Avaliação de sistema de vigilância de óbitos perinatais em hospital terciário do interior paulista, 2014/2015
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Data
2016-08-22
Autores
Moraes, Marina Frolini [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
A vigilância epidemiológica é essencial para o planejamento, implementação e avaliação das práticas de saúde pública. O monitoramento da mortalidade perinatal, dentro do sistema de vigilância epidemiológica, depende da qualidade dos dados dos sistemas de informação. Objetivo: Avaliar o sistema de vigilância de óbitos perinatais de Núcleo Hospitalar de Epidemiologia (NHE) de hospital terciário do interior paulista. Métodos: Trata-se de estudo transversal, realizado a partir dos 80 óbitos ocorridos entre abril de 2014 e abril de 2015 em NHE de hospital terciário do interior paulista. O referencial de avaliação utilizado foi proposto pelo Center for Disease Control americano para uso em saúde pública. Foram abordados os seguintes atributos: utilidade, simplicidade, qualidade dos dados, aceitabilidade, sensibilidade, representatividade, oportunidade, flexibilidade, valor preditivo positivo, estabilidade. Este estudo foi aprovado por Comitê de Ética em Pesquisa local. Resultados: Utilidade: o sistema é pouco utilizado, os dados não são devolvidos aos profissionais, não são utilizados na proposição de ações para evitar a ocorrência de novos casos nem na gestão em saúde. Qualidade dos dados: 6,2% das variáveis estavam em branco nas investigações; a taxa de concordância entre as investigações originais e as realizadas para o estudo foi de 79,1%, sendo que a categoria com maior discordância/ausência de dados foi assistência ao parto (35,8%). Simplicidade: a grande maioria (91,2%) das investigações foi realizada a partir de apenas uma fonte de dados e o tempo médio gasto na investigação de óbitos infantis foi 63,4 minutos com intervalo interquartil de 29,2 minutos e de óbito fetal, 27,3 minutos com intervalo interquartil de 12,5 minutos. Aceitabilidade: nenhum caso de óbito foi notificado pelos atores envolvidos. Sensibilidade: há problemas a serem superados pelo NHE e Núcleo de Vigilância Epidemiológica. Representatividade: 96,8% dos óbitos do município ocorreram no Hospital do estudo. Oportunidade: o tempo entre a ocorrência do óbito e o encaminhamento ao município da investigação completa foi de 15,7 dias. Flexibilidade: o sistema foi considerado flexível. Valor preditivo positivo: todas as investigações de 2015 foram realizadas a partir da Declaração de Óbito e eram compatíveis com os casos. Estabilidade: alguns problemas eventuais foram apontados, tecnológicos ou por deficiências de recursos humanos. Conclusões: Para aprimorar o sistema de vigilância de óbitos perinatais será necessário: implementar ações voltadas aos diferentes profissionais atuantes na área materno infantil do hospital, para que passem a informar os casos ao NHE e para aprimorar a qualidade dos registros de dados nos prontuários; implementar busca ativa de óbitos perinatais em todas as unidades hospitalares que atendem gestantes e recém-nascidos e buscar mecanismos que permitam identificar, além dos óbitos infantis, os óbitos fetais pelo sistema de informática do hospital.
Epidemiological surveillance is essential for the planning, implementation and evaluation of public health practices. The monitoring of perinatal mortality, within the system of epidemiological surveillance, depends on quality of data in information systems. Object: To evaluate the perinatal deaths surveillance system of the Hospital Nucleus of Epidemiology (HNE) of a tertiary referral hospital in the interior of São Paulo state. Methods: A transversal study was conducted based on 80 deaths between April 2014 and April 2015 at the HNE of a tertiary referral hospital in the interior of São Paulo state. Our evaluation references were proposed by the American Center for Disease Control to be used in public health. The following attributes were addressed: utility, simplicity, data quality, acceptability, sensitivity, representativeness, timeliness, flexibility, predictive value positive, and stability. This study was approved by the local Research Ethics Committee. Results: Utility: the system is little used, the data are not returned to professionals, they are used neither in action proposals in order to avoid the emergence of new cases, nor in health management. Data quality: 6.2% of variables were blank in investigations; the agreement rate between original investigations and the ones conducted for the study was 79.1%, of which the category with the greatest disagreement/lack of data was birth assistance (35.8%). Simplicity: the vast majority (91.2%) of investigations was conducted on a single source of data, and the average time spent on investigating infant deaths was 63.4 minutes, with interquartile range of 29.2 minutes and 27.3 minutes with interquartile range of 12.5 minutes on fetal deaths. Acceptability: no death was reported by the individuals involved. Sensitivity: there are issues to be overcome by the NHE and the Epidemiological Surveillance Nucleus. Representativeness: 96.8% of deaths in the municipality occurred in the hospital under study. timeliness: the time span between death and referring the complete investigation to the municipality was 15.7 days. Flexibility: the system was considered flexible. Predictive value positive: all investigations in 2015 were conducted based on the date of death and were compatible with the cases. Stability: some possible problems (of a technological nature or due to lack of staff) were highlighted. Conclusions: To have a better surveillance system for perinatal deaths, it will be necessary to: implement actions geared at different professionals working at the maternity and child ward of the hospital so that they begin to report cases to the HNE and improve the quality of records in patients’ files; to implement an active search of perinatal deaths in all hospital units dealing with pregnant women and newborns and to search for mechanisms that make it possible to identify, besides infant deaths, fetal deaths by means of the hospital’s IT system.
Epidemiological surveillance is essential for the planning, implementation and evaluation of public health practices. The monitoring of perinatal mortality, within the system of epidemiological surveillance, depends on quality of data in information systems. Object: To evaluate the perinatal deaths surveillance system of the Hospital Nucleus of Epidemiology (HNE) of a tertiary referral hospital in the interior of São Paulo state. Methods: A transversal study was conducted based on 80 deaths between April 2014 and April 2015 at the HNE of a tertiary referral hospital in the interior of São Paulo state. Our evaluation references were proposed by the American Center for Disease Control to be used in public health. The following attributes were addressed: utility, simplicity, data quality, acceptability, sensitivity, representativeness, timeliness, flexibility, predictive value positive, and stability. This study was approved by the local Research Ethics Committee. Results: Utility: the system is little used, the data are not returned to professionals, they are used neither in action proposals in order to avoid the emergence of new cases, nor in health management. Data quality: 6.2% of variables were blank in investigations; the agreement rate between original investigations and the ones conducted for the study was 79.1%, of which the category with the greatest disagreement/lack of data was birth assistance (35.8%). Simplicity: the vast majority (91.2%) of investigations was conducted on a single source of data, and the average time spent on investigating infant deaths was 63.4 minutes, with interquartile range of 29.2 minutes and 27.3 minutes with interquartile range of 12.5 minutes on fetal deaths. Acceptability: no death was reported by the individuals involved. Sensitivity: there are issues to be overcome by the NHE and the Epidemiological Surveillance Nucleus. Representativeness: 96.8% of deaths in the municipality occurred in the hospital under study. timeliness: the time span between death and referring the complete investigation to the municipality was 15.7 days. Flexibility: the system was considered flexible. Predictive value positive: all investigations in 2015 were conducted based on the date of death and were compatible with the cases. Stability: some possible problems (of a technological nature or due to lack of staff) were highlighted. Conclusions: To have a better surveillance system for perinatal deaths, it will be necessary to: implement actions geared at different professionals working at the maternity and child ward of the hospital so that they begin to report cases to the HNE and improve the quality of records in patients’ files; to implement an active search of perinatal deaths in all hospital units dealing with pregnant women and newborns and to search for mechanisms that make it possible to identify, besides infant deaths, fetal deaths by means of the hospital’s IT system.
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Palavras-chave
Óbito perinatal, Óbito fetal, Epidemiologia, Vigilância em saúde pública, Perinatal death, Fetal death, Epidemiology, Surveillance in public health