Adesão e impacto de um programa computacional de gerenciamento clínico em indicadores de qualidade em hemodiálise: da elaboração à utilização
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2018-02-27
Autores
Oliveira, Rogerio Carvalho de
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Universidade Estadual Paulista (Unesp)
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Introdução As unidades de diálise deparam-se com uma demanda crescente de portadores de doença renal crônica com necessidade de tratamento renal substitutivo. Neste cenário, uma quantidade massiva de dados clínicos e laboratoriais é gerada diariamente. Há diretrizes e incentivos financeiros internacionais que compelem as unidades à captura, armazenamento, análise e divulgação desses dados na forma de indicadores de qualidade assistencial. Os sistemas de informação em saúde no âmbito geral de saúde, têm sido foco de questionamentos acerca da usabilidade e interoperabilidade. Ademais, há controvérsias quanto à capacidade na redução de mortalidade ou melhora em indicadores clínico-laboratoriais. Imputa-se, esse fato, dentre outras causas, à pouca participação de profissionais da saúde em etapas do desenvolvimento ou manutenção dessas tecnologias. Assim, o objetivo do corrente trabalho foi descrever a implantação de um sistema desenvolvido localmente, com a participação de profissionais da saúde, e avaliar o comportamento de indicadores de qualidade em associação à métrica de seu uso. Material e Métodos Neste estudo é descrita a implementação de um programa de gerencialmente clínico em hemodiálise desenvolvido por médicos nefrologistas, com escopo limitado ao auxilio desse profissional em suas tarefas diárias e ensino de conceitos de diálise ao residente de nefrologia. É mensurada a intensidade de uso do programa e sua associação com mortalidade, internações e melhora em indicadores laboratoriais no período de agosto de 2008 à agosto de 2015 em uma coorte de pacientes incidentes que estiveram em terapia por mais de 90 dias. Resultados Inicialmente, foi descrita a elaboração e implantação do Software na unidade de diálise. Em seguida foram avaliados 314 pacientes com idade superior a 18 anos que iniciaram a diálise no período de estudo e sobreviveram por mais de 90 dias. Observou-se que houve melhora progressiva dos níveis de hemoglobina, albumina e hormônio da paratireóide, que são indicadores de qualidade em diálise. O número de pacientes atendidos aumentou progressivamente sem aumento paralelo do número de internações, o que resultou em menor frequência de internações por paciente atendido na diálise. A sobrevida total e a sobrevida livre de internações foi associada ao maior uso da ferramenta computacional, mesmo após ajuste para variáveis confundidoras. Conclusão Este trabalho buscou prover informação adicional e contribuir para a comunidade médica e científica fornecendo subsídios para um entendimento das dificuldades rotineiras do ambiente de diálise que tem sido tratado com abordagens gerais. É sugerido na literatura que abordagens mais gerais não atingem os requisitos em áreas especializadas como é o caso da diálise. Com isso, mostra-se que ocorreu redução do tempo livre de internação e redução de mortalidade associadas à intensidade do uso da ferramenta computacional.
Dialysis units are faced with a growing demand from patients with chronic renal disease requiring renal replacement treatment. In this scenario, a large mass of clinical and laboratory data is generated on a daily basis and international guidelines and financial incentives compel units to the capture, storage, analysis and in dissemination of dialysis data in the form of service quality indicators. Health information systems have been under debate with focus on the usability and interoperability as well as inconsistent data and finally its real capacity to reduce mortality or improvement in clinical and laboratory indicators. Among many other causes being imputed, the low participation of physicians in the development or maintenance stages of these technologies. There are no previous studies that have described the impact of the implementation of locally developed computerized systems for the clinical management of hemodialysis patients. The objective of this study was to describe the implementation of a locally developed system and evaluate the consequences associated with the metric of its use. Material and methods It describes the implementation of a clinical managerial program in hemodialysis developed by nephrologists, with limited scope to aid these professionals in their daily tasks and teaching concepts to dialysis resident of Nephrology. It measured the intensity of use of the program and its association on mortality, hospitalizations and improvement in laboratory indicators from August 2008 to August 2015 in a cohort of incident patients who have been in therapy for more than 90 days. Results It was initially described the design and implementation of software in the dialysis unit, which took place with satisfactory adherence and usability recognized by those involved. Next were evaluated 314 patients over the age of 18 who started dialysis in the study period and survived more than 90 days. It was observed that there was progressive improvement in hemoglobin, albumin and parathyroid hormone, which are indicators of quality in dialysis. The number of patients increased progressively unparalleled increase in the number of hospitalizations, which resulted in lower frequency of hospitalizations per patient on dialysis. Overall survival and hospitalization-free survival was associated with computer cover charge, even after adjusting for confounding variables. Conclusion This study aimed to provide additional information and contribute to the medical and scientific community providing grants for an understanding of the routine difficulties of dialysis environment that has been treated with general approaches. It is suggested in the literature that more general approaches do not meet the requirements in specialized areas such as the dialysis case. Thus, it is shown that there was an increase in hemoglobin levels, increased albumin, reduced hospitalization time off and mortality reduction associated with the intensity of use of the tool.
Dialysis units are faced with a growing demand from patients with chronic renal disease requiring renal replacement treatment. In this scenario, a large mass of clinical and laboratory data is generated on a daily basis and international guidelines and financial incentives compel units to the capture, storage, analysis and in dissemination of dialysis data in the form of service quality indicators. Health information systems have been under debate with focus on the usability and interoperability as well as inconsistent data and finally its real capacity to reduce mortality or improvement in clinical and laboratory indicators. Among many other causes being imputed, the low participation of physicians in the development or maintenance stages of these technologies. There are no previous studies that have described the impact of the implementation of locally developed computerized systems for the clinical management of hemodialysis patients. The objective of this study was to describe the implementation of a locally developed system and evaluate the consequences associated with the metric of its use. Material and methods It describes the implementation of a clinical managerial program in hemodialysis developed by nephrologists, with limited scope to aid these professionals in their daily tasks and teaching concepts to dialysis resident of Nephrology. It measured the intensity of use of the program and its association on mortality, hospitalizations and improvement in laboratory indicators from August 2008 to August 2015 in a cohort of incident patients who have been in therapy for more than 90 days. Results It was initially described the design and implementation of software in the dialysis unit, which took place with satisfactory adherence and usability recognized by those involved. Next were evaluated 314 patients over the age of 18 who started dialysis in the study period and survived more than 90 days. It was observed that there was progressive improvement in hemoglobin, albumin and parathyroid hormone, which are indicators of quality in dialysis. The number of patients increased progressively unparalleled increase in the number of hospitalizations, which resulted in lower frequency of hospitalizations per patient on dialysis. Overall survival and hospitalization-free survival was associated with computer cover charge, even after adjusting for confounding variables. Conclusion This study aimed to provide additional information and contribute to the medical and scientific community providing grants for an understanding of the routine difficulties of dialysis environment that has been treated with general approaches. It is suggested in the literature that more general approaches do not meet the requirements in specialized areas such as the dialysis case. Thus, it is shown that there was an increase in hemoglobin levels, increased albumin, reduced hospitalization time off and mortality reduction associated with the intensity of use of the tool.
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hemodiálise, software, prontuário, qualidade, mortalidade