Electronic Medication Reconciliation Tools Aimed at Healthcare Professionals to Support Medication Reconciliation: a Systematic Review.

The development of health information technology available and accessible to professionals is increasing in the last few years. However, a low number of electronic health tools included some kind of information about medication reconciliation. To identify all the electronic medication reconciliation tools aimed at healthcare professionals and summarize their main features, availability, and clinical impact on patient safety. A systematic review of studies that included a description of an electronic medication reconciliation tool (web-based or mobile app) aimed at healthcare professionals was conducted. The review protocol was registered with PROSPERO: registration number CRD42022366662, and followed PRISMA guidelines. The literature search was performed using four healthcare databases: PubMed, EMBASE, Cochrane Library, and Scopus with no language or publication date restrictions. We identified a total of 1227 articles, of which only 12 met the inclusion criteria.Through these articles,12 electronic tools were detected. Viewing and comparing different medication lists and grouping medications into multiple categories were some of the more recurring features of the tools. With respect to the clinical impact on patient safety, a reduction in adverse drug events or medication discrepancies was detected in up to four tools, but no significant differences in emergency room visits or hospital readmissions were found. 12 e-MedRec tools aimed at health professionals have been developed to date but none was designed as a mobile app. The main features that healthcare professionals requested to be included in e-MedRec tools were interoperability, "user-friendly" information, and integration with the ordering process.

Modelling and verification of post-quantum key encapsulation mechanisms using Maude.

Communication and information technologies shape the world's systems of today, and those systems shape our society. The security of those systems relies on mathematical problems that are hard to solve for classical computers, that is, the available current computers. Recent advances in quantum computing threaten the security of our systems and the communications we use. In order to face this threat, multiple solutions and protocols have been proposed in the Post-Quantum Cryptography project carried on by the National Institute of Standards and Technologies. The presented work focuses on defining a formal framework in Maude for the security analysis of different post-quantum key encapsulation mechanisms under assumptions given under the Dolev-Yao model. Through the use of our framework, we construct a symbolic model to represent the behaviour of each of the participants of the protocol in a network. We then conduct reachability analysis and find a man-in-the-middle attack in each of them and a design vulnerability in Bit Flipping Key Encapsulation. For both cases, we provide some insights on possible solutions. Then, we use the Maude Linear Temporal Logic model checker to extend the analysis of the symbolic system regarding security, liveness and fairness properties. Liveness and fairness properties hold while the security property does not due to the man-in-the-middle attack and the design vulnerability in Bit Flipping Key Encapsulation.

Hybrid post-quantum Transport Layer Security formal analysis in Maude-NPA and its parallel version.

This article presents a security formal analysis of the hybrid post-quantum Transport Layer Security (TLS) protocol, a quantum-resistant version of the TLS protocol proposed by Amazon Web Services as a precaution in dealing with future attacks from quantum computers. In addition to a classical key exchange algorithm, the proposed protocol uses a post-quantum key encapsulation mechanism, which is believed invulnerable under quantum computers, so the protocol's key negotiation is called the hybrid key exchange scheme. One of our assumptions about the intruder's capabilities is that the intruder is able to break the security of the classical key exchange algorithm by utilizing the power of large quantum computers. For the formal analysis, we use Maude-NPA and a parallel version of Maude-NPA (called Par-Maude-NPA) to conduct experiments. The security properties under analysis are (1) the secrecy property of the shared secret key established between two honest principals with the classical key exchange algorithm, (2) a similar secrecy property but with the post-quantum key encapsulation mechanism, and (3) the authentication property. Given the time limit T = 1,722 h (72 days), Par-Maude-NPA found a counterexample of (1) at depth 12 in T, while Maude-NPA did not find it in T. At the same time T, Par-Maude-NPA did not find any counterexamples of (2) and (3) up to depths 12 and 18, respectively, and neither did Maude-NPA. Therefore, the protocol does not enjoy (1), while it enjoys (2) and (3) up to depths 12 and 18, respectively. Subsequently, the secrecy property of the master secret holds for the protocol up to depth 12.

Impact of healthcare capacity disparities on the COVID-19 vaccination coverage in the United States: A cross-sectional study.

Background: The impact of the COVID-19 vaccination campaign in the US has been hampered by a substantial geographical heterogeneity of the vaccination coverage. Several studies have proposed vaccination hesitancy as a key driver of the vaccination uptake disparities. However, the impact of other important structural determinants such as local disparities in healthcare capacity is virtually unknown. Methods: In this cross-sectional study, we conducted causal inference and geospatial analyses to assess the impact of healthcare capacity on the vaccination coverage disparity in the US. We evaluated the causal relationship between the healthcare system capacity of 2417 US counties and their COVID-19 vaccination rate. We also conducted geospatial analyses using spatial scan statistics to identify areas with low vaccination rates. Findings: We found a causal effect of the constraints in the healthcare capacity of a county and its low-vaccination uptake. Counties with higher constraints in their healthcare capacity were more probable to have COVID-19 vaccination rates ≤50, with 35% higher constraints in low-vaccinated areas (vaccination rates ≤ 50) compared to high-vaccinated areas (vaccination rates > 50). We also found that COVID-19 vaccination in the US exhibits a distinct spatial structure with defined "vaccination coldspots". Interpretation: We found that the healthcare capacity of a county is an important determinant of low vaccine uptake. Our study highlights that even in high-income nations, internal disparities in healthcare capacity play an important role in the health outcomes of the nation. Therefore, strengthening the funding and infrastructure of the healthcare system, particularly in rural underserved areas, should be intensified to help vulnerable communities. Funding: None.

A partial evaluation methodology for optimizing rewrite theories incrementally.

Partial evaluation (PE) is a branch of computer science that achieves code optimization via specialization. This article describes a PE methodology for optimizing rewrite theories that encode concurrent as well as nondeterministic systems by means of the Maude language. The main advantages of the proposed methodology can be summarized as follows:•An automatic program optimization technique for rewrite theories featuring several PE criteria that support the specialization of a broad class of rewrite theories.•An incremental partial evaluation modality that allows the key specialization components to be encapsulated at the desired granularity level to facilitate progressive refinements of the specialization.•All executability theory requirements are preserved by the PE transformation. Also the transformation ensures the semantic equivalence between the original rewrite theory and the specialized theory under rather mild conditions.

El papel de los estimulantes de trombopoyetina (eltrombopag y romiplostim) en trombocitopenia inmune secundaria a Lupus

Introducción: la púrpura trombocitopénica inmune (PTI) es una manifestación hematológica frecuente en el lupus eritematoso sistémico (LES). Los corticoesteroides son la primera línea de manejo para la trombocitopenia moderada o grave, en conjunto con antimaláricos y otros inmunosupresores. En casos particulares, en donde la respuesta a las intervenciones iniciales no sea la adecuada, se cuenta con terapias de segunda línea. Objetivo: esta revisión narrativa se enfocará en dos medicamentos agonistas del receptor de trombopoyetina (RTPO): eltrombopag y romiplostim y en su papel en la PTI secundaria a LES. Además, se revisará su perfil farmacológico, dosis e indicaciones en el contexto de esta enfermedad. Métodos: se realizó una búsqueda de literatura en diferentes bases de datos, se analizaron artículos científicos y guías de manejo, tanto de LES como de trombocitopenia inmune, con el fin de contestar diferentes preguntas clínicas surgidas en el escenario de la práctica cotidiana. Resultados y conclusiones: el uso de los estimulantes de TPO es una alternativa terapéutica para escenarios particulares de pacientes con LES y trombocitopenia inmune. Sin embargo, son necesarios estudios enfocados en esta población específica para poder hacer recomendaciones acertadas acerca de su manejo. Los datos actuales son extrapolados de la trombocitopenia inmune primaria.

SUMMARY Introduction: Immune thrombocytopenia is a frequent hematologic manifestation in systemic lupus erythematosus (SLE). Corticosteroids are the first line of treatment for moderate to severe thrombocytopenia in this disease, in conjunction with antimalarials or other immunosuppressants. In particular cases where the response to initial interventions is not achieved, second-line therapies with different mechanisms of action are available. Objective: This narrative review will focus on two thrombopoietin receptor agonist drugs (TPO-RA): eltrombopag and romiplostim, and their role in immune thrombocytopenia secondary to SLE. In addition, its pharmacological profile, dose and indications will be reviewed in the context of this disease. Methods: A literature search was conducted in different databases; scientific articles and guidelines were analyzed, both for SLE and immune thrombocytopenia. With the purpose of answering different clinical questions that constantly arise in the scene of daily practice. Results and conclusions: The use of TPO-RA stimulants is a therapeutic alternative for particular scenarios in patients with SLE and immune thrombocytopenia, however studies focused on this particular population are necessary to be able to make strong recommendations about its utility. Current data are extrapolated from primary immune thrombocytopenia.

Relación entre la flexibilidad de los isquiotibiales y la fuerza del soleo con el salto y la velocidad en jugadores de ultimate frisbee / Relationship between the flexibility of the hamstring and the strength of soleus muscle with jump and speed in ultimate frisbee players / Relação entre a flexibilidade dos isquiotibiais, a força do sóleo com o salto e a velocidade emjogadores de ultimate frisbee

Problema: la reducción de la flexibilidad de los isquiotibiales es común en adolescentes, asociándose con dolor lumbar, hernia de disco y riesgo de lesiones musculares. El ultimate frisbee implica aceleraciones y desaceleraciones en cortas distancias. Los antecedentes reportan lesiones en miembros inferiores, sin correlacionarlas con patrones de movimiento como fuerza, velocidad o salto. Objetivo: determinar la relación entre la flexibilidad de los isquiotibiales y la fuerza del soleo, con el salto y la velocidad en jugadores de ultimate frisbee. Método: estudio descriptivo, correlacional, con 103 deportistas universitarios de Medellín, Colombia. La información se recolectó mediante encuesta y observación. Se evaluó la flexibilidad, la velocidad y el salto. Los datos se analizaron con SPSS, versión 24.0. Resultados: la flexibilidad de los isquiotibiales se correlacionó positivamente con la velocidad, pero inversamente con el salto. Conclusión: a mayor flexibilidad de los isquiotibiales, mayor desarrollo de velocidad, pero menor capacidad de salto.

Problem: Reduction of hamstring flexibility is common in adolescents, associating with low back pain, disc herniation, andrisk of muscle injuries. Ultimate frisbee implies accelerations and decelerations over short distances. The background reports injuries in thelower limbs, without correlating them with movement patterns such as strength, speed or jump. Objective: To determine the relationship between hamstring flexibility and the strength ofthe soleus muscle with jump and speed in ultimate frisbee players. Method: Descriptive and correlational study, with 103 university athletes from Medellin, Colombia. Information wascollected through survey and observation. Flexibility, speed and jump were evaluated. Data were analyzed with SPSS® version 24.0. Results: Hamstring flexibility was positively correlated with speed, but inversely with jump. Conclusion: A greater flexibility of the hamstrings, greater speed development, but lessjumping ability.

Problema: a redução da flexibilidade dos isquiotibiais é um quadro clínico comum emadolescentes, esta redução foi reportada como um fator associado à prevalência de dor lombar, hérnia de disco e alto risco de lesões musculares. O ultimatefrisbee combina padrões de movimento similares ao futebol e ao handebol, onde se realizam cortes, arremessos, saltos, velocidade, voos e aceleração ­desaceleração em curtas distâncias. Os antecedentes encontrados nesse esporte reportam índices de lesões em membros inferiores, mas não se constataramcorrelações entre padrões de movimento específico com o salto, a força e a velocidade. Objetivo: determinar a relação da flexibilidade dos isquiotibiais, a força do sóleo com o salto e avelocidade em jogadores de ultimate frisbee. Método: realizou-se um estudo descritivo com alcance correlacional e amostra de conveniência de 103 jogadoresuniversitários de ultimate frisbee da cidade de Medellin-Colômbia. Os esportistas cumpriram os critérios de inclusão e assinaram o consentimentoinformado. No que se refere às técnicas de coleta de informação, utilizou-se a pesquisa de opinião e a observação. Avaliou-se a flexibilidade, a velocidade eo salto. Os dados se analisaram com o programa estadístico SPSS versão 24.0. Realizou-se uma análise uni-variada de estadística descritiva, que confirmou asfrequências absolutas e relativas. Além disso, determinou-se a distribuição da normalidade de todas as variáveis através do teste Kolmogorov-Smirnov, queassinalou normalidade para as variáveis com um valor < 0,05. Resultados: estabeleceu-se que a flexibilidade dos isquiotibiais tem correlação positivacom a velocidade, mas inversa com o salto. Conclusão: quanto maior a flexibilidade dos isquiotibiais, maior o desenvolvimento da velocidade, porémmenor a capacidade de salto.

Nueva metodología geométrica para evaluar la morfología del eritrocito normal / New physical and mathematical methodology to evaluate the morphology of normal erythrocyte

Resumen Objetivo. Desarrollar una nueva metodología para caracterizar la estructura del eritrocito normal mediante el espacio ocupado por el anillo del eritrocito normal caracterizado con el método de Box Counting. Método. Se analizaron las imágenes de 20 extendidos de sangre periférica, cuyos eritrocitos fueron evaluados por un experto como normales. Se superpusieron dos rejillas Kp de 5 x 5 pixeles y Kg de 10 x 10 pixeles, para calcular el espacio ocupado por dos regiones del eritrocito estos son, el disco y centro de este, visto de manera frontal mediante el método de Box Counting. Resultados. Los espacios ocupados por la región del disco con la rejilla Kp variaron entre 47 y 56, la región del centro del eritrocito, varió entre 9 y 14. La dimensión fractal de estas dos regiones varió entre 0,941 y 1,115 para el disco, entre 0,652 y 1,222 para el centro. Conclusiones. La estructura del eritrocito normal puede ser caracterizada mediante el espacio ocupado por cada una de las regiones del eritrocito a partir de la geometría fractal.

Abstract Objective. Develop a new methodology to characterize the structure of the normal erythrocyte through the space occupied by the ring of the normal erythrocyte characterized by the method of Box Counting. Method. Images of10 peripheral blood smears were analysed, whose erythrocytes were evaluated by an expert as normal. There were superimposed two Kp grids of 5 x 5 pixels and Kg of 10 x 10 pixels, to calculate the space occupied by two regions of the erythrocyte which are, disc and centre of this, seen of way frontal by the method of Box Counting. Results. The spaces occupied by the disc region with grid Kp varied between 47 and 56, the central region of the erythrocyte, varied between 9 and 14. The fractal dimension of these two regions varied between 0,941 and 1,115 for the disc, between 0.652 and 1,222 for the centre. Conclusions. The normal erythrocyte structure can be characterized by the space occupied by the regions erythrocyte from fractal geometry.

[History and functions of Chilean ophthalmologic primary care units]. / Unidades de atención primaria en oftalmología en Chile: historia y funciones.

The access to ophthalmological care in Chile has been historically a problem. Only at the end of the twentieth century concrete solutions were promoted. In 1960, Primary Care Ophthalmologic Units were created to ease the access to ophthalmology, due to the efforts of Professor Juan Arentsen. Their functioning was organized and standardized subsequently using a model proposed by the Chilean Ophthalmologic Society, leading to a better patient flow and reducing waiting lists. These units became an innovative initiative to reduce the gaps in Chilean public health, optimizing the professional and infrastructural assets of the public health care system and achieving a new organization for the ophthalmological health care net.

Unidades de atención primaria en oftalmología en Chile: historia y funciones / History and functions of Chilean ophthalmologic primary care units

The access to ophthalmological care in Chile has been historically a problem. Only at the end of the twentieth century concrete solutions were promoted. In 1960, Primary Care Ophthalmologic Units were created to ease the access to ophthalmology, due to the efforts of Professor Juan Arentsen. Their functioning was organized and standardized subsequently using a model proposed by the Chilean Ophthalmologic Society, leading to a better patient flow and reducing waiting lists. These units became an innovative initiative to reduce the gaps in Chilean public health, optimizing the professional and infrastructural assets of the public health care system and achieving a new organization for the ophthalmological health care net.

[Surgical relevance of some aspects of heart's embriology]. / Importancia quirúirgica de algunos aspectos de la embriología del corazon.

We consider some aspects of cardiac embriology which explain the formation of pericardial cysts, anomalies of venae cavae, types of atrial septal defect (ostium primum, secundum, foramen ovale), anomalies in septal ventricular development by absence of structures to perform the septum (atrio-ventricularis communis, truncus arteriosus), lack of alineation (Taussig-Bing's complex, transposition of the great vessels, Eisenmenger's complex, Fallot's tetralogy) or interruption in their development (isolated ventricular septal defect). Finally the evolution of aortic arcs, ductus, aorta's istmus and anomalies in coronary arteries, are also considered.

[Historical data and some comments on closed techniques in cardiac surgery]. / Datos históricos y algunos comentarios sobre las técnicas cerradas en cirugía cardíaca.

On the 29th of May, 1907 Ortiz de la Torre preformed, in the General Hospital of Madrid, the first surgery to treat a cardiac wound. In this same year Rehn reported the first 124 cases of sutured cardiac wounds, following the first one, performed by him, in the world on the 9th of September, 1896 which opened the cardiac surgery. This started with the so called closed techniques. We are presenting some data according to our own experience in honor to those pioneers surgeons. The most important contributions are reviewed as follows: 1. The suture of the heart's wounds with the definitive aportation of Rehn on the 9th of September, 1896. 2. The extracardiac surgery related with: a) Pathology of the pericardium with the proposals of Weill in 1895 and Delorme in 1898, about removing it in case of constrictive pericarditis and the first decortication executed by Rehn in 1920. The first case of removing a pericardium's cyst by Pickhardt in 1934, is mentioned. b) The great vessels' pathology with the contribution of Trendelenburg (1908) in case of lung embolie and the first patient operated with success by Kirschner in 1924. The ligature of the patent ductus arteriosus done by Gross and Hubbard in 1939, with the previous findings of Munro and Strieder. The resection of the narrow segment in coarctation of the aorta done by Crafoord, under sugerence of Nylin, in 1944. c) Extracardiac surgery in order to correct intracardiac pathology with reference to the several types of systemic-pulmonary anastomosis, starting with Blalock-Taussig operation in Fallot's tetralogy done the first time November 29th of 1944, and after that the Pott's aorto-pulmonary anastomosis (1946), the superior vena cava-right pulmonary artery anastomosis or Glenn's operation (1954), the Waterston's ascending aorta-right pulmonary artery anastomosis (1962) with the Cooley's modification (1965). It is also mentioned the banding of the pulmonary artery after Miller and Dammann (1952) as well as the techniqes aiming to correct the pulmonary hypertension in mitral stenosis. Lastly he quotes venous transposition operations in the treatment of transposition of the great vessels (Lillehei, Greech, Baffes). 3. With regard to the group of closed techniques which aim is to correct intracardiac pathology, the following techniques are taken into account: Blalock-Hanlon's operation (1948) that create an interauricular communication in case of transposition of great arteries and Rahskind's technique. Within mitral stenosis, sugerence of sir Lauden Brunton (1902), efforts of Cutler, Levine and Beck and the pioneer Souttar's surgical procedure, in 1925, are described. Afterwards Bailey's intervention (10th Juny 1948) and Harken and other surgeons are mentioned. Figuera's instrument, introduced through left auricle is also described. The first efforts to correct aortic and pulmonary stenosis are described from the initial contributions of Tuffier, Doyen (1913), Brock and Sellors (1948) ending with the ingenious attempts of closing interauricular communication with Swan's and Hufnagel's buttons (1950), Bailey's atrioseptopexy, Sondergaard's technique and Gross'well technique. Finally the pioneer Bailey's aportation (February 6th 1951) for closing interventricular septal defect using a tube of pericardium introduced through the interventricular defect, going out through the wall of the left ventricle.

[Cardiac transplant and artificial heart. Historical data]. / Trasplante cardiaco y corazón artificial. Datos históricos.

After mentioning the importance of implementing these techniques, frecuently used both in USA and Spain, he refers to his experience on 70 dogs since the end of the 50's in the last century. Not only does he refer to the heterotopic transplant, on the neck, undertaken to test the importance of the denervation, maintenance of the viability of the organ using hypothermia, and the anatomopathologic study of the inmunologic rejection, but also to the orthotopic transplant, this is the replacement of one heart by other, using extracorporeal circulation. He refers to the first transplant practiced by Hardy, on the 23rd of January 1964, in which he unsuccessfully used the heart of a chimpanzee and to the one performed by Barnard the 3rd of December 1967, with a survival span of 18 days. He mentions current techniques to preserve the replacement heart, using POPS, as well as the procedures to avoid the rejection and the clinical experience in Spain until now, including the obtained results. Thereafter, he makes a detailed description of the Liotta's artificial heart, the Jarvik 7 (Symbyon, CardioWest), which provided a survival period of 112 days. Also he refers to the Jarvik 2000, the model of DeBakey, the Novacor, the AbioCor, explaining the experience achieved with them, ending with the description with the model proposed by Schenk, in Cleveland, the MagScrew TAH.

[Historical evolution of prosthetic heart valves]. / Evolución histórica de las prótesis valvulares cardíacas.

The historical evolution of the prosthetic heart valves is resumed, quoting the first experimental steps, the conditions that a prosthesis has to fulfil, and the first clinical attempts with the Hufnagel's valve in the treatment of the aortic insufficiency (September 11, 1952) and with the Chesterman's in the pathology of the mitral valve (July 22, 1955) till the Starr Edwards' ball valve (Agoust 12, 1960). The characteristics of the different types of ball valve are described (Harken, Smeloff, etc), disc valves (Kay-Shiley, Beall, Lillehei-Nakib etc.), tilting disc valves (Bjork-Shiley, Hall-Kaster, Omniscience etc), bileaflet valves ( St. Jude and others) and biological valves, using autologous tisues (diaphragm, fascia lata, pericardium) homologous (aortic and mitral valves, duramater) and heterologous (porcine and bovine valves, Carpentier-Edwards, Hancock, Ionescu's valve of bovine pericardium), to conclude with the new trends with valves made from autologous cells, the valves made with polymers, those based on the concept of flexible tubes and finally with those used by percutaneous transcatheter implantation (Boudjemline y Bonhoeffer. Cribier.).

Sistema de pago para la atención de la población pobre no afiliada al sistema general de seguridad social en salud en la ciudad de Bogotá / Payment system for the care of the poor population not affiliated to the general social security health system in the city of Bogota

Antecedentes: a A finales de 1999, la Secretaría Distrital de Salud de Bogotá (SDS), sustituyó la facturación Fee For Service (presupuestación histórica) por un nuevo mecánismo de pago llamado "Pago Fijo Global Prospectivo por actividad final en salud", para financiar la atención de la población pobre no afiliada al Sistema de Seguridad Social en Salud. La SDS decidió contratar un estudio que tuviera como fin la disminución de la variabilidad de cada uno de los paquetes. Objetivos: redefinir unidades homogéneas para el sistema de pago por actividades finales a las Empresas Sociales del Estado adscritas a la Secretaría Distrital de Salud de Bogotá, de tal forma que se disminuya la variabilidad en los paquetes de servicios. Metodología:se utilizó la información de facturación que los hospitales enviaron a la SDS en el período comprendido entre mayo de 1999 y junio de 2000, el procedimiento principal de atención y el nivel del hospital; con esta información se desarrollaron los procesos estadísticos y el ajuste de modelos de regresión múltiple. Resultados: Se buscó aumentar la homogeneidad de los paquetes evaluando la influencia de los valores extremos (Outliers) y discriminando los paquetes con base en las variables relacionadas anteriormente. Al obtener una disminución importante de la variabilidad al separarse las actividades finales en valores Outliers y valores normales, se estructuró un pago diferencial para los primeros y se definieron las nuevas tarifas para los segundos, disminuyendo el riesgo financiero de los hospitales para el conjunto de las actividades finales. Conclusión: esta forma de pago estimula en los prestadores el control de costos y la eficiencia en la prestación de los servicios, lo cual es fundamental en un escenario de restricción de recursos financieros y costos ascendentes en el sector de la salud.

Background: a At the end of 1999, the District Health Secretariat of Bogota (SDS) replaced Fee For Service billing (historical budgeting) with a new payment mechanism called "Prospective Global Fixed Payment for final health activity" to finance the care of the poor population not affiliated with the Social Security Health System. The SDS decided to contract a study aimed at reducing the variability of each of the packages. Objectives: to redefine homogeneous units for the final activity-based payment system for the State Social Enterprises attached to the District Health Secretariat of Bogota, in order to reduce variability in the service packages. Methodology: We used the billing information that the hospitals sent to the SDS between May 1999 and June 2000, the main procedure of care and the hospital level; with this information we developed the statistical processes and the adjustment of multiple regression models. Results: We sought to increase the homogeneity of the packages by evaluating the influence of the extreme values (outliers) and discriminating the packages based on the variables listed above. By obtaining a significant decrease in variability when separating the final activities into Outliers and normal values, a differential payment was structured for the former and new rates were defined for the latter, reducing the hospitals' financial risk for the final activities as a whole. Conclusion: this form of payment stimulates providers to control costs and efficiency in the provision of services, which is essential in a scenario of financial resources restriction and rising costs in the health sector.