Rediseño de la infraestructura de red local del Centro de Investigaciones Médico Quirúrgicas (CIMEQ). Cuba / Redesign Local Network Infrastructure of CIMEQ. Cuba

El empleo de las tecnologías de la información y la comunicación en el sector de la salud mejoran considerablemente el funcionamiento de los procesos asistenciales y de gestión médico-administrativa, todo lo cual contribuye a una mayor eficiencia hospitalaria y desempeño competitivo de las instituciones. La presente investigación aborda la problemática existente con el diseño de la infraestructura de red del Centro de Investigaciones Médico Quirúrgicas (CIMEQ), la cual afecta los procesos sustantivos de la institución, como la gestión de pacientes y la trasmisión de imágenes médicas. El objetivo de la investigación es rediseñar la infraestructura de red del CIMEQ, lo que permitirá elevar su rendimiento y seguridad. La investigación tiene un enfoque cuantitativo, con alcance descriptivo, de tipo retrospectivo y diseño experimental, de corte longitudinal. Se emplearon los métodos científicos de modelación y análisis documental. Como resultado se rediseñó la infraestructura de red de área local del CIMEQ, a través de métodos de segmentación que permitieron crear grupos de trabajo de manera dinámica, aprovechar las bondades de los equipos gestionables instalados y la implementación de nuevos cortafuegos. La propuesta de segmentación obtenida, por medio de redes de área local virtual, aplicación de medidas de seguridad a nivel de capa 2 y capa 3 del modelo OSI y la administración del ancho de banda mediante la implementación de calidad de servicio QoS para las aplicaciones que requieran prioridad en el tráfico de la red, mejoró el rendimiento y seguridad de la infraestructura de red del CIMEQ, lo cual impacta en un mayor desempeño competitivo y eficiencia hospitalaria desde el empleo de las tecnologías de la información y la comunicación(AU)

Using of information and communication technologies In the health sector improve considerably the functioning of healthcare processes and medical-administrative management, all of which it contributes to greater hospital efficiency and competitive performance of the institutions. This research addresses the existing problem with the design of the network infrastructure of the Medical Surgical Research Center (CIMEQ), which affects the substantive processes of the institution, such as patient management and the transmission of medical images. The objective of the research is to redesign the CIMEQ network infrastructure, which allows increase its performance and security. The research has a quantitative approach, with a descriptive scope, of a retrospective type and an experimental design, of longitudinal cut. Scientific methods of modeling and documentary analysis were used. As a result, the CIMEQ local area network infrastructure was redesigned, through segmentation methods that allowed dynamic workgroups to be created, take advantage of the benefits of installed manageable equipment and the implementation of new firewalls. The segmentation proposal obtained, through virtual local area networks, application of security measures in the layer 2 and layer 3 of the OSI model and bandwidth management through the implementation of quality of service for applications that require priority in network traffic, improved the performance and security of the CIMEQ network infrastructure, which impacts in a greater competitive performance and hospital efficiency(AU)

Las tecnologías de la información y la comunicación como factor de desempeño competitivo en instituciones de salud / Information and Communication Technologies as a competitive performance factor in health

En la actualidad la elevación del desempeño competitivo constituye una prioridad en las instituciones de salud. Tal exigencia tiene el propósito de reducir los costos de atención y aumentar la productividad, en un contexto donde la demanda de servicios hospitalarios es cada vez mayor por el acelerado envejecimiento poblacional y el incremento de los costos de atención. Disímiles investigaciones han demostrado que con el empleo de las tecnologías de la información y la comunicación se puede elevar el desempeño competitivo en salud. Dentro de estas, la Minería de Procesos posibilita mejorar la ejecución de los procesos de negocio, con el impacto en el empleo de recursos, así como en los tiempos y en la satisfacción del proceso de atención. El objetivo de la investigación fue analizar el impacto que tienen las tecnologías de la información y la comunicación como factor de desempeño competitivo en las instituciones de salud, a partir de su evaluación en el Sistema de Información Hospitalaria XAVIA HIS, por medio de la aplicación de Minería de Procesos. La investigación presentó un enfoque cualitativo, con alcance explicativo y un diseño no experimental, donde se empleó el análisis documental y la modelación. Fue aplicada al Sistema de Información Hospitalaria XAVIA HIS en el año 2019. Para esto, fue utilizada la metodología computacional para la aplicación de la Minería de Procesos. Como resultado se obtuvo un modelo adecuado a la realidad y fácilmente analizable, que constató el impacto de las tecnologías de la información y la comunicación en la elevación del desempeño competitivo en las instituciones de salud(AU)

At present, it constitutes a priority the competitive performance elevation in health institutions. This exigence has a purpose to reduce the costs of healthcare and increase productivity, in a context where the demand for hospital services is increasing, due to the accelerated aging of the population and the increase in the costs of healthcare. Different researches have shown that with the use of Information and Communication Technologies, competitive performance in health can be increased. Within this, Process Mining allows to improve the execution of business processes, which it impacts the use of resources, as well as the times and satisfaction of the healthcare process. The objective is to analyze the impact that Information and Communication Technologies have, as a factor of competitive performance in health institutions, based on their evaluation in the XAVIA HIS Hospital Information System, through the application of Process Mining. The research has a qualitative approach, with explanatory scope and non-experimental design, where documentary analysis and modeling are used. It is applied to the Hospital Information System XAVIA HIS in 2019. For this, the Methodology was used for the application of process mining. As a result, a model adapted to reality and easily analyzed is obtained, which it is confirms the impact of Information and Communication Technologies in increasing competitive performance in health institutions(AU)

Análisis con GRD: El egreso hospitalario indiferenciado de la maternidad no representa la complejidad de las pacientes con alto riesgo obstétrico / DRG analysis: undifferentiated hospital discharges of maternity does not represent the complexity of patients with high obstetric risk

INTRODUCCIÓN: La gestión actual de camas hospitalarias sigue un modelo de indiferenciación en el que existen camas quirúrgicas, médicas y de pacientes críticos. Las maternidades si bien no siguen este modelo, tienen egresos indiferenciados con pacientes que pueden egresar post parto o aún embarazadas (con patologías perinatales). OBJETIVO: Evaluar diferencias entre egresos con parto normal y aquellos con patologías de alto riesgo obstétrico (ARO) respecto a estancia media (EM) y el consumo de recursos cuantificado con el peso medio de los grupos relacionados con el diagnóstico (PMGRD). MÉTODO: Estudio transversal con egresos maternales periodo 2017-2018. Se usó Categoría Diagnóstica Mayor (CIE - 10) para definir dos grupos de egreso: 1. Con parto normal a término o 2. Con patología ARO. Se compararon 1.658 y 1.669 egresos del grupo 1 y 2 respectivamente. Las variables de resultado son EM y PMGRD. Se compararon variables cuantitativas con t de student y Kruskal Wallis. Se usó Odds Ratio con respectivo intervalo de confianza para evaluar asociación entre variables y regresión logística multivariada para ajustar asociación. RESULTADOS: La edad, proporción de gestantes tardías, EM y PMGRD fue mayor en los egresos ARO (p<0,05). Existe fuerte asociación de EM prolongada (>4 días) y PMGRD elevado (>0.3109) con los egresos ARO (ORa=3.75; IC95%=3.21-4.39 y ORa=1.28; IC95%=1.1-1.49 respectivamente). CONCLUSIONES: Es necesario diferenciar los egresos del servicio de maternidad porque los egresos de ARO muestran mayor complejidad. La evaluación del riesgo usando EM y PMGRD permite analizar con especificidad los egresos maternales para una mejor gestión de camas y del recurso humano.

INTRODUCTION: The current management of hospital beds in Chile follows an undifferentiation model in which there are surgical, medical and critical patient bed. Maternity hospitals although they do not follow this model, have undifferentiated discharges with patients who may leave poatpartum or still pregnant (with perinatal pathologies) OBJECTIVE: To assess differences between discharges with normal delivery and those with high obstetric risk pathologies (HOR) with respect to mean stay (MS) and the resource spending quantified with the average weight of the diagnosis related group (AWDRG). METHOD: Cross-sectional study with maternal discharges between 2017-2018 period. Major Diagnostic Category (ICD - 10) was used to define two discharge groups: 1. With normal term birth or 2. With HOR pathology. 1,658 and 1,669 egress from group 1 and 2 were compared respectively. The outcome variables are EM and AWDRG. Quantitative variables were compared with student t and Kruskal Wallis. Odds Ratio and respective confidence interval were used to evaluate association between variables and multivariate logistic regression to adjust association. RESULTS: Age, proportion of late pregnant women, MS and AWDRG was higher in HOR discharges (p <0.05). There is a strong association of prolonged MS (> 4 days) and elevated AWDRG (> 0.3109) with HOR discharges (ORa = 3.75; 95% CI 3.21-4.39 and ORa = 1.28; 95% CI 1.1-1.49 respectively). CONCLUSIONS: It is necessary to differentiate medical discharge of the maternity service because the HOR egress show greater complexity. The risk assessment using MS and AWDRG allows to analyze with specificity the maternal discharge for a better management of beds and human resources.

Saturación en los servicios de urgencias: Análisis de cuatro hospitales de Medellín y simulación de estrategias / Emergency Department Overcrowding: A Four-Hospital Analysis in Medellín and a Strategy Simulation / Saturação nos serviços de urgência: Análise de quatro hospitais de Medellín e simulação de estratégias

Resumen Las urgencias médicas pueden saturarse debido a factores externos e internos al servicio. Esto se refleja en congestión, tiempos de espera elevados e insatisfacción de los usuarios. Identificar y simular estrategias para gestionar las urgencias médicas, procurando atenuar la saturación. Investigación exploratoria y analítica, con trabajo de campo en cuatro unidades de urgencias de Medellín y simulación de estrategias contra la saturación mediante dinámica de sistemas. Las estrategias utilizadas son: reorganizar el registro, remitir los pacientes que no requieren atención urgente, implementar consultorio fast-track e incrementar el traslado a pisos. Esta última es la estrategia más efectiva en la simulación. Aunque las estrategias de flujo pueden ayudar a resolver la saturación a partir de sus causas internas, como lo sugiere la literatura, su alcance es limitado. Se requieren estrategias de entrada, que no están al alcance del servicio, y estrategias de salida del sistema hospitalario. Es posible disminuir la saturación, concibiendo las urgencias y el hospital como dos elementos de un mismo sistema, de modo que se agilice el flujo de pacientes y se cuente con oferta adecuada de camas hospitalarias sin sobredimensionar la capacidad instalada.

Abstract Medical emergency services can be overcrowded due to both external and internal service factors. This is evinced in the congestion, longer waits, and dissatisfaction by the users. To identify and simulate strategies for processing medical emergency requests in order to mitigate the overcrowding. An exploratory and analytical research was conducted based on the field work at four emergency rooms in hospitals of Medellín; simulation strategies were then proposed against the overcrowded service with system dynamics. The strategies included: to reorganize the sign-in, refer to other places those patient not requiring emergency services, implement fast-track services, and increase the inpatient capacity. The last one becomes the most effective strategy in the simulation. While the flow strategies can help to solve the service overcrowding due to internal causes as suggested in the literature, these strategies are limited in their scope. The required patient sign-in strategies as well as the patient discharge strategies are not easy-to-do in these emergency rooms. Overcrowding can be reduced by thinking of the hospital and the emergency room as two elements in a single system, so that the patient flow can be speeded up; the bed number for inpatients must be improved without overflowing the hospital capacity.

Resumo As urgências médicas podem se saturar devido a fatores externos e internos ao serviço. Isso se reflete em congestão, tempos de espera elevados e insatisfação dos usuários. Identificar e simular estratégias para gerir as urgências médicas, procurando atenuar a saturação. Pesquisa exploratória e analítica, com trabalho de campo em quatro unidades de urgências de Medellín e simulação de estratégias contra a saturação mediante dinâmica de sistemas. As estratégias utilizadas são: reorganizar o cadastro, reencaminhar os pacientes que não precisam atendimento urgente, implementar clínica ambulatória fast-track e facilitar o traslado aos quartos. Esta última é a estratégia mais efetiva na simulação. Ainda que as estratégias de fluxo possam ajudar a resolver a saturação a partir de suas causas internas, como sugere a literatura, seu escopo é limitado. Precisam-se estratégias de entrada, que no estão dentro do escopo do serviço e estratégias de saída do sistema hospitalar. Conclusões: é possível diminuir a saturação, concebendo as urgências e o hospital como dois elementos de um mesmo sistema, de jeito de agilitar o fluxo de pacientes e contar com oferta adequada de leitos hospitalares sem superdimensionar a capacidade instalada.

The present situation of hospital efficiency evaluation in China:Based on bibiometrics analysis / 中国卫生政策研究

This paper analyzed the present situation on efficiency in hospitals and reasons for the failure of im-plementation. The analysis found that the research experienced a stage of fragmentation-dualization-systematic phase. The research subjects mainly included integrated or general hospitals (84. 21% ), hospitals of Grade II or above (55. 79% ), mixed and local systems (95. 26% ), and public hospitals dominated with 97. 89% , all of the subjects being covered from 22 provinces and municipalities. The comprehensive, technical and pure technical efficiencies had propor-tions of 87. 89% , 68. 84% and 86. 84 respectively and were concentrated in the research content, the evaluation meth-od being mainly DEA and and/or BCC (67. 89% ). The selection of indicators was mainly qualitative (47. 36% for pure literature analysis) and the main indicators were almost internally set. The first three were used in the frequency divi-sion outpatient emergency number (55 visits), number of beds and fixed assets (44) and total expenditures (42). The main sources of data were public access (27. 89% ), internal data (31. 05% ), investigations or various surveys (30. 53% ) and the hospitals’ own data reports (15. 26% ), and more than half (54. 21% ) was single road. Conclusion:The hospital efficiency evaluation focused on the integrated public hospitals above the grade two, mainly based on the relative efficiency of DEA, which involves many contents, wide geographical area and large span but the selection of in-dicators, data sources, and quantification of factors still restrict the quality of the results. The imbalance between the needs of researchers and managers for efficiency evaluation, inadequate understanding ad unbalanced knowledge togeth- er with the lack of relevant policies hindered the transformation of results. Therefore, the consistent mechanism for hospi-tals efficiency evaluation should be established from the angle of top-level design and actual situation of hospitals in China.

A model for multidimensional efficiency analysis of public hospital management

Abstract Introduction Multidimensional efficiency analysis can provide important insights into the performance of hospitals. In this paper, we propose a multidimensional model based on Data Envelopment Analysis (DEA) to investigate and compare the efficiency of public hospitals in Brazil. Methods Data from 21 public hospitals were collected from public databases (OECD - Organization for Economic Co-operation and Development; SIH-SUS - SUS Hospital Information System, Datasus, Brazil). Four inputs (Number of medical and non-medical staff, Annual revenue, Number of beds, Average length of patient hospitalization), four Variables of Influence (Type of hospital, Accredited hospital, Number of medical specialties, Resources from government) and four Outputs (Number of outpatient care services, Number of hospitalizations, Number of surgeries, Number of exams) were used to feed the DEA model. Results Seven hospital units reach 100% efficiency and, according to DEA, can be considered efficient units. Two units were considered "almost efficient" and the remaining twelve units perform poorly, considering the data supplied to the DEA model. As a whole, the average efficiency of the hospitals investigated was 79% (0.79). Conclusion A very heterogeneous performance has been found among the Brazilian public hospitals investigated. Besides, the reasonably low average efficiency seems to indicate that the system has a large potential for improvement in almost all areas associated with the input and output variables investigated in this paper.

Study on DEA-based Chinese hospital efficiency and applied indicators / 中国卫生政策研究

Objective:This study aims to explore recent developments in DEA-based hospital efficiency studies in China, so as to provide reference for further research in DEA-based hospital efficiency. Methods:In this study, a 30-year retrospective systematic review is conducted for the classification of 85 hospital efficiency studies that have been published in China with DEA. The characteristics are summarized and compared with those of international liter-ature according to the selection of input and output indicators to evaluate the normalization of studies in China. Re-sults:The classification reveals several problems existing in DEA-based hospital efficiency studies in China, such as too few studies on hospital allocation efficiency, the application of simple classical models, imprecise selection of in-put-output indicators, inappropriate application of monetary variables as output indicators, etc. Conclusions and sug-gestions:The normalization and rationality of DEA methods applied in China’s hospital efficiency research need to be improved, so as to shorten the gap between China and the international world. Chinese researchers should pay more attention to studying the latest international research findings, so as to scientifically select input and output indicators. In depth analysis of methods and application conditions should be conducted so as to improve the normalization and science of China’s hospital efficiency research.

Data dimensionality reduction for hospital efficiency measurement / 中华医院管理杂志

A comparison was made for the correlation and application scope of the statistical methods commonly used by hospitals for their efficiency measurement.Hospital data processed with PCA (principal component analysis)for dimension reduction were used in a correlation analysis for the results of ratio analysis (RA),stochastic frontier analysis(SFA)and data envelopment analysis(DEA).The authors hold that the RA can expediently display the order of hospital efficiency,the SFA demands a stricter premise yet presents more stable results,while the DEA boasts greater relative advantages and thus suitable for processing hospital efficiency measurement tasks of multi-input and multi-output indexes.

Analysis on the Efficiency of 14 Division-level Hospitals of Xinjiang Production and Construction Corps Based on DEA Model / 中国卫生经济

Objective: To evaluate the operational efficiency of the division-level hospitals of Xinjiang Production and Construction Corps. Methods: Use DEA’s CCR model and BCC model to calculate the overall efficiency, pure technical efficiency and scale efficiency of Xinjiang Production and Construction Corps, and use super-efficiency model to calculate efficiency ranking of the division-level hospitals. Results: In the total pattern, there were 28.6%of the agricultural division hospitals at the stage of constant returns scale;in the medical service model, there were only 14.3% hospitals at that stage. Conclusion: From the results of two models, the technical efficiency has more room for improvement, compared with efficiency scale. The hospital needs to improve the level of health care technique, avoid blind expansion, minimize unnecessary input, strengthen internal meticulous management, and improve the overall operating efficiency of the hospital.

Hospital Efficiency: Concept, Measurement Techniques and Review of Hospital Efficiency Studies

In a time of rising demands on hospital reimbursement levels, focus on efficient operations is becoming more imperative. In health care systems, the measurement of efficiency is usually the first step in auditing individual performance of production units, e.g. hospitals, health centers, etc. It constitutes the rational framework for the distribution of human and other resources between and within health care facilities. The term efficiency is broadly used in economics and refers to the best utilization of resources in production. Typical example of efficiency is technical efficiency, referring to the effective use of resources in producing outputs. In the Farrell framework, a hospital is judged to be technically efficient if it is operating on the best practice production frontier in its hospital industry. In general, there are two main frontier methods in measuring efficiency. The first is Data Envelopment Analysis (DEA), a linear programming method which enables the measurement of efficiency consistent with the theoretically based concept of production efficiency. DEA typically examines the relationship between inputs to a production process and the outputs of that process. The second technique for assessing efficiency that is employed is Stochastic Frontier Analysis (SFA). This is an econometric technique to estimate a conventional function; with the difference being that efficiency is measured using the residuals from the estimated equation. The error term is therefore divided into a stochastic error term and a systematic inefficiency term.

Correlation between medical market structure and hospital efficiency in the Hangzhou area / 中华医院管理杂志

Objective To assess the efficiency of central urban and rural hospitals in the 7 cities, counties and districts under the jurisdiction of Hangzhou City and the status of the medical markets so as to provide theoretical basis for the promotion of decentralized medical markets. Methods On the basis of defining the scope of a medical market, the HHI values of the medical markets in places where 37 hospitals in Hangzhou were located was calculated, the average efficiency of the various hospitals was measured by means of DEA, and an analysis was made on the correlation between the average efficiency and the HHI values. Results The central urban and rural medical markets in the various places surveyed, whose HHI values were all greater than 1 800, belonged to markets of monopolistic competition. Of the 37 hospitals, there were 11 whose relative efficiency reached 100% and another 11 whose relative efficiency was less than 60%. The greater the monopoly of a medical market, the lower the average efficiency of its hospitals. Conclusion Establishing competitive markets with low market concentration is an effective way of enhancing overall hospital efficiency.