The Large-Scale Implementation of a Health Information System in Brazilian University Hospitals: Process and Outcomes.

Governments around the globe are paving the way for healthcare services that can have a profound impact on the overall well-being and development of their nations. However, government programs to implement health information technologies on a large-scale are challenging, especially in developing countries. In this article, the process and outcomes of the large-scale implementation of a hospital information system for the management of Brazilian university hospitals are analyzed. Based on a qualitative approach, this research involved 21 hospitals and comprised a documentary search, interviews with 24 hospital managers and two system user focus groups, and a questionnaire of 736 respondents. Generally, we observed that aspects relating to the wider context of system implementation (macro level), the managerial structure, cultural nuances, and political dynamics within each hospital (meso level), as well as the technology, work activities, and individuals themselves (micro level) acted as facilitators and/or obstacles to the implementation process. The dynamics and complex interactions established between these aspects had repercussions on the process, including the extended time necessary to implement the national program and the somewhat mixed outcomes obtained by hospitals in the national network. Mostly positive, these outcomes were linked to the eight emerging dimensions of practices and work processes; planning, control, and decision making; transparency and accountability; optimization in the use of resources; productivity of professionals; patient information security; safety and quality of care; and improvement in teaching and research. We argued here that to maximize the potential of information technology in healthcare on a large-scale, an integrative and cooperative vision is required, along with a high capacity for change management, considering the different regional, local, and institutional contexts.

Caracterização de variáveis clínicas e do desenvolvimento motor de recém-nascidos prematuros / Characterization of clinical variables and neuromotor development of preterm infants

A Organização Mundial de Saúde considera prematuro aquele nascido com idade gestacional entre 20 a 37 semanas. Com os avanços tecnológicos existentes nas Unidades de Terapia Intensiva Neonatal, tem-se maior sobrevida destes, que apresentam desenvolvimento neuromotor inferior aos recém-nascidos a termo. Este estudo objetivou caracterizar o desenvolvimento motor e variáveis clínicas de prematuros nascidos em um hospital público. Trata- se de um estudo misto. A pontuação na Escala Motora Infantil de Alberta, peso ao nascimento, idade gestacional, tempo de internação na Unidade de Terapia Intensiva Neonatal e Apgar de 1o e 5o minuto de prematuros com idade corrigida entre 0 e 18 meses foram coletadas dos prontuários, entre maio de 2013 a abril de 2014. Para análise estatística, utilizou-se o teste do Qui-Quadrado (nível de significância p<0,05). Foram incluídos 267 prematuros, com mediana de idade gestacional de 32(30 - 33) semanas, de tempo de internação de 35 (25 - 58,5) dias e de peso médio de 1430 (11-75 - 1690) gramas. Foi encontrado em 10,49% das crianças o Apgar no 5o minuto inferior a 7. Verificou-se que 36,89% dos prematuros entre 0 e 5 meses, 39,6% entre 06 e 12 meses e 23,5% entre 13 e 18 meses estavam com riscos ou atrasos motores evidentes. Não foi observada correlação entre o Apgar do 5o minuto e o desenvolvimento motor. A maioria das crianças entre 06 e 12 meses apresentou risco para atrasos motores, justificando a importância do seguimento de prematuros em serviços de referência, mesmo após o primeiro ano de vida.

The World Health Organization considers preterm those born with a gestational age between 20 and 37 weeks. With the technological advances in Neonatal Intensive Care Units, we have seen a higher survival rate among preterms, who present lower neuromotor development than full term newborns. The aim of this study was to characterize the motor development and clinical variables of preterm infants born in a public hospital. It is a mixed study. The score on the Alberta Infant Motor Scale, birth weight, gestational age, time of stay in the Neonatal Intensive Care Unit, and the 1st and 5th minute Apgar of preterm infants with ages between 0 and 18 months corrected age, were collected from their files between May 2013 and April 2014. For statistical analysis, the Chisquare test (significance level of p < 0.05) was used. A total of 267 premature babies were included, with median gestational age of 32 (30-33) weeks, duration of stay of 35 (25-58.5) days, and mean weight of 1,430 (1,175-1,690) grams. A 5th minute Apgar score below 7 was found in 10.49% of the children. It was found that 36.89% of the infants between 0 and 5 months, 39.6% between 6 and 12 months, and 23.5% between 13 and 18 months of age were at risk of or had evident motor delay. No correlation was observed between the 5th minute Apgar and motor development. Most of the infants between 6 and 12 months were at risk for motor delay, justifying the importance of the follow-up for premature infants in specialized services even after the first year of life.