title: Evaluation of maternal and neonatal hospital care: quality index of completeness.
abstract: OBJECTIVE
  Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System.
  
  
  METHODS
  This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country.
  
  
  RESULTS
  A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country.
  
  
  CONCLUSIONS
  The index of completeness proved to be of great value for monitoring the maternal and neonatal hospital care of Brazilian Unified Health System and indicated that the quality of health care was unsatisfactory. However, its application does not replace specific evaluations.
authors.affiliation: Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil.
authors.forename: Ana Lúcia Andrade da
authors.initials: AL
authors.lastname: Silva
authors.affiliation: Departamento de Saúde Coletiva, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil.
authors.forename: Antonio da Cruz Gouveia
authors.initials: Ada C
authors.lastname: Mendes
authors.affiliation: Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil.
authors.forename: Gabriella Morais Duarte
authors.initials: GM
authors.lastname: Miranda
authors.affiliation: Departamento de Saúde Coletiva, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil.
authors.forename: Domicio Aurélio de
authors.initials: DA
authors.lastname: Sá
authors.affiliation: Departamento de Saúde Coletiva, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil.
authors.forename: Wayner Vieira de
authors.initials: WV
authors.lastname: Souza
authors.affiliation: Departamento de Saúde Coletiva, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil.
authors.forename: Tereza Maciel
authors.initials: TM
authors.lastname: Lyra
mesh_terms: D001938:Brazil; D002648:Child; D002662:Child Health Services / Q000592:standards*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D017598:Efficiency, Organizational; D005260:Female; D006751:Hospital Information Systems; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D009313:National Health Programs; D011247:Pregnancy; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results