Biblioteca (Todos)
A Critique of Health System Performance Measurement
AUTOR(ES): Lynch, T.
ANO: 2015
RESUMO: Health system performance measurement is a ubiquitous phenomenon. Many authors have identified multiple methodological and substantive problems with performance measurement practices. Despite the validity of these criticisms and their cross-national character, the practice of health system performance measurement persists. Theodore Marmor suggests that performance measurement invokes an "incantatory response" wrapped within "linguistic muddle." In this article, I expand upon Marmor's insights using Pierre Bourdieu's theoretical framework to suggest that, far from an aberration, the "linguistic muddle" identified by Marmor is an indicator of a broad struggle about the representation and classification of public health services as a public good. I present a case study of performance measurement from Alberta, Canada, examining how this representational struggle occurs and what the stakes are.
FONTE:
REFERENCIA: Lynch, T. A Critique of Health System Performance Measurement. Int J Health Serv. 2015;45(4):743-61. doi: 10.1177/0020731415585987. Epub 2015 May 19.
A critical analysis on Italian perinatal mortality in a 50-year span
AUTOR(ES): Scioscia,M.; Vimercati,A.; Maiorano,A.; Depalo,R.; Selvaggi,L.
ANO: 2007
RESUMO: BACKGROUND: Perinatal mortality rate is used as an indicator of reproductive health worldwide. In western countries, national mortality registers are usually accurate and reliable. METHODS AND AIMS: We reviewed the data recorded in the past 50 years in Italy on perinatal and infant mortality. Each single class of mortality rate (according to WHO definitions) was assessed on temporal trends allowing a critical speculative analysis, mainly focusing on the last 20 years, in an attempt to evaluate the impact of prenatal diagnosis. RESULTS: Infant mortality rate (IMR) constantly decreased in the study period whereas early neonatal mortality rate progressively diminished in a 5-year comparison till the early 1990s. Perinatal mortality showed a linear negative trend until the 1980s, after which the decrease steadied at about 23% in the following 5-year period. Infant mortality attributable to congenital anomalies throughout a 20-year span (1980-2000) was steady at about 23% although a progressive reduction in general infant mortality was reported. CONCLUSIONS: A higher reduction in neonatal and perinatal mortality rate was found before the wide availability of the ultrasonographic prenatal diagnosis and the introduction of the law on voluntary abortion in Italy. Given these data, it seems that advances in neonatal care have improved the infant survival rates more than prenatal diagnosis, whereas obstetric care is linked to a reduction of the early perinatal mortality rate.
FONTE:
REFERENCIA: SCIOSCIA et al. A critical analysis on Italian perinatal mortality in a 50-year span. Eur J Obstet Gynecol Reprod Biol. 2007, 130: 60-65. 10.1016/j.ejogrb.2005.12.021.
A conceptual framework for public health: NICE's emerging approach
AUTOR(ES): Kelly, M.P.; Stewart, E.; Morgan, A.; Killoran, A.; Fischer, A.; Threlfall, A.; Bonnefoy, J.
ANO: 2009
RESUMO: This paper outlines the National Institute for Health and Clinical Excellence's (NICE) emerging conceptual framework for public health. This is based on the experience of the first 3 years of producing public health guidance at NICE (2005-2008). The framework has been used to shape the revisions to NICE's public health process and methods manuals for use post 2009, and will inform the public health guidance which NICE will produce from April 2009. The framework is based on the precept that both individual and population patterns of disease have causal mechanisms. These are analytically separate. Explanations of individual diseases involve the interaction between biological, social and related phenomena. Explanations of population patterns involve the same interactions, but also additional interactions between a range of other phenomena working in tandem. These are described. The causal pathways therefore involve the social, economic and political determinants of health, as well as psychological and biological factors. Four vectors of causation are identified: population, environmental, organizational and social. The interaction between the vectors and human behaviour are outlined. The bridge between the wider determinants and individual health outcomes is integration of the life course and the lifeworld.
FONTE:
REFERENCIA: KELLY, M. A conceptual framework for public health: NICE s emerging approach. Public Health, v. 123, n. 1, p.14-20, jan. 2009.
A comprehensive health service evaluation and monitoring framework
AUTOR(ES): Reeve, Carole; Humphreys, John; Wakerman, John.
ANO: 2015
RESUMO: Objective: To develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services. Method: A targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders. Results: The framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable. Conclusion: Data collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle.
FONTE:
REFERENCIA: REEVE at al. A comprehensive health service evaluation and monitoring framework. Evaluation and Program Planning. Volume 53, December 2015, pp. 91-98.
A Comparison of the Health Systems in China and India
AUTOR(ES): Ma, Sai; Sood, Neeraj
ANO: 2008
RESUMO: In this paper, we compare the health systems of China and India-the world's two most populous countries, each of which is undergoing dramatic demographic, societal, and economic transformations-to determine what approaches to improving health in these two countries do and do not work. In particular, we compare the health systems of China and India along three dimensions: policy levers, intermediate outcomes, and ultimate ends.
FONTE:
REFERENCIA: MA, Sai; NOOD, Neeraj. A comparison of the health systems in China and India. Santa Monica, CA: RAND, Center for Asia Pacific Policy, 2008.
2007 National Healthcare Disparities Report (U.S.)
AUTOR(ES): Agency for Healthcare Research and Quality
ANO: 2008
RESUMO: Since 2003, the Agency for Healthcare Research and Quality (AHRQ), together with its partners in the Department of Health and Human Services (HHS), has reported on progress and opportunities for improving health care quality. With this fifth annual National Healthcare Quality Report (NHQR), these reports will have provided more than 50,000 data points about health care quality in the United States. Has it made a difference? Have Federal and State governmental agencies, provider organizations, insurers, and employers made progress in improving health care quality and safety? While every previous release of the NHQR has attempted to summarize the direction in which health care quality is going, this fifth report tries to summarize the progress that has been made and the remaining challenges to improve health care quality in this Nation. The NHQR is built on 218 measures categorized across four dimensions of quality-effectiveness, patient safety, timeliness, and patient centeredness. This year's report focuses on the state of health care quality for a group of 41 core report measures that represent the most important and scientifically credible measures of quality for the Nation, as selected by the HHS Interagency Work Group.i The distillation of 41 core measures for the 2007 report provides a more readily understandable summary and explanation of the key results derived from the data.ii While the measures selected for inclusion in the NHQR are derived from the most current scientific knowledge, this knowledge base is not evenly distributed across health care. The analysis in the following pages centers on measures for which data are available from the baseline year of 2000 or 2001 and the comparison year of 2004 or 2005. Three themes that emerge from the 2007 NHQR emphasize the need to accelerate progress in achieving high quality health care: Health care quality continues to improve, but the rate of improvement has slowed; variation in quality of health care across the Nation is decreasing, but not for all measures; the safety of health care has improved since 2000, but more needs to be done.
FONTE:
REFERENCIA: Agency for Healthcare Research and Quality. 2007 National Healthcare Quality Report. Rockville, MD: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality; February 2008. AHRQ Pub. No. 08-0040.
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