3 research outputs found
Psychometric properties of the Child Health Assessment Questionnaire (CHAQ) applied to children and adolescents with cerebral palsy
<p>Abstract</p> <p>Background</p> <p>Cerebral palsy (CP) patients have motor limitations that can affect functionality and abilities for activities of daily living (ADL). Health related quality of life and health status instruments validated to be applied to these patients do not directly approach the concepts of functionality or ADL. The Child Health Assessment Questionnaire (CHAQ) seems to be a good instrument to approach this dimension, but it was never used for CP patients. The purpose of the study was to verify the psychometric properties of CHAQ applied to children and adolescents with CP.</p> <p>Methods</p> <p>Parents or guardians of children and adolescents with CP, aged 5 to 18 years, answered the CHAQ. A healthy group of 314 children and adolescents was recruited during the validation of the CHAQ Brazilian-version. Data quality, reliability and validity were studied. The motor function was evaluated by the Gross Motor Function Measure (GMFM).</p> <p>Results</p> <p>Ninety-six parents/guardians answered the questionnaire. The age of the patients ranged from 5 to 17.9 years (average: 9.3). The rate of missing data was low (<9.3%). The floor effect was observed in two domains, being higher only in the visual analogue scales (≤ 35.5%). The ceiling effect was significant in all domains and particularly high in patients with quadriplegia (81.8 to 90.9%) and extrapyramidal (45.4 to 91.0%). The Cronbach alpha coefficient ranged from 0.85 to 0.95. The validity was appropriate: for the discriminant validity the correlation of the <it>disability index </it>with the visual analogue scales was not significant; for the convergent validity CHAQ <it>disability index </it>had a strong correlation with the GMFM (0.77); for the divergent validity there was no correlation between GMFM and the pain and overall evaluation scales; for the criterion validity GMFM as well as CHAQ detected differences in the scores among the clinical type of CP (p < 0.01); for the construct validity, the patients' <it>disability index </it>score (mean:2.16; SD:0.72) was higher than the healthy group (mean:0.12; SD:0.23)(p < 0.01).</p> <p>Conclusion</p> <p>CHAQ reliability and validity were adequate to this population. However, further studies are necessary to verify the influence of the ceiling effect on the responsiveness of the instrument.</p
An analysis of the indicators for organizational performance in an outpatient physiotherapy care institution: the search for enhancements to quality improvement processes
The current scenario of Economy Health has a very important role in the world. Hence, the study is appropriate due to the characteristics of a national market with strong governmental regulation and considerable competitiveness, associated with a fast technological advancement that generates new techniques and products, when there is a consequent increase in the cost of services in health and a constant quest for excellence in service quality. To survive in the health market, it is necessary an innovation from a competitive strategy and a development of a management information system adapted to the service provided, especially in rehabilitation, given that there is little research related to management control. Thus, the company Physiotherapy´s Clinic, has implemented technical and methodological tools to maintain and improve the quality of care provided (Strategic Planning, Balanced Scorecard and Management by Guidelines). However, these instruments and techniques needed evaluation in relation to the adopted strategies. From the data provided by the company, proposed the creation and analysis of three indicators: Physiotherapist Technical Evaluation; Resolutivity by Therapeutic Objectives; and Resolutivity by Physiotherapeutic Specialty. To develop the research, 4,773 medical records were analyzed from 2015 to 2017. The results of this study revealed the optimization in the levels of healthcare provided based on quality standards, the development of physical therapists, the ability to go to meeting customer demands, better targeting of investments in the technology park, significant differences between individual physical therapy care and with more than one patient simultaneously. However, it was found that through the analysis of quality indicators it was possible to evaluate the predictability of internal operations and promote the direction for the management of the Physiotherapy service. It is believed that this study may contribute to improving the management and sustainability of public or private Physiotherapy or Rehabilitation clinics, according to the reality of each institution.Tese (Doutorado)O cenário atual da Economia em Saúde possui papel extremamente relevante em todo o mundo. Nesse sentido, o estudo é apropriado devido às características de um mercado nacional com forte regulamentação governamental e bastante competitividade, aliado ao rápido avanço tecnológico que gera novas técnicas e produtos, em que há o consequente aumento dos custos dos serviços em saúde e a busca constante pela excelência na qualidade dos serviços. Para a sobrevivência no mercado de saúde, faz-se necessária a inovação a partir de uma estratégia competitiva e da construção de um sistema de informações gerenciais adaptado ao serviço prestado, principalmente em reabilitação, dado que existem poucas pesquisas relacionadas ao controle gerencial. Dessa forma, a empresa Clínica de Fisioterapia, implementou instrumentos técnicos e metodológicos com vistas à manutenção e melhoria na qualidade da atenção prestada (Planejamento Estratégico, Balanced Scorecard e Gerenciamento pelas Diretrizes). Porém, estes instrumentos e técnicas necessitavam de avaliação em relação às estratégias adotadas. A partir dos dados fornecidos pela empresa, propôs-se a criação e análise de três indicadores: Avaliação Técnica do Fisioterapeuta; Resolutividade por Objetivos Terapêuticos; e Resolutividade por Especialidade Fisioterapêutica. Para desenvolver a pesquisa foram analisados 4.773 prontuários, de 2015 a 2017. Os resultados deste estudo revelaram a otimização nos níveis dos cuidados de saúde prestados baseados em normas da qualidade, o desenvolvimento dos fisioterapeutas, a capacidade de ir ao encontro das demandas do cliente, melhor direcionamento nos investimentos no parque tecnológico, diferenças significativas entre o atendimento fisioterapêutico individual e com mais de um paciente simultaneamente. Contudo, constatou-se que, por meio da análise dos indicadores de qualidade, foi possível avaliar a previsibilidade das operações internas e promover o direcionamento para a gestão do serviço de Fisioterapia. Acredita-se que esse estudo poderá contribuir para a melhoria da gestão e sustentabilidade das clínicas de Fisioterapia ou Reabilitação pública ou privada, conforme a realidade de cada instituição