Problem list completeness in electronic health records: A multi-site study and assessment of success factors.

OBJECTIVE: To assess problem list completeness using an objective measure across a range of sites, and to identify success factors for problem list completeness. METHODS: We conducted a retrospective analysis of electronic health record data and interviews at ten healthcare organizations within the United States, United Kingdom, and Argentina who use a variety of electronic health record systems: four self-developed and six commercial. At each site, we assessed the proportion of patients who have diabetes recorded on their problem list out of all patients with a hemoglobin A1c elevation>=7.0%, which is diagnostic of diabetes. We then conducted interviews with informatics leaders at the four highest performing sites to determine factors associated with success. Finally, we surveyed all the sites about common practices implemented at the top performing sites to determine whether there was an association between problem list management practices and problem list completeness. RESULTS: Problem list completeness across the ten sites ranged from 60.2% to 99.4%, with a mean of 78.2%. Financial incentives, problem-oriented charting, gap reporting, shared responsibility, links to billing codes, and organizational culture were identified as success factors at the four hospitals with problem list completeness at or near 90.0%. DISCUSSION: Incomplete problem lists represent a global data integrity problem that could compromise quality of care and put patients at risk. There was a wide range of problem list completeness across the healthcare facilities. Nevertheless, some facilities have achieved high levels of problem list completeness, and it is important to better understand the factors that contribute to success to improve patient safety. CONCLUSION: Problem list completeness varies substantially across healthcare facilities. In our review of EHR systems at ten healthcare facilities, we identified six success factors which may be useful for healthcare organizations seeking to improve the quality of their problem list documentation: financial incentives, problem oriented charting, gap reporting, shared responsibility, links to billing codes, and organizational culture.

Assessment of completion of forms requesting skin biopsies.

BACKGROUND: Information contained in request forms for histopathological examinations is essential for interpreting tissue changes observed in microscopy. OBJECTIVE: To determine the adequacy of information provided on forms requesting skin biopsies. METHOD: Assessment, in two health institutions, of 647 forms requesting skin biopsies in order to determine the completeness on the forms of the clinical details/items considered necessary for undertaking skin biopsies. RESULTS: Of the total 18 items on the forms, 7 were found to relay complete information in under 10% of the forms and only 9 items were correctly completed in over 80% of the requests. CONCLUSION: We concluded that information on many of the essential items required for a correct interpretation of the anatomopathologic examination was missing from the request forms.

Assessment of completion of forms requesting skin biopsies / Avaliação do preenchimento de solicitações de biópsias da pele

BACKGROUND: Information contained in request forms for histopathological examinations is essential for interpreting tissue changes observed in microscopy. OBJECTIVE: To determine the adequacy of information provided on forms requesting skin biopsies. METHOD: Assessment, in two health institutions, of 647 forms requesting skin biopsies in order to determine the completeness on the forms of the clinical details/items considered necessary for undertaking skin biopsies. RESULTS: Of the total 18 items on the forms, 7 were found to relay complete information in under 10% of the forms and only 9 items were correctly completed in over 80% of the requests. CONCLUSION: We concluded that information on many of the essential items required for a correct interpretation of the anatomopathologic examination was missing from the request forms.

FUNDAMENTOS: As informações contidas nas requisições de exames histopatológicos são fundamentais para a interpretação das alterações teciduais observadas na microscopia. OBJETIVO: Verificar a frequência do preenchimento de itens de requisições de biópsias da pele. MÉTODO: Avaliação do preenchimento de 647 solicitações de biópsias de pele, em duas instituições de saúde, em relação aos itens considerados necessários. RESULTADOS: De um total de 18 itens avaliados, 7 foram preenchidos em menos de 10% das requisições e 9 foram preenchidos corretamente em mais de 80% das requisições. CONCLUSÃO: Verificou-se uma insuficiência do preenchimento de itens fundamentais para uma interpretação adequada do exame anatomopatológico.

[Colombian death certificate quality, 2002-2006]. / La calidad de certificación de la mortalidad en Colombia, 2002-2006.

OBJECTIVE: Mortality study is useful for the estimation of cancer incident cases; but a quality assessment of the mortality information is required previous to the process of cancer incidence estimation. The aim of this study is to evaluate the quality of death-certification in Colombia. MATERIALS AND METHODS: Overall quality of death certification and quality of cancer mortality certification was analyzed for the period 2002-2006. Classic validity indexes were described through simple percentages for each district and four cities, where operating population-based cancer registries: Bucaramanga, Cali, Manizales, and Pasto. A principal component analysis was performed in order to identify relationships that might not be evident in the descriptive analysis. RESULTS: 952 104 registries were analyzed, 150 163 corresponding to cancer deaths. A high quality index was observed for overall death certification, with 92.8 % of the overall mortality properly certified. Most errors were due to ill defined causes of death. A high quality index was also observed for cancer death registration with 91.5 % of the cancer deaths properly certified. Ill-defined, secondary and unspecified cancer sites certification prevailed as the most frequent causes of error. CONCLUSION: Colombia has high quality standards for overall death and cancer death certification. Mortality data can be used confidently in the cancer incidence estimation process, without requirements for any specific corrections.

La calidad de certificación de la mortalidad en Colombia, 2002-2006 / Colombian death certificate quality, 2002-2006

Objetivo El estudio de la mortalidad resulta útil en la estimación de casos incidentes de cáncer; sin embargo se requiere evaluar la calidad de la certificación de la mortalidad antes de proceder a hacer las estimaciones de incidencia. El objetivo de este estudio es evaluar la calidad de la certificación de la mortalidad en Colombia. Materiales y métodos Se analizó la calidad de la certificación de la mortalidad general y por cáncer en Colombia en el quinquenio 2002-2006. Se describieron indicadores clásicos de validez por medio de porcentajes simples para cada Departamento y además para cuatro áreas en donde operan registros poblacionales de cáncer (el área metropolitana de Bucaramanga y las ciudades de Cali, Manizales y Pasto). Se realizó un análisis de componentes principales con el fin de identificar relaciones no evidentes en el análisis descriptivo. Resultados Se analizaron 952 104 registros de defunción dentro de los cuales había 150 163 muertes por cáncer. El 92,8 por ciento de la mortalidad general estaba bien certificada. Predominaron los errores debidos al mal diligenciamiento. El 91,5 por ciento de la mortalidad por cáncer estaba bien certificada. Predominaron los errores debidos a la mala definición de la localización del tumor primario como causa de defunción. Conclusión La calidad de la certificación de la mortalidad general y por cáncer en Colombia es buena y ante la baja magnitud de problemas en la certificación, se puede emplear los datos de mortalidad en las estimaciones de incidencia de cáncer, sin aplicar más correcciones que las que se hacen de manera estándar.

Objective Mortality study is useful for the estimation of cancer incident cases; but a quality assessment of the mortality information is required previous to the process of cancer incidence estimation. The aim of this study is to evaluate the quality of deathcertification in Colombia. Materials and methods Overall quality of death certification and quality of cancer mortality certification was analyzed for the period 2002-2006. Classic validity indexes were described through simple percentages for each district and four cities, where operating population-based cancer registries: Bucaramanga, Cali, Manizales, and Pasto. A principal component analysis was performed in order to identify relationships that might not be evident in the descriptive analysis. Results 952 104 registries were analyzed, 150 163 corresponding to cancer deaths. A high quality index was observed for overall death certification, with 92.8 percent of the overall mortality properly certified. Most errors were due to ill defined causes of death. A high quality index was also observed for cancer death registration with 91.5 percent of the cancer deaths properly certified. Ill-defined, secondary and unspecified cancer sites certification prevailed as the most frequent causes of error. Conclusion Colombia has high quality standards for overall death and cancer death certification. Mortality data can be used confidently in the cancer incidence estimation process, without requirements for any specific corrections.

Problemas no preenchimento da declaração de óbito: estudo exploratório / Problemas en la cumplimentación de la declaración de defunción (DO): estudio exploratorio / Problems filling out death certificates: exploratory study

Os dados do Sistema de Informação sobre Mortalidade (SIM) representam a principal fonte de informações sobre mortalidade no Brasil, embora apresentem com frequência alguma inconsistência. Uma dificuldade para a geração dos dados de mortalidade confiáveis é o correto preenchimento da Declaração de Óbito (DO), instrumento de alimentação de dados para o SIM. O artigo relata estudo exploratório sobre problemas de preenchimento da DO, utilizando abordagem semiqualitativa. A coleta dos dados foi realizada por meio de entrevistas semiestruturadas e questionários estruturados aplicados a médicos. Os resultados mostram que os principais problemas relacionados ao preenchimento da DO são o desconhecimento médico acerca da importância do correto preenchimento de todos os campos do formulário, a pouca utilização dos materiais de instrução fornecidos aos médicos pelos órgãos e instituições responsáveis, o desconhecimento sobre a importância do detalhamento e a adequação da cadeia de eventos patológicos no campo das possíveis causas de morte.

Los datos del Sistema de Información sobre Mortalidad (SIM) representan la principal fuente de información sobre mortalidad en Brasil, aunque presenten con frecuencia alguna inconsistencia. Una dificultad para la generación de datos de mortalidad fiables es la correcta cumplimentación de la Declaración de Defunción (DO), instrumento de alimentación de datos del SIM. El artículo versa sobre un estudio exploratorio acerca de problemas de cumplimentación de la DO, utilizando un enfoque semicualitativo. La recogida de datos fue realizada mediante entrevistas semiestructuradas y cuestionarios estructurados aplicados a médicos. Los resultados muestran que los principales problemas relacionados con la cumplimentación de la DO son el desconocimiento médico, acerca de la importancia de la correcta cumplimentación de todos los campos del formulario; la poca utilización de los materiales de instrucción proporcionados a los médicos por los órganos e instituciones responsables; el desconocimiento sobre la importancia de documentos detallados y la adecuación de la cadena de eventos patológicos en el campo de las posibles causas de muerte.

Data from the Brazilian Mortality Information System (SIM, in Portuguese) represent the main source of information on mortality in Brazil, even though the system contains many inconsistencies. One difficulty in generating reliable data on mortality is the correct filling out of death certificates (DOs), which are source instruments for the SIM system. This article describes an exploratory study on problems related to the filling out of DOs, using a semi-qualitative approach. The data was collected in semi-structured interviews and questionnaires with medical doctors. The results show that the main problems related to filling out DOs are lack of medical information regarding the importance of the correct filling out of all the fields on the form, the limited use of the instructions issued by responsible organs and institutions, and lack of knowledge as to the importance of certain details and descriptions of the chain of pathological events in the field of possible causes of death.

Duplicates and misclassification of tuberculosis notification records in Brazil, 2001-2007.

OBJECTIVE: To evaluate the change in tuberculosis (TB) notification rates due to the removal of unwanted duplicate records from the Brazilian notification system (2001-2007, data extracted in October 2008), and therefore extending the period of investigation of the previous study using the same methodology (2000-2004, data extracted in February 2006). METHODS: Repeat records were identified using a probabilistic record linkage, classified into six mutually exclusive categories, and then kept, combined or removed from the database. RESULTS: In the TB database, 22.7% of all records belonged to patients with multiple records. When we excluded the first record of every patient in this group, 43.7% were classified as transfers, 29% as returns after default, 16.3% as relapses and 6.6% as true duplicates, while 2.9% were inconclusive and 1.5% had missing data. Removal of unwanted duplicate records reduced the notification rates of new cases by 4% to 6.3%, and increased the proportion cured by 3.4% to 4.9%. DISCUSSION: Linkage of records within the TB notification database and the implementation of procedures to distinguish between new and retreatment or transfer-in records yielded better data. Recommendations are provided on how to prevent duplicates and misclassifications in national TB databases.

Guidelines for HER2 testing in breast cancer: a national consensus of the Spanish Society of Pathology (SEAP) and the Spanish Society of Medical Oncology (SEOM).

Identifying breast cancers with HER2 overexpression or amplification is critical as these usually imply the use of HER2-targeted therapies. DNA (amplification) and protein (overexpression) HER2 abnormalities usually occur simultaneously and both in situ hybridisation and immunohistochemistry may be accurate methods for the evaluation of these abnormalities. However, recent studies, including those conducted by the Association for Quality Assurance of the Spanish Society of Pathology, as well as the experience of a number of HER2 testing National Reference Centres have suggested the existence of serious reproducibility issues with both techniques. To address this issue, a joint committee from the Spanish Society of Pathology (SEAP) and the Spanish Society of Medical Oncology (SEOM) was established to review the HER2 testing guidelines. Consensus recommendations are based not only on the panellists' experience, but also on previous consensus guidelines from several countries, including the USA, the UK and Canada. These guidelines include the minimal requirements that pathology departments should fulfil in order to guarantee proper HER2 testing in breast cancer. Pathology laboratories not fulfilling these standards should make an effort to meet them and, until then, are highly encouraged to submit to reference laboratories breast cancer samples for which HER2 determination has clinical implications for the patients.

Hacia una revalorización asistencial y médico-legal de la historia clínica / Towards a welfare revaluation and legal medical of the clinical history

Cada día asistimos con asombro a una especie de "degradación" en la confección de la Historia Clínica médica no sólo en cuanto a la escritura de los profesionales médicos, sino también en referencia a los contenidos esenciales que son inherentes a la ciencia médica. La Historia Clínica en gran número de oportunidades no refleja el intelecto y razonamiento médico sobre la patología, sino que también es frecuentemente indescifrable para otros profesionales que tienen acceso. En el presente trabajo se reúnen los tópicos fundamentales para su confección como ser la veracidad, su clara redacción, los elementos que la integran, sus funciones y determinadas características en su confección de interés médico-legal.(AU)

Every day we represent amazedly since a species of "degradation" has taken place in the confection of the clinical medical history not only as for the writing of the medical professionals but also in reference to the essential contents and that are inherent in the medical science. The clinical history in great number of opportunities does not reflect the intellect and medical reasoning on the pathology but also it is frequently undecipherable for other professionals who have access. In the present work the fundamental topics meet for his confection as being the veracity, his clear draft, the elements that integrate it, his functions and certain characteristics in his confection of medical legal interest.(AU)

Hacia una revalorización asistencial y médico-legal de la historia clínica / Towards a welfare revaluation and legal medical of the clinical history

Cada día asistimos con asombro a una especie de "degradación" en la confección de la Historia Clínica médica no sólo en cuanto a la escritura de los profesionales médicos, sino también en referencia a los contenidos esenciales que son inherentes a la ciencia médica. La Historia Clínica en gran número de oportunidades no refleja el intelecto y razonamiento médico sobre la patología, sino que también es frecuentemente indescifrable para otros profesionales que tienen acceso. En el presente trabajo se reúnen los tópicos fundamentales para su confección como ser la veracidad, su clara redacción, los elementos que la integran, sus funciones y determinadas características en su confección de interés médico-legal.

Every day we represent amazedly since a species of "degradation" has taken place in the confection of the clinical medical history not only as for the writing of the medical professionals but also in reference to the essential contents and that are inherent in the medical science. The clinical history in great number of opportunities does not reflect the intellect and medical reasoning on the pathology but also it is frequently undecipherable for other professionals who have access. In the present work the fundamental topics meet for his confection as being the veracity, his clear draft, the elements that integrate it, his functions and certain characteristics in his confection of medical legal interest.

Norma para el manejo del expediente clínico: guía para el manejo del expediente clínico / Standard for the management of personal file guide for the management of medical records

El Ministerio de Salud presenta la Norma para el manejo del Expediente Clínico":"guía para el manejo del expediente clínico" donde se proporcionan las reglas que combinan varios pautas sobre el manejo del expediente clínico con la finalidad de ajustar y darle seguimiento al empleo correcto y adecuado del mismo; el cual continua siendo el principal documento médico legal para valorar calidad de la atención de un usuario en establecimiento de salud. Es el primer paso para ordenar la actvidad de los registros médicos y paramédicos, tratanbdo de evaluar las estructuras, archivo y normalización de los expedientes clínicos para conducir a la sistematización de nuestros registros y expedientes clínicos. En este documento también se proporciona información para la orgaización y funcionamiento del Sub-Comité de Análisis de Expedientes Clínicos. Es una herramienta inicial práctica y oficial, que coadyuvará a la estandarización del análisis y evaluación de los expedientes clìnicos en los hospitales públicos y privados del país. El producto final de ete documento es logar registros uniformes y evitar confunsiones en el manejo del expediente, lo cual elevará la calidad d ela atención al paciente y asegurará que la documentación clínica proporcione una información exacta, oportuna y confidencial...

Norma para el manejo del expediente clínico: guía para el manejo del expediente clínico

El Ministerio de Salud presenta la Norma para el manejo del Expediente Clínico":"guía para el manejo del expediente clínico" donde se proporcionan las reglas que combinan varios pautas sobre el manejo del expediente clínico con la finalidad de ajustar y darle seguimiento al empleo correcto y adecuado del mismo; el cual continua siendo el principal documento médico legal para valorar calidad de la atención de un usuario en establecimiento de salud. Es el primer paso para ordenar la actvidad de los registros médicos y paramédicos, tratanbdo de evaluar las estructuras, archivo y normalización de los expedientes clínicos para conducir a la sistematización de nuestros registros y expedientes clínicos. En este documento también se proporciona información para la orgaización y funcionamiento del Sub-Comité de Análisis de Expedientes Clínicos. Es una herramienta inicial práctica y oficial, que coadyuvará a la estandarización del análisis y evaluación de los expedientes clìnicos en los hospitales públicos y privados del país. El producto final de ete documento es logar registros uniformes y evitar confunsiones en el manejo del expediente, lo cual elevará la calidad d ela atención al paciente y asegurará que la documentación clínica proporcione una información exacta, oportuna y confidencial...

Los costos del trauma en el Hospital General del Oeste "Dr. José Gregorio Hernández" / Trauma costs the Hospital General del Oeste Dr. José Gregorio Hernández

Conocer las características y el costo del trauma en el Hospital General del Oeste "Dr. José Gregorio Hernández", Caracas-Venezuela. Estudio prospectivo y descriptivo de casos que ingresaron por trauma. Ingresaron, entre enero y junio del 2004, 251 pacientes, 90 por ciento masculinos y 88 por ciento menores de 40 años. El principal mecanismo de lesión fue el arma de fuego, afectando principalmente extremidades y abdomen. Treinta y dos por ciento de los casos ameritó intervención quirúrgica, siendo la laparotomía exploradora la más frecuente, y la más costosa la exploración vascular. El promedio de hospitalización fue de 6,8 días con un costo de Bs. 222.653,89 - BF 222,66-por día y Bs. 2.377.135, -237,14 BF- promedio por caso (US$ 1.238,09). El trauma afecta con más frecuencia a la población masculina en edad productiva, prevaleciendo el penetrante sobre el cerrado, involucrando en orden de frecuencia las extremidades, el abdomen, el tórax, la cabeza y el cuello. La laparotomía exploradora fue la intervención más frecuente, siendo la más costosa la exploración vascular, seguida de la toracotomía y la laparotomía. El costo mínimo fue de Bs. 2.377.135 o 237,14 BF (US$ 1.238), hallándose la mayor inversión en el área de hospitalización, seguida por área quirúrgica y emergencias.

[Quality of death statistics by unknown causes in Brazilian states]. / Qualidade das estatísticas de óbitos por causas desconhecidas dos Estados brasileiros.

OBJECTIVE: To evaluate the quality of reported adult deaths by unknown causes and to explore their relationships with some indicators. METHOD: There were evaluated adult deaths by unknown causes for all Brazilian federal units from 1990 to 2000. Criteria were established to categorize the overall proportion of deaths by quality into four groups. The age patterns of ill-defined causes were represented by typical states and correlation coefficients between these causes and other indicators were estimated, such as external causes and urbanization level. RESULTS: "Good" quality data was found in the South-Southeast regions and "fair" quality in the North-Northeast regions. Improvement on reported deaths was seen in half of the states, especially for women. The proportion of ill-defined deaths increased with age and a strong association with death coverage, urbanization level and external causes was verified. CONCLUSIONS: Although lowered quality of reported deaths by basic causes was seen in several Brazilian states, the overall quality can be considered at least as satisfactory. This means the explanatory power of death statistics by defined causes can be recovered.

Avaliação do instrumento de registro na sala de recuperação anestésica por alunos de graduação em enfermagem / Valuation of the register instrument in the Anesthetic Recovery room by nursing graduate students

Realizamos uma pesquisa com o objetivo de verificar a opinião dos alunos do quarto semestre de graduação em enfermagem quanto à adequação de um instrumento proposto para o registro das ações do enfermeiro na sala de Recuperação Anestésica, baseado no Sistema de assistência de Enfermagem Perioperatória (SAEP). No total, 77 acadêmicos participaram do estudo, no qual utilizamos o método eploratório-descritivo simples para a análise quantitativa dos dados em uma instituição de saúde privada do município de campinas....

Quality management systems and the admissibility of scientific evidence: the Costa Rican experience.

Certainty and truth are, by definition, objectives of science. There is a tendency among people to believe that anything produced by a scientist is science and is therefore certain. On the contrary, scientific findings are not free of error. In fact, science evolves, among other things, by questioning and verifying the ideas and theories that are held to be scientifically valid and by continuously searching for new knowledge. As judicial systems in several countries have evolved over time, they have established minimum criteria for the admissibility of scientific evidence in order to ensure accuracy as far as possible. Forensic laboratories in countries with such requirements have established quality systems as a tool for verifying the standards of the scientific information they provide to courts as evidence. The International Standard ISO/IEC 17025 has been chosen in testing laboratories, including forensic laboratories, to provide uniform technical criteria for developing a quality management system. There is agreement between the ISO standard and admissibility requirements for courts. Therefore, the application of international quality standards to forensic laboratories is of interest to, and must be understood by, not only scientists but also judicial authorities. The present article describes the Costa Rican experience.

Um modelo de autorização e controle de acesso para o prontuário eletrônico de pacientes em ambientes abertos e distribuídos / An authorization and access control model for electronic patient record in open distributed environments

Conceber modelos para autorização e controle de de acesso para prontuário eletrônico do paciente (PEP) é indispensável para viabilizar o uso em larga escala do PEP em grandes instituições de saúde. Este trabalho propõe um modelo de autorização adequado às exigências de controle de acesso ao PEP, buscando assegurar a privacidade do paciente e a segurança de acesso aos seus dados, mas flexível o suficiente para tratar casos de exceção com base em informações constextuais. O modelo permite regular o acesso dos usuários ao PEP com base nas funções (papéis) que estes exercem numa organização, estendendo e refinando o modelo de referência para controle de acesso baseado em papéis do tipo simétrico definido pelo NIST (National Institute of Standards and Techology). Suporta hierarquia de papéis com herança de autorizações; controle de acesso seletivo aos recursos do PEP; autorizações positivas e negativas; exceções estáticas e dinâmicas baseadas em contextos; separação de responsabilidades estática e dinâmica baseadas em conflitos fortes e fracos entre papéis. Uma arquitetura é proposta para implementar este modelo usando o serviço de diretório LDAP (Lightweight Directory Access Protocol), a linguagem de programação Java, e os padrões CORBA/OMG CORBA Security Service e Resource Access Decision Facility. Com estes padrões abertos e distribuídos, os componentes heterogêneos do PEP podem solicitar serviços de autorização de acesso de modo unificado e consistente a partir de múltiplas plataformas. O PEP na WEB do InCor foi selecionado como aplicação piloto para emprego deste modelo e hoje cerca de 780 usuários o acessa com diferentes privilégios, dependendo dos papéis associados a cada um deles. Desenvolvimentos futuros incluem a especificação de modelos contextuais para criação de autorizações dinâmicas para o PEP e a utilização de mecanismos mais robustos de autenticação do usuário

Subsídios para a otimização dos serviços da clínica odontológica da Faculdade de Odontologia da Universidade de São Paulo: aspectos éticos e legais / Subsidies for university odontology odontological clinic services optimization of São Paulo: ethical and legal aspects

No presente estudo procurou-se analisar, do ponto de vista ético e legal, os serviços de assistência odontológica desenvolvidos pela Faculdade de Odontologia da Universidade de São Paulo (FOUSP) diante das necessidades odontológicas e dos direitos da população que se utiliza deles. Analisaram-se um total de 11.559 fichas clínicas arquivadas no período de agosto a dezembro de 1996 contendo procedimentos realizados nos pacientes nesta clínica, verificando-se que 93,2 por cento delas encontravam-se incompletas. O exame clínico foi realizado em 232 pacientes no período de 02.04.1997 a 07.05.1997, observando que os serviços de clínicas da FOUSP condizem com as necessidades da população. Também foi verificada a qualidade das informações dos prontuários e fichas clínicas existentes nesta clínica, tendo em vista ser este um direito do paciente e sua feitura um dever do profissional. Assim , propõe-se a padronização dos prontuários, facilitando a representação do atendimento prestado aos pacientes, dentro das normas ético-jurídicas. Como auxílio, sugere-se a formação de um Comitê de Ética Clínica que, em parceria com o Serviço de Triagem e com as Disciplinas de Aplicação da Faculdade de Odontologia da Universidade de São Paulo, possa realizar o delineamento das políticas de seleção e atendimento a serem adotadas no parendizado técnico-científico do aluno de graduaçào e na promoção da qualidade de vida dos pacientes