The First Two Years of Instituto Estadual do Cérebro Paulo Niemeyer: Initial Results of a Brazilian Public Hospital Dedicated to Neurosurgery

The dissemination of specialty hospitals throughout the urban centers has revolutionized the full spectrum of care for cardiology, oncology and orthopedics during the last decades. To centralize care, from translational and basic research to clinicians and surgeons, in the same dedicated institution leads to a decrease in complications rates, mortality and possible reductions in the length of hospital stays. Moreover, there has been a significant impact on hospital costs and on the quality of care. The Insituto Estadual do Cérebro Paulo Niemeyer (IECPN, in the Portuguese acronym) was opened in June 2013 in Rio de Janeiro, Brazil. It is the very first high-volume neurosurgical institution in the country. The core foundation of this institution is that the anesthesiologists, intensive care practitioners, nurses, pathologists, radiologists and rehabilitation staffs are trained and live the full management of neurosurgical lesions at the same facility on a daily basis. The present paper seeks to analyze the circumstances in which the institution was planned and opened as well as its complexity, infrastructure and initial results following its first 24 months of operation.

Eficiencia de los procesos administrativos para la gestión del Fondo de Protección contra Gastos Catastróficos en México / Administrative efficiency in the Mexican Fund for the Prevention of Catastrophic Expenditures in Health

Resumen: Objetivo: Mostrar que el régimen administrativo de hospitales de especialidad influye en la eficiencia de los procesos administrativos para operar el Fondo de Protección contra Gastos Catastróficos (FPGC), para la atención de cáncer de mama, cáncer cérvicouterino y leucemia linfoblástica aguda. Material y métodos: La variable para estimar la eficiencia del proceso administrativo fue el tiempo entre la notificación del caso y el reembolso. Para su estimación se realizaron entrevistas semiestructuradas con actores clave involucrados en la gestión de casos financiados por el FPGC. Se organizó también un grupo de expertos para emitir recomendaciones de mejora. Resultados: Los hospitales de especialidad con un esquema descentralizado mostraron menor tiempo en el proceso administrativo en contraste con el modelo administrado por los Servicios Estatales de Salud, donde los tiempos fueron mayores y donde hubo mayores niveles de intermediación. Conclusiones: El modelo de hospitales especializados con un esquema descentralizado es más eficiente debido a que tiene mayor autonomía.

Abstract: Objective: To show that the administrative regime of specialized hospitals has some influence on the administrative processes to operate the Mexican Fund for Catastrophic Expenditures in Health (FPGC, in Spanish), for providing health care to breast cancer, cervical cancer and child leukemia. Materials and methods: The variable for estimating administrative efficiency was the time estimated from case notification to reimbursement. For its estimation, semistructured interviews were applied to key actors involved in management of cancer care financed by FPGC. Additionally, a group of experts was organized to make recommendations for improving processes. Results: Specialized hospitals with a decentralized scheme showed less time to solve the administrative process in comparison with the model on the hospitals dependent on State Health Services, where timing and intermediation levels were higher. Conclusions: Decentralized hospitals administrative scheme for specialized care is more efficient, because they tend to be more autonomous.

Healthcare Spending and Performance of Specialty Hospitals: Nationwide Evidence from Colorectal-Anal Specialty Hospitals in South Korea

PURPOSE: Aim of this study is to investigate the characteristics and performance of colorectal-anal specialty vs. general hospitals for South Korean inpatients with colorectal-anal diseases, and assesses the short-term designation effect of the government's specialty hospital. MATERIALS AND METHODS: Nationwide all colorectal-anal disease inpatient claims (n=292158) for 2010-2012 were used to investigate length of stay and inpatient charges for surgical and medical procedures in specialty vs. general hospitals. The patients' claim data were matched to hospital data, and multi-level linear mixed models to account for clustering of patients within hospitals were performed. RESULTS: Inpatient charges at colorectal-anal specialty hospitals were 27% greater per case and 92% greater per day than those at small general hospitals, but the average length of stay was 49% shorter. Colorectal-anal specialty hospitals had shorter length of stay and a higher inpatient charges per day for both surgical and medical procedures, but per case charges were not significantly different. A "specialty" designation effect also found that the colorectal-anal specialty hospitals may have consciously attempted to reduce their length of stay and inpatient charges. Both hospital and patient level factors had significant roles in determining length of stay and inpatient charges. CONCLUSION: Colorectal-anal specialty hospitals have shorter length of stay and higher inpatient charges per day than small general hospitals. A "specialty" designation by government influence performance and healthcare spending of hospitals as well. In order to maintain prosperous specialty hospital system, investigation into additional factors that affect performance, such as quality of care and patient satisfaction should be carried out.

Reglamento general del Comité de Admisión / General regulation of the Admission Committee

El Centro Médico Nacional- Hospital Nacional es un centro de alta complejidad y considerando que el nivel de atención en centros de esta naturaleza está en relación directa con el grado de preparación científico-técnica y las cualidades éticas del personal que lo compone, surge que la selección de su personal debe basarse estrictamente en la Constitución Nacional, en las Leyes y reglamentos de la República y en los modelos de selección de personal universalmente aceptados para su óptimo funcionamiento. El reglamento general del Hospital Nacional dispone la creación, a instancias de la Junta Directiva Consultiva, del Comité de Admisión para seleccionar correctamente al personal que ingresará al Centro Médico Nacional, optimizando los servicios de la institución, eligiendo los postulantes más idóneos.

The Centro Médico nacional-Hospital Nacional is a highly complex center and considering that the level of care in centers of this nature is directly related to the degree of scientific-technical preparation and the ethical qualities of the staff that compose it, it appears that the The selection of its personnel must be strictly based on the National Constitution, the Laws and regulations of the Republic and the universally accepted personnel selection models for its optimal functioning. The general regulations of the Hospital Nacional provide for the creation, at the request of the Advisory Board of Directors, of the Comité de Admisión to correctly select the personnel who will enter the Centro Médico Nacional, optimizing the services of the institution, choosing the most suitable applicants.

O processo de desenvolvimento de sistemas de gestäo em organizaçoes hospitalares e a importância da profissionalizaçäo de seus dirigentes: consideraçoes a partir de um processo de consultoria no Hospital Evandro Chagas, Fundaçäo Oswaldo Cruz / Process of development of the management system in hospitals

Trata do processo de transformaçäo do sistema de gestäo do Hospital Evandro Chagas/FIOCRUZ. Enfoca as características das organizaçoes hospitalares públicas e os desafios de coordenaçäo do trabalho médico e de pesquisa, tomando aquele hospital como referência para reflexäo. Apresenta e discute osprincípios de organizaçäo de sistemas de gestäo a partir das compreensoes do planejamento estratégico-situacional e da teoria das macro-organizaçoes de Carlos Matus. Considera que o processo de desenvolvimento gerencial das organizaçoes hospitalares, a partir da experência em foco, deve ser compreendido em pelo menos duas dimensoes mutuamente condicionantes: a primeira, ao nível do aperfeiçoamento das estruturas e métodos gerenciais; e a segunda, ao nível da profissionalizaçäo dos dirigentes hospitalares

Análisis instrumental Hospital Médico Quirúrgico "Dr. Ricardo Baquero González" / Instrumental analysis medical surgery Hospital \"Dr. Ricardo Baquero González\"

Se realizó un análisis técnico-administrativo y evaluación de los indicadores de calidad de atención del Hospital "Dr. Ricardo Baquero González" y se tomó como referencia para el estudio el año 1989, y se realizó un análisis instrumental en los aspectos de hospitalizaciones, consulta externa, emergencia. Se llegó mediante el análisis a conclusiones y recomendaciones para que el hospital como organización en contacto con la comunidad y relación a los problemas de salud pueda brindar un mejor servicio