Impact of COVID-19 on Neurosurgery in Brazil's Health System: The Reality of a Developing Country Affected by the Pandemic.

BACKGROUND: The coronavirus disease identified in 2019 (COVID-19) pandemic changed neurosurgery protocols to provide ongoing care for patients while ensuring the safety of health care workers. In Brazil, the rapid spread of the disease led to new challenges in the health system. Neurooncology practice was one of the most affected by the pandemic due to restricted elective procedures and new triage protocols. We aim to characterize the impact of the pandemic on neurosurgery in Brazil. METHODS: We analyzed 112 different types of neurosurgical procedures, with special detail in 11 neurooncology procedures, listed in the Brazilian Hospital Information System records in the DATASUS database between February and July 2019 and the same period in 2020. Linear regression and paired t-test analyses were performed and considered statistically significant at P < 0.05. RESULTS: There was an overall decrease of 21.5% (28,858 cases) in all neurosurgical procedures, impacting patients needing elective procedures (-42.46%) more than emergency surgery (-5.93%). Neurooncology procedures decreased by 14.89%. Nonetheless, the mortality rate during hospitalization increased by 21.26%. Linear regression analysis in hospitalizations (Slope = 0.9912 ± 0.07431; CI [95%] = 0.8231-1.159) and total cost (Slope = 1.03 ± 0.03501; CI [95%] = 0.9511-1.109) in the 11 different types of neurooncology procedures showed a P < 0.0001. The mean cost per type of procedure showed an 11.59% increase (P = 0.0172) between 2019 and 2020. CONCLUSIONS: The COVID-19 pandemic has increased mortality, decreased hospitalizations, and therefore decreased overall costs, despite increased costs per procedure for a variety of neurosurgical procedures. Our study serves as a stark example of the effect of the pandemic on neurosurgical care in settings of limited resources and access to care.

Procedimentos cirúrgicos nas internações em hospitais do Departamento Regional de Saúde de Ribeirão Preto-SP / Surgical procedures in admissions to hospitals of the Regional Health Department of Ribeirão Preto-SP / Procedimientos quirúrgicos en las admisiones de hospitales del Departamento Regional de Salud de Ribeirão Preto-SP

Estudo descritivo com objetivo de analisar produção física e financeira das internações hospitalares processadas pela Direção Regional de Saúde de Ribeirão Preto (DRS-XIII), nos hospitais conveniados/contratados pelo SUS, na especialidade de clínica cirúrgica, segundo município, no período de 1996-2007. A população de estudo foram Autorizações de Internação Hospitalar (AIH) processadas através do SIH-SUS. Foram processadas 478.241 internações, sendo Ribeirão Preto, responsável por cerca de 70% delas. A cirurgia obstétrica se destacou quanto à produção física, totalizando 49,5% e 24,5%, na região e em Ribeirão Preto, respectivamente. Quanto ao financeiro, nos hospitais da região, maior gasto foi cirurgia obstétrica; nos hospitais de Ribeirão Preto, tal produção foi maior em cirurgia cardiológica. Ribeirão Preto consumiu cerca de 90% dos recursos financeiros. O acompanhamento da produção de internações é fundamental para ordenação do fluxo de usuários, prestação de contas e tratamento equitativo entre municípios, além de disponibilizar elementos que permitem a gestão...

Descriptive study aimed to analyze the physical and financial production of hospital admissions by the Regional Health Department of Ribeirão Preto (DRS-XIII) in private hospitals / contracted by the SUS in the specialty of clinical surgery, second city, in the period 1996 - 2007. The study population was composed by hospital admissions forms (AIH) processed through the SIH-SUS. 478,241 hospitalizations were processed, and Ribeirao Preto, accounting for about 70% of them. The obstetric surgery highlighted physical production, totaling 49.5% and 24.5% in the region and in Ribeirão Preto, respectively. As for the financial, in regional hospitals, increased spending was obstetric surgery, at hospitals in Ribeirão Preto, such production was higher in cardiac surgery. Ribeirao Preto consumed about 89% of financial resources. Monitoring the production of admissions is essential for sorting the flow of users, accountability and equitable treatment among municipalities, as well as provide elements that allow the management...

Estudio descriptivo con objetivo de analizar el producción física y financiera de las internaciones hospitalarios por el Departamento Regional de Salud de Ribeirão Preto (DRS-XIII) en los hospitales privados contratados por el SUS en la especialidad de cirugía clínica, según ciudad, período 1996 - 2007. La población de estudio fueron las Autorizaciones de Internación Hospitalaria (HAI) procesados en el SIH-SUS. Se procesaron 478,241 hospitalizaciones, siendo Ribeirão Preto que representa alderredor de 70% de estos. La cirugía obstétrica fue superior a la producción física, por un total de 49,5% y 24,5% en la región y en Ribeirão Preto, respectivamente. Referente a los recursos financieros, en los hospitales regionales, el aumento del gasto fue la cirugía obstétrica, en los hospitales de Ribeirão Preto, esa producción fue mayor en la cirugía cardíaca. Ribeirão Preto consume alrededor de 90% de los recursos financieros. Control de la producción de ingresos es esencial para clasificación del flujo de usuarios, la rendición de cuentas y trato equitativo entre municipios, así como aportar elementos que permitan la gestión...

A comparative study of the quality and availability of health information used to facilitate cost burden analysis of diabetes and hypertension in the Caribbean / Estudio comparativo de la calidad y disponibilidad de la información sobre la salud usada para facilitar el análisis del nivel de costos de la diabetes y la hipertensión en el Caribe

OBJECTIVE: Non-communicable Diseases (NCDs) are leading threats to health and well-being in the Caribbean. A study was undertaken in the latter part of 2005 to compute the economic burden of diabetes mellitus and hypertension within the Caribbean Community and Common Market (CARICOM). This report critiques the quality and availability of health information which can be used to facilitate cost burden analysis of diabetes mellitus and hypertension. METHODS: A form was developed and disseminated to obtain epidemiological and health service utilization data. Subsequent visits were made to seven CARICOM member countries to collect the data. RESULTS: The results revealed (i) a number of deficiencies in the reliability and validity of the data received, in particular, those needed to facilitate the analysis of cost-specific complications such as ischaemic heart disease, cerebrovascular disease, chronic renal failure, hypertensive and diabetic retinopathy and peripheral circulatory complications; (ii) data management systems in hospitals were not linked to facilitate generation of cost-effectiveness estimates and other information required to compare options for health investment; (iii) despite repeated attempts by regional governments to develop/strengthen Health Information Systems within the Caribbean, sustainability has been significantly hampered by human, material and financial resource constraints and ongoing monitoring and evaluation is generally poor. CONCLUSION: There are deficiencies in the quality and availability of health information to facilitate cost burden analysis of hypertension and diabetes mellitus in the Caribbean. Strong commitment from CARICOM governments will be necessary to address these concerns if economic evaluations are to be undertaken more frequently as part of the effort to reduce the morbidity and mortality from these diseases.

OBJETIVO: Las enfermedades no comunicables (ENC) se cuentan entre las principales amenazas a la salud y el bienestar en el Caribe. Se llevó a cabo un estudio hacia finales de 2005, con el fin de computar la carga económica de la diabetes mellitus y la hipertensión dentro de la Comunidad y el Mercado Común del Caribe (CARICOM). Este reporte constituye un análisis crítico de la calidad y disponibilidad de información sobre la salud, que puede ser usada para facilitar el análisis del nivel de costos de la diabetes mellitus y la hipertensión. MÉTODOS: Se desarrolló y distribuyó un formulario para obtener datos acerca de la utilización de servicios de salud y servicios epidemiológicos. Posteriormente se realizaron visitas a siete países miembros de CARICOM con el propósito de recoger datos. RESULTADOS: Los resultados revelaron (i) algunas deficiencias en cuanto a la confiabilidad y la validez de los datos recibidos, en particular los necesarios para facilitar el análisis de las complicaciones costo-específicas, tales como la enfermedad cardíaca isquémica, la enfermedad cerebrovascular, el fallo renal crónico, la retinopatía hipertensiva y diabética, y las complicaciones circulatorias periféricas; (ii) los sistemas de administración de datos en los hospitales no estaban conectados para facilitar la producción de estimados de costo-efectividad y otras informaciones requeridas para comparar las opciones de inversión para la salud; (iii) a pesar de reiterados intentos de los gobiernos regionales por desarrollar y fortalecer los sistemas de información de salud en el área del Caribe, su sostenimiento ha sido obstaculizado significativamente a causa de restricciones en cuanto a recursos humanos, materiales y financieros, y por el hecho de que el monitoreo y la evaluación actuales son generalmente pobres. CONCLUSIÓN: Existen deficiencias en la calidad y disponibilidad de información sobre la salud, en cuanto a facilitar el análisis del nivel de la magnitud del costo de la hipertensión y la diabetes mellitus en el Caribe. Será necesario un fuerte compromiso por parte de los gobiernos del CARICOM para abordar estos problemas, si se ha de emprender evaluaciones económicas con mayor frecuencia, como parte del esfuerzo por reducir la morbilidad y la mortalidad por estas enfermedades.

A comparative study of the quality and availability of health information used to facilitate cost burden analysis of diabetes and hypertension in the Caribbean.

OBJECTIVE: Non-communicable Diseases (NCDs) are leading threats to health and well-being in the Caribbean. A study was undertaken in the latter part of 2005 to compute the economic burden of diabetes mellitus and hypertension within the Caribbean Community and Common Market (CARICOM). This report critiques the quality and availability of health information which can be used to facilitate cost burden analysis of diabetes mellitus and hypertension. METHODS: A form was developed and disseminated to obtain epidemiological and health service utilization data. Subsequent visits were made to seven CARICOM member countries to collect the data. RESULTS: The results revealed (i) a number of deficiencies in the reliability and validity of the data received, in particular, those needed to facilitate the analysis of cost-specific complications such as ischaemic heart disease, cerebrovascular disease, chronic renal failure, hypertensive and diabetic retinopathy and peripheral circulatory complications; (ii) data management systems in hospitals were not linked to facilitate generation of cost-effectiveness estimates and other information required to compare options for health investment; (iii) despite repeated attempts by regional governments to develop/strengthen Health Information Systems within the Caribbean, sustainability has been significantly hampered by human, material and financial resource constraints and ongoing monitoring and evaluation is generally poor. CONCLUSION: There are deficiencies in the quality and availability of health information to facilitate cost burden analysis of hypertension and diabetes mellitus in the Caribbean Strong commitment from CARICOM governments will be necessary to address these concerns if economic evaluations are to be undertaken more frequently as part of the effort to reduce the morbidity and mortality from these diseases.

Surveillance of interpersonal violence in Kingston, Jamaica: an evaluation.

Injuries are among the leading causes of death in Jamaica. Homicide rates have been sharply increasing since 1991. In 1997, the rate of homicide (45/100,000) in Jamaica was over five times the US rate in 1997 (7.9/100,000). In response to this problem and the alarming increase in non-fatal assaultive injuries, the Jamaican Ministry of Health together with the CDC established a Violence-Related Injury Surveillance System (VRISS) using patient registration data from Kingston Public Hospital. The VRISS was evaluated for usefulness, and for system attributes: system acceptability, simplicity, flexibility, sensitivity, and predictive value positive (PVP). System-identified cases were compared with clinical records and data from direct patient interviews. The surveillance system was flexible, acceptable to clinical staff and Ministry officials, and moderately sensitive, detecting 62% to 69% of violent injuries identified from clinical records and a patient survey. The system's predictive value positive was high, with 86% of potential cases confirmed as actual cases. Although adequate, system sensitivity was reduced by incomplete or no registration of patients during periods of staff shortage. In conclusion, despite some logistic shortcomings, the system appeared promising for collecting limited information on non-fatal interpersonal violent injuries. With modification and expansion, the system may be capable of collecting unintentional-injury data also.

Renewing information infrastructure at Hospital das Clínicas.

In this paper we describe the process of renewing the Informatics infrastructure of Sao Paulo University Medical School Hospital, a very complex environment. Our proposal consists of a change in the paradigm of Informatics and the use of Information Technology in the hospital. That change aims at making information available to the hospital, its managers, health care workers and patients. The paradigm change is reflected in every aspect of the new infrastructure: human resources, methods, and organizational structure, as we intend to demonstrate in this paper. This process is expected to be concluded by the end of this year, yielding benefits regarding costs, efficiency, and better patient care.

It's a jungle out there: strategies for controlling information systems costs.

This article discusses four major areas where healthcare financial managers can reconcile the conflicting goals their healthcare organizations face: keeping up with the latest in technology while at the same time constantly striving to reduce healthcare information systems costs.

Standard cost accounting and productivity systems--an integrated approach.

Today's hospital managers require management systems that provide better operational and financial information. The standard response to meeting this need for more sophisticated management information has been the implementation of a fragmented set of information systems products. The result of this has been that managers are getting inconsistent information on the performance of their operations. This article describes the approach taken to respond to the need for better information through the development and implementation of an integrated productivity management, cost accounting, and flexible budgeting system.