Impacto econômico e assistencial das complicações relacionadas à internação hospitalar
| Ano de defesa: | 2015 |
|---|---|
| Autor(a) principal: | |
| Orientador(a): | |
| Banca de defesa: | |
| Tipo de documento: | Dissertação |
| Tipo de acesso: | Acesso aberto |
| Idioma: | por |
| Instituição de defesa: |
Universidade Federal de Minas Gerais
UFMG |
| Programa de Pós-Graduação: |
Não Informado pela instituição
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| Departamento: |
Não Informado pela instituição
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| País: |
Não Informado pela instituição
|
| Palavras-chave em Português: | |
| Link de acesso: | http://hdl.handle.net/1843/BUBD-A2MJCX |
Resumo: | It is a case-control study to determine the economical and health impacts of healthcare-acquired conditions. The economic impact was evaluated through the length of stay and the health impact through mortality. Patients were paired by hospital institution, DRG category using DRG Brasil system, age, sex and weight for neonates. Coding of healthcare-acquired conditions was duplicated, one retrospective and other prospective, by DRG coders and by healthcare safety and infection control professionals. The coding of other variables was retrospective and single, at 3 hospitals that together add up to 510 beds of the private healthcare sector. The hospitals are of high complexity, certified ISO 9001 and 2 are accredited ONA level 3, a brazilian certification system. The study took place during the years of 2012 to 2014. Information was collected through the review of hospital records by a supervised team that evaluated the consistency of results and corrected any inconsistencies. 57.215 were included in the study with 2.281 patients with at least one healthcare-acquired condition and in 1.887 we were able to find a corresponding pair. The economic impact of complications was measured by variations in the length of stay. McNemars chi-square and Students T Test were used and the results were considered significant with a p value of < 0,05. Healthcare-acquired conditions occurred in 4% of patients admitted to the hospital. Length of stay for controls was 9,1 ± 14,0 days while for cases it was 18,8 ± 25,6 days. We considered the average time between hospital admission and the occurrence of the hospital-acquired condition in cases (7,6 ± 21,3 days) and average time of hospital stay of the control group (9,1 ± 14,0 days) (p=0,008), excluding deaths. Complications related to hospital admission happened on the average number of days related to discharge time determining the prolonged stay and suggesting a cause-effect relation between healthcare-acquired conditions and increased length of stay. Complications consumed 10,3% of all health resources of the population studied taking into account only hospital bed use. Generalizing the costs to the private health sector we estimate a waste of R$ 3,296 billion having the fiscal year of 2012 as reference. We also found meaningful statistical difference in regards to patients evolving to death. 23,7% of patients with healthcare-acquired conditions or cases evolved to death while controls evolved to death in 7,1%. Mortality was 333% greater in cases with 166 deaths per 1000 HAC patients. It is the first brazilian study to evaluate healthcare-acquired conditions through original Diagnosis Related Groups - DRG methodology records. |