[Quality and efficiency in hospitals].
The objective of this research was to study the relationship between structural characteristics of hospitals (number and types of personnel, size of hospital units, and specialization of services) and health care outcomes, as measured by in-hospital mortality and average weight gain (AWG) in children under 1 year diagnosed with acute diarrheal disease (ADD). The study was carried out at 14 nonprofit acute-care hospitals located in greater Buenos Aires. The units of analysis were 23 pediatric wards (1,718 beds). The study population included 3,434 ADD cases (15.6% of total ward discharges). Various generalized linear models were used in the analysis, and the findings were adjusted according to the patients' age, severity of illness, and nutritional status. The acuteness of the disease investigated was verified. Of the study patients, 80.4% were 6 months old or younger and 40.1% suffered from some nutritional deficiency. According to an analysis of 32% of the cases, age was inversely associated with severity of illness, grade I nutritional deficiency, and in-hospital mortality, and directly associated with AWG. The adjusted case-fatality rates for the wards studied were different. Analysis of the relationship between the structural variables and the outcomes revealed that the number of nurses was inversely related to in-hospital mortality, while ward specialization and professional experience were directly related to AWG. These associations were statistically significant. There was a direct, statistically significant relationship between number of hospital staff and in-hospital mortality. Structural variables measuring the physicians' commitment to the institution, ward size, and hospital size were not found to be related to the outcomes. These findings can provide useful support for decision-making about hospital resource allocation, as well as about hospital organization and management. There is a need for more in-depth study of the relationship between the structure of hospitals and health systems and health care outcomes.
Paganini
J M
JM
Organización Panamericana de la Salud, División de Sistemas y Servicios de Salud, Washington, D.C. 20037.
D000208:Acute Disease; D000367:Age Factors; D001118:Argentina / Q000453:epidemiology; D015897:Comorbidity; D003968:Diarrhea, Infantile / Q000453:epidemiology*; D004469:Economics, Hospital; D006742:Hospital Bed Capacity; D006748:Hospital Departments; D006752:Hospital Planning; D006769:Hospitals, General / Q000592:standards; D006776:Hospitals, Pediatric / Q000592:standards; D006783:Hospitals, State / Q000592:standards*; D006801:Humans; D007223:Infant; D009748:Nutrition Disorders / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010564:Personnel, Hospital; D011785:Quality Assurance, Health Care; D015430:Weight Gain
Calidad y eficiencia en hospitales.