[Social determinants of access to the explicit guarantees health program implemented in Chile]. / Determinantes sociales que influyen en el acceso en Chile al Plan GES, según CASEN 2017.

BACKGROUND: In Chile, an eventual implementation of a plan with universal health coverage is a challenge. The already implemented explicit health guarantees plan (GES) could be a benchmark. For this reason, it is important to obtain information about the results of its implementation. AIM: To identify the social determinants of health that influence the access to GES. MATERIAL AND METHODS: The National Socioeconomic Characterization Survey performed in 2017 was used as a data source. The beneficiaries of 20 diseases covered by GES and inquired in the survey were considered for the present study. RESULTS: People with the higher probability of access to GES plan belong to the lowest income quintiles, are nationals, live in the central-southern metropolitan Santiago, have lower education, have a public health insurance program (FONASA) and are aged mostly over 60 years. The diseases with the highest probability of access to the program are primary arterial hypertension, type 1 and type 2 diabetes mellitus, acute myocardial infarction, moderate and severe bronchial asthma, breast cancer, colon cancer, and bipolar disorder. CONCLUSIONS: The access probability to the GES program is in line with the epidemiological profile of the Chilean population, and with a greater social vulnerability.

Determinantes sociales que influyen en el acceso en Chile al Plan GES, según CASEN 2017 / Social determinants of access to the explicit guarantees health program implemented in Chile

BACKGROUND: In Chile, an eventual implementation of a plan with universal health coverage is a challenge. The already implemented explicit health guarantees plan (GES) could be a benchmark. For this reason, it is important to obtain information about the results of its implementation. AIM: To identify the social determinants of health that influence the access to GES. MATERIAL AND METHODS: The National Socioeconomic Characterization Survey performed in 2017 was used as a data source. The beneficiaries of 20 diseases covered by GES and inquired in the survey were considered for the present study. RESULTS: People with the higher probability of access to GES plan belong to the lowest income quintiles, are nationals, live in the central-southern metropolitan Santiago, have lower education, have a public health insurance program (FONASA) and are aged mostly over 60 years. The diseases with the highest probability of access to the program are primary arterial hypertension, type 1 and type 2 diabetes mellitus, acute myocardial infarction, moderate and severe bronchial asthma, breast cancer, colon cancer, and bipolar disorder. CONCLUSIONS: The access probability to the GES program is in line with the epidemiological profile of the Chilean population, and with a greater social vulnerability.

Evaluación del desempeño del APACHE II y SAPS III, en una unidad de cuidados intensivos / Performance evaluation of APACHE II and SAPS III in an intensive care unit / Avaliação de desempenho do APACHE II e SAPS III, em unidade de terapia intensiva

RESUMEN Objetivo El objetivo principal de este trabajo, fue validar y comparar la capacidad predictiva de mortalidad de los indicadores de gravedad APACHE II (Acute Physiology and Chronic Health Evaluation, Score II) y SAPS III (Simplified Acute Physiology, Score III) en una muestra de pacientes admitidos en la Unidad de Cuidados Intensivos Adulto (UCI) del Hospital de Curicó, entre los años 2011 y 2013. Materiales y Métodos Estudio analítico, observacional de cohorte histórica de casos consecutivos desde la admisión a la UCI hasta el egreso hospitalario. Para el análisis, se usó el Modelo de Regresión Logística Binaria. De un total de 1 042 pacientes ingresados a la UCI, se incluyó a 793 pacientes sobrevivientes, y a 249 pacientes fallecidos, que representaban el 76,1% y 23,9% respectivamente, del total. Resultados El SAPS III presenta mejor capacidad predictiva que el APACHE II, según el área bajo la curva de características operativas del receptor 0,81 y 0,80 respectivamente. La sensibilidad para el modelo SAPS III es 0,95 y para APACHE II es 0,93. El índice de especificidad es 0,3 para el SAPS III y 0,4 para el APACHE II, con probabilidad superior a 0,5. Conclusión Los indicadores de predicción de mortalidad en UCI; APACHE II y SAPS III tienen una buena capacidad predictiva general, pero ambos indicadores presentan una baja especificidad.(AU)

ABSTRACT Objective The main objective of this work was to validate and compare the predictive capacity of mortality of the severity score systems APACHE II (Acute Physiology and Chronic Health Evaluation, Score II) and SAPS III (Simplified Acute Physiology, Score III) in a sample of patients admitted to the Adult Intensive Care Unit (ICU) of the Hospital de Curicó between 2011 and 2013. Materials and Methods Analytical, observational, retrospective cohort study of consecutive cases since admission to the ICU until hospital discharge. A binary logistic regression model was used for the analysis. Out of 1 042 patients admitted to the ICU, 793 surviving patients and 249 deceased patients were included, representing 76.1% and 23.9%, respectively, of the total sample. Results The SAPS III score has a better predictive capacity than the APACHE II, according to the area under the curve and the receiver operating characteristic curve: 0.81 and 0.80, respectively. Sensitivity for the SAPS III model was 0.95 and for APACHE II was 0.93. The specificity index was 0.3 for SAPS III and 0.4 for APACHE II, with a probability above 0.5. Conclusion APACHE II and SAPS III, as ICU mortality prediction indicators, have a good predictive power but low specificity.(AU)

RESUMO Objetivo O objetivo principal deste trabalho foi validar e comparar a capacidade preditiva de mortalidade dos sistemas de escore de gravidade APACHE II (Fisiologia Aguda e Avaliação Crônica de Saúde, Escore II) e SAPS III (Fisiologia Aguda Simplificada, Escore III) em uma amostra de pacientes internado na Unidade de Terapia Intensiva Adulto (UTI) do Hospital de Curicó entre 2011 e 2013. Materiais e métodos Estudo de coorte analítico, observacional e retrospectivo de casos consecutivos desde a admissão na UTI até a alta hospitalar. Um modelo de regressão logística binária foi usado para a análise. Dos 1.042 pacientes admitidos na UTI, foram incluídos 793 pacientes sobreviventes e 249 falecidos, representando 76,1% e 23,9%, respectivamente, do total da amostra. Resultados O escore SAPS III tem melhor capacidade preditiva do que o APACHE II, de acordo com a área sob a curva e a curva de característica de operação do receptor: 0,81 e 0,80, respectivamente. A sensibilidade para o modelo SAPS III foi de 0,95 e para APACHE II foi de 0,93. O índice de especificidade foi de 0,3 para SAPS III e 0,4 para APACHE II, com probabilidade superior a 0,5. Conclusão APACHE II e SAPS III, como indicadores de predição de mortalidade em UTI, apresentam bom poder preditivo, mas baixa especificidade.(AU)

Determinación y análisis de costos reales de tratamientos intensivos por paciente y día cama / Analysis of real costs of intensive treatments per patient and bed/day

El objetivo del trabajo es medir los costos reales asociados a las patologías tratadas en las Unidades de Cuidados Intensivos Adulto de los Hospitales Públicos de la Región del Maule, y compararlos con el costo asignado por Fonasa al día cama para el año 2011. Materiales y métodos: Se trata de un estudio prospectivo, aplicando el Sistema de Costos Basado en Actividades (ABC). Se incluyó 469 pacientes, 222 pacientes de la Unidad de Cuidados Intensivos del Hospital de Curicó y 247 pacientes la Unidad de Cuidados Intensivos del Hospital de Talca entre el 01 de enero y 30 de agosto de 2011, los que de acuerdo a edad y APACHE, representan los niveles de complejidad de pacientes de Unidades de Cuidados Intensivos a nivel nacional. Los pacientes se clasificaron según las patologías: sepsis, cardiovascular, respiratorias, neurológicas, trauma, digestivos, renales y otros. Resultados: Las patologías que presentan mayor mediana de costos por día cama son: sepsis ($362.115), respiratorias ($352.793), trauma ($348.442), renales ($341.928) y cardiovascular ($291.061). La estructura de costos del día cama está conformada principalmente por el costo asociado al recurso humano, cuyo valor máximo asciende a 64 por ciento, seguido del costo asociado a los medicamentos con un valor máximo de 15 por ciento. Los pacientes con sepsis y trauma absorben la mayor proporción de recursos en la Unidad de Cuidados Intensivos en estudio; 35 por ciento y 19 por ciento respectivamente y una proporción significativa de dichos costos es utilizada por pacientes que fallecen (34 por ciento y 19 por ciento) respectivamente. Conclusión: Todas las patologías en estudio tienen desviación desfavorable de costos, con respecto al arancel fijado por Fonasa, que sólo asciende a $192.160, para el año 2011.

The aim of the study is measures the real costs associated with the pathologies treated in the of Intensive Care Unid (ICU) Adults of the Public Hospitals of the region of the Maule, and to compare them with the cost assigned by Fonasa to the bed/day for the year 2011. Materials and methods: it is a question of a market study, applying the Activity-based costing (ABC). There was included 469 patients, 222 patients of the ICU of the Curicó’s Hospital and 247 patients the ICU of the Talca’s Hospital between January 01 and August 30, 2011, which in agreement to age and APACHE II, represent the levels of patients’ complexity of ICU to national level. The patients qualified according to the pathologies: sepsis, cardiovascular, respiratory, neurological, trauma, digestive, renal and others. Results: The pathologies that present major median of costs per day bed are: sepsis ($362.115), respiratory ($352.793),trauma ($348.442), renal ($341.928) and cardiovascular ($291.061). The structure of costs of the day bed is shaped principally by the cost associated with the human resource, which maximum value promotes 64 percent, followed by the cost associated with the medicines with a maximum value of 15 percent. The patients with sepsis and trauma absorbed the major proportion of resources in the ICU in our study; 35 percent and 19 percent respectively and a significant proportion of the abovementioned costs is used by patients who die (34 percent and 19 percent)respectively. Conclusion: All the pathologies in study have unfavorable diversion of costs, with regard to the duty fixed by Fonasa, which only promotes to $192.160, for the year2011.