Desenvolvimento de um modelo integrado so Activity-Based Management (ABM) para análise de eficácia em serviços de emergência

A gestão assistencial, cada vez mais, assume a responsabilidade integral do desempenho dos serviços e/ou unidades hospitalares, passando a responder não somente pelo desempenho assistencial como também pelo econômico. Em conseqüência, há maior compreensão do processo e dos recursos consumidos. Assim, os indicadores assistenciais (tempo médio de permanência, taxas de infecção, taxas de óbito) passam a ser as causas mais óbvias e verdadeiramente afins para explicar e revestir os valores econômicos. Todavia, ela necessita de um modelo administrativo que a norteie, possibilitando assim, um gerenciamento sistematizado, científico e qualificado, que atinja as metas traçadas, refletidas nos indicadores de resultado da qualidade assistencial e econômica. Este trabalho teve como objetivo desenvolver um modelo integrado ao Activity-Based Management (ABM) para melhor analisar a eficácia em Serviços de Emergência, buscando através do mapeamento dos processos e custeio das principais atividades, propor o gerenciamento dos Protocolos Clínicos e das Intervenções Terapêuticas - Therapeutic lntervention Scoring System (TISS) pelo método ABM. O desenvolvimento do modelo deu-se em duas etapas: I°) Identificação dos principais serviços prestados e mapeamento dos processos e principais atividades do Plantão Médico do Hospital Mãe de Deus, Porto Alegre -RS; 2°) Desdobramento da análise de Eficiência e Eficácia através de um sistema de informações, onde as entradas consideradas foram os processos, subprocessos e atividades mapeadas e custeadas pelo método Activity- Based Costing (ABe); os processadores foram os protocolos clínicos (ABM estratégico), as rotinas, o TISS e a estatística descritiva (ABM operacional); resultando na saída do sistema a análise da Eficácia (qualidade, tempo e custo) gerando relatórios da Eficácia Assistencial. Considerando-se que na saúde, mesmo contando com a utilização dos melhores recursos e tempos hábeis, existe a probabilidade de desfechos insatisfatórios, o modelo assumiu que para análise da qualidade, a avaliação está embasada num todo, onde se somam basicamente o tempo ideal preconizado para cada situação e a expectativa da utilização otimizada dos recursos (mão-de-obra, materiais, medicamentos, exames e equipamentos). Para análise dos tempos, considerou-se as evidências da obtenção de melhores resultados clínicos. Assim sendo, toda vez que os tempos forem além do preconizado pelos protocolos e rotinas, haverá ineficácia no processo, pois os objetivos assistenciais dos desfechos clínicos serão perturbados. E por fim, na análise dos custos, foram considerados ao mesmo tempo o meio e o fim da quantificação de ociosidade ou desperdício e da qualidade assistencial respectivamente. Fazer as coisas que devem ser feitas, com qualidade a custo menor, proporciona perspectivas de eficácia ao encontro dos objetivos da organização. Como resultados, pode-se constatar que os protocolos clínicos e as intervenções pelo TISS integrados ao ABM e com o uso da estatística descritiva, muito embora não sejam fórmulas rígidas a serem seguidas, mostraram indiscutivelmente a eficácia e a eficiência do processos assistencial, respeitadas as variabilidades de condutas e utilização de recursos explicáveis pela diversidade das doenças.

Uma experiência na utilizacao do vbm (value based management) como ferramenta de desenvolvimento de estratégias de negócio

Esta tese baseia-se na experiência adquirida com a participação num projeto de implantação do conceito de Value Based Management em urna empresa multinacional de bens de consumo. A maior parte do material aqui comentado foi colhido durante o primeiro semestre do ano de 1995 - período em que durou o projeto - e parte durante duas semanas no início do ano, nas quais participei em Londres de um treinamento intensivo, ministrado por uma conceituada firma de consultoria internacional, sobre a teoria e prática deste novo conceito, juntamente com diversos participantes de outros projetos VBM ao redor do mundo como Estados Unidos, França, Itália, Alemanha, Inglaterra, Espanha, entre outros

A experiência de empresas brasileiras com a implantação do sistema de shareholder value based management: um estudo clínico

Através de um estudo clínico que compreendeu o uso de questionário detalhado, entrevistas de profundidade e workshop de validação, é feita análise da experiência de um pequeno grupo de empresas brasileiras com a implantação do Shareholder Value Based Management, ou gestão baseada em valor. São apresentados os vários critérios de cálculo de valor utilizados e identificados os pontos fortes e fracos de cada método

The meaning of evidence-based management to brazilian senior nurse leaders

Purpose: The study objective was to understand the meaning of evidence-based management for senior nurse leaders in accredited, public hospitals in the State of Sao Paulo, Brazil. Design and Method: A phenomenological approach was used to analyze interviews conducted with 10 senior nurse leaders between August 2011 and March 2012. The analytic method was developed by the Brazilian phenomenologist, Martins. Findings: Senior nurse leaders described how they critically appraise many sources of evidence when making managerial decisions. They emphasized the importance of working with their teams to locally adapt and evaluate best evidence associated with managerial decision making and organizational innovations. Their statements also demonstrated how they use evidence-based management to support the adoption of evidence-based practices. They did not, however, provide specific strategies for seeking out and obtaining evidence. Notable challenges were traditional cultures and rigid bureaucracies, while major facilitators included accreditation, teamwork, and shared decision making. Conclusions: Evidence-based management necessitates a continuous process of locating, implementing, and evaluating evidence. In this study leaders provided multiple, concrete examples of all these processes except seeking out and locating evidence. They also gave examples of other leadership skills associated with successful adoption of evidence-based practice and management, particularly interdisciplinary teamwork and shared decision making. Clinical Relevance: This study demonstrates senior nurse leaders' awareness and utilization of evidence-based management. The study also suggests what aspects of evidence-based management need further development, such as more active identification of potential, new organizational innovations. © 2013 Sigma Theta Tau International.

Evidence-based management of bullous pemphigoid

Bullous pemphigoid (BP) is the most common autoimmune subepidermal bullous disease typically affecting the elderly. Although different therapeutic regimens have been proposed, a review of the evidence is needed to aid clinicians in their decision making and management. Systemic therapies such as corticosteroids and adjuvants are effective in BP but are plagued with adverse effects, and potent topical steroids are an alternative treatment. This article reviews the evidence supporting different therapeutic options in the management of BP.

Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area

Rapid diagnostic tests (RDT) are sometimes recommended to improve the home-based management of malaria. The accuracy of an RDT for the detection of clinical malaria and the presence of malarial parasites has recently been evaluated in a high-transmission area of southern Mali. During the same study, the cost-effectiveness of a 'test-and-treat' strategy for the home-based management of malaria (based on an artemisinin-combination therapy) was compared with that of a 'treat-all' strategy. Overall, 301 patients, of all ages, each of whom had been considered a presumptive case of uncomplicated malaria by a village healthworker, were checked with a commercial RDT (Paracheck-Pf). The sensitivity, specificity, and positive and negative predictive values of this test, compared with the results of microscopy and two different definitions of clinical malaria, were then determined. The RDT was found to be 82.9% sensitive (with a 95% confidence interval of 78.0%-87.1%) and 78.9% (63.9%-89.7%) specific compared with the detection of parasites by microscopy. In the detection of clinical malaria, it was 95.2% (91.3%-97.6%) sensitive and 57.4% (48.2%-66.2%) specific compared with a general practitioner's diagnosis of the disease, and 100.0% (94.5%-100.0%) sensitive but only 30.2% (24.8%-36.2%) specific when compared against the fulfillment of the World Health Organization's (2003) research criteria for uncomplicated malaria. Among children aged 0-5 years, the cost of the 'test-and-treat' strategy, per episode, was about twice that of the 'treat-all' (U.S.$1.0. v. U.S.$0.5). In older subjects, however, the two strategies were equally costly (approximately U.S.$2/episode). In conclusion, for children aged 0-5 years in a high-transmission area of sub-Saharan Africa, use of the RDT was not cost-effective compared with the presumptive treatment of malaria with an ACT. In older patients, use of the RDT did not reduce costs. The question remains whether either of the strategies investigated can be made affordable for the affected population.

A Time-based Passive Source Localization System for Narrow-band Signal

Time-based indoor localization has been investigated for several years but the accuracy of existing solutions is limited by several factors, e.g., imperfect synchronization, signal bandwidth and indoor environment. In this paper, we compare two time-based localization algorithms for narrow-band signals, i.e., multilateration and fingerprinting. First, we develop a new Linear Least Square (LLS) algorithm for Differential Time Difference Of Arrival (DTDOA). Second, fingerprinting is among the most successful approaches used for indoor localization and typically relies on the collection of measurements on signal strength over the area of interest. We propose an alternative by constructing fingerprints of fine-grained time information of the radio signal. We offer comprehensive analytical discussions on the feasibility of the approaches, which are backed up by evaluations in a software defined radio based IEEE 802.15.4 testbed. Our work contributes to research on localization with narrow-band signals. The results show that our proposed DTDOA-based LLS algorithm obviously improves the localization accuracy compared to traditional TDOA-based LLS algorithm but the accuracy is still limited because of the complex indoor environment. Furthermore, we show that time-based fingerprinting is a promising alternative to power-based fingerprinting.

Dynamic Model-based Management of Service-Oriented Infrastructure.

Models are an effective tool for systems and software design. They allow software architects to abstract from the non-relevant details. Those qualities are also useful for the technical management of networks, systems and software, such as those that compose service oriented architectures. Models can provide a set of well-defined abstractions over the distributed heterogeneous service infrastructure that enable its automated management. We propose to use the managed system as a source of dynamically generated runtime models, and decompose management processes into a composition of model transformations. We have created an autonomic service deployment and configuration architecture that obtains, analyzes, and transforms system models to apply the required actions, while being oblivious to the low-level details. An instrumentation layer automatically builds these models and interprets the planned management actions to the system. We illustrate these concepts with a distributed service update operation.

The impact of cognitive control on children's goal monitoring in a time-based prospective memory task

Peer reviewed

Effect of community based management in failure to thrive: randomised controlled trial

Objective: To evaluate the effectiveness of a health visitor led intervention for failure to thrive in children under 2 years old.