[Service delivery and quality of hospital care in the State of Rio de Janeiro, Brazil--1992 to 1995].
BACKGROUND
Recent trends in hospital care in the State of Rio de Janeiro, Brazil, are analysed. The data are taken from the Unified Health Care System (SUS) and cover monthly observations between January 1992 and October 1995 for the public, teaching and private hospital subsectors.


METHODS
The data entries are based on hospital declarations on the AIH form, processed by the National Inpatient Information System (SIH-SUS). When comparing the three subsectors, production of services and outcome were examined particularly closely. Comparisons are made using structural models for time series based on the break-down of a time series into components of interest, such as trend, seasonal variation and irregularity.


RESULTS
The analysis shows a significant downward trend in the frequency of hospital admissions in the State of Rio de Janeiro, probably reflecting the deliberate withdraw of financial investments in this sector, which began in 1993. This reduction was selective with regard to age group distribution--being greater in the adult and elderly groups. The analysis has also shown that the teaching sector has steadily raised its admissions. The quality of care was analysed through the sentinel event approach. For the State of Rio de Janeiro as a whole, the occurrence of avoidable deaths during the hospital admission process shows a weak overall tendency to decline as detected by the reduction of this kind of death in the private sub-sector. In public and teaching hospitals the frequency of avoidable deaths has remained stable. The frequency of maternal deaths has remained high and stable, while the number of caesarean sections shows a significant increase, despite the high figures observed at the beginning of the period.


CONCLUSIONS
The results of this study indicate an overall decline in the quality of health care offered by the SUS within the Rio de Janeiro State. Regardless of the existing limitations in SIH-SUS, this study has shown this to be a useful instrument for monitoring hospital care services.
de Gouvêa
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CS
Centro de Informações da Saúde da Secretaria de Estado de Saúde do Rio de Janeiro, Brasil.
Travassos
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Fernandes
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D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D019992:Databases as Topic; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D006296:Health Services / Q000592:standards*; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care
Produção de serviços e qualidade da assistência hospitalar no Estado do Rio de Janeiro, Brasil--1992 a 1995.