and cultural orientation in Mexico to identify all people in risk and do following of previous parameters about their health.
