Medium-complexity hospitals in the Emergency Care Network: what does their production reveal?

ABSTRACT The objective of this study aimed to analyze the performance of two general public hospitals of medium complexity in the Attention to Emergency Care Network of a health region, according to hospital production data. A cross-sectional, descriptive and quantitative study was carried out, with secondary data for the period from January 2016 to June 2017, obtained from hospitals, municipal audit service, Hospital Information System of the Unified Health System and Brazilian National Registry of Healthcare Establishments. It was evidenced that 96.2% and 97.4% of the attendances at hospital A and B, respectively, were from citizens; the average of 70.8% of the attendances in both hospitals was not regulated, being 72.3% and 65.2% for hospital A and B, respectively, with access by spontaneous search. A low number of emergency heal care that evolve to hospitalization was identified; Primary Care Sensitive Conditions represented an average, in both hospitals, of 39.3% (17%-20% of hospitalization expenses). Although constituting regional references, these hospitals showed low performance in emergency care to users from other municipalities, revealing the need to expand access to health services, especially local, and seeking the qualification of regional regulatory and communicative mechanisms to qualify access to the studied hospitals.

摘要 本研究旨在基于医院运营数据，分析某卫生区域急诊护理网络中两家中等复杂度综合公立医院的运营绩效。本研究采用横断面、描述性与定量研究设计，所用二手数据采集自2016年1月至2017年6月，数据来源包括医院、市级审计服务部门、统一卫生系统医院信息系统（Hospital Information System of the Unified Health System）以及巴西全国医疗保健机构登记处。研究显示，A院与B院的就诊人次中分别有96.2%与97.4%来自本地居民；两家医院总计70.8%的就诊未经过区域分诊调度，其中A院与B院该类自发到院就诊占比分别为72.3%与65.2%。研究发现，转为住院治疗的急诊诊疗人次占比较低；两家医院的基层医疗敏感病症（Primary Care Sensitive Conditions）就诊占比平均为39.3%，相关住院费用占总住院费用的17%~20%。尽管两家医院均为区域医疗枢纽，但在接诊外市患者的急诊服务中表现欠佳，这反映出需进一步扩大卫生服务可及性（尤其是本地服务），并优化区域分诊与沟通机制，以提升本研究涉及医院的就诊服务质量。