Gaps between supply and demand of acute myocardial infarction treatment in Mexico / Brechas entre la oferta y la demanda del tratamiento de infarto agudo al miocardio en México

Abstract Objective: To analyze acute myocardial infarction (AMI) admissions and in-hospital mortality rates and evaluate the competence of the Ministry of Health (MOH) hospitals to provide AMI treatment. Materials and methods: We used a mixed-methods approach: 1) Joinpoint analysis of hospitalizations and in-hospital mortality trends between 2005 and 2017; 2) a nation-wide cross-sectional MOH hospital survey. Results: AMI hospitalizations are increasing among men and patients aged >60 years; women have higher mortality rates. The survey included 527 hospitals (2nd level =471; 3rd level =56). We identified insufficient competence to diagnose AMI (2nd level 37%, 3rd level 51%), perform pharmacological perfusion (2nd level 8.7%, 3rd level 26.8%), and mechanical reperfusion (2nd level 2.8%, 3rd level 17.9%). Conclusions: There are wide disparities in demand, supply, and health outcomes of AMI in Mexico. It is advisable to build up the competence with gender and age perspectives in order to diagnose and manage AMI and reduce AMI mortality effectively.

Resumen Objetivo: Analizar las tendencias de admisiones y mortalidad hospitalaria por infarto agudo al miocardio (IAM) y evaluar la competencia hospitalaria de la Secretaría de Salud (SS) para tratarlo. Material y métodos. Enfoque de métodos mixtos: Jointpoint análisis de tendencias de hospitalizaciones y mortalidad hospitalaria entre 2005 y 2017, y encuesta en hospitales de la SS. Resultados: Las hospitalizaciones por IAM están aumentando entre hombres y pacientes >60 años. Las mujeres tienen mayor mortalidad. La encuesta incluyó 527 hospitales (2º nivel =471, 3er nivel =56). Los hospitales tienen competencias insuficientes para diagnosticar IAM (2º nivel 37%, 3er nivel 51%), realizar perfusión farmacológica (2º nivel 8.7%, 3er nivel 26.8%) y reperfusión mecánica (2º nivel 2.8%, 3er nivel 17.9%). Conclusiones: Existen disparidades en demanda, oferta y resultados en salud del IAM. Es aconsejable fortalecer las competencias, con perspectivas de género y edad, para diagnosticar y tratar IAM, y reducir su mortalidad efectivamente.

Gaps between supply and demand of acute myocardial infarction treatment in Mexico.

OBJECTIVE: To analyze acute myocardial infarction (AMI) admissions and in-hospital mortality rates and evaluate the competence of the Ministry of Health (MOH) hospitals to provide AMI treatment. MATERIALS AND METHODS: We used a mixed-methods approach: 1) Joinpoint analysis of hos-pitalizations and in-hospital mortality trends between 2005 and 2017; 2) a nation-wide cross-sectional MOH hospital survey. RESULTS: AMI hospitalizations are increasing among men and patients aged >60 years; women have higher mortal-ity rates. The survey included 527 hospitals (2nd level =471; 3rdlevel =56). We identified insufficient competence to diagnose AMI (2nd level 37%, 3rd level 51%), perform pharmacological perfusion (2nd level 8.7%, 3rd level 26.8%), and mechanical reperfusion (2nd level 2.8%, 3rd level 17.9%). CONCLUSIONS: There are wide disparities in demand, supply, and health outcomes of AMI in Mexico. It is advisable to build up the competence with gender and age perspectives in order to di-agnose and manage AMI and reduce AMI mortality effectively.

OBJETIVO: Analizar las tendencias de admisiones y mortali-dad hospitalaria por infarto agudo al miocardio (IAM) y eva-luar la competencia hospitalaria de la Secretaría de Salud (SS) para tratarlo. MATERIAL Y MÉTODOS: Enfoque de métodos mixtos: Jointpoint análisis de tendencias de hospitalizaciones y mortalidad hospitalaria entre 2005 y 2017, y encuesta en hospitales de la SS. RESULTADOS: Las hospitalizaciones por IAM están aumentando entre hombres y pacientes >60 años. Las mujeres tienen mayor mortalidad. La encuesta incluyó 527 hospitales (2º nivel =471, 3er nivel =56). Los hospitales tienen competencias insuficientes para diagnosticar IAM (2º nivel 37%, 3er nivel 51%), realizar perfusión farmacológica (2º nivel 8.7%, 3er nivel 26.8%) y reperfusión mecánica (2º nivel 2.8%, 3er nivel 17.9%). CONCLUSIONES: Existen disparidades en demanda, oferta y resultados en salud del IAM. Es aconsejable fortalecer las competencias, con perspectivas de género y edad, para diagnosticar y tratar IAM, y reducir su mortalidad efectivamente.

Access to paediatric cancer care treatment in Mexico: responding to health system challenges and opportunities.

In Mexico, paediatric cancer is the leading cause of death for children aged 0-18 years. This study analyses the main challenges for paediatric cancer care from the perspective of three key health systems functions: stewardship, financing and service delivery. The study used a mixed methods approach comprised of: (1) a scoping literature review, (2) an analysis of 2008-18 expenditures on paediatric cancer by the Fund for Protection against Catastrophic Expenditures (FPGC) of Seguro Popular and (3) a nation-wide survey of the supply capacity of 59 Ministry of Health (MoH) and 39 Mexican Institute of Social Security (IMSS) hospitals engaged in paediatric cancer care. The study found that while Mexico has made substantial progress towards universal health coverage (UHC) for paediatric cancer treatment, serious gaps persist. FPGC funds for paediatric cancer increased from 2008 to 2011 to reach US$36 million and then declined to US$13.6 million in 2018, along with the number of covered cases. The distribution of health professionals and paediatric oncology infrastructure is uneven between MoH and IMSS hospitals and across Mexican regions. Both institutions share common barriers for continuous and co-ordinated health care and lack monitoring activities that cripple their capacity to apply uniform standards for high-quality cancer care. In conclusion, achieving universal and effective coverage of paediatric cancer treatment is a critical component of UHC for Mexico. This requires periodic and ongoing assessment of health system performance specific to paediatric cancer to identify gaps and propose strategies for continued investment and improvement of access to care and health outcomes for this important cause of premature mortality.

Barriers and opportunities to improve the foundations for high-quality healthcare in the Mexican Health System.

This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated. We used thematic content and descriptive analyses to analyse the data. We found that QoC foundations, evaluation and improvement activities pose essential challenges for the Mexican health sector. Governance for QoC is weakly aligned across MoH, IMSS and ISSSTE. Each institution follows its own agenda of evaluation and improvement programmes and has distinct QoC indicators and information systems. The institutions share similar barriers to strengthening QoC: poor organizational structure at a facility level, scarcity of financial resources, lack of training in QoC for executive/managerial staff and health professionals and limited public participation. In conclusion, a stronger legal framework and policy dialogue is needed to foster governance by the MoH, to define and align health sector-wide QoC policies, and to set common goals and articulate QoC improvement actions among institutions. Robust QoC organizational structure with designated staff and clarity on their responsibilities should be established at all levels of healthcare. Investment is necessary to fund formal and in-service QoC training programmes for health professionals and to reinforce quality evaluation and improvement activities and quality information systems. QoC evaluation results should be available to healthcare providers and the population. Active public participation in the design and implementation of improvement initiatives should be strengthened.

[Adverse events identified in medical complaints]. / Eventos adversos identificables en las quejas médicas.

BACKGROUND: "To err is human" (Institute of Medicine, 1999) begun the Patients' Safety movement worldwide. We undertook this study to determine the frequency of patient complaints related to adverse events in the National Health Services. METHODS: The National Commission of Medical Arbitration and the Vice-Ministry for Innovation and Quality has the aim of determining the frequency of real adverse events as a reason for complaints by patients and relatives against healthcare professionals and health services. RESULTS: The Emergency Department registered the highest number of events. Negligence and absence of protocols account for more than half of the adverse events. CONCLUSIONS: Management protocols in emergency departments are areas of opportunity for improvement that must be considered.

Eventos adversos identificables en las quejas médicas / Adverse events identified in medical complaints

BACKGROUND: "To err is human" (Institute of Medicine, 1999) begun the Patients' Safety movement worldwide. We undertook this study to determine the frequency of patient complaints related to adverse events in the National Health Services. METHODS: The National Commission of Medical Arbitration and the Vice-Ministry for Innovation and Quality has the aim of determining the frequency of real adverse events as a reason for complaints by patients and relatives against healthcare professionals and health services. RESULTS: The Emergency Department registered the highest number of events. Negligence and absence of protocols account for more than half of the adverse events. CONCLUSIONS: Management protocols in emergency departments are areas of opportunity for improvement that must be considered.

Análisis comparativo hospitalario del evento adverso en México: utilidad del reporte voluntario en línea / No disponible

Objetivo: Análisis comparativo del reporte en línea de eventos adversos al Sistema Nacional de Registro y Aprendizaje de Eventos Centinela(SiNRAECe) de dos hospitales generales durante 2005 y 2006. Material y método: Análisis retrospectivo de la base de datos contenida en el SiNRAECe, de octubre de 2005 a diciembre de 2006, de dos hospitales generales. Se contó con 371 registros, la totalidadde ese período. Se realizó el análisis mediante comparación de proporciones ( 2), ANOVA y cálculo de riesgo expresado en odds ratio, y se consideró significativa la diferencia cuando p 0,05. Resultados: Se encontraron diferencias significativas entre los hospitales comparados respecto a los siguientes aspectos: aparición de eventos adversos (EA) en urgencias (el 32,3 y el 7,9%; p 0,001); seocasionó o se pudo ocasionar un daño con pérdida permanente de funciones o muerte (el 22,7 y el 46,7%; p 0,001); EA clasificado como infección nosocomial (el 57,8 y el 4,3%; p 0,001); opiniónde que el EA era evitable (el 96,1 y el 36,1%; p 0,001), y acciones correctivas (el 97 y el 48,8%; p 0,001). En el hospital 2, la probabilidad de un EA que causara daño fue 2,4 veces mayorque en el hospital 1 (p = 0,001; intervalo de confianza del 95%, 1,4-4,2). Conclusiones: El reporte en línea facilita la comparación de los casosde EA hospitalarios, tanto en su frecuencia como en las condiciones organizacionales que pudieran identificar las áreas de riesgo, y ayuda a identificar áreas de oportunidad de mejora en los procesos.La información derivada del análisis de dicha información será útil para la toma de decisiones en la gerencia hospitalaria

Objective: We performed a comparative analysis of the on-line reports of adverse events made to the National Sentinel Event Registration and Learning System (SiNRAECe) by two general hospitalsin 2005 and 2006. Material and method: A retrospective analysis of the database containedin the SiNRAECe from October 2005 to December 2006 fromtwo general hospitals was performed. There were a total of 372 records in this period. Analysis was performed by means of proportion comparison ( 2), ANOVA and risk calculus expressed in odds ratio. Significance was set at p 0,05. Results: Significant differences were found between the two hospitals in the following variables: the occurrence of adverse events (AE) in theemergency department (32.3 vs. 7.9%; p 0.001); the occurrence or possible occurrence of death or injury with permanent loss of function(22.7% vs. 46.7%; p 0.001); AE classified as in-hospital infection (57.8% vs. 4.3%; p 0.001); the opinion that the AE were preventable(96.1% vs. 36.1; p 0.001), and corrective actions (97% vs. 48.8%; p 0.001). In hospital 2, the probability of having an AE causing injury was 2.4 times greater (p 0.001; 95% confidence interval, 1.4-4.2) than in hospital 1. Conclusions: On-line reporting facilitates comparison of the occurrence of in-hospital AE, both their frequency and the organizationalconditions that could identify the risk areas. Likewise, this system helps to identify opportunities for improvement. Information derivedfrom analysis of these data will be useful in decision making in hospital management