Strategies for the quality assessment of the health care service providers in the treatment of Gastric Cancer in Colombia.

BACKGROUND: While, at its inception in 1993, the health care system in Colombia was publicized as a paradigm to be copied across the developing world, numerous problems in its implementation have led to, what is now, an inefficient and crisis-ridden health system. Furthermore, as a result of inappropriate tools to measure the quality of the health service providers, several corruption scandals have arisen in the country. This study attempts to tackle this situation by proposing a strategy for the quality assessment of the health service providers (Entidades Promotoras de Salud, EPS) in the Colombian health system. In particular, as a case study, the quality of the treatment of stomach cancer is analyzed. METHODS: The study uses two complementary techniques to address the problem. These techniques are applied based on data of the treatment of gastric cancer collected on a nation-wide scale by the Colombian Ministry of Health and Welfare. First, Data Envelopment Analysis (DEA) and the Malmquist Index (MI) are used to establish the most efficient EPS's within the system, according to indicators such as opportunity indicators. Second, sequential clustering algorithm, related to process mining a field of data mining, is used to determine the medical history of all patients and to construct typical care pathways of the patients belonging to efficient and inefficient EPS's. Lastly, efforts are made to identify traits and differences between efficient and inefficient EPS's. RESULTS: Efficient and inefficient EPS were identified for the years 2010 and 2011. Additionally, a Malmquist Index was used to calculate the relative changes in the efficiency of the health providers. Using these efficiency rates, the typical treatment path of patients with gastric cancer was found for two EPSs: one efficient and another inefficient. Finally, the typical traits of the care pathways were established. CONCLUSIONS: Combining DEA and process mining proved to be a powerful approach understanding the problem and gaining valuable insight into the inner workings of the Colombian Health System, especially in terms of the treatment process performed by health care providers in critical illnesses such as cancer. However, no sufficiently compelling results were found to establish the contribution of such a combination to evaluate the quality in the delivery of health services.

[Data availability and morbidity profile in Colombia]. / Disponibilidad de datos y perfil de morbilidad en Colombia.

OBJECTIVE: To characterize morbidity in the Colombian population by diagnosis, sex, age, region, and health coverage system, and evaluate the availability and quality of information on diseases in the country. A descriptive, cross-sectional study to analyze morbidity treated in outpatient visits, hospitalization, and emergencies in Colombia during the 2004-2008 five-year period. METHODS: Based on Colombia's personal health records (Registro Individual de Prestación de Servicios-RIPS), diagnoses were classified according to World Health Organization cause groups. Each cause group for services utilization was differentiated by geographical region, sex, and type of affiliation to the health system. RESULTS: Communicable disease diagnoses were more concentrated in younger age groups, while noncommunicable diseases were more frequent in older age groups. External causes (accidents, self-inflicted injuries, and violence) were a major cause of morbidity and more frequently affected the population aged 5-44 years. Communicable diseases were more prevalent in females (39.98%) than in males (28%), while males were more affected by external causes than females (18.5% and 7.3%, respectively). CONCLUSIONS: Although diagnoses of noncommunicable diseases have increased in Colombia, infections continue to have an important presence in all age groups and health services delivery settings. This situation requires a review of health policies, not only to orient them toward improving the health of the population, but also toward bridging the services gap that exists among the country's different regions. Furthermore, although RIPS are a valuable source of health data, they need to be strengthened with a view to achieving information coverage for all or at least the vast majority of Colombians.

Disponibilidad de datos y perfil de morbilidad en Colombia / Data availability and morbidity profile in Colombia

OBJETIVO: Caracterizar la morbilidad de la población colombiana según causas diagnósticas, género, edad, región y régimen de cobertura en salud, evaluando al mismo tiempo la disponibilidad y la calidad de la información sobre enfermedades en el país. Estudio de tipo descriptivo, transversal, que analiza la morbilidad atendida en consulta externa, hospitalización y urgencias en Colombia durante el quinquenio 2004-2008. MÉTODOS: Se utilizaron los "Registros individuales de prestación de servicios" (RIPS) de Colombia, clasificándose los diagnósticos según los grupos de causas definidos por la Organización Mundial de la Salud. Cada grupo de causas para utilización de servicios se discriminó por región geográfica, género y régimen de afiliación al sistema de salud. RESULTADOS: Los diagnósticos de enfermedades transmisibles se encontraron más concentrados en los grupos de edad inferiores, mientras que las no transmisibles fueron más frecuentes en los grupos etarios superiores. Las externalidades (accidentes, lesiones autoinfligidas y violencia) fueron una causa importante de morbilidad y afectaron con más fuerza a la población de entre 5 y 44 años de edad. Las patologías transmisibles fueron más prevalentes en mujeres (39,98 por ciento) que en hombres (28 por ciento), en tanto que los hombres se vieron más afectados por las externalidades que las mujeres (18,5 y 7,3 por ciento, respectivamente). CONCLUSIONES: Si bien en Colombia han aumentado los diagnósticos de enfermedades no transmisibles, las infecciones siguen teniendo una presencia relevante en todos los grupos de edad y escenarios de prestación de servicios de salud. Tal situación exige revisar las políticas sanitarias para orientarlas no solo a mejorar la salud de la población sino también a reducir la brecha de servicios que existe entre las diferentes regiones del país. Por otro lado, aun cuando los RIPS constituyen una valiosa fuente de datos sanitarios, es preciso fortalecerlos...

OBJECTIVE: To characterize morbidity in the Colombian population by diagnosis, sex, age, region, and health coverage system, and evaluate the availability and quality of information on diseases in the country. A descriptive, cross-sectional study to analyze morbidity treated in outpatient visits, hospitalization, and emergencies in Colombia during the 2004-2008 five-year period. METHODS: Based on Colombia's personal health records (Registro Individual de Prestación de Servicios-RIPS), diagnoses were classified according to World Health Organization cause groups. Each cause group for services utilization was differentiated by geographical region, sex, and type of affiliation to the health system. RESULTS: Communicable disease diagnoses were more concentrated in younger age groups, while noncommunicable diseases were more frequent in older age groups. External causes (accidents, self-inflicted injuries, and violence) were a major cause of morbidity and more frequently affected the population aged 5-44 years. Communicable diseases were more prevalent in females (39.98 percent) than in males (28 percent), while males were more affected by external causes than females (18.5 percent and 7.3 percent, respectively). CONCLUSIONS: Although diagnoses of noncommunicable diseases have increased in Colombia, infections continue to have an important presence in all age groups and health services delivery settings. This situation requires a review of health policies, not only to orient them toward improving the health of the population, but also toward bridging the services gap that exists among the country's different regions. Furthermore, although RIPS are a valuable source of health data, they need to be strengthened with a view to achieving information coverage for all or at least the vast majority of Colombians.