O uso de indicadores como ferramenta de gestão na estratégia saúde da família

Aim: to verify the use of health indicators in the daily work of nursing managers of the Family Health Strategy in a medium-sized municipality in the state of Santa Catarina, Brazil. Methods: this study is a descriptive research with qualitative approach. Data were collected with thirteen nursing managers through semi structured interviews and were subsequently analyzed by thematic analyses. Results: the indicators are considered a possibility for planning and evaluating the actions in health in the Family Health Unit, even though some distance between theory and practice was shown. Conclusion: it is suggested a change of perspective of the professionals involved and it is pointed to the need for investment in lifelong learning as an alternative to overcome the difficulties experiencedObjetivo: verificar el uso de los indicadores de salud en el trabajo diario de enfermeros gerentes de la estrategia de salud familiar en una ciudad de medio porte del interior de Santa Catarina, Brasil. Método: se trata de una investigación descriptiva con abordaje cualitativo. Se colectaron los datos junto a 13 enfermeros gerentes, mediante entrevista semiestructurada, sometidos posteriormente a análisis temático. Resultados: los indicadores son concebidos como una posibilidad para la planificación y evaluación de las acciones en salud en la unidad de salud de la familia, aunque se haya evidenciado cierto distanciamiento entre la teoría y la práctica. Conclusión: se sugiere un cambio de foco de los profesionales involucrados y se llama la atención para la necesidad de inversión en formación permanente como una alternativa de superación de las dificultades vivenciadas.Doi: 10.5902/2179769214150Objetivo: verificar o uso dos indicadores de saúde no cotidiano do trabalho de enfermeiros gerentes da estratégia saúde da família, em um município de médio porte do interior do estado de Santa Catarina, Brasil. Método: trata-se de uma pesquisa descritiva com abordagem qualitativa. Os dados foram coletados junto a treze enfermeiros gerentes, por meio de entrevista semiestruturada, sendo posteriormente submetidos à análise temática. Resultados: os indicadores são concebidos como uma possibilidade para o planejamento e avaliação das ações em saúde na estratégia saúde da família, embora tenha se evidenciado certo distanciamento entre a teoria e prática. Conclusão: sugere-se uma mudança de olhar dos profissionais envolvidos e aponta-se para a necessidade de investimento em educação permanente como uma alternativa de superação das dificuldades vivenciadas

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)