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O aumento na procura dos cuidados de saúde aliado a um maior custo na prestação desses mesmos cuidados faz com que diminuir as despesas em saúde seja uma necessidade económica.
Uma das estratégias para alcançar essa meta são as políticas relacionadas com a diminuição do tempo de permanência dos doentes no hospital, uma vez que diversos estudos demonstram que cerca de uma em cada três admissões é inapropriada e um terço dos dias totais de internamento no hospital são inadequados.
Desta forma, a criação de ferramentas para avaliar a adequação do momento de admissão no internamento hospitalar bem como da sua duração, permitindo identificar falhas e corrigi-las, é um dos maiores desafios da gestão hospitalar.
Esta dissertação, através de uma revisão bibliográfica, pretende apresentar as principais ferramentas de revisão clínica criadas até à data e uma compilação de estudos realizados, nacional e internacionalmente, que utilizem o Appropriateness Evaluation Protocol, o instrumento de revisão clínica mais utilizado a nível mundial atualmente.
Dos 4 estudos nacionais analisados, a taxa de inadequação das admissões no internamento variou entre 19% e 24,6% e a percentagem de dias de internamento inadequados, apenas avaliadas em dois dos estudos, foi de 37,4% e de 46%. Da análise de diversos estudos feitos em vários países, a proporção de inadequação das admissões variou entre 6,9% e 38,1%, na Europa, e 7,4% e 22,85%, na Ásia. O único estudo americano apresentou valores de 14,2%. Já relativamente à inadequação dos dias de internamento, os valores são um pouco superiores variando entre 11% e 54%, na Europa e entre 14,9% e 34,6%, na Ásia. Os dois estudos realizados em países americanos apresentaram valores de 9% e 22,8%.
A admissão prematura, o internamento para procedimentos que poderiam ter sido realizados em ambulatório e a prática conservadora foram apontadas como as principais causas de inadequação das admissões nos internamentos. Como fatores de inadequação de dias de internamento foram identificados a prática conservadora, a demora na obtenção de exames de diagnóstico e a inexistência de uma instituição alternativa para transferência do doente.
No que respeita às estratégias para redução dos internamentos inadequados há a salientar as intervenções a nível da reorganização interna hospitalar, de articulação com a rede de cuidados continuados, de otimização dos cuidados de saúde primários e capacitação do doente.
The increase in the demand of health care combined with a higher cost in providing these same care, makes decreasing the health expenses an economic necessity. One of the strategies to reach that goal are the politics related to the decrease of time that patients stay in the hospital, uma vez que several studies show that about one in three admissions is inapropriate and one third of the internamento days at the hospital inapropriate. Therefore, the creation of tools that evaluate the adequação at the momento of admission in the hospital admission as well as it’s duration, alowing to identify flaws and fix them, is one of the greatest chalenges in hospital management. This dissertation, through a biográfic revision, intends to presente the main tools of clinic revision created so far and a compilation of studies carried out, national and international, that use the Appropriateness Evaluation Protocol, the most used clinic revision tool worldwide. Of the four national studies analyzed, the admissions inadequacy rate in hospital admission was between 19% and 24,6% and the percentage of inadequate hospital stay, only evaluated in two of the studies, was 37,4% and 46%. From the analysis of several studies conducted in several countries, the proportion of admission varied between 6,9% and 38,1%, in Europe, and 7,4% and 22,85%, in Asia. The American study presented values of 14,2%. Regarding the inadequacy of the days of hospitalizations, the values are slightly higher ranging between 11% and 54%, in Europe, 14,9% and 34,6%, in Asia, and the two studies conducted in American countries presented values of 9% and 22,8%. The premature admission, the hospitalization to procedures wich could have beem preformed in the outpatient clinic and the conservative practice were identified as the main causes of inadequacy of hospital admissions. As factors of inadequacy of the days of hospitalization were identified the conservative practice, the social problems and the lack of an alternative institution to transfer the patient. With regard to strategies to reduce inadequate hospital admissions, interventions in internal hospital reorganization, articulation with the network of continued care, optimization of primary health care and patient empowerment should be emphasized.
The increase in the demand of health care combined with a higher cost in providing these same care, makes decreasing the health expenses an economic necessity. One of the strategies to reach that goal are the politics related to the decrease of time that patients stay in the hospital, uma vez que several studies show that about one in three admissions is inapropriate and one third of the internamento days at the hospital inapropriate. Therefore, the creation of tools that evaluate the adequação at the momento of admission in the hospital admission as well as it’s duration, alowing to identify flaws and fix them, is one of the greatest chalenges in hospital management. This dissertation, through a biográfic revision, intends to presente the main tools of clinic revision created so far and a compilation of studies carried out, national and international, that use the Appropriateness Evaluation Protocol, the most used clinic revision tool worldwide. Of the four national studies analyzed, the admissions inadequacy rate in hospital admission was between 19% and 24,6% and the percentage of inadequate hospital stay, only evaluated in two of the studies, was 37,4% and 46%. From the analysis of several studies conducted in several countries, the proportion of admission varied between 6,9% and 38,1%, in Europe, and 7,4% and 22,85%, in Asia. The American study presented values of 14,2%. Regarding the inadequacy of the days of hospitalizations, the values are slightly higher ranging between 11% and 54%, in Europe, 14,9% and 34,6%, in Asia, and the two studies conducted in American countries presented values of 9% and 22,8%. The premature admission, the hospitalization to procedures wich could have beem preformed in the outpatient clinic and the conservative practice were identified as the main causes of inadequacy of hospital admissions. As factors of inadequacy of the days of hospitalization were identified the conservative practice, the social problems and the lack of an alternative institution to transfer the patient. With regard to strategies to reduce inadequate hospital admissions, interventions in internal hospital reorganization, articulation with the network of continued care, optimization of primary health care and patient empowerment should be emphasized.
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Keywords
Admissão Inadequada Appropriateness Evaluation Protocol Ferramentas de Revisão Internamento Inadequado Protocolo de Revisão de Utilização