a research protocol for a mixed methods study

Funding Information: This work was supported by the European Union under the Horizon Europe Research and Innovation Programme under the grant agreement no 101057825. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2024 Valli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Introduction Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. Aim SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. Methods We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. Discussion The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.publishersversionpublishe

Eficiencia del gasto público y total en salud en la región de América Latina y Caribe: un análisis comparativo

Màster en Economia de la Salut i el Medicament (UPF Barcelona School of Management). Curs 2020-2022Mentor: Josep Maria Vilaseca LlobetAntecedentes: el estudio de la eficiencia del gasto en salud ha ganado relevancia en los últimos años a causa del aumento en la demanda de servicios de salud y la constatación de que parte de los recursos invertidos se desaprovechan a causa de la ineficiencia. Materiales y métodos: el trabajo plantea un análisis comparativo de la eficiencia del gasto público y total en salud en los 33 países de la región de América Latina y Caribe a partir del concepto de función de producción, donde los inputs son el gasto público y total en salud y el output se mide a través de Años de Vida Ajustados por Discapacidad (AVAD), un indicador de carga de enfermedad que captura mejor las contribuciones de un sistema de salud a las metas sociales que indicadores que solo contemplan la mortalidad prematura. Se elaboran también unos índices para tratar de dimensionar la magnitud de la ineficiencia. Resultados: los países que se asignan su gasto total de manera eficiente son Chile, Costa Rica, Perú, Santa Lucía, Venezuela y Haití. En lo que refiere al gasto público, son Chile, Perú, Antigua y Barbuda, Barbados, Santa Lucía, Venezuela, Honduras, Guatemala y Haití. Análisis y próximos pasos: los resultados constituyen un punto de partida para la formulación de políticas que ayuden a cerrar las brechas entre los patrones de morbi-morbilidad de las poblaciones de la Región y los perfiles de gasto de sus territorios.Background: the measurement of health expenditure efficiency has been gaining attention over the last few years due to a rising healthcare services demand and the confirmation that part of the invested resources are misused because of inefficiency. Materials and methods: the study presents a comparative analysis of the total and public health expenditure efficiency for the 33 countries of the Latin American and Caribbean region taking the concept of health production function as starting point, where inputs are total and public health expenditure and the output is measured through Disability Adjusted Life Years (DALY), a burden of disease indicator which reflects better than other indicators which just capture premature mortality how a health system must contribute to social goals. Some indexs to quantify the degree of inefficiency are also elaborated. Results: countries which distribute their total expenditure efficiently are Chile, Costa Rica, Perú, Saint Lucia, Venezuela and Haiti. Regarding public expenditure, the countries are Chile, Perú, Antigua and Barbuda, Barbados, Saint Lucia, Venezuela, Honduras, Guatemala and Haiti. Analysis and way forward: results represent a starting point for policy formulation aimed at closing the gaps between national morbi-mortality patterns and expenditure schemes