Relación del Presupuesto por Resultados (PPR) en la Ejecución de los Tratamientos Dentales en la Estrategia Sanitaria de Salud Bucal de las Microredes de Salud de Tacna 2014.

El presente estudio tuvo como objetivo principal, estudiar la relación que existe entre el gasto público y la cantidad de atenciones y atendidos , en las diferentes redes y micro redes de la DIRESA TACNA. Se estudiaron todas las redes de salud de Tacna en el período 2012 obteniendose además el consolidado de atenciones (n= 222618) y atendidos ( n=146436) del regristro de estadística HIS del Ministerio de Salud y el gasto de la página web del ministerio de Economía del Péru. La técnica fue observación documental, el análisis estadístico descriptivo que se empleó fue de frecuencias y porcentajes. Los resultados encontrados, nos mostraron que hay una buena ejecución en tratamientos preventivos y recuperativos, y cero actividad en tratamientos especializados, motivo por el cual Tacna, quedó en último lugar de ejecución de estas labores en comparación con otras regiones. El presente estudio demostró mediante la observación de los resultados sanitarios del reporte HIS, que en las Redes de Salud con poca población asignada, el gasto no corresponde a la cantidad de atenciones a diferencia de las otras redes donde el volumen de compra y gasto de recursos es concordante con la ejecución de metas de actividades. La hipótesis se comprobó, mediante la prueba de regresión lineal y el R cuadrado de Pearson.Tesi

Relación del Presupuesto por Resultados (PPR) en la Ejecución de los Tratamientos Dentales en la Estrategia Sanitaria de Salud Bucal de las Microredes de Salud de Tacna 2014.

TesisEl presente estudio tuvo como objetivo principal, estudiar la relación que existe entre el gasto público y la cantidad de atenciones y atendidos , en las diferentes redes y micro redes de la DIRESA TACNA. Se estudiaron todas las redes de salud de Tacna en el período 2012 obteniendose además el consolidado de atenciones (n= 222618) y atendidos ( n=146436) del regristro de estadística HIS del Ministerio de Salud y el gasto de la página web del ministerio de Economía del Péru. La técnica fue observación documental, el análisis estadístico descriptivo que se empleó fue de frecuencias y porcentajes. Los resultados encontrados, nos mostraron que hay una buena ejecución en tratamientos preventivos y recuperativos, y cero actividad en tratamientos especializados, motivo por el cual Tacna, quedó en último lugar de ejecución de estas labores en comparación con otras regiones. El presente estudio demostró mediante la observación de los resultados sanitarios del reporte HIS, que en las Redes de Salud con poca población asignada, el gasto no corresponde a la cantidad de atenciones a diferencia de las otras redes donde el volumen de compra y gasto de recursos es concordante con la ejecución de metas de actividades. La hipótesis se comprobó, mediante la prueba de regresión lineal y el R cuadrado de Pearson

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially