Indicadores estratégicos em saúde pública / Strategic indicators in public health

O Relatório anual da Organização Mundial de Saúde (OMS) teve como foco, no ano de 2000, a discussão de modelos de análise de sistemas de saúde ao redor do mundo. O documento propõe que todo sistema de saúde deve ter como objetivo fundamental a promoção da melhoria da saúde das pessoas, mas ao mesmo tempo ser justo nos gastos orçamentários e responsivo às demandas da população (WHO, 2020). Para atingir estes objetivos, torna-se crucial o conceito de performance, ou seja, como executar essas ações com os recursos disponíveis com o máximo desempenho, também entendido como eficiência, ou seja, a relação entre o produto da intervenção de saúde e os recursos utilizados (ALBUQUERQUE et al, 2017).

The Annual Report of the World Health Organization (WHO) focused, in 2000, on the discussion of models of analysis of health systems around the world. The document proposes that every health system should have as its fundamental objective the promotion of improving people's health, but at the same time be fair in budget expenditures and responsive to the demands of the population (WHO, 2020). To achieve these objectives, the concept of performance becomes crucial, that is, how to perform these actions with the available resources with maximum performance, also understood as efficiency, that is, the relationship between the product of the health intervention and the resources used (ALBUQUERQUE et al, 2017)

30 years of data: impact of the United States in vitro fertilization data registry on advancing fertility care.

OBJECTIVE: To summarize and assess the impact of key research generated through the Society of Assisted Reproductive Technology (SART)-initiated United States IVF registry and annual reporting system. DESIGN: Review. SETTING: Eligible studies included those that analyzed data generated by the National IVF data collection program (through SART or Centers for Disease Control and Prevention). PATIENT(S): Not applicable. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Summarize and report outcomes of research using National IVF registry data. RESULT(S): The Society of Assisted Reproductive Technology was founded in 1985 and published the first annual US IVF data report 30 years ago in 1988 in Fertility and Sterility. In 1995, the Centers for Disease Control and Prevention subsequently began collecting data from IVF programs and published their first report in 1997. This annual National IVF data collection and reporting is a significant responsibility and effort for IVF programs. Using these data sources, 199 articles have been published by clinicians and researchers from across the country. This research has guided the development of evidence-based assisted reproductive technology (ART) practice guidelines during the past 30 years, which have ultimately led to improved quality and patient care. CONCLUSION(S): Since the first SART National IVF data report publication 30 years ago, SART has achieved its original goals of creating a national IVF registry that successfully assesses clinical effectiveness, quality of care, and safety.

Érase una vez la calidad (I): de Babilonia a Chicago / No disponible

No disponible

Electronic multidimensional health assessment questionnaire (eMDHAQ): past, present and future of a proposed single data management system for clinical care, research, quality improvement, and monitoring of long-term outcomes.

An MDHAQ/RAPID3 (multidimensional health assessment questionnaire/routine assessment of patient index data) was developed from the HAQ over 25 years, based on observations made from completion by every patient (with all diagnoses) at every routine rheumatology visit since 1980. Modification of the HAQ was viewed as similar to improving a laboratory test, with a primary focus on clinical value for diagnosis, prognosis, and/or management, as well as feasibility for minimal effect on clinical workflow. Rigorous attention, was also directed to validity, reliability, other methodologic and technological considerations, but after clinical value and feasibility were established. A longer "intake" MDHAQ was introduced for new patients to record a complete past medical history - illnesses, hospitalisations, surgeries, allergies, family history, social history and medications. MDHAQ scales not found on the HAQ record complex activities, sleep quality, anxiety, depression, self-report joint count, fatigue, symptom checklist, morning stiffness, exercise status, recent medical history, social history and demographic data within 2 pages on one sheet of paper. An electronic eMDHAQ/RAPID3 provides a similar platform to pool data from multiple sites. A patient may be offered a patient-administered, password-protected, secure, web site, to store the medical history completed on the eMDHAQ. This eMDHAQ would allow a patient to complete a single general medical history questionnaire rather than different intake questionnaires in different medical settings. The eMDHAQ would be available for updates and correction by the patient for future visits, regardless of electronic medical record (EMR). The eMDHAQ is designed to interface with an EMR using HL7 (health level seven) and SMART (Substitutable Medical Apps, Reusable Technology) on FHIR (Fast Healthcare Interoperability Resources), although implementation requires collaboration with the EMR vendor. Advanced features include reports for the physician formatted as a medical record note of past medical history for entry into any EMR without typing or dictation, and a periodic "tickler" function to monitor long-term outcomes with minimal effort of the physician and staff. Nonetheless, clinical use of an eMDHAQ should be guided primarily not by the latest technology, but by value and feasibility in clinical care, the same principles that guided development of the pencil-and-paper MDHAQ/RAPID3.

Quality measurement in the emergency department: past and future.

As the United States seeks to improve the value of health care, there is an urgent need to develop quality measurement for emergency departments (EDs). EDs provide 130 million patient visits per year and are involved in half of all hospital admissions. Efforts to measure ED quality are in their infancy, focusing on a small set of conditions and timeliness measures, such as waiting times and length-of-stay. We review the history of ED quality measurement, identify policy levers for implementing performance measures, and propose a measurement agenda. Initial priorities include measures of effective care for serious conditions that are commonly seen in EDs, such as trauma; measures of efficient use of resources, such as high-cost imaging and hospital admission; and measures of diagnostic accuracy. More research is needed to support the development of measures of care coordination and regionalization and the episode cost of ED care. Policy makers can advance quality improvement in ED care by asking ED researchers and organizations to accelerate the development of quality measures of ED care and incorporating the measures into programs that publicly report on quality of care and incentive-based payment systems.

La calidad de los medicamentos fabricados industrialmente en España entre 1850 y 1950. Revisión de los requerimientos de calidad establecidos para los medicamentos en la legislación oficial durante este período / No disponible

Objetivo: Estudiar la evolución de los requerimientos de calidad establecidos en los expedientes de solicitud de autorización de los medicamentos fabricados industrialmente desde 1850 a 1950 y su relación con la calidad de los mismos, teniendo en cuenta la influencia del contexto político-social. Material y métodos: Análisis de la legislación publicada en España referente al Registro Farmacéutico desde 1850 hasta 1950, comparando las referencias a la calidad de cada documento con las de la legislación inmediatamente anterior destacando lo que representa un avance. Consulta de revistas y documentos no publicados. Discusión de la evolución de la calidad de los medicamentos relacionándola con el contexto político-social del país. Resultados y conclusiones: Hasta 1855 no se podía hablar de medicamentos sino de remedios secretos. La Ley de 28 de Noviembre de 1855 estableció la obligación de declarar los remedios a la Autoridad Sanitaria. Posteriormente el Real Decreto de 1919 estableció el Registro Farmacéutico y la asignación del nº de registro. El Real Decreto de 1924 lo actualizaba sin avanzar en la calidad. Siguió un estancamiento tanto en normativa como en calidad, debido a la guerra civil y al bloqueo internacional. La Ley de Bases de 1944 anunciaba una reforma que aún tardó en producirse. En resumen período largo y cambiante con bastantes avances en organización y pocos en exigencias de calidad. Los expedientes de registro son un elemento de referencia fundamental para conocer la calidad de un medicamento en un momento determinado(AU)

Objectives: The aim is to study the evolution of quality requirements in the application file for approval of drug products and their relationship with the quality of industrially manufactured drugs between 1850 and 1950, taking into account the influence of political and social context. Materials and methods: Analysis of the legislation published in Spain referring to pharmaceutical registration from 1850 to 1950, comparing the quality benchmarks to highlight the improvement. Search of information in journals and unpublished documents. Discussion on quality progress related to the socio-political context of the country. Results and conclusions: Until 1855 drugs did not exist as such, there were only secret remedies. The Law of November 28, 1855 established the obligation to declare the remedies to the Health Authority. Since then there was an evolution until the Royal Decree of 1919 established the official register of medicines and assigned a registration number to each medicine. The Royal Decree of 1924 updated the 1919 Decree but no advance was done referring to quality. Then a period of stagnation followed in both the rules of registration and the quality due to the civil war and the international blockade. A Law Reform was announced in 1944 but it took a long time to be done. Summarizing: It was a long period, with advances in organization and little progress in quality requirements in the pharmaceutical registration. When quality requirements increased, drug quality also did. Application files for registration are an essential reference to know the quality at some time(AU)

'Good in all respects': appearance and dress at Staffordshire County Lunatic Asylum, 1818-54.

Dress was integral to the ideals and practice of Staffordshire County Lunatic Asylum, an institution catering for all social classes. Lunatics' appearance was used to gauge the standard of care inside the asylum and beyond. Clothing was essential for moral treatment and physical health. It helped to denote social and institutional class: clothes were integral to paupers' admission; rich patients spent time and money dressing; for disturbed inmates and those who destroyed asylum attire, the consequence could be'secure dress', which was fundamental to therapeutics. Later, when an ethos of non-restraint was introduced, the superintendent used patients' appearance to propagate an image of his enlightened care.

Propuesta de un Formato para la Evaluación de la Calidad Técnica de la Historia Clínica / Proposal of a Format for the Evaluation of the Clinical History's Technical Quality

La historia clínica es un documento privado de valor legal, científico e investigativo. Actualmente con las reformas instauradas en el campo de la salud en nuestro país se convierte en el medio más importante para analizar la calidad técnica y humana del personal de salud, por lo que la veracidad de la información consignada va a dar validez a la evaluación que se haga de los servicios de salud. Un formulario ágil y sencillo para evaluar la calidad de la historia clínica se hace necesario para medir de manera objetiva la eficiencia y eficacia de la institución prestdora de servicios; es por ello que en el presente artículo presentamos un formato para la evaluación de la calidad técnica de la historia clínica, basándonos en los registros diligenciados en la Fundación Oftalmológica de Santander de la Clínica Carlos Ardila Lulle