Gestión por procesos y costos basados en actividades en una empresa de salud / Activity-based management in a healthcare business processes and costs

Introducción: El Instituto de Nutrición (IN) está dedicado al tratamiento de obesidad. Existen herramientas de gestión tales como, el enfoque basado en procesos (PR), y el costeo basado en actividades (ABC). Los objetivos del trabajo son confeccionar los PR operativos del IN; y realizar un modelo de ABC de éstos. Materiales y Métodos: para la confección de los procesos PR se siguió la sistemática de trabajo de Narbarte y Col. Para la realización del ABC se siguió la propuesta de trabajo de Quesada. Resultados: Se confeccionaron los procesos operativos, se les aplicó las herramientas de costeo. Se describieron los PR y se Confeccionaron las herramientas de control. Con la información de costos y la descripción de las actividades de los PR se realizó el modelo de ABC, obteniendo el costeo de los PR y del plan de tratamiento. Conclusiones: con la aplicación de la GP ha mejorado la forma de trabajo del IN hacia una burocracia profesional, mejorando la percepción de los clinetes desde la organización. El ABC ha permitido comprender con más profundidade los costos y trazar politicas de incentivo hacia los empleados y participantes

Summary: Introduction: The Institute of Nutrition (IN) is dedicated to the treatment of obesity. There are management tools like the process approach (PR) and activity-based costing (ABC). The objectives of this work are to make IN operative PR, and to model their ABC. Materials and Methods: to build the PR followed the systematic of Narbarte et al. and to carry out the ABC methodology, is used the work of Quesada. Results: operative PR was built, and tools were applied. PR was described and monitoring tools were constructed. With cost information and description of the activities of PR was performed ABC model, obtaining the costing of the PR and the treatment plan. Conclusions: the implementation fo the PR has imporved the way to work to a professional bureaucracy in the IN, improving customer perception from the organization. The ABC has enabled more fully understand the costs and draw incentive policies to employees and participants

[Risk factors associated to upper gastrointestinal bleeding in non intensive care units]. / Factores de riesgo asociados a hemorragia digestiva alta, en sala común.

UNLABELLED: Upper gastrointestinal bleeding--UGB-, as a complication, is well studied at intensive care units (ICU), but is less known in non ICU settings. OBJECTIVES: To determine incidence and risk factors of this entity at clinical hospitalization. MATERIALS AND METHODS: A case-control study of patients with gastric ulcer disease diagnosed by endoscopy who presented with melena and hematemesis. Ten controls were taken for each case, matching sex, age and prophylaxis for gastric hemorrhage. Demographic data and other know risks factors were analyzed. RESULT: We found ten bleeding case among 35070 discharges (incidence: 2.8/10000 discharges). Mortality was not increased but the number of transfusion was higher in the bleeding group. We found an assocciation betwen UGB and systemic inflammatory response syndrome--SIRS-(OR: 9.22 IC 95% 2.98-28.17) and diabetes (OR: 7.8 IC 95% 2.3-26.8). The rest of the factors studied did not rich a statistical significance. CONCLUSIONS: UGB during clinical hospitalization is a rare complication that requires an increased staying at hospital and a great number of transfusions. It may be probably associated in a positive way with diabetes and SIRS.