Proadess - Avaliação do Desempenho do Sistema de Saúde

Biblioteca (Artigos de periódicos)

SUS: oferta, acesso e utilização de serviços de saúde nos últimos 30 anos

Health system performance reporting in Canada: Bridging theory and practice at pan-Canadian level

Measuring health system performance: A new approach to accountability and quality improvement in New Zealand

Measuring the performance of health care services: a review of international experiences and their application to urban contexts

Ranked Performance of Canada's Health System on the International Stage: A Scoping Review

AUTOR(ES): Najafizada SAM, Sivanandan T, Hogan K, Cohen D, Harvey J.

ANO: 2017

RESUMO: INTRODUCTION: Since the release of the World Health Report in 2000, health system performance ranking studies have garnered significant health policy attention. However, this literature has produced variable results. The objective of this study was to synthesize the research and analyze the ranked performance of Canada's health system on the international stage. METHOD: We conducted a scoping review exploring Canada's place in ranked health system performance among its peer Organisation for Economic Co-operation and Development countries. Arksey and O'Malley's five-stage scoping review framework was adopted, yielding 48 academic and grey literature articles. A literature extraction tool was developed to gather information on themes that emerged from the literature. SYNTHESIS: Although various methodologies were used to rank health system performance internationally, results generally suggested that Canada has been a middle-of-the-pack performer in overall health system performance for the last 15 years. Canada's overall rankings were 7/191, 11/24, 10/11, 10/17, "Promising" and "B" grade across different studies. According to past literature, Canada performed well in areas of efficiency, productivity, attaining health system goals, years of life lived with disability and stroke mortality. By contrast, Canada performed poorly in areas related to disability-adjusted life expectancy, potential years of life lost, obesity in adults and children, diabetes, female lung cancer and infant mortality. CONCLUSION: As countries introduce health system reforms aimed at improving the health of populations, international comparisons are useful to inform cross-country learning in health and social policy. While ranking systems do have shortcomings, they can serve to shine a spotlight on Canada's health system strengths and weaknesses to better inform the health policy agenda.

FONTE:

REFERENCIA: Najafizada SAM, Sivanandan T, Hogan K, Cohen D, Harvey J. Ranked Performance of Canada's Health System on the International Stage: A Scoping Review. Classement du rendement du système de santé canadien sur la scène internationale : un examen de la portée. Health Policy. 2017;13(1):59–73. doi:10.12927/hcpol.2017.25191

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Health system performance comparison: new directions in research and policy

Resolving the challenges in the international comparison of health systems: the must do's and the trade-offs

Methodological concerns and recommendations on policy consequences of the World Health Report 2000

Estudo exploratório dos modelos de avaliação de desempenho em saúde: uma apreciação da capacidade avaliativa

Random variation and rankability of hospitals using outcome indicators

AUTOR(ES): Van Dishoeck A, Lingsma HF, Mackenbach JP, et al

ANO: 2011

RESUMO: OBJECTIVE: There is a growing focus on quality and safety in healthcare. Outcome indicators are increasingly used to compare hospital performance and to rank hospitals, but the reliability of ranking (rankability) is under debate. This study aims to quantify the rankability of several outcome indicators of hospital performance currently used by the Dutch government. METHODS: From 52 indicators used by the Netherlands Inspectorate, the authors selected nine outcome indicators presenting a fraction and absolute numbers. Of these indicators, four were combined into two, resulting in seven indicators for analysis. The official data of 97 Dutch hospitals for the year 2007 were used. Uncertainty in the observed outcomes within the hospitals (within hospital variance, σ(2)) was estimated using fixed effect logistic regression models. Heterogeneity (between hospital variance, τ(2)) was measured with random effect logistic regression models. Subsequently, the rankability was calculated by relating heterogeneity to uncertainty within and between hospitals (τ(2)/(τ(2) +median σ(2))). RESULTS: Sample sizes varied but were typically around 200 per hospital (range of median 90-277) with a median of 2-21 cases, causing a substantial uncertainty in outcomes per hospital. Although fourfold to eightfold differences between hospitals were noted, the uncertainty within hospitals caused a poor (<50%) rankability in three indicators and moderate rankability (50-75%) in the other four indicators. CONCLUSION: The currently used Dutch outcome indicators are not suitable for ranking hospitals. When judging hospital quality the influence of random variation must be accounted for to avoid overinterpretation of the numbers in the quest for more transparency in healthcare. Adequate sample size is a prerequisite in attempting reliable ranking.

FONTE:

REFERENCIA: Van Dishoeck A, Lingsma HF, Mackenbach JP, et al. Random variation and rankability of hospitals using outcome indicators. BMJ Quality & Safety 2011;20:869-874.

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Ranking hospitals: do we gain reliability by using composite rather than individual indicators?

AUTOR(ES): Hofstede SN, Ceyisakar IE, Lingsma HF, et al.

ANO: 2019

RESUMO: Background Despite widespread use of quality indicators, it remains unclear to what extent they can reliably distinguish hospitals on true differences in performance. Rankability measures what part of variation in performance reflects ‘true’ hospital differences in outcomes versus random noise. Objective This study sought to assess whether combining data into composites or including data from multiple years improves the reliability of ranking quality indicators for hospital care. Methods Using the Dutch National Medical Registration (2007–2012) for stroke, colorectal carcinoma, heart failure, acute myocardial infarction and total hiparthroplasty (THA)/ total knee arthroplasty (TKA) in osteoarthritis (OA), we calculated the rankability for in-hospital mortality, 30-day acute readmission and prolonged length of stay (LOS) for single years and 3-year periods and for a dichotomous and ordinal composite measure in which mortality, readmission and prolonged LOS were combined. Rankability, defined as (between-hospital variation/between-hospital+within hospital variation)×100% is classified as low (<50%), moderate (50%–75%) and high (>75%). Results Admissions from 555 053 patients treated in 95 hospitals were included. The rankability for mortality was generally low or moderate, varying from less than 1% for patients with OA undergoing THA/TKA in 2011 to 71% for stroke in 2010. Rankability for acute readmission was low, except for acute myocardial infarction in 2009 (51%) and 2012 (62%). Rankability for prolonged LOS was at least moderate. Combining multiple years improved rankability but still remained low in eight cases for both mortality and acute readmission. Combining the individual indicators into the dichotomous composite, all diagnoses had at least moderate rankability (range: 51%–96%). For the ordinal composite, only heart failure had low rankability (46% in 2008) (range: 46%–95%). Conclusion Combining multiple years or into multiple indicators results in more reliable ranking of hospitals, particularly compared with mortality and acute readmission in single years, thereby improving the ability to detect true hospital differences. The composite measures provide more information and more reliable rankings than combining multiple years of individual indicators.

FONTE:

REFERENCIA: Hofstede SN, Ceyisakar IE, Lingsma HF, et al. Ranking hospitals: do we gain reliability by using composite rather than individual indicators? BMJ Quality & Safety 2019;28:94-102.

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The multiple aims of pay-forperformance and the risk of unintended consequences

Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017

AUTOR(ES): Zimmerman FJ, Anderson NW.

ANO: 2019

RESUMO: Importance Health equity is an often-cited goal of public health, included among the 4 overarching goals of the Department of Health and Human Services’ Healthy People 2020. Yet it is difficult to find summary assessments of national progress toward this goal. Objectives To identify variation in several measures of health equity from 1993 to 2017 in the United States and to test whether there are significant time trends. Design, Setting, and Participants Survey study using 25 years of data, from January 1, 1993, to December 31, 2017, from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System to assess trends in health equity and health justice by race/ethnicity, sex, and income in 3 categories by year. Main Outcomes and Measures Health equity was assessed separately for each of 2 health constructs: healthy days—the average of physical and mental healthy days over the previous 30 days—and general health in 5 categories, rescaled to approximate a continuous variable. For each health construct, average health was calculated along with 4 measures of health equity: disparities across 3 income groups; black-white disparities; health justice—a measure of the correlation of health outcomes with income, race/ethnicity and sex; and a summary health equity metric. Results Among the 5 456 006 respondents, the mean (SD) age was 44.5 (12.7) years; 3 178 688 (58.3%) were female; 4 163 945 (76.3%) were non-Latinx white; 474 855 (8.7%) were non-Latinx black; 419 542 (7.7%) were Latinx; and 397 664 (7.3%) were of other race/ethnicity. The final sample included 5 456 006 respondents for self-reported health and 5 349 527 respondents for healthy days. During the 25-year period, the black-white gap showed significant improvement (year coefficient: healthy days, 0.021; 97.5% CI, 0.012 to 0.029; P < .001; self-reported health, 0.030; 97.5% CI, 0.025 to 0.035; P < .001). The health equity metric for self-reported health showed no significant trend. For healthy days, the Health Equity Metric declined over time (year coefficient: healthy days, −0.025; 97.5% CI, −0.033 to −0.017; P < .001). Health justice declined over time (year coefficient: healthy days, −0.045; 97.5% CI, −0.053 to −0.038; P < .001; self-reported health, −0.035; 97.5% CI, −0.046 to−0.023; P < .001), and income disparities worsened (year coefficient: healthy days, −0.060; 97.5% CI, −0.076 to −0.044; P < .001; self-reported health, −0.029; 97.5% CI, −0.046 to −0.012; P < .001). Conclusions and Relevance Results of this analysis suggest that there has been a clear lack of progress on health equity during the past 25 years in the United States. Achieving widely shared goals of improving health equity will require greater effort from public health policy makers, along with their partners in medicine and the sectors that contribute to the social determinants of health.

FONTE:

REFERENCIA: Zimmerman FJ, Anderson NW. Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017. JAMA Netw Open. 2019;2(6):e196386. doi:10.1001/jamanetworkopen.2019.6386

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Performance of UK National Health Service compared with other high income countries: observational study

AUTOR(ES): Irene Papanicolas, Elias Mossialos, Anders Gundersen, Liana Woskie, Ashish K Jha

ANO: 2019

RESUMO: Objective - To determine how the UK National Health Service (NHS) is performing relative to health systems of other high income countries, given that it is facing sustained financial pressure, increasing levels of demand, and cuts to social care. Design - Observational study using secondary data from key international organisations such as Eurostat and the Organization for Economic Cooperation and Development. Setting Healthcare systems of the UK and nine high income comparator countries: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US. Main outcome measures 79 indicators across seven domains: population and healthcare coverage, healthcare and social spending, structural capacity, utilisation, access to care, quality of care, and population health. Results - The UK spent the least per capita on healthcare in 2017 compared with all other countries studied (UK $3825 (£2972; €3392); mean $5700), and spending was growing at slightly lower levels (0.02% of gross domestic product in the previous four years, compared with a mean of 0.07%). The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per capita, despite having average levels of utilisation (number of hospital admissions). The UK had slightly below average life expectancy (81.3 years compared with a mean of 81.7) and cancer survival, including breast, cervical, colon, and rectal cancer. Although several health service outcomes were poor, such as postoperative sepsis after abdominal surgery (UK 2454 per 100 000 discharges; mean 2058 per 100 000 discharges), 30 day mortality for acute myocardial infarction (UK 7.1%; mean 5.5%), and ischaemic stroke (UK 9.6%; mean 6.6%), the UK achieved lower than average rates of postoperative deep venous thrombosis after joint surgery and fewer healthcare associated infections. Conclusions - The NHS showed pockets of good performance, including in health service outcomes, but spending, patient safety, and population health were all below average to average at best. Taken together, these results suggest that if the NHS wants to achieve comparable health outcomes at a time of growing demographic pressure, it may need to spend more to increase the supply of labour and long term care and reduce the declining trend in social spending to match levels of comparator countries.

FONTE:

REFERENCIA: Papanicolas Irene, Mossialos Elias, Gundersen Anders, Woskie Liana, Jha Ashish K. Performance of UK National Health Service compared with other high income countries: observational study BMJ 2019; 367 :l6326

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Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting

AUTOR(ES): Karoun H Bagamian, John D Anderson, Farzana Muhib, Oliver Cumming, Lindsey A Laytner, Thomas F Wierzba, Richard Rheingans

ANO: 2020

RESUMO: Background - Diarrhoea, a global cause of child mortality and morbidity, is linked to adverse consequences including childhood stunting and death from other diseases. Few studies explore how diarrhoeal mortality varies subnationally, especially by cause, which is important for targeting investments. Even fewer examine indirect effects of diarrhoeal morbidity on child mortality. We estimated the subnational distribution of mortality, morbidity, and childhood stunting attributable to enterotoxigenic Escherichia coli (ETEC) and shigella infection in children younger than 5 years from 11 eastern and central African countries. These pathogens are leading causes of diarrhoea in young children and have been linked to increased childhood stunting. Methods - We combined proxy indicators of morbidity and mortality risk from the most recent Demographic and Health Surveys with published relative risks to estimate the potential distribution of diarrhoeal disease risk. To estimate subnational burden, we used country-specific or WHO region-specific morbidity and mortality estimates and distributed them subnationally by three indices that integrate relevant individual characteristics (ie, underweight, probability of receiving oral rehydration treatment of diarrhoea, and receiving vitamin A supplementation) and household characteristics (ie, type of drinking water and sanitation facilities). Findings - Characterising ETEC and shigella subnational estimates of indirect morbidity (infection-attributable stunting) and indirect mortality (stunting-related deaths from other infectious diseases) identified high-risk areas that could be missed by traditional metrics. Burundi and Democratic Republic of the Congo had the highest ETEC-associated and shigella-associated mortality and stunting rates. Mozambique, Democratic Republic of the Congo, and Zimbabwe had the greatest subnational heterogeneity in most ETEC and shigella mortality measures. Inclusion of indirect ETEC and shigella mortality in burden estimates resulted in a 20–30% increase in total ETEC and shigella mortality rates in some subnational areas. Interpretation - Understanding the indirect mortality and morbidity of diarrhoeal pathogens on a subnational level will strengthen disease control strategies and could have important implications for the relative impact and cost-effectiveness of new enteric vaccines. Because our methods rely on publicly available data, they could be employed for national planning.

FONTE:

REFERENCIA: Karoun H Bagamian, John D Anderson, Farzana Muhib, Oliver Cumming, Lindsey A Laytner, Thomas F Wierzba, Richard Rheingans, Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting, The Lancet Global Health, Volume 8, Issue 1, 2020, Pages e101-e112, ISSN 2214-109X, https://doi.org/10.1016/S2214-109X(19)30456-5. (http://www.sciencedirect.com/science/article/pii/S2214109X19304565)

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