title: [Factors associated with the use of clinical guidelines by health plan operators and their inpatient care providers].
abstract: This paper is aimed at identifying factors related to the use of clinical guidelines by health plan operators and their inpatient care providers in the supplementary care sector in Brazil from the viewpoint of managers. The study is based on two national surveys: one involving 90 health plan operators randomly selected from a universe of 1573, oriented towards characterizing the implementation of clinical guidelines and other tools of clinical governance; and another involving 74 hospitals, selected from a universe of 3817 inpatient care providers, aimed at capturing micro-regulation mechanisms applied by health plan operators and their repercussions on hospital practices. Use of clinical guidelines was reported by 32.3% of the health plan operators, and 51.6% of the hospitals interviewed. Among the first, geographical location, type and size of the organization were independently associated with use of clinical guidelines while among the hospitals size, complexity and use of other tools of clinical governance were independently associated with the dependent variable. The results show how incipient and unsatisfactory the intervention of the health plan and hospital managements still is with regard to the quality of health services offered to the beneficiaries.
authors.affiliation: Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ. mportela@ensp.fiocruz.br
authors.forename: Margareth Crisóstomo
authors.initials: MC
authors.lastname: Portela
authors.forename: Sheyla Maria Lemos
authors.initials: SM
authors.lastname: Lima
authors.forename: Maurício Teixeira Leite
authors.initials: MT
authors.lastname: de Vasconcellos
authors.forename: Claudia Caminha
authors.initials: CC
authors.lastname: Escosteguy
authors.forename: Vanja Maria Bessa
authors.initials: VM
authors.lastname: Ferreira
authors.forename: Miguel Murat
authors.initials: MM
authors.lastname: Vasconcellos
authors.forename: Cláudia
authors.initials: C
authors.lastname: Brito
mesh_terms: D001938:Brazil; D003695:Delivery of Health Care; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D007348:Insurance, Health