RESUMO
Background The Diagnosis Related Groups (DRG) constitute a method of classifying hospital discharges. Aim To report its development and implementation in a Chilean University Hospital and global results of 10 years Material and Methods We included 231,600 discharges from 2007 to 2016. In the development we considered the physical plant, clinical record flow, progressively incorporated human resources and computer equipment for coding and analysis to obtain results. The parameters used were: average stay, average DRG weight, mean of diagnosis and codified procedures, behavior of upper outliers, hospital mortality, distribution by severity and its relationship with other variables. Results The global complexity index was 0.9929. The average of diagnoses coded was 4.35 and of procedures was 7.21. The average stay was 4.56 days, with a downward trend. The top outliers corresponded to 2.25%, with stable hospital days and average DRG weight. The median of hospital mortality was 1.65% with a tendency to decrease and stable DRG mean weight. Seventy two percent had a grade 1 severity, with low median hospital stay. They occupied 40% of bed days. Nine percent had a grade 3 severity with high median hospital stay and accounting for 31.5% of bed days. Conclusions DRG methodology is a valuable information tool for decision making and result assessment in hospital management.
Assuntos
Humanos , Masculino , Feminino , Alta do Paciente/estatística & dados numéricos , Mortalidade Hospitalar , Grupos Diagnósticos Relacionados/classificação , Tempo de Internação/estatística & dados numéricos , Índice de Gravidade de Doença , Chile , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Hospitais UniversitáriosRESUMO
Background The Diagnosis Related Groups (DRG) constitute a method of classifying hospital discharges. Aim To report its development and implementation in a Chilean University Hospital and global results of 10 years Material and Methods We included 231,600 discharges from 2007 to 2016. In the development we considered the physical plant, clinical record flow, progressively incorporated human resources and computer equipment for coding and analysis to obtain results. The parameters used were: average stay, average DRG weight, mean of diagnosis and codified procedures, behavior of upper outliers, hospital mortality, distribution by severity and its relationship with other variables. Results The global complexity index was 0.9929. The average of diagnoses coded was 4.35 and of procedures was 7.21. The average stay was 4.56 days, with a downward trend. The top outliers corresponded to 2.25%, with stable hospital days and average DRG weight. The median of hospital mortality was 1.65% with a tendency to decrease and stable DRG mean weight. Seventy two percent had a grade 1 severity, with low median hospital stay. They occupied 40% of bed days. Nine percent had a grade 3 severity with high median hospital stay and accounting for 31.5% of bed days. Conclusions DRG methodology is a valuable information tool for decision making and result assessment in hospital management.
Assuntos
Grupos Diagnósticos Relacionados/classificação , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Chile , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Feminino , Hospitais Universitários , Humanos , Masculino , Índice de Gravidade de DoençaRESUMO
Introdução: A meningite tuberculosa (MTB) é a forma mais grave e fatal de tuberculose. O diagnóstico oportuno e o tratamento adequado e precoce são os principais fatores associados com o bom prognóstico. Os métodos utilizados na prática médica diária - achados clínicos, exames de imagem e análise de líquido cefalorraquidiano (LCR) - têm baixa acurácia. A pesquisa do DNA do Mycobacterium tuberculosis no LCR através da reação em cadeia da polimerase (PCR, do inglês polimerase chain reaction) com a metodologia nested é promissora, especialmente quando associada à praticidade da amplificação do DNA em tempo real. Objetivo: Avaliar o valor diagnóstico da nested PCR em tempo real (nRT-PCR, do inglês nested real-time PCR) na investigação de pacientes com MTB. Métodos: Estudo observacional realizado em duas fases: uma prospectiva e outra retrospectiva. Na fase prospectiva, foram incluídos pacientes com suspeita de MTB internados no Instituto de Infectologia Emílio Ribas (IIER). Informações clínicas, laboratoriais e radiológicas foram coletadas, assim como amostra de LCR de todos os pacientes. A partir de critérios internacionais padronizados, os pacientes foram categorizados como "MTB Definitiva", "MTB Provável", "MTB Possível" e "Não MTB". A nRT-PCR, utilizando o gene alvo mpt64, foi realizada em todas as amostras de LCR no Laboratório de Meningites Bacterianas do Instituto Adolfo Lutz. Sensibilidade, especificidade e intervalos de confiança (IC 95%) da nRT-PCR foram calculados com base no padrão-ouro (cultura positiva para M. tuberculosis ou isolamento de BAAR no sistema nervoso central) e nos pacientes com outros diagnósticos estabelecidos (Não MTB). Também foi calculada a proporção de pacientes com a nRT-PCR positiva em cada categoria clínica. Na fase retrospectiva, foi realizada uma revisão de prontuários de pacientes que tiveram a nRT-PCR solicitada no IIER e no Centro de Referência e Treinamento em DST/AIDS. Os mesmos procedimentos...
Background: Tuberculous meningitis (TBM) is the most serious and lethal presentation of tuberculosis. Timely diagnosis and appropriated treatment are the main factors associated with good outcome. Methods used in the daily medical practice - clinical, radiological and cerebrospinal fluid (CSF) findings - have low accuracy. Search for Mycobacterium tuberculosis DNA in the CSF by polymerase chain reaction (PCR) using the nested methodology is promising, especially when combined with the practical approach of the real time DNA amplification. Objective: To evaluate the diagnostic value of a nested real-time PCR (nRT-PCR) in the investigation of patients with TBM. Methods: A two-phase observational study was carried out: prospective and retrospective. In the prospective phase, patients with suspected TBM hospitalized at "Instituto de Infectologia Emílio Ribas" (IIER) were included. Clinical, laboratory and radiological data were collected, as well as CSF samples of all patients. According to international standard criteria, patients were categorized as "TBM Definite", "TBM Probable", "TBM Possible" and "Not TBM". The nRT-PCR, using the mpt64 gene, was performed on all CSF sample in the Laboratory of Bacterial Meningitis, Adolfo Lutz Institute. Sensitivity, specificity and confidence intervals (95% CI) of the nRT-PCR were calculated based on the gold standard (culture positive for M. tuberculosis or AFB isolation on the central nervous system) and on patients with other established diagnoses ("Not TBM"). The proportion of patients with a positive nRT-PCR in each clinical category was also calculated. In the retrospective phase, medical chart review was performed in those patients who had the nRT-PCR requested in IIER and in the "Centro de Referência e Treinamento em DST/AIDS". The same diagnostic categorization and calculations of sensitivity and specificity were adopted. Results: 102 patients were included in the prospective phase, 92 of them...
Assuntos
Humanos , Masculino , Adulto , Líquido Cefalorraquidiano , DNA , Grupos Diagnósticos Relacionados/classificação , Mycobacterium tuberculosis , Técnicas de Amplificação de Ácido Nucleico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Sensibilidade e Especificidade , Tuberculose Meníngea/diagnósticoRESUMO
BACKGROUND: Temporomandibular disorder (TMD) patients might present a number of concurrent clinical diagnoses that may be clustered according to their similarity. Profiling patients' clinical presentations can be useful for better understanding the behavior of TMD and for providing appropriate treatment planning. The aim of this study was to simultaneously classify symptomatic patients diagnosed with a variety of subtypes of TMD into homogenous groups based on their clinical presentation and occurrence of comorbidities. METHODS: Clinical records of 357 consecutive TMD patients seeking treatment in a private specialized clinic were included in the study sample. Patients presenting multiple subtypes of TMD diagnosed simultaneously were categorized according to the AAOP criteria. Descriptive statistics and two-step cluster analysis were used to characterize the clinical presentation of these patients based on the primary and secondary clinical diagnoses. RESULTS: The most common diagnoses were localized masticatory muscle pain (n = 125) and disc displacement without reduction (n = 104). Comorbidity was identified in 288 patients. The automatic selection of an optimal number of clusters included 100% of cases, generating an initial 6-cluster solution and a final 4-cluster solution. The interpretation of within-group ranking of the importance of variables in the clustering solutions resulted in the following characterization of clusters: chronic facial pain (n = 36), acute muscle pain (n = 125), acute articular pain (n = 75) and chronic articular impairment (n = 121). CONCLUSION: Subgroups of acute and chronic TMD patients seeking treatment can be identified using clustering methods to provide a better understanding of the clinical presentation of TMD when multiple diagnosis are present. Classifying patients into identifiable symptomatic profiles would help clinicians to estimate how common a disorder is within a population of TMD patients and understand the probability of certain pattern of clinical complaints.
Assuntos
Transtornos da Articulação Temporomandibular/diagnóstico , Dor Aguda/classificação , Dor Aguda/fisiopatologia , Adolescente , Adulto , Idoso , Artralgia/classificação , Artralgia/fisiopatologia , Bruxismo/classificação , Bruxismo/fisiopatologia , Criança , Dor Crônica/classificação , Dor Crônica/fisiopatologia , Análise por Conglomerados , Grupos Diagnósticos Relacionados/classificação , Dor Facial/classificação , Dor Facial/fisiopatologia , Feminino , Humanos , Luxações Articulares/classificação , Luxações Articulares/fisiopatologia , Masculino , Músculos da Mastigação/fisiopatologia , Pessoa de Meia-Idade , Osteoartrite/classificação , Osteoartrite/fisiopatologia , Medição da Dor , Planejamento de Assistência ao Paciente , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Sinovite/classificação , Sinovite/fisiopatologia , Disco da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/classificação , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto JovemRESUMO
OBJECTIVE: The International Classification of Primary Care was developed as an attempt to overcome the limitations of the International Statistical Classification of Diseases and Related Health Problems, 10th revision, when used for primary health care. The aim of the study was to evaluate the interobserver reliability of the International Classification for Primary Care when coding reasons for health-related interruption of daily activities. METHODS: Data analyzed pertained to 801 subjects from Phase 2 of the Pró-Saúde Study, involving the employees of a Rio de Janeiro university who reported having been prevented from carrying out any of their usual activities (work, study, or leisure) for health-related reasons in the two weeks prior to data collection. Health problems reported in response to an open question were separately coded by two classifiers. Interobserver reliability with respect to number of health problems was calculated by weighted kappa; for the remaining analyses (chapters and full codes), crude kappa coefficients were used. RESULTS: A total of 1,641 health problems were coded by the first classifier, and 1,629 by the second. Interobserver reliability with respect to the number of health problems coded was substantial (weighted kappa=0.94; 95% CI: 0.93;0.94). Chapter and full codes showed substantial (kappa=0.89; 95% CI: 0.88;0.90) and moderate (0.76; 95% CI: 0.76;0.78) reliability, respectively. CONCLUSIONS: The results suggest that the International Classification of Primary Care is adequate for the coding of health-related reasons for interruption of daily activities.
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Grupos Diagnósticos Relacionados/classificação , Classificação Internacional de Doenças , Variações Dependentes do Observador , Atenção Primária à Saúde/classificação , Estudos de Coortes , Feminino , Humanos , Internacionalidade , Masculino , Reprodutibilidade dos TestesRESUMO
During the last 20 years, a number of studies have examined the effect of Diagnosis Related Group (DRG)-based health care prospective payment systems on the cost and quality of services. To examine these issues, it is necessary to control for variations in patient mix and the related resources needed by incorporating some form of a case mix index. As part of our ongoing research on comparative DRG-based health care payment systems, we develop a preliminary, international case mix index using the Organization for Economic Cooperation and Development (OECD) health care database. We illustrate the application of our case mix index and use it to devise a standardized cost per case and a standardized cost per day for several countries. We also provide some preliminary analysis of the data demonstrating the observable and predictable effects of DRG-based payments on case m ix index, length of stay,cost per day, and cost per case.
Assuntos
Benchmarking , Grupos Diagnósticos Relacionados/classificação , Custos Hospitalares/estatística & dados numéricos , Agências Internacionais , Tempo de Internação/estatística & dados numéricos , Sistema de Pagamento Prospectivo/estatística & dados numéricos , Canadá , Comparação Transcultural , Coleta de Dados , Bases de Dados como Assunto , Grupos Diagnósticos Relacionados/economia , Europa (Continente) , Pesquisa sobre Serviços de Saúde , Custos Hospitalares/classificação , Custos Hospitalares/tendências , Humanos , Tempo de Internação/economia , Tempo de Internação/tendências , México , Sistema de Pagamento Prospectivo/economia , Turquia , Estados UnidosRESUMO
Fleet Hospital FIVE personnel treated more than 24,000 patients during a 1997 military operation other than war in Haiti. Sample data were analyzed for 10,215 Haitians who received humanitarian assistance care at field treatment sites and for 353 military, United Nations personnel, and Haitian nationals who were treated at the fleet hospital. Demographic data, type of encounter, diagnoses, and prescriptions were tabulated. Children aged 1 to 10 years accounted for 31% of humanitarian assistance visits. Females outnumbered males; in adults aged 21 to 30 years, the proportion was almost three to one. Most (97%) were initial encounters. Infectious and parasitic diseases, such as worms or scabies, accounted for 25% of diagnoses. At the fleet hospital, more than 80% of patients were males; these were most often older than 21 years. Injuries and aftercare procedures constituted 51.5% of diagnoses. Of 18,100 prescriptions, 57% were for anti-inflammatories, vitamins, or anti-parasitics. Implications for medical planning are described.
Assuntos
Missões Médicas/estatística & dados numéricos , Medicina Naval/estatística & dados numéricos , Socorro em Desastres/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Grupos Diagnósticos Relacionados/classificação , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Feminino , Haiti/epidemiologia , Pesquisas sobre Atenção à Saúde , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Morbidade , Avaliação das Necessidades , Distribuição por Sexo , Estados Unidos/etnologiaRESUMO
The severity of clinical illness was evaluated through the psychophysics method of magnitude estimation. The purpose of this experiment was: 1) to compare the scales derived from right judgement (magnitude estimation) used in three different Brazilian samples; 2) to verify the stability and agreement of severity estimations of clinical situations judged in Brazil, USA and England. In order to develop this study, professionals who work in the areas of psychology, nursing and medicine were invited. The lower coefficient of Pearson's correlation among the groups were of 0.88 the and the greater of 0.94. The exponents found between the Brazilian and American samples were of 1.22 and between the Brazilian and English samples of 1.15.
Assuntos
Atitude do Pessoal de Saúde , Grupos Diagnósticos Relacionados/classificação , Índice de Gravidade de Doença , Adulto , Idoso , Brasil , Comparação Transcultural , Inglaterra , Humanos , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Médicos/psicologia , Psicologia , Psicometria , Reprodutibilidade dos Testes , Estados UnidosRESUMO
This study had in its aim the construction and the validation of a patient classification instrument which has been based on the patient's individual necessities that require the nursing care. It was considered in the instrument 13 critical indicators: Mental State and Level of Consciousness. Breathing, Vital Signs, Nutrition and Hydration, Movement, Locomotion, Corporeal Hygiene, Eliminations, Therapy, Health Teaching, Behavior, Communication and Skin Integrety. Each one of these indicators has a 1 to 5 gradation denoting an increasing level in the nursing care complexity. The patient is classified in all the indicators in one of the five levels, in the option that better describes his/her situation. The content validation of the instrument was done by the Delphi Technique application through 2 rounds. A team of 15 nursing experts who attend patients or teach in the Medical School in São José do Rio Preto were participants in this research. The obtained results have showed the experts' agreement concerned to: the maintenance of the 13 critical indicators in the instrument; property and intelligibility of the critical indicator contents and the presence of an increasing level in the nursing care complexity.
Assuntos
Atividades Cotidianas , Grupos Diagnósticos Relacionados/classificação , Avaliação em Enfermagem/métodos , Cuidados de Enfermagem/classificação , Pacientes/classificação , Índice de Gravidade de Doença , Técnica Delphi , Humanos , Reprodutibilidade dos Testes , Carga de TrabalhoRESUMO
National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.