The role of medical care in contributing to health improvements within societies
AUTOR(ES): Bunker, J.P.
ANO: 2001
RESUMO:
FONTE:
REFERENCIA: BUNKER, JP. The role of medical care in contributing to health improvements within societies. Int J Epidemiol 2001; 30:1260-3.
The quality of health care delivered to adults in the United States
AUTOR(ES): McGlynn,E.A.; Asch,S.M.; Adams,J.; Keesey,J.; Hicks,J.; DeCristofaro,A.; Kerr,E.A.
ANO: 2003
RESUMO: In this article, we report results from the Community Quality Index (CQI) study, a collateral study of the Community Tracking Study (CTS). The CTS, conducted by the Center for Studying Health System Change (CSHSC), monitors changes in health care markets in the United States. The CTS obtains self-reported information from a random sample of the U.S. population on their insurance coverage, patterns of utilization of health care services, and health status. The CSHSC has reported on trends in health care costs, factors affecting the choice of employer-sponsored or public insurance, and changes in the structure of managed-care plans. However, the CTS lacks detailed information about the implications of these variations in health care markets for the quality of health care. By collaborating with the CSHSC, we were able to assess the extent to which the recommended processes of medical care - one critical dimension of quality - are delivered to a representative sample of the U.S. population for a broad spectrum of conditions.
FONTE:
REFERENCIA: MCGLYNN et al. The Quality of Health Care Delivered to Adults in the United States. N Engl J Med 2003; 348:2635-2645, June 26, 2003. DOI: 10.1056/NEJMsa022615.
The Interplay Between Continuity of Care, Multimorbidity, and Adverse Events in Patients With Diabetes
AUTOR(ES): Weir DL, McAlister FA, Majumdar SR, Eurich DT
ANO: 2016
RESUMO: OBJECTIVES: To evaluate the impact of continuity of care and multimorbidity on health outcomes in patients with diabetes. RESEARCH DESIGN: Using a US claims database of insured patients, we identified those with incident diabetes between 2004 and 2008 and followed them until death, disenrollment, or December 31, 2010. Continuity of care was defined using Breslau's Usual Provider of Continuity (UPC; proportion of visits to the usual or predominant provider within 2 y of diabetes diagnosis). Multivariable logistic regression was used to determine the association between UPC in the first 2 years after diabetes diagnosis and subsequent 1-year composite primary outcome of all-cause hospitalization or death in year 3 in patients with/without multimorbidity. RESULTS: Of the 285,231 patients with incident diabetes, 74% had multimorbidity; their average age was 53 years (SD=10.5) and 49% were female. A total of 77,270 (27%) individuals had a mean UPC?75% in the first 2 years. During year 3 of follow-up, 33,632 (12%) patients died or were hospitalized for any cause. Greater continuity of care (UPC?75%) was associated with reduced risk of subsequent death or hospitalization [7.2% vs. 13.5%; adjusted odds ratio (aOR)=0.72; 95% CI, 0.70-0.75]. Although multimorbidity was independently associated with an increased risk of our primary composite endpoint (13.4% vs. 7.2%; aOR=1.26; 95% CI, 1.21-1.30), the association between greater continuity and better outcomes was similar in those with multimorbidity (aOR=0.71; 95% CI, 0.69-0.71) as in those without (aOR=0.75; 95% CI, 0.71-0.80). CONCLUSIONS: In patients with incident diabetes, greater continuity of care is associated with improved outcomes, irrespective of whether or not they have multimorbidity.
FONTE:
REFERENCIA: Weir DL, McAlister FA, Majumdar SR, Eurich DT. The Interplay Between Continuity of Care, Multimorbidity, and Adverse Events in Patients With Diabetes. Med Care. 2016 Apr;54(4):386-93. doi: 10.1097/MLR.0000000000000493. PubMed PMID: 26807539.
The impact of private-sector provision on equitable utilisation of coronary revascularisation in London
AUTOR(ES): Mindell,J.; Klodawski,E.; Fitzpatrick,J.; Malhotra,N.; Mckee,M.; Sanderson,C.
ANO: 2008
RESUMO: Objective: To investigate the impact of including private-sector data on assessments of equity of coronary revascularisation provision using NHS data only. Design: Analyses of hospital episodes statistics and private-sector data by age, sex and primary care trust (PCT) of residence. For each PCT, the share of London's total population and revascularisations (all admissions, NHS-funded, and privately-funded admissions) were calculated. Gini coefficients were derived to provide an index of inequality across subpopulations, with parametric bootstrapping to estimate confidence intervals. Setting: London. Participants: London residents undergoing coronary revascularisation April 2001-December 2003. Intervention: Coronary artery bypass graft or angioplasty. Main outcome measures: Directly standardised revascularisation rates, Gini coefficients. Results: NHS-funded age-standardised revascularisation rates varied from 95.2 to 193.9 per 100 000 and privately funded procedures from 7.6 to 57.6. Although the age distribution did not vary by funding, the proportion of revascularisations among women that were privately funded (11.0%) was lower than among men (17.0%). Privately funded rates were highest in PCTs with the lowest death rates (p = 0.053). NHS-funded admission rates were not related to deprivation nor age-standardised deaths rates from coronary heart disease. Privately funded admission rates were lower in more deprived PCTs. NHS provision was significantly more egalitarian (Gini coefficient 0.12) than the private sector (0.35). Including all procedures was significantly less equal (0.13) than NHS-funded care alone. Conclusion: Private provision exacerbates geographical inequalities. Those responsible for commissioning care for defined populations must have access to consistent data on provision of treatment wherever it takes place.
FONTE:
REFERENCIA: Mindell J, Klodawski E, Fitzpatrick J, et al. The impact of private-sector provision on equitable utilisation of coronary revascularisation in London. Heart 2008; 94:1008-1011.
The impact of primary care reform on health system performance in Canada: a systematic review
AUTOR(ES): Carter, R; Riverin, B; Levesque, JF; Gariepy, G; Quesnel-Vallée, A.
ANO: 2016
RESUMO: BACKGROUND: We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. METHODS: We searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines. Full-text studies were synthesized and organized according to the three outcome categories: health service utilization, processes of care, and physician costs and productivity. RESULTS: We found moderate quality evidence that team-based models of care led to reductions in emergency department use, but the evidence was mixed for hospital admissions. We also found low quality evidence that team-based models, blended capitation models and pay-for-performance incentives led to small and sometimes non-significant improvements in processes of care. Studies examining new payment models on physician costs and productivity were of high methodological quality and provided a coherent body of evidence assessing enhanced fee-for-service and blended capitation payment models. CONCLUSION: A small number of studies suggested that team-based models contributed to reductions in emergency department use in Quebec and Alberta. Regarding processes of diabetes care, studies found higher rates of testing for blood glucose levels, retinopathy and cholesterol in Alberta's team-based primary care model and in practices eligible for pay-for-performance incentives in Ontario. However pay-for-performance in Ontario was found to have null to moderate effects on other prevention and screening activities. Although blended capitation payment in Ontario contributed to decreases in the number of services delivered and patients seen per day, the number of enrolled patients and number of days worked in a year was similar to that of enhanced fee-for-service practices.
FONTE:
REFERENCIA: CARTER, Renee et al. The impact of primary care reform on health system performance in Canada: a systematic review. BMC Health Services Research, v. 16, n. 1, p. 324, 2016.
The Health System Assessment Approach: A How-To Manual Version 2.0
AUTOR(ES): HSA
ANO: 2012
RESUMO: The HSAA manual has been used to assess health systems and guide policymakers and program planners in many countries and regions. Health system assessment (HSA) results have contributed to national strategic plans, PEPFAR partnership frameworks, and numerous other Health System Strengthening (HSS) and programmatic activities. Based on lessons learned from experience and consultations with experts, Health Systems 20/20 has updated the Health System Assessment Approach: A How-To Manual and published Version 2.0 in 2012. The approach covers key health system functions and is organized around WHO's six health system building blocks: leadership and governance; health financing; service delivery; human resources for health; medical products, vaccines, and technologies; and health information systems.
FONTE:
REFERENCIA: Health Systems 20/20. 2012. The Health System Assessment Approach: A How-To Manual. Version 2.0. www.healthsystemassessment.org
The health professions and the performance of future health systems in low-income countries: support or obstacle?
AUTOR(ES): Dussault,Gilles.
ANO: 2008
RESUMO: This paper discusses the present and future role of the health professions in health services delivery systems in low-income countries. Unlike richer countries, most low-income countries do not have a tradition of labour market regulation and the capacity of the professions themselves to regulate the provision of health services by their members tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources, responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. The suggestion is made that a "social contract", granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services, may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their role.
FONTE:
REFERENCIA: DUSSAULT, Gilles. The health professions and the performance of future health systems in low-income countries: support or obstacle?. Soc Sci Med. 2008 May; 66(10): 2088-2095. Published online 2008 Mar 11. doi: 10.1016/j.socscimed.2008.01.035
The Good Indicators Guide: understanding how to use and choose indicators
AUTOR(ES): Pencheon, David.
ANO: 2008
RESUMO: This short guide focuses on the key principles behind developing, understanding and using indicators. It is designed to be an essential and readable guide to those in senior positions who may not always feel entirely comfortable with this important areaThis guide is intended to be a short, practical resource for anyone in any health system who is responsible for using indicators to monitor and improve performance, systems or outcomes.
FONTE:
REFERENCIA: PENCHEON, David. The Good Indicators Guide: Understanding how to use and choose indicators. NHS Institute for Innovation and Improvement, 2008.
The association between continuity of care and outcomes: a systematic and critical review
AUTOR(ES): Van Walraven, C., Oake, N., Jennings, A. and Forster, A. J.
ANO: 2010
RESUMO: BACKGROUND: Numerous studies have tried to determine the association between continuity and outcomes. Studies doing so must actually measure continuity. If continuity and outcomes are measured concurrently, their association can only be determined with time-dependent methods. OBJECTIVE: To identify and summarize all methodologically studies that measure the association between continuity of care and patient outcomes. METHODS: We searched MEDLINE database (1950-2008) and hand-searched to identify studies that tried to associate continuity and outcomes. English studies were included if they: actually measured continuity; determined the association of continuity with patient outcomes; and properly accounted for the relative timing of continuity and outcome measures. RESULTS: A total of 139 English language studies tried to measure the association between continuity and outcomes but only 18 studies (12.9%) met methodological criteria. All but two studies measured provider continuity and used health utilization or patient satisfaction as the outcome. Eight of nine high-quality studies found a significant association between increased continuity and decreased health utilization including hospitalization and emergency visits. Five of seven studies found improved patient satisfaction with increased continuity. CONCLUSIONS: These studies validate the belief that increased provider continuity is associated with improved patient outcomes and satisfaction. Further research is required to determine whether information or management continuity improves outcomes.
FONTE:
REFERENCIA: Van Walraven, C., Oake, N., Jennings, A. and Forster, A. J. (2010), The association between continuity of care and outcomes: a systematic and critical review. Journal of Evaluation in Clinical Practice, 16: 947-956. doi:10.1111/j.1365-2753.2009.01235.x
The Amazing Noncollapsing U.S. Health Care System - Is Reform Finally at Hand?
AUTOR(ES): Brown, Lawrence.
ANO: 2008
RESUMO:
FONTE:
REFERENCIA: BROWN, L. The Amazing Noncollapsing U.S. Health Care System - Is Reform Finally at Hand? N Engl J Med 2008; 358:325-327, January 24, 2008. DOI: 10.1056/NEJMp0708600
Tendências em dez anos das condições de saúde de idosos brasileiros: evidências da Pesquisa Nacional por Amostra de Domicílios (1998, 2003, 2008)
AUTOR(ES): Lima-Costa, Maria Fernanda; Matos, Divane Leite; Camargos, Vitor Passos; Macinko, James
ANO: 2011
RESUMO: Foram examinadas as tendências em saúde da população idosa brasileira utilizando-se dados da Pesquisa Nacional por Amostra de Domicílios (1998-2008). O estudo incluiu uma amostra probabilística de 105.254 pessoas com> 60 anos de idade. A média da idade foi de 69 anos e 56% eram mulheres. Houve um aumento gradativo da boa autoavaliação da saúde (39,3%, 43,5% e 45,0% em 1998, 2003 e 2008, respectivamente) e uma diminuição na prevalência de artrite, doença do coração e depressão autorreferidas. A prevalência da hipertensão (43.9%, 48.8% e 53.3%, respectivamente) e do diabetes autorreferidos (10.3%, 13.0% e 16.1% respectivamente) aumentou acentuadamente. A prevalência da incapacidade para realizar atividades da vida diária (alimentar-se, tomar banho ou ir ao banheiro) permaneceu estável (6.5%, 6.4% e 6.9%, respectivamente). A realização de três ou mais consultas médicas nos 12 meses precedentes aumentou 21% entre 1998 e 2008. As hospitalizações diminuíram 10% no mesmo período. Essas tendências foram independentes do sexo e da idade. Os resultados mostram melhora em algumas dimensões da saúde dos idosos, mas não em todas. As mudanças no uso de serviços de saúde ocorreram como esperado em decorrência da expansão das atividades de atenção primária no Brasil.
FONTE:
REFERENCIA: Ciênc. saúde coletiva, 2011, vol.16, n.9, pp. 3689-3696.
Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008
AUTOR(ES): Barros, Marilisa Berti de Azevedo; Francisco, Priscila Maria Stolses Bergamo; Zanchetta, Luane Margarete; César, Chester Luiz Galvão.
ANO: 2011
RESUMO: Os objetivos do estudo foram: estimar as prevalências de doenças crônicas na população brasileira em 2008, comparando-as com as de 2003; avaliar o impacto da doença crônica no uso de serviços e nas restrições das atividades; e, analisar os diferenciais nas prevalências de doenças crônicas específicas, segundo nível de escolaridade e filiação a plano privado de saúde. Os dados foram obtidos do suplemento saúde das PNAD-2008 e 2003. As análises (prevalências e razões de prevalências brutas e ajustadas) foram feitas com o aplicativo Stata 11. A prevalência de ter ao menos uma doença crônica foi mais elevada em: idosos, mulheres, cor/raça preta ou indígena, menor escolaridade, migrantes, moradores em áreas urbanas e na região Sul do país. As condições crônicas mais prevalentes foram: hipertensão, doença de coluna, artrite e depressão. Houve, entre 2003 e 2008, aumento da prevalência de diabetes, hipertensão, câncer e cirrose, e redução de insuficiência renal crônica e tuberculose. A maioria das doenças estudadas foram mais prevalentes nos segmentos de menor escolaridade e sem plano de saúde. As maiores diferenças entre os segmentos sociais foram observadas nas prevalências de cirrose, insuficiência renal crônica, tuberculose e artrite/reumatismo.
FONTE:
REFERENCIA: BARROS, Marilisa Berti de Azevedo; FRANCISCO, Priscila Maria Stolses Bergamo; ZANCHETTA, Luane Margarete and CESAR, Chester Luiz Galvão. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008. Ciênc. saúde coletiva [online]. 2011, vol.16, n.9 [cited 2016-11-08], pp.3755-3768. Available from:
Tendência na utilização de serviços odontológicos entre idosos brasileiros e fatores associados: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (1998 e 2003)
AUTOR(ES): Matos, Divane Leite; Lima-Costa, Maria Fernanda.
ANO: 2007
RESUMO: O objetivo deste estudo foi determinar a prevalência e os fatores associados ao uso de serviços odontológicos entre idosos brasileiros em 1998 e 2003. O modelo de Andersen & Newman foi utilizado como base conceitual da pesquisa. Participaram do estudo 28.943 e 35.040 idosos participantes da PNAD 1998 e 2003, respectivamente. As características daqueles que haviam visitado o dentista há < 1 ano foram comparadas às daqueles que visitaram o dentista há mais tempo (<1 ano) e às daqueles que jamais foram ao dentista, utilizando-se regressão logística multimonial. No período considerado, a prevalência de visitas ao dentista há < 1 ano aumentou de 13,2 para 17,4 por cento. Características de predisposição (sexo, idade e escolaridade), de necessidade (percepção da saúde geral) e de facilitação (renda domiciliar per capita, filiação a plano de saúde, situação rural/urbana do domicílio e macrorregião de residência) apresentaram associações independentes e significantes com o uso de serviços odontológicos. Observam-se importantes desigualdades sociais associadas ao uso de serviços odontológicos por idosos, apontando para a necessidade premente de políticas que visem a redução dessas desigualdades.(AU)
FONTE:
REFERENCIA: MATOS, Divane Leite and LIMA-COSTA, Maria Fernanda. Tendência na utilização de serviços odontológicos entre idosos brasileiros e fatores associados: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (1998 e 2003). Cad. Saúde Pública [online]. 2007, vol.23, n.11 [cited 2016-11-08], pp.2740-2748. Available from:
Temporal trends in motor vehicle fatalities in the United States, 1968 to 2010 - a joinpoint regression analysis
AUTOR(ES): Bandi P, Silver D, Mijanovich T, Macinko J.
ANO: 2015
RESUMO: Background: In the past 40 years, a variety of factors might have impacted motor vehicle (MV) fatality trends in the US, including public health policies, engineering innovations, trauma care improvements, etc. These factors varied in their timing across states/localities, and many were targeted at particular population subgroups. In order to identify and quantify differential rates of change over time and differences in trend patterns between population subgroups, this study employed a novel analytic method to assess temporal trends in MV fatalities between 1968 and 2010, by age group and sex. Methods: Cause-specific MV fatality data from traffic injuries between 1968 and 2010, based on death certificates filed in the 50 states, and DC were obtained from Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). Long-term (1968 to 2010) and short-term (log-linear piecewise segments) trends in fatality rates were compared for males and females overall and in four separate age groups using joinpoint regression. Results: MV fatalities declined on average by 2.4% per year in males and 2.2% per year in females between 1968 and 2010, with significant declines observed in all age groups and in both sexes. In males overall and those 25 to 64 years, sharp declines between 1968 and mid-to-late 1990s were followed by a stalling until the mid-2000s, but rates in females experienced a long-term steady decline of a lesser magnitude than males during this time. Trends in those aged <1 to 14 years and 15 to 24 years were mostly steady over time, but males had a larger decline than females in the latter age group between 1968 and the mid-2000s. In ages 65+, short-term trends were similar between sexes. Conclusions: Despite significant long-term declines in MV fatalities, the application of Joinpoint Regression found that progress in young adult and middle-aged adult males stalled in recent decades and rates in males declined relatively more than in females in certain age groups. Future research is needed to establish the causes of these observed trends, including the potential role of contemporaneous MV-related policies and their repeal. Such research is needed in order to better inform the design and evaluation of future population interventions addressing MV fatalities nationally.
FONTE:
REFERENCIA: Bandi, P., Silver, D., Mijanovich, T., & Macinko, J. (2015). Temporal trends in motor vehicle fatalities in the United States, 1968 to 2010 - a joinpoint regression analysis. Injury Epidemiology, 2(1), 4. http://doi.org/10.1186/s40621-015-0035-6.
Tabagismo, situação no mercado de trabalho e gênero: análise da PNAD 2008
AUTOR(ES): Giatti, Luana; Barreto, Sandhi Maria.
ANO: 2011
RESUMO: O presente estudo teve como objetivo verificar se o tabagismo atual está associado à inserção no mercado de trabalho, após ajuste por escolaridade, renda e saúde em homens e mulheres; objetivou, também, discutir hipóteses explicativas. Foram estudados indivíduos de 15 a 64 anos, residentes em regiões metropolitanas brasileiras, pertencentes à população economicamente ativa, incluídos na Pesquisa Nacional por Amostra de Domicílios (2008). Razão de prevalência (RP) e intervalo de 95 por cento de confiança (IC95 por cento) foram obtidos pela regressão de Poisson. Após ajustes, o tabagismo foi estatisticamente maior em indivíduos inseridos no trabalho sem proteção social (homens, RP = 1,31, IC95 por cento: 1,24-1,38; mulheres, RP = 1,22, IC95 por cento: 1,12-1,31) e desempregados (homens, RP = 1,31, IC95 por cento: 1,18-1,44; mulheres, RP = 1,16, IC95 por cento: 1,03-1,32). Prevalências mais altas de tabagismo foram observadas nos homens inseridos no trabalho sem proteção social. Nossos resultados confirmam que a situação no mercado de trabalho é uma dimensão independente das desigualdades sociais no tabagismo. O gradiente social observado foi mais acentuado nos homens, mas a associação entre inserção no trabalho e tabagismo está presente nos dois gêneros.(AU)
FONTE:
REFERENCIA: GIATTI, Luana and BARRETO, Sandhi Maria. Tabagismo, situação no mercado de trabalho e gênero: análise da PNAD 2008. Cad. Saúde Pública [online]. 2011, vol.27, n.6 [cited 2016-11-08], pp.1132-1142. Available from: