scholarly journals Performance evaluation of hospitals that provide care in the public health system, Brazil

2015 ◽  
Vol 49 (0) ◽  
pp. 1-9 ◽  
Author(s):  
Marcelo Cristiano de Azevedo Ramos ◽  
Lucila Pedroso da Cruz ◽  
Vanessa Chaer Kishima ◽  
Wilson Modesto Pollara ◽  
Antônio Carlos Onofre de Lira ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Health System ◽  
Legal Status ◽  
Average Length ◽  
Public Hospitals ◽  
Educational Activity ◽  
Southeastern Brazil ◽  
Occupancy Rate ◽  
Hospital Occupancy

<sec><title>OBJECTIVE</title><p> To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System.</p></sec><sec><title>METHODS</title><p> This cross-sectional study evaluated data from the Hospital Information System and the <italic>Cadastro Nacional de Estabelecimentos de Saúde</italic> (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction.</p></sec><sec><title>RESULTS</title><p> The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed.</p></sec><sec><title>CONCLUSIONS</title><p> The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.</p></sec>

Burden of hospitalisation among older people in the Brazilian public health system: a big data analysis from 2009 to 2015

2019 ◽  
Vol 73 (6) ◽  
pp. 537-543 ◽  
Author(s):  
Roger Daglius Dias ◽  
Jacson Venancio de Barros
Keyword(s):  
Public Health ◽  
Hospital Mortality ◽  
Older People ◽  
Health System ◽  
Hospital Admissions ◽  
Public Health System ◽  
Average Length ◽  
Admission Rate ◽  
Older Population ◽  
Icu Admission

BackgroundThe world’s population is progressively ageing, and this trend imposes several challenges to society and governments. The aim of this study was to investigate the burden generated by the hospitalisation of older (>60 years) compared with non-older population, as well as the epidemiology of these hospital admissions.MethodsUsing the Brazilian Unified Health System (known as ‘Sistema Único de Saúde’ (SUS)), an analysis of all hospital admissions of adult patients in the SUS from 2009 to 2015 was undertaken. The following indicators were used: hospital admission rate, intensive care unit (ICU) admission rate, average length of hospital and ICU stay, hospital mortality and average reimbursement per hospitalisation.ResultsA total of 61 958 959 admissions during the 7-year period, were analysed, encompassing 17 893 392 (28.9%) older patients. Elderly represent 15% (n=21 294 950) of the Brazilian adult population, but are responsible for 29% (n=17 893 392) of hospitalisations, 52% (n=1 731 299) of ICU admissions and 66% (n=1 885 291) of hospital mortality. Among the adults, elderly represents 39% of the total reimbursement made related to admission/hospitalisation. For 2009 to 2015, while the older population increased 27%, ICU admission rate increased 20%; the average length of ICU stay was 12% higher in 2015 (6.5 days) compared with 2009 (5.8 days); and the hospital mortality increased from 9.8% to 11.2%.ConclusionThese findings illustrate the current panorama of the burden due to hospitalisation of older people in the Brazilian public health system, and evidence the consolidation of the epidemiological transition toward the predominance of non-communicable diseases as the main cause of hospitalisation among the elderly in Brazil.

scholarly journals Analysis of in-hospital mortality among people with and without Diabetes in Australian Public Hospitals (2014-2017)

2021 ◽  
Author(s):  
Tina Gao ◽  
Kingsley E Agho ◽  
Milan K Piya ◽  
David Simmons ◽  
Uchechukwu L Osuagwu
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Age Groups ◽  
Public Health Problem ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Public Hospitals ◽  
Major Public Health Problem ◽  
Factors Associated ◽  
Cardiovascular Comorbidities

Abstract Background Diabetes is a major public health problem affecting about 1.4 million Australians, especially in South Western Sydney, a hotspot of diabetes with higher than average rates for hospitalisations. The current understanding of the international burden of diabetes and related complications is poor and there is paucity of data on hospital outcomes and/or what common factors influence mortality rate in people with diabetes in Australia. This study determined in-hospital mortality rate and the factors associated among people with and without diabetes. Methods Retrospective data for 554,421 adult inpatients was extracted from the population-based New South Wales (NSW) Admitted Patient Data over 3 financial years (from 2014-15 to 2016-17). The in-hospital mortality per 1000 admitted persons, standardised mortality ratios (SMR) were calculated. Binary logistic regression was performed, adjusting for potential covariates and co-morbidities for people with and without diabetes over three years. Results Over three years 8.7% (48,038 people) of admissions involved those with diabetes. This increased from 8.4% in 2014-15 to 8.9% in 2016-17 (p = 0.007). Across all age groups, in-hospital mortality rate was significantly greater in people with diabetes (20.6, 95% Confidence intervals CI 19.3–21.9 per 1000 persons) than those without diabetes (11.8, 95%CI 11.5–12.1) and more in men than women (23.1, 95%CI 21.2–25.0 vs 17.9, 95%CI 16.2–19.8) with diabetes. The SMR for those with and without diabetes were 3.13 (95%CI 1.78–4.48) and 1.79 (95%CI 0.77–2.82), respectively. There were similarities in the factors associated with in hospital mortality in both groups including: aged > 54years, men, the widowed, those who stayed longer than 4 days or received intensive care in admission and had respiratory and cardiovascular comorbidities. Conclusions The study found that in-patients with diabetes continue to have higher mortality rates than those without diabetes and the Australian population. Overall, similar factors influenced mortality rate in people with and without diabetes in this region indicating that continued improved management of all inpatients is needed in order to minimise the persistent poor outcomes.

scholarly journals Evolution of incidence, mortality and cost of nontraumatic abdominal emergencies treated in Brasil in a period of nine years

2018 ◽  
Vol 64 (4) ◽  
pp. 374-378
Author(s):  
Carolina Maria Lemos ◽  
Mariana Alem ◽  
Tercio de Campos
Keyword(s):  
Duodenal Ulcer ◽  
Mortality Rate ◽  
Average Length ◽  
Acute Diverticulitis ◽  
Length Of Hospital Stay ◽  
Healthcare Services ◽  
Public Hospitals ◽  
Ulcer Disease ◽  
Abdominal Emergencies ◽  
The One

SUMMARY OBJECTIVE: To evaluate the incidence, mortality and cost of non-traumatic abdominal emergencies treated in Brazilian emergency departments. METHODS: This paper used DataSus information from 2008 to 2016 (http://www.tabnet.datasus.gov.br). The number of hospitalizations, costs - AIH length of stay and mortality rates were described in acute appendicitis, acute cholecystitis, acute pancreatitis, acute diverticulitis, gastric and duodenal ulcer, and inflammatory intestinal disease. RESULTS: The disease that had the highest growth in hospitalization was diverticular bowel disease with an increase of 68.2%. For the period of nine years, there were no significant changes in the average length of hospital stay, with the highest increase in gastric and duodenal ulcer with a growth of 15.9%. The mortality rate of gastric and duodenal ulcer disease increased by 95.63%, which is significantly high when compared to the other diseases. All had their costs increased but the one that proportionally had the highest increase in the last nine years was the duodenal and gastric ulcer, with an increase of 85.4%. CONCLUSION: Non-traumatic abdominal emergencies are extremely prevalent. Hence, the importance of having updated and comparative data on the mortality rate, number of hospitalization and cost generated by these diseases to provide better healthcare services in public hospitals.

The Health Sector Evolution Plan and the Technical Efficiency of Public Hospitals in IranBackground: Iranian public hospitals have been excessively changing during the healthcare reform since 2014. This study aimed to examine the technical efficiency of p

2020 ◽  
Author(s):  
Edris KAKEMAM ◽  
Hossein DARGAHI
Keyword(s):  
Length Of Stay ◽  
Technical Efficiency ◽  
Healthcare Reform ◽  
Average Length ◽  
Health Sector ◽  
Public Hospitals ◽  
Occupancy Rate ◽  
Bed Occupancy ◽  
Tobit Regression ◽  
Average Length Of Stay

Background: Iranian public hospitals have been excessively changing during the healthcare reform since 2014. This study aimed to examine the technical efficiency of public hospitals during before and after the implementation of Health Sector Evolution Plan (HSEP) and to determine whether, and how, efficiency is affected by various factors. Methods: Forty-two public hospitals were selected in Tehran, Iran, from 2012 to 2016. Data envelopment analysis was employed to estimate the technical and scale efficiency sample hospitals. Tobit regression was used to relate the technical efficiency scores to seven explanatory variables in 2016, the last year. Results: Overall, 24 (57.1%), 26 (61.9%), 26 (61.9%), 24 (57.1%) and 21 (50%) of the 42 sample hospitals ran inefficiently in 2012 to 2016, with average technical efficiency of 0.859, 0.836, 0.845, 0.905 and 0.934, respectively. The average pure technical efficiency in sample hospitals increased from 0.860 in 2010 (before the HSEP) to 0.944 in 2012 (after the HSEP). Tobit regression showed that average length of stay had a negative impact on technical efficiency of hospitals. In addition, bed occupancy rate, ratio of beds to nurses and ratio of nurses to physicians assumed a positive sign with technical efficiency. Conclusion: Despite government support, public hospitals operated relatively inefficien. Managers can enhance technical efficiency by increasing bed occupancy rate through shortening the average length of stay, proportioning the number of doctors, nurses, and beds along with service quality assurance.

scholarly journals Analysis of in-hospital mortality among people with and without diabetes in South Western Sydney public hospitals (2014–2017)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tina Gao ◽  
Kingsley E. Agho ◽  
Milan K. Piya ◽  
David Simmons ◽  
Uchechukwu L. Osuagwu
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Age Groups ◽  
Public Health Problem ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Public Hospitals ◽  
Major Public Health Problem ◽  
Factors Associated ◽  
Patients With Diabetes

Abstract Background Diabetes is a major public health problem affecting about 1.4 million Australians, especially in South Western Sydney, a hotspot of diabetes with higher than average rates for hospitalisations. The current understanding of the international burden of diabetes and related complications is poor and data on hospital outcomes and/or what common factors influence mortality rate in people with and without diabetes in Australia using a representative sample is lacking. This study determined in-hospital mortality rate and the factors associated among people with and without diabetes. Methods Retrospective data for 554,421 adult inpatients was extracted from the population-based New South Wales (NSW) Admitted Patient Data over 3 financial years (from 1 July 2014–30 June 2015 to 1 July 2016–30 June 2017). The in-hospital mortality per 1000 admitted persons, standardised mortality ratios (SMR) were calculated. Binary logistic regression was performed, adjusting for potential covariates and co-morbidities for people with and without diabetes over three years. Results Over three years, 8.7% (48,038 people) of admissions involved people with diabetes. This increased from 8.4% in 2014–15 to 8.9% in 2016–17 (p = 0.007). Across all age groups, in-hospital mortality rate was significantly greater in people with diabetes (20.6, 95% Confidence intervals CI 19.3–21.9 per 1000 persons) than those without diabetes (11.8, 95%CI 11.5–12.1) and more in men than women (23.1, 95%CI 21.2–25.0 vs 17.9, 95%CI 16.2–19.8) with diabetes. The SMR for those with and without diabetes were 3.13 (95%CI 1.78–4.48) and 1.79 (95%CI 0.77–2.82), respectively. There were similarities in the factors associated with in hospital mortality in both groups including: older age (> 54 years), male sex, marital status (divorced/widowed), length of stay in hospital (staying longer than 4 days), receiving intensive care in admission and being admitted due to primary respiratory and cardiovascular diagnoses. The odds of death in admission was increased in polymorbid patients without diabetes (28.68, 95%CI 23.49–35.02) but not in those with diabetes. Conclusions In-patients with diabetes continue to have higher mortality rates than those without diabetes and the Australian population. Overall, similar factors influenced mortality rate in people with and without diabetes, but significantly more people with diabetes had two or more co-morbidities, suggesting that hospital mortality may be driven by those with pre-existing health/comorbidities. Urgent measures in primary care to prevent admissions among people with multiple co-morbidities are needed.

scholarly journals Effect of the Health Promotion Plan on the Performance of Hospitals: Evidences from East of Iran

2021 ◽  
Author(s):  
Javad Ghoddoosi Nejad ◽  
Morteza Arab-Zozani ◽  
Rouhollah Yaghoubi
Keyword(s):  
Length Of Stay ◽  
Health Reform ◽  
Average Length ◽  
Health Sector ◽  
Public Hospitals ◽  
Public Expenditures ◽  
Occupancy Rate ◽  
Bed Occupancy ◽  
Reform Plan ◽  
South Khorasan

Background: Hospitals are considered as the most central and resource-consuming units in the healthcare system. They use from 50 to 80% of public expenditures. As hospitals become more efficient, the better the allocated resources in health sector will be used. Objectives: The aim of this study was to assess hospitals’ efficiency in South Khorasan using the Pabon Lasso model. Methods: In this quasi-experimental and time-series study, we investigated the efficacy of South Khorasan hospitals during 2010 - 2018 (before and after the implementation of the health reform plan). All public hospitals in South Khorasan province were enrolled. Data including bed occupancy rate (BER), bed turnover (BT), and patient length of stay (LOS) were collected from hospitals in summer 2018 and analyzed using SPSS, version 21. Results: The means of the Pabon Lasso performance indicators for eight years were 74.4% for bed occupancy rate, 89.9 times for bed turnover, and 3.01 days for the length of stay. The coefficient of occupancy index after the implementation of the health reform plan was 5.7% higher than before, the bed turnover index increased 4.1 times, and the average length of stay increased by 0.08 day. On average, 35% of the hospitals were located in region 1, while 38% in region 2, 21% in Region 3, and 6% in Region 4 in the Pabon Lasso Diagram. Conclusions: Only 21% of the hospitals were in the region 3 of the Pabon Lasso Diagram, which is the desirable region for the efficiency of hospitals. This situation is not desirable and acceptable for hospitals. To increase productivity, interventions are required, and health planners and authorities need to apply economic tools for the improvement of this situation.

scholarly journals In-hospital mortality rate after osteoporotic hip fracture in Bucharest

2019 ◽  
Vol 2 (1) ◽  
pp. 48-51
Author(s):  
Ramona Dobre ◽  
Dan Niculescu ◽  
Gheorghe Popescu ◽  
Adrian Barbilian ◽  
Cătălin Cîrstoiu ◽  
...  
Keyword(s):  
Risk Factor ◽  
Hip Fracture ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Average Length ◽  
Fragility Fractures ◽  
Fragility Hip Fracture ◽  
Osteoporotic Hip Fracture ◽  
Increased Risk ◽  
Male Sex

AbstractIntroduction: Hip fracture is the most severe consequence of osteoporosis and an important cause of excess mortality in the elderly.Objective: We aimed to evaluate the in-hospital mortality rate after osteoporotic hip fracture in patients treated surgically or functionally in specialized centers in Bucharest.Materials and methods: We calculated the in-hospital mortality rate in 745 patients (540 women [72.48%], with a mean age of 79.1 ± 11 years), surgically or functionally treated for fragility hip fracture over a 12 months period.Results: Average length of hospitalization was 18.12 days. In hospital mortality rate was 5.36% (n=40, women 60%). An important risk factor associated with mortality was age, p=0.001. The male sex was also a risk factor with a mortality rate of 7,8% (n=16), compared to 4.44% in women, p<0.005, with OR of 1.57. Out of the 40 patients, 57.5% had a femoral neck fracture, 35% intertrochanteric, and 5.5% atypical fracture in absence of bisphosphonates. 7.5% had previous fragility fractures. 85% of the patients had a history of one or more cardiac pathologies (34.28% with atrial fibrillation), 57.5% underwent surgical intervention (n=23) with an average day of intervention of 8.82 after admission. None of the patients had an osteoporosis treatment before the event and on average 3.73 medications with an increased risk of falling and fracture.Conclusion: In-hospital mortality rate after hip fracture remains high; probably this being related to the high comorbidity associated with male sex and increased age as risk factors.

scholarly journals Epidemiological analysis of 869,220 varicose vein surgeries over 12 years in Brazil: trends, costs and mortality rate.

2021 ◽  
Author(s):  
Marcela Juliano Silva ◽  
Andressa Cristina Sposato Louzada ◽  
Marcelo Fiorelli Alexandrino da Silva ◽  
Maria Fernanda Cassino Portugal ◽  
Marcelo Passos Teivelis ◽  
...  
Keyword(s):  
Public Health ◽  
Mortality Rate ◽  
Health System ◽  
Varicose Vein ◽  
Public Health System ◽  
Varicose Veins ◽  
Average Rate ◽  
Public Hospitals ◽  
Chronic Venous Disease ◽  
Venous Disease

Objectives: to assess the total numbers of surgical procedures performed between 2008 and 2019 for the treatment of varicose veins in the Public Health System, which exclusively insures more than 160 millions Brazilian, the distribution of the surgeries over time, as well as its costs and mortality rates. Design, Materials and Methods: data referring to surgeries to treat chronic venous disease between 2008 and 2019 were extracted from the database of the Brazilian Public Health System. Results: In total, 869,220 surgeries were performed to treat chronic venous disease in public hospitals and outpatient clinics in Brazil, with an average rate of 4,52 surgeries per 10,000 inhabitants per year. From 2015 on, we observe a slight downward trend in the total number of procedures. The total amount reimbursed by the government was US$ 266,628,181.69. A total of 49 deaths were registered following varicose vein surgery, corresponding to a mortality rate of 0.005%. Conclusions: a total of 869,220 surgeries were performed to treat varicose in twelve years, with an overall rate of 4.52 procedures per 10,000 inhabitants per year. The mortality rate was very low, 0.005%.

scholarly journals 366. Characteristics and Outcomes of COVID-19 Patients with Fungal Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S253-S253
Author(s):  
Erica Herc ◽  
Nicholas F Yared ◽  
Adam Kudirka ◽  
Geehan Suleyman
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Fungal Infections ◽  
Average Length ◽  
Demographic Data ◽  
Descriptive Analysis ◽  
Retrospective Chart Review ◽  
Central Line ◽  
Source Control

Abstract Background There is concern that patients with coronavirus disease 2019 (COVID-19) are at risk of developing secondary bacterial and fungal infections; however, data on the clinical characteristics and outcomes of COVID-19 patients with fungal infections are limited. We evaluated the risk factors and mortality of hospitalized COVID-19 patients with fungal infections. Methods This was a retrospective chart review of 51 patients with fungal infections at an 877-bed teaching hospital in Detroit, Michigan from March through May 2020. Demographic data, comorbidities, complications, treatment, and outcomes, including relapse, readmission and mortality were collected. We performed a descriptive analysis. Results A total of 51 patients with fungal infections were included, in which 31 (60.8%) had confirmed or suspected COVID-19 infection. Of the COVID-19 patients, the average age was 66 years and the majority (54.9%) were female. The average length of stay (LOS) was 29.3 days. Aspergillus sp. (2 A. fumigatus, 1 A. niger) were isolated in 3 (10%) patients while 23 (74.2%) had candidemia diagnosed via blood culture or T2Candida® Panel. One had a positive serum galactomannan. The average time from admission to diagnosis was 13 days. Significant comorbidities included hypertension (74%), diabetes (51.6%), coronary artery disease (25.8%), congestive heart failure (32.2%), chronic kidney disease (22.6%), and malignancy (16.1%). Most patients received steroids (83.9%) and broad-spectrum antibiotics (80.6%), had a central line (80.6%), and required intensive care unit management (90%). Only 71% were treated with antifungals. One patient with candidemia relapsed due to poor source control; two were readmitted within 30 days. In-hospital mortality rate was 51.6% among COVID-19 patients. Conclusion COVID-19 patients with fungal infections had multiple comorbidities, prolonged hospitalization and predisposing risk factors for fungal infections with a high in-hospital mortality rate. Prevention of fungal infections in COVID-19 patients is paramount. Disclosures All Authors: No reported disclosures

scholarly journals Ten-years of bariatric surgery in Brazil: in-hospital mortality rates for patients assisted by universal health system or a health maintenance organization

2014 ◽  
Vol 27 (4) ◽  
pp. 261-267 ◽  
Author(s):  
Silvana Márcia Bruschi KELLES ◽  
Carla Jorge MACHADO ◽  
Sandhi Maria BARRETO
Keyword(s):  
Bariatric Surgery ◽  
Health Insurance ◽  
Hospital Mortality ◽  
Health System ◽  
Health Maintenance Organization ◽  
Similar Rate ◽  
Southeastern Brazil ◽  
Morbidly Obese ◽  
Insurance Company ◽  
Health Maintenance

BACKGROUND: Bariatric surgery is an option for sustained weight loss for the morbidly obese patient. In Brazil coexists the Unified Health System (SUS) with universal coverage and from which depend 150 million Brazilians and supplemental health security, predominantly private, with 50 million beneficiaries. AIM: To compare access, in-hospital mortality, length of stay and costs for patients undergoing bariatric surgery, assisted in one or another system. METHODS: Data from DATASUS and IBGE were used for SUS patients' and database from one health plan of southeastern Brazil for the health insurance patients. RESULTS: Between 2001 and 2010 there were 24,342 and 4,356 surgeries performed in SUS and in the health insurance company, respectively. The coverage rates for surgeries performed in 2010 were 5.3 and 91/100.000 individuals in SUS and health insurance respectively. The rate of in-hospital mortality in SUS, considering the entire country, was 0.55 %, 0.44 % considering SUS Southeast, and 0.30 % for the health insurance. The costs of surgery in the SUS and in the health insurance trend to equalization over the years. CONCLUSION: Despite differences in access and characteristics that may compromise the outcome of bariatric surgery, patients treated at the Southeast SUS had similar rate of in-hospital mortality compared to the health insurance patients.

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