Avaliação do desempenho nos serviços de saúde: aplicação do sistema de custeio baseado em actividades a uma unidade de cuidados intensivos polivalente

É frequente afirmar-se que a saúde não tem preço. Mas, tal como acontece em todos os processos de produção, seja de bens ou de serviços, também nas organizações de saúde cada doente tratado comporta um custo para a instituição. A natureza das prestações de cuidados de saúde e a quase gratuitidade dos serviços prestados implicam, não obstante, que se atribua particular atenção às formas mais adequadas de controlo dos custos nas organizações de saúde. Com efeito, se do lado da receita as instituições estão condicionadas pelas regras impostas pela tutela, sem prejuízo da negociação dos objectivos anuais de produção, por outro lado a gestão da despesa encontra como constrangimentos as exigências de manutenção do nível de qualidade do serviço prestado e a actualização dos meios tecnológicos mais eficazes e inovadores na formulação da terapêutica. O controlo de gestão só pode sobreviver com um profundo conhecimento da estrutura de custos e proveitos. Do lado dos custos, e porque é este o âmbito do nosso trabalho, temos que os sistemas de custeio têm como principal função apoiar as decisões inerentes ao processo de gestão estratégica e operacional das organizações. Mas um sistema de custeio só cumpre eficazmente estas funções se conseguir fornecer à gestão de topo informação adequada e precisa sobre os custos reais do processo produtivo. O sistema de Custeio Baseado em Actividades tem-se destacado na literatura por se entender que este modelo serve os propósitos mencionados. Apesar de ser um modelo genericamente aplicado ao sector industrial, são já várias as referências da sua implementação em serviços de saúde, mormente em serviços de imagiologia, bloco operatório ou urgência. O trabalho que ora se desenvolve procura estudar a validade da aplicação do Custeio Baseado em Actividades ao sector da saúde, caracterizando-se pela inovação na área em que foi aplicado – internamento, dada a insipiência de estudos nesta área de actividade e em particular em serviços como as unidades de cuidados intensivos, onde a componente de custos tem um peso muito grande nos custos totais da organização. Este estudo permitirá perceber de que forma deve o modelo de Custeio Baseado em Actividades ser ajustado às particularidades de um serviço de internamento, constituindo uma ferramenta de avaliação do desempenho do serviço através do conhecimento das actividades desenvolvidas e dos custos que lhes estão associados.We frequently say health is priceless, but like in any other production process, be it goods or services, in healthcare organisations each patient has a specific cost for the institution. The nature of the healthcare services and the services you get almost for free imply that a certain attention is paid to the most adequate ways for controlling costs in healthcare organisations. In fact, there are two perspectives to consider. On the one hand, bearing in mind the turnover, institutions are conditioned by rules imposed by the organisations in charge – without putting at jeopardy the negotiation of annual production goals. On the other hand, cost management finds its constraints on maintenance demands at the level of quality of a certain service and update of the technological means which are most effective and innovative in therapeutic formulation. Management control can only survive unless there’s a deep knowledge on the cost-profit structure. On the costs’ side – and because this is the main study field of our project –, the main function of costing systems is to support the decisions inherent to the strategic and operational management process within organisations. But a costing system can only accomplish these functions if it manages to grant top management adequate and exact information on the real costs of the production system. Activity-Based Costing stands out in literature as one understands this model serves the abovementioned purposes. Although it is a model generically applied to the industrial sector, authors have been referring to it and its implementation in healthcare services, namely in radiology, in the O.R and E.R. With this project we aim to study the validity of the application of Activity-Based Costing of the health sector characterised by the innovation in the field to which it was applied – the admission, given the scarcity of studies in this field, and in specific services such as the Intensive Care Units, in which the costing component weighs a lot among the total costs within the organisation. This study will allow us to understand how the Activity-Based Costing model may be adjusted to the particularities of an admission service, composing a performance evaluation tool of the service through knowledge of the activities developed and the costs associated to it

Valores pessoais e a qualidade dos serviços : um estudo com utentes do serviço de urgência hospitalar

Dissertação de mestrado em Estratégia Empresarial pela Faculdade de Economia da Universidade de Coimbra, 2009

Unraveling the genetic background of individuals with a clinical familial hypercholesterolemia phenotype

Familial hypercholesterolemia (FH) is a common genetic disorder of lipid metabolism caused by pathogenic/likely pathogenic variants in LDLR, APOB, and PCSK9 genes. Variants in FH-phenocopy genes (LDLRAP1, APOE, LIPA, ABCG5, and ABCG8), polygenic hypercholesterolemia, and hyperlipoprotein (a) [Lp(a)] can also mimic a clinical FH phenotype. We aim to present a new diagnostic tool to unravel the genetic background of clinical FH phenotype. Biochemical and genetic study was performed in 1,005 individuals with clinical diagnosis of FH, referred to the Portuguese FH Study. A next-generation sequencing panel, covering eight genes and eight SNPs to determine LDL-C polygenic risk score and LPA genetic score, was validated, and used in this study. FH was genetically confirmed in 417 index cases: 408 heterozygotes and 9 homozygotes. Cascade screening increased the identification to 1,000 FH individuals, including 11 homozygotes. FH-negative individuals (phenotype positive and genotype negative) have Lp(a) >50 mg/dl (30%), high polygenic risk score (16%), other monogenic lipid metabolism disorders (1%), and heterozygous pathogenic variants in FH-phenocopy genes (2%). Heterozygous variants of uncertain significance were identified in primary genes (12%) and phenocopy genes (7%). Overall, 42% of our cohort was genetically confirmed with FH. In the remaining individuals, other causes for high LDL-C were identified in 68%. Hyper-Lp(a) or polygenic hypercholesterolemia may be the cause of the clinical FH phenotype in almost half of FH-negative individuals. A small part has pathogenic variants in ABCG5/ABCG8 in heterozygosity that can cause hypercholesterolemia and should be further investigated. This extended next-generation sequencing panel identifies individuals with FH and FH-phenocopies, allowing to personalize each person’s treatment according to the affected pathway

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved