Desarrollo e implementación de una herramienta para la validación de cuentas médicas y gestión de glosas en el sector salud en Colombia / Development and implementation of a validation tool for medical bills and disallowance management in the health sector in Colombia / Desenvolvimento e implementação de uma ferramenta para a validação de contas médicas e gestão de glosas no setor saúde na Colômbia

Objetivo: la investigación pretende validar una herramienta de auditoría para la validación de cuentas médicas y la gestión de glosas en los procesos de auditoría con el fin de evaluar, controlar y mejorar los estándares de calidad y gestión en las instituciones de salud. Metodología: se optó por un estudio de corte exploratorio mixto. La investigación se realizó en tres fases: primero, se identificaron las principales causas por la que las EPS glosan las facturas a las IPS; posteriormente, se diseñó una herramienta que permite la auditoría interna de las facturas, previo envío a las EPS y la gestión de las glosas recibidas y; finalmente, se sometió la herramienta a validación por medio de un panel de expertos. Resultados: se diseñó una herramienta incorporando criterios de validación de facturas para los conceptos de tarifas y soportes, se incorporaron seis módulos que permiten parametrizar contratos EPS ­ IPS, registrar facturas, auditar soportes y tarifas, cargar facturas de forma masiva, gestionar glosas y generar indicadores y soportes del proceso de gestión. La herramienta fue validada con un panel de expertos, conformado por cinco miembros, quienes valoraron la usabilidad, claridad, facilidad y factibilidad de aplicación de la herramienta en el sector salud. Conclusiones: la investigación propone una herramienta constituida por diferentes módulos de acuerdo con el proceso y se valoraron criterios de claridad, cumplimiento de normatividad y factibilidad de aplicación en las IPS del país. El panel de expertos coincidió en la importancia del desarrollo de estas herramientas que entregan información de cumplimiento normativo y de la gestión hospitalaria ya que benefician la toma de decisiones acertada y oportuna en la gestión de glosas y los procesos de recuperación de cartera en las IPS.

Objective: This study aims to validate an audit tool for medical accounts and the management of disallowances in the audit processes to assess, control, and improve quality standards and management in the hospitals. Methodology: A mixed, exploratory study was conducted. Research was carried out in three phases: first, we identified the main causes for which the EPS deny the medical bills to the IPS; subsequently, a tool was designed to internally audit invoices before sending them to the EPS and the management of the disallowances received; lastly, the tool was submitted to validation by a panel of experts. Results: A tool was designed that incorporates the validation of rates and supports. Six modules were incorporated to parameterize EPS - IPS contracts, register invoices, validate accounting supports and rates, batch invoicing, manage disallowances and generate indicators and accounting supports of the management process. The tool was validated by 5-member panel of experts who evaluated the usability, clarity, ease, and viability of the application of the tool in the health sector. Conclusions: This study proposes a tool made up of different modules based on the process and the criteria assessed included clarity, regulation compliance, and feasibility of application in the IPS offices around the country. The panel of experts agreed on the importance of the development of tools that provide information on regulation compliance and hospital management, as they benefit correct and opportune decision-making in the management of disallowances and portfolio recovery processes in the hospitals.

Objetivo: a investigação pretende validar una ferramenta de auditoria para a validação de contas médicas e a gestão de glosas nos processos de auditoria com o fim de avaliar, controlar e melhorar os padrões de qualidade e gestão nas instituições de saúde. Metodologia: se optou por um estudo de corte exploratório misto. A investigação se realizou em três fases: primeiro, se identificaram as principais causas pela que as EPS glosam as faturas às IPS; posteriormente, se desenhou uma ferramenta que permite a auditoria interna das faturas, prévio envio às EPS e a gestão das glosas recebidas e; finalmente, se submeteu a ferramenta a validação por meio de um painel de especialistas. Resultados: se desenhou uma ferramenta incorporando critérios de validação de faturas para os conceitos de tarifas e suportes, se incorporaram seis módulos que permitem parametrizar contratos EPS ­ IPS, registrar faturas, auditar suportes e tarifas, carregar faturas de forma massiva, gerir glosas e gerar indicadores e suportes do processo de gestão. A ferramenta foi validada com um painel de especialistas, conformado por cinco membros, quem valoraram a usabilidade, claridade, facilidade e factibilidade de aplicação da ferramenta no setor saúde. Conclusões: a investigação propõe uma ferramenta constituída por diferentes módulos de acordo com o processo e se valorizaram critérios de claridade, cumprimento de normatividade e factibilidade de aplicação nas IPS do país. O painel de especialistas coincidiu na importância do desenvolvimento destas ferramentas que entregam informação de cumprimento normativo e da gestão hospitalar já que beneficiam a toma de decisões acertada e oportuna na gestão de glosas e os processos de recuperação de carteira nas IPS.

Herramienta de evaluación de tecnologías para la adquisición de equipos biomédicos / Health technology assessment tools for biomedical equipment acquisition / Ferramenta de avaliação de tecnologias para a aquisição de equipamentos biomédicos

La Evaluación de Tecnologías en Salud es una práctica que permite a las Instituciones de Salud valorar de forma integral las consecuencias del uso de una tecnología, sin embargo, la falta de estandarización y de metodologías que guíen el proceso sigue siendo un reto por superar. Este trabajo presenta el desarrollo y la validación de una herramienta de Evaluación de Tecnologías en Salud la cual se realizó en tres fases: primero se desarrolló la herramienta que permite valorar el proceso de adquisición de equipos biomédicos, después se conformó un grupo de discusión para obtener diferentes percepciones frente a la metodología empleada, el diseño y desarrollo de la herramienta para finalmente implementarla mediante casos de estudio evaluando su uso real y aplicando una encuesta que permitió valorar su utilidad en los procesos de adquisición de equipos biomédicos. Se ponderó la importancia de cada tipo de evaluación de tecnologías seleccionada y se desarrollaron los módulos para las evaluaciones técnica, clínica, económica y ética, social y organizacional. Por su parte, la validación con expertos demostró la utilidad de la herramienta en los procesos de selección y adquisición de equipos biomédicos de manera que se disminuyan costos y se realicen mejores inversiones.

Health Technologies Assessment is a practice that enablesthe evaluation of the consequences of the use of a technology. However, the lack of standardization and methodologies that guide the process remains a challenge. This paper presents the development and validation of a Health Technology Assessment tool which process was carried out in three phases. First, the tool was developed to assess the acquisition process of medical equipment, after which a discussion group was formed to obtain different perceptions regarding the tool. Finally,was the implementation through case studies, evaluating its real use and applying an evaluation survey to measure its usefulness in the processes of acquisition of medical equipment. The importance of each type of technology assessment was weighed and modules for technical, clinical, economic, ethical, social and organizational evaluation were developed. In addition, validation with experts demonstrated the usefulness of the tool in the selection and acquisition processes of medical equipment in a way that will reduce costs and enable better investments.

A Avaliação de Tecnologias em Saúde é uma prática que permite às Instituições de Saúde valorizar de forma integral as consequências do uso de uma tecnologia, no entanto, a falta de estandardização e de metodologias que guiem o processo segue sendo um desafio por superar. Este trabalho apresenta o desenvolvimento e a validação de uma ferramenta de Avaliação de Tecnologias em Saúde a qual se realizou em três fases: primeiro desenvolveu-se a ferramenta que permite valorizar o processo de aquisição de equipamentos biomédicos, depois se conformou um grupo de discussão para obter diferentes percepções em frente à metodologia empregada, o desenho e desenvolvimento da ferramenta para finalmente implementá-la mediante casos de estudo avaliando seu uso real e aplicando uma pesquisa que permitiu valorizar sua utilidade nos processos de aquisição de equipamentos biomédicos. Ponderou-se a importância de cada tipo de avaliação de tecnologias selecionadas e desenvolveram-se os módulos para as avaliações técnica, clínica, económica, ética, social e organizacional. Por sua vez, a validação com experientes demonstrou a utilidade da ferramenta nos processos de seleção e aquisição de equipamentos biomédicos de maneira que se diminuam custos e se realizem melhores investimentos.

Gestión de equipos médicos: implementación y validación de una herramienta de auditoría / Health technology management: implementation and validation of an audit tool

Resumen: La auditoría en salud es un proceso dinámico y en continuo avance que permite evaluar y controlar estándares de calidad en las instituciones de salud, sin embargo, la falta de estandarización y confiabilidad de resultados sigue siendo un reto por superar. Este trabajo presenta la validación de un prototipo de herramienta de auditoría para la gestión de equipos médicos la cual se realizó en dos fases: primero durante la implementación en tres hospitales del Área Metropolitana del Valle de Aburra, en Antioquia, Colombia, y posteriormente a través del análisis estadístico del juicio de expertos. Los hallazgos permitieron generar acciones de mejora con base en los informes de fortalezas y debilidades puntuales. Por su parte las mediciones de coeficientes de confiabilidad (Cronbach α= 0.90) y correlación de expertos (Spearman =0.88) indicaron resultados favorables para la herramienta. Además, la medición de promedios, desviaciones estándar y coeficientes de variación para cada ítem de la validación, expuso las mejoras que requiere la herramienta para una versión futura. La propuesta de la herramienta se limita a la regulación en salud Colombiana sin embargo no se aleja del marco normativo internacional, por lo que se considera es un paso relevante importante para convertir las auditorias en salud en procesos estandarizados. Puede concluirse que integrar al ingeniero biomédico en actividades de auditoría de calidad en salud con herramientas confiables ofrece un beneficio importante para la toma de decisiones oportuna en la gestión de los equipos médicos.

Abstract: Audit in health is a dynamic process and continuous advancement that permits to asses monitor and improve quality standards in healthcare institutions; however, the lack of standardization and reliability of results remains a challenge to be overcome. This study presents the validation of a prototype of an audit tool to the management of medical equipment which took place in two phases: first during the implementation in three hospitals in the metropolitan area of Antioquia, Colombia, and subsequently through the statistical analysis of the trial of twelve selected experts. As results audit reports were generated with strengths and weaknesses points, which enabled us to build improvement measures suitable for hospitals. Measurements of coefficients of reliability (Cronbach α= 0.90) and correlation of experts (Spearman =0.88) indicated favorable results for the tool. In addition, the measurement of mean, standard deviations and coefficients of variation for each item of the validation set out the improvements required by the tool for a future version. This tool is limited to the health regulation in Colombia; nevertheless, the tool is an important step to find and transform the health audits in standardized process that can have an objective assessment. To can be concluded to integrate the biomedical engineer in the activities of audit quality on health with reliable tools offers an important benefit for accurate decision making and timely management of the medical equipment.

Homocysteine inhibits the proliferation and invasive potential of HT-1080 human fibrosarcoma cells.

The impairment of homocysteine metabolism has been related to several disorders and diseases. Recently, homocysteine has been shown to inhibit key steps of angiogenesis, including endothelial cell proliferation, invasion, and remodeling of the extracellular matrix. Since these are also key steps in tumor invasion and metastasis, it can be hypothesized that homocysteine can also interfere in these processes. Therefore, we studied the effects of homocysteine on tumor proliferation and invasion, as well as on urokinase, a key extracellular matrix-degrading protease, using a model human tumor cell line. This study demonstrates that, in fact, homocysteine inhibits HT-1080 proliferation and invasion, and is a potent inhibitor of tumor cell urokinase expression.

Histamine prevents polyamine accumulation in mouse C57.1 mast cell cultures.

The effects of histamine on polyamine uptake and metabolism was studied in a mouse mast cell line (C57.1), as a cell model in which both biogenic amines are important for maintaining cell function and viability. Results obtained after incubations with exogenous histamine indicated that histamine prevents polyamine accumulation by affecting polyamine uptake. A plasma membrane transport system for polyamines has been also studied in mast cells. It seems to be a Na(+)-dependent uptake with high affinity for both spermine and spermidine and lower affinity for putrescine and agmatine. Polyamine uptake was reduced in both cells treated with exogenous histamine and histamine-preloaded cells. However, ornithine decarboxylase activity and cell proliferation were not affected by histamine. Incubation with histamine enhanced the spermidine/spermine acetyl transferase induction caused by N(1)-ethyl-N(11)-[(cyclopropyl)methyl]-4,8-diazaundecane, suggesting that polyamine acetylation could be another mechanism by which histamine prevents polyamine accumulation in C57.1 mast cells.

Essential function of Wnt-4 in mammary gland development downstream of progesterone signaling.

Female reproductive hormones control mammary gland morphogenesis. In the absence of the progesterone receptor (PR) from the mammary epithelium, ductal side-branching fails to occur. We can overcome this defect by ectopic expression of the protooncogene Wnt-1. Transplantation of mammary epithelia from Wnt-4(-)/(-) mice shows that Wnt-4 has an essential role in side-branching early in pregnancy. PR and Wnt-4 mRNAs colocalize to the luminal compartment of the ductal epithelium. Progesterone induces Wnt-4 in mammary epithelial cells and is required for increased Wnt-4 expression during pregnancy. Thus, Wnt signaling is essential in mediating progesterone function during mammary gland morphogenesis.

Prolactin controls mammary gland development via direct and indirect mechanisms.

The inactivation of the prolactin receptor gene by homologous recombination has made it possible to investigate the role of prolactin signaling in mammary gland development without resort to ablative surgery of the endocrine glands. In knockout mice lacking the prolactin receptor, mammary development is normal up to puberty. Subsequently, the ducts branch less frequently than those of wild-type animals. While terminal end buds differentiate to alveolar buds in wild-type females by the end of puberty, in knockout females terminal end bud-like structures persist at the ductal ends. To distinguish between the developmental defects that are intrinsic to the epithelium and those that result from systemic endocrine alterations in prolactin receptor knockout mice, mammary epithelium from prolactin receptor knockouts was transplanted into mammary fat pads of wild-type mice. In virgin mice, the knockout epithelial transplants developed normally at puberty, indicating an indirect effect of prolactin on ductal development. Prolactin receptor knockout females are infertile due to multiple reproductive defects, but epithelial transplants allowed us to assess the extent to which the absence of prolactin receptor is limiting, under systemic conditions that allow full mammary gland development. During pregnancy, the prolactin receptor knockout transplants showed normal side branching and the formation of alveolar buds, but no lobuloalveolar development. Thus, prolactin affects mammary morphogenesis in two different ways: it controls ductal side branching and terminal end bud regression in virgin animals via indirect mechanisms, but acts directly on the mammary epithelium to produce lobuloalveolar development during pregnancy.

DNA-chlorpheniramine interaction studied by spectroscopic techniques.

It was previously studied that the antihistaminic chlorpheniramine elicits a biphasic response on cell growth and regulates polyamine metabolism, as described for polyamines. In part, polyamine effects on macromolecular synthesis and cell growth are attributed to nucleic acid:polyamine interactions. In this work, we have tested the hypothesis of a DNA:chlorpheniramine interaction, using fluorometry, FTIR and Raman spectroscopic techniques. The results indicate that DNA:chlorpheniramine interaction occurs inducing conformational changes in the macromolecule by affecting both phosphodiester bonds and bases. Results open new perspectives for characterization of action mechanisms of natural or synthetic diamines with pharmacological or physiological importance.