A large number of emerging infectious diseases (including influenza epidemics) has been identified during the last century. The emergence and re-emergence of infectious diseases have a negative impact on global health. Influenza epidemics alone cause between 3 and 5 million cases of severe illness annually, and between 250,000 and 500,000 deaths. In addition to the human suffering, influenza epidemics also impose heavy demands on the health care system. For example, hospitals and intensive care units have limited excess capacity during infectious diseases epidemics. Therefore, it is important that increased influenza activity is noticed early at local levels to allow time to adjust primary care and hospital resources that are already under pressure. Algorithms for the detection and prediction of influenza epidemics are essential components to achieve this. Although a large number of studies have reported algorithms for detection or prediction of influenza epidemics, outputs that fulfil standard criteria for operational readiness are seldom produced. Furthermore, in the light of the rapidly growing availability of “Big Data” from both diagnostic and prediagnostic (syndromic) data sources in health care and public health settings, a new generation of epidemiologic and statistical methods, using several data sources, is desired for reliable analyses and modeling. The rationale for this thesis was to inform the planning of local response measures and adjustments to health care capacity during influenza epidemics. The overall aim was to develop a method for detection and prediction of influenza epidemics. Before developing the method, three preparatory studies were performed. In the first of these studies, the associations (in terms of correlation) between diagnostic and pre-diagnostic data sources were examined, with the aim of investigating the potential of these sources for use in influenza surveillance systems. In the second study, a literature study of detection and prediction algorithms used in the field of influenza surveillance was performed. In the third study, the algorithms found in the previous study were compared in a prospective evaluation study. In the fourth study, a method for nowcasting of influenza activity was developed using electronically available data for real-time surveillance in local settings followed by retrospective application on the same data. This method includes three functions: detection of the start of the epidemic at the local level and predictions of the peak timing and the peak intensity. In the fifth and final study, the nowcasting method was evaluated by prospective application on authentic data from Östergötland County, Sweden. In the first study, correlations with large effect sizes between diagnostic and pre-diagnostic data were found, indicating that pre-diagnostic data sources have potential for use in influenza surveillance systems. However, it was concluded that further longitudinal research incorporating prospective evaluations is required before these sources can be used for this purpose. In the second study, a meta-narrative review approach was used in which two narratives for reporting prospective evaluation of influenza detection and prediction algorithms were identified: the biodefence informatics narrative and the health policy research narrative. As a result of the promising performances of one detection algorithm and one prediction algorithm in the third study, it was concluded that both further evaluation research and research on methods for nowcasting of influenza activity were warranted. In the fourth study, the performance of the nowcasting method was promising when applied on retrospective data but it was concluded that thorough prospective evaluations are necessary before recommending the method for broader use. In the fifth study, the performance of the nowcasting method was promising when prospectively applied on authentic data, implying that the method has potential for routine use. In future studies, the validity of the nowcasting method must be investigated by application and further evaluation in multiple local settings, including large urbanizations.

Made available in DSpace on 2016-04-29T13:31:32Z (GMT). No. of bitstreams: 1 Juliana A Oliveira.pdf: 795655 bytes, checksum: cd71278ab84392899b8db3021d0e1f1b (MD5) Previous issue date: 2007-05-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The Reform of Psychiatric services in Brazil is in process of consolidation and the transition from treatment at psychiatric hospitals to rehabilitation and shelter services is still under way. As such, due to a variety of reasons, some clients of these services prefer to remain at psychiatric hospitals instead of returning to their homes. Research was carried out at a psychiatric hospital attached to SUS (Sistema Único de Saúde) and located in the city of São Paulo, in order to better understand the reasons for the resistance to disinterment. Information was gathered with clients and professionals using a diversity of research strategies (observations, conversations, interviews and participation in routine activities) during the visits made to the institution between August 2005 and March 2006. Interviews were carried out with patients that, according to the various health professionals working at this institution, externalized the "desire to remain in the internment" and with a Charity Sister that assumed the role of "spokesman" for the professional team. The analysis was base on Discursive Social Psychology in dialogue with a constructionist perspective. The desire to remain at the hospital was based on multiple factors, including lack of financial conditions, of housing, family, work and social relationships, as well as the progressive weakening of these social bonds due to frequent psychiatric internments. Moreover, the psychiatric hospital seems to function as a protective shell from a society that is intolerant with regards to mental illness. However, the desire to remain in hospital seems to be more related to lack of alternatives than to internment itself as the people that were interviewed often were sad and their speech presented many lapses and contradictions indicating paradoxical positions regarding staying in and leaving. We conclude that it is urgent to implement the proposals of the Psychiatric Reform, specially concerning strategies for strengthening social bonds in order that the desire to return to social life can truly blossom / Partindo do pressuposto que a Reforma Psiquiátrica está em pleno processo de construção e que em decorrência de seus pontos falhos, alguns usuários podem querer continuar vivendo em hospitais psiquiátricos, o presente estudo investiga, por meio das práticas discursivas de usuários e trabalhadores de um serviço de Saúde Mental da cidade de São Paulo, os sentidos que sustentam o suposto desejo de permanecer internado . Para coleta de informações elegimos um hospital psiquiátrico da cidade de São Paulo, predominantemente vinculado ao SUS, onde fizemos visitas durante o período de agosto de 2005 a março de 2006, distribuídas entre observação das rotinas, participação nas variadas atividades, entrevistas com usuárias que verbalizaram o desejo de permanecer no internamento e uma Irmã de Caridade, porta-voz da equipe profissional. A análise das informações coletadas foi sustentada a partir da perspectiva do construcionismo social. De modo geral, as entrevistas contribuíram para melhor entender o suposto desejo de permanecer no hospital psiquiátrico . A falta de condições financeiras, habitação, trabalho, relacionamentos sociais, além de internações psiquiátricas recorrentes, pareceram dificultar a reinserção social, bem como diminuir a proximidade com a família. Além disso, o hospital psiquiátrico pareceu tornar-se uma proteção do usuário em uma sociedade intolerante perante a loucura. É válido destacar as falas das usuárias sobre o hospital e a experiência de internação psiquiátrica foram acompanhadas de lapsos de linguagem e feições entristecidas, retratando o sofrimento da internação e a contradição presente em optar pela vida intra-muros. A partir dessas reflexões indaga-se sobre a urgência do fortalecimento efetivo da rede social extra-muros, a partir da estruturação da Reforma Psiquiátrica, de modo a possibilitar o desejo de retorno ao convívio social

The rarity of a disease can give rise to challenges that differ from conventional diseases. For example, rarity hampers research and development of new drugs, and patients with severe, rare diseases have limited access to qualified treatments. When drugs are available, clinical evidence has higher uncertainty and the drugs can be very expensive. When setting priorities in the healthcare sector, treatments aimed at patients with rare diseases, so called orphan drugs, have become a source of concern. Orphan drugs seldom show solid evidence of effectiveness or cost-effectiveness. Still, treatments for rare disease patients, available on the European market, has increased rapidly since the adoption of a regulation offering incentives for research and development of orphan drugs. The question arises as to whether the publicly funded health care system should provide such expensive treatments, and if so, to what extent. This doctoral thesis aims to investigate healthcare priority setting and rare diseases in the context of orphan drug reimbursement. Priority setting for orphan drugs is located at the intersection of economic, ethical and psychological perspectives. This intersection is explored by studying the public’s view on the relevance of rarity when setting priorities for orphan drugs, and by examining how orphan drugs are managed when making reimbursement decisions in practice. Papers I and II in this thesis employ quantitative, experimental methods in order to investigate preferences for prioritising rare diseases, and the extent to which psychological factors influence such preferences. Papers III and IV employ qualitative methods to further explore what factors (apart from rarity) influence priority-setting decisions for orphan drugs, as well as how decisions regarding orphan drugs are made in practice in England, France, the Netherlands, Norway and Sweden. Combining quantitative and qualitative methods has provided a more comprehensive understanding of the topic explored in the thesis, and the methods have complemented each other. Paper I shows that there is no general preference for giving higher priority to rare disease patients when allocating resources between rare and common disease patients. However, results show that preferences for treating the rare patients are malleable to a set of psychological factors, in particular “proportion dominance”. Paper II shows that the identifiability of an individual has no, or a negative, influence on the share of respondents choosing to allocate resources to him/her (compared to a nonidentified individual). Paper III confirms that rarity per se is not seen as a factor that should influence priority-setting decisions (i.e. accept a greater willingness to pay for orphan drugs), however, other factors such as disease severity, treatment effect and whether there are treatment alternatives were seen as relevant for consideration. Paper IV explores the challenges with and solutions for orphan drug reimbursement, as perceived by different actors in five European countries. Perceived challenges are related to the components involved when making reimbursement decisions, to the reimbursement system, and to the acceptance of the final decision. Solutions are either specific for orphan drugs, or general measures that can be used for orphan drugs as well as for other drugs. In conclusion, priority setting for orphan drugs is complex and requires particular attention from decision makers. There are many factors to consider when making reimbursement decisions for orphan drugs. The consequences of a decision are potentially severe (both for rare disease patients and for common disease patients, depending on the decision) and psychological factors can potentially influence decisions.

Bakgrund: Ljumskbråck är den vanligaste operationen inom allmänkirurgin, varje år utförs nästan 20 000 operationer i Sverige. I Östergötland utförs ljumskbråcksoperationer på tre ställen inom ramen för dagkirurgi; vid Aleris Specialistvård i Motala (ASM), Närsjukvården i Finspång (NiF) samt Medicinskt Centrum i Linköping (MCL). Det finns en teori om att privata vårdgivare är mer tidseffektiva än offentliga vårdgivare. De privata anses kunna utföra fler operationer under en given tid, men ingen studie har gjorts på tidseffektiviteten kring operationerna hos respektive vårdgivare. Denna studie har genomförts för att detektera om det finns en skillnad i hur lång tid olika moment tar att utföra och vad denna skillnad i sådana fall beror på, samt om patientunderlaget skiljer sig mellan klinikerna. Metod: Studien omfattade 70 patienter fördelade på tre kliniker; ASM, MCL och NiF. Ljumskbråcksoperationerna delades upp i flertalet moment som mättes med digital klocka. Dessutom samlades uppgifter in om patientens ålder, ASA-klass, BMI samt information om vilka som närvarade i operationssalen. Statistisk analys gjordes enligt Kruskal-Wallis. Programvaran som användes var SPSS version 22. Resultat: Studien fann ingen signifikant skillnad i BMI, ASA-klass eller ålder mellan klinikernas patienter (p > 0,05 för samtliga). Däremot fanns stora skillnader vad gäller hur lång tid ett flertal av momenten under ljumskbråcksoperationen tog. Slutsats: Studien påvisar att det finns stora skillnader i olika moment vid ljumskbråcksoperationer. De privata klinikerna var alltid snabbare än den offentliga kliniken. Då det saknas studier inom området vore det intressant att se om det finns liknande skillnader vid andra ingrepp som utförs av olika aktörer. / Background: Inguinal hernia surgery is one of the most common surgeries within general surgery, with approximately 20 000 surgeries per year in Sweden. There are three places in Östergötland County where inguinal hernias are executed within outpatient surgery; at Aleris Specialistvård in Motala (ASM), Närsjukvården in Finspång (NiF) and at Medicinskt Centrum in Linköping (MCL). There is a theory that private health care providers are more time-efficient than public health care providers. The private health care providers are considered to perform more operations over a given time though no studies has been done on time efficiency. This study was performed to detect if there is a difference in time in the various steps during the surgery between the clinics, what causes these differences and if the patients differ. Methods: The study includes 70 patients distributed on three outpatient surgery clinics; ASM, MCL and NiF. The inguinal hernia operations were divided into shorter steps measured with a digital watch.  Furthermore, data were noted about the patients’ age, ASA-score, BMI and who were present in the operating room. Statistical analyses were performed with the Kruskal-Wallis one-way analysis of variance. The software used was SPSS version 22. Results: The study found no significant difference in BMI, ASA-score and age between the health care providers (p > 0,05). However, regarding the time efficiency, there were significant differences between the clinics. Conclusions: The study concludes that there are big differences in time, within the various steps in the inguinal hernia surgeries, between the clinics. The private health care providers were always faster than the public health care provider. Since no earlier studies have been made in this area, it would be interesting to see if there are similar differences in other types of surgeries.

Thesis (LLM. (Labour Law)) -- University of Limpopo, 2013 / The South African government gazzetted the Green Paper introducing the NHI on 12 August 2012. This policy seeks to progressively realize the right of access to quality health care services for everyone. Those who cannot provide for themselves will be assisted by government at the expense of the elite. The NHI was first recommended by the Taylor Commission and it has been under the discussion since then. Since this announcement, there has been growing pressure for mandatory health insurance to be included in the development of a comprehensive social security system, as was envisaged by the Taylor Committee of Inquiry. This discussion was further debated at the 52nd conference of the African National Congress (ANC) in Polokwane in December 2007 where numerous resolutions were taken with regard to the NHI. The Freedom Charter of 1955 and also section 27 and 28 also provided some guidance.

I vård och omsorgssektorn är sjukfrånvaron hög. Det finns många orsaker till ohälsa och i många fall är det arbetsrelaterat och de anställda har en ökad risk att drabbas av psykisk ohälsa och främst stress. Finns det en obalans i arbetslivet och kraven överstiger resurserna kan det få negativa effekter. En god arbetsmiljö kan inspirera medarbetaren till att behålla sina egna resurser och bidra till en ökad medvetenhet relaterat till välbefinnande. Fysisk aktivitet har positiva effekter på hälsan och kan skydda individer från att utveckla psykiska ohälsa orsakad av stress. Måttlig intensitet av träning, 150 minuter per vecka är tillräckligt för att uppleva mindre stress och ett ökat välbefinnande. Arbetsmiljölagen ställer krav på arbetsgivaren att arbetet ska anpassas till den enskilda arbetstagarens psykiska och fysiska förutsättningar. I det ingår att undvika stress genom att anpassa arbetet till arbetstagaren. Syftet med studien är att belysa om det finns ett samband mellan fysisk aktivitet och upplevelsen av stress och den psykosociala arbetsmiljön hos medarbetare inom vård och omsorg. En kvantitativ metod har använts och olika professioner i vård och omsorgssektorn har svarat på en enkät. Resultatet visar att det inte finns signifikant skillnad i upplevelsen av stress mellan de som inte är fysiskt aktiva och de som är fysiskt aktiva. Däremot finns det ett samband mellan fysiskt aktiva individer kopplat till att de har lättare att hantera arbetskrav i form av arbetsmängd. De fysiskt aktiva upplever att de har stöd från arbetskamrater vänner och familj i större utsträckning än de fysiskt inaktiva. / In the healthcare and care sector sick leave is high. There are many causes of ill health and in many cases it is work-related and employees have an increased risk of mental illness and, above all, stress. If there is an imbalance in working life and the requirements exceed the resources, it can have negative effects. A good working environment can inspire the employee to maintain his own resources and contribute to increased awareness of well-being. Physical activity has positive effects on health and can protect individuals from developing mental health caused by stress. Moderate intensity of exercise, 150 minutes per week is enough to experience less stress and increased well-being. The Work Environment Act requires employers to adapt the work to the individual employee. The purpose of the study is to highlight whether there is a connection between physical activity and the experience of stress and the psychosocial work environment of the employee in healthcare and care. A quantitative method has been used and various professions in the healthcare and care sector have responded to a questionnaire. The result shows that there is no significant difference in the experience of stress between those who are not physically active and those who are physically active. On the other hand, there is a connection between physically active individuals linked to the fact that they are easier to handle work demands in terms of workload. The physical activists experience that they have support from workmates, friends and family to a greater extent than the physically inactive ones.

Bakgrund: Komplexa verksamheter måste fokusera på processerna, ett organisatoriskt helhetsperspektiv och lärande samt ha patienten i centrum för att säkra vårdkvaliteten. På Operations- och intensivvårdskliniken, Ryhov, har processarbete påbörjats men utvecklingspotential finns samt utrymme för tydligare rutiner gällande patientdelaktighet.   Syfte: Förbättringsarbetets syfte var att identifiera och minska kvalitetsgap i verksamheten som påverkar patienten, genom att utveckla klinikens processledning och det organisatoriska lärandet. Studiens syfte var att beskriva medarbetarens uppfattning om processledningens koppling till vårdkvalitet, samt beskriva deras erfarenheter från processledningsutvecklingsarbetet.   Metod: Förbättringsarbetet har i projektgruppsformat och med Nolans förbättringsmodell utvecklat det organisatoriska lärandet kring två pilotprocesser. Studien av förbättringsarbetet är kvalitativ och baseras på sex fokusgruppsintervjuer. Intervjumaterialet analyserades med hjälp av kvalitativ innehållsanalys med induktiv ansats.   Resultat: Processledning kräver tillgång till förbättrings- och yrkeskompetens. Organisationen måste ge förutsättningar för en varaktighet där nyttan är tydlig och resurser är tillräckliga. Vårdkvaliteten ökar när organisationen arbetar strukturerat, personcentrerat och med patientsäkerhet som fokus.   Slutsatser: Processledning kan ge organisationen förutsättningar att skapa kontinuerlig förbättring med fokus på organisatoriskt lärande och ökad vårdkvalitet för patienten. Organisationen måste arbeta aktivt för att göra detta till en integrerad och levande del av verksamheten. / Background: Complex organizations need to be patient centred, focus on processes, have holistic view and promote organizational learning to secure quality. Operation and intensive care unit, Ryhov, has potential to develop its Process Management (PM) and there is room for improved patient participation.   Purpose: The purpose of the quality improvement project (QIP) was to identify and reduce quality gaps affecting patients, by develop PM and organizational learning. The purpose of the study was to describe co-workers’ understanding of the connection between PM and quality of care and describe their experiences from QIP.   Methods: The QIP has developed organizational learning concerning two pilot processes by using Nolan’s model for improvement. The study of the QIP is qualitative, based on six focus group interviews. Qualitative content analysis was used to analyse the interviews.   Results: PM demands access to improvement and professional knowledge. The organization need to create conditions for sustainability, make benefits obvious and ensure enough resources. Quality of care increases when the organization works structured and patient centred.   Conclusions: PM creates conditions for continual improvements with focus on organizational learning and increased quality of care. The organization need to actively make PM an integral and living part.

Introduktion: Multisjuka patienter är individer med många sjukdomar och komplexa vårdbehov. För denna grupp är vikten av kontinuitet för att öka känsla­n av trygghet stor. Syfte med förbättringsarbetet: : Att skapa en trygg och möjlig ASIH-vård för multisjuka äldre genom att utveckla arbetssätt som möjliggör anslutning och en trygg utskrivning för multisjuka äldre. Syftet med studie av förbättringsarbetet: Att undersöka och analysera medarbetares gemensamma erfarenheter. Metod: Förbättringsarbetet genomfördes med stöd av Nolans förbättringsmodell. Studien av förbättringsarbetet genomfördes med en fallstudie med kvalitativ innehållsanalys. Resultat: Förbättringsarbetet resulterade i ett jämnt inflöde av remisser och kortare anslutningstid till ASIH. Patientens upplevelse av trygghet skattades i en enkät till 76%.  Möjlighet till återanslutning till ASIH fick 7 patienter mellan 1-7 gånger under förbättringsprojektet. Studien av förbättringsarbetet sammanfattades i temat: ”Villkor för samverkan mot det gemensamma målet” då ett tydligt mönster framkom i fokusgruppsintervjuerna. Följande villkor sågs som betydelsefulla: kontinuitet, lärande, samarbete och kommunikation.. Diskussion: ASIH är en alternativ vårdform som kan bidra till att skapa trygghet och underlätta övergången till hemmet för gruppen multisjuka äldre. I bästa fall också minska behov av vård på akutsjukhus vid försämring. För att möjliggöra denna vård krävs återkoppling som skapar lärande genom tydliga mål och mätbara resultat. / Introduction: Patients with multiple illnesses are individuals with complex needs of care. For this group of patients, continuity of care and their sense of security is is of great importance. Improvement work objective: To create secure and accessible ASIH for elders with multiple illnesses by¨develop ways of working to enable re-admittance and secure discharges for this group of patients. Case study objective: To Investigate and analyze team members’ common experiences. Method: Implementation using Nolan’s improvement model. A case study using qualitative contents analysis. Result: The improvement work resulted in an even flow of referrals and shortened admission times to ASIH. Patients’ sense of security were rated to 76%. Seven Seven patients had the possibility towere be  re-admitted 1-7 times 1-7 times during the project. Casestudy summary: ”Conditions for cooperationfor a common goal”. A clear pattern with the following significant conditions emerged from the focusgroups interviews: continuity, learning, cooperation, and communication. Discussion: ASIH can be an option to facilitate the transition home for elderly patients with multiple illnesses. ASIH provides a sense of security and may prevent re-hospitalization. This model of cooperation requires clear, common goals and opportunities for feedback to enable learning contributes to measurable results.

Este trabalho teve por finalidade analisar a importância e a qualidade percebida (desempenho) de determinados atributos, em serviços de atendimento secundário em saúde, sob a ótica de seus pacientes, visando gerar subsídios para aprovação e elaboração do planejamento estratégico e de orçamentos (investimentos) de seus serviços. O estudo foi realizado no Ambulatório Central (Amce) da Universidade de Caxias do Sul (UCS), que tem sido um ponto de apoio à população caxiense e da região na prestação de serviços nas áreas da saúde, incluindo medicina, enfermagem, psicologia, fisioterapia, nutrição e serviço social. Foi realizada uma pesquisa quantitativa com a utilização de questionários distribuídos aos pacientes em três fases do serviço do Amce (fase A - recepção e atendimento clínico, fase B realização do exame e fase C resultado do exame e revisão da consulta). As principais variáveis investigadas incluem: a facilidade de acesso ao Amce, recepção e sala de espera, estrutura física e funcional, atendimento pelo profissional da saúde, confiança na própria recuperação, aceitação de atendimento por profissional da saúde junto com alunos, tempo de espera para ser atendido e propensão para indicar o Amce a outras pessoas. Os dados foram analisados por intermédio de uma matriz importância versus desempenho, sendo que todos os construtos permaneceram no quadrante superior direito (quadrante B), para o qual é sugerido que se mantenha o bom serviço. Foram realizadas análises estatísticas adicionais, as quais mostraram que as principais variáveis em estudo apresentaram diferenças significativas entre suas médias. Com análise dos resultados foi possível detectar que há um espaço para a realização de melhorias nos serviços prestados no desempenho dos serviços ambulatoriais. / Submitted by Marcelo Teixeira (mvteixeira@ucs.br) on 2014-05-22T18:03:29Z No. of bitstreams: 1 Dissertacao Alexandre Calcagnotto.pdf: 655666 bytes, checksum: f4d497bb79461c6e26d6afc396ec2fce (MD5) / Made available in DSpace on 2014-05-22T18:03:29Z (GMT). No. of bitstreams: 1 Dissertacao Alexandre Calcagnotto.pdf: 655666 bytes, checksum: f4d497bb79461c6e26d6afc396ec2fce (MD5) / The aim of this work was to measure the importance and the quality of some specific topics (performance) offered by a secondary health care Out-patient Clinic as perceived by the patients. It had the purpose of generating data that can help to develop strategic planning to manage the clinical services. This study was carried out at the Central Out-patient Clinic (Amce) of the University of Caxias do Sul (UCS). The Amce has been playing an important role in providing health care (medicine, nursing, psychology, physiotherapy, nutrition and social service) to the population of Caxias do Sul and neighborhood areas. To implement this study a quantitative research was performed, giving a questionnaire to a sample of patients of Amce (Phase A reception and clinical assistance, phase B - carrying out of complementary exams and phase C exams results and clinical follow up). The key variables of the study included: accessibility to the Amce, reception and waiting room, building conditions, behavior of the healthcare professional, confidence on the self-recovery, acceptance to be treated by a healthcare professional and students together, quickness to handle pacient´s demands, and readiness to indicate Amce services to other people. The data was analyzed by using a matrix method correlating importance versus performance. Additional statistical analyses were carried out, which indicated significant differences between means of the main research variables. With this study it was possible to verify that the importance and performance had relevant results. Therefore, the Acme may have room to improve the rendering of health care services.

Este trabalho teve por finalidade analisar a importância e a qualidade percebida (desempenho) de determinados atributos, em serviços de atendimento secundário em saúde, sob a ótica de seus pacientes, visando gerar subsídios para aprovação e elaboração do planejamento estratégico e de orçamentos (investimentos) de seus serviços. O estudo foi realizado no Ambulatório Central (Amce) da Universidade de Caxias do Sul (UCS), que tem sido um ponto de apoio à população caxiense e da região na prestação de serviços nas áreas da saúde, incluindo medicina, enfermagem, psicologia, fisioterapia, nutrição e serviço social. Foi realizada uma pesquisa quantitativa com a utilização de questionários distribuídos aos pacientes em três fases do serviço do Amce (fase A - recepção e atendimento clínico, fase B realização do exame e fase C resultado do exame e revisão da consulta). As principais variáveis investigadas incluem: a facilidade de acesso ao Amce, recepção e sala de espera, estrutura física e funcional, atendimento pelo profissional da saúde, confiança na própria recuperação, aceitação de atendimento por profissional da saúde junto com alunos, tempo de espera para ser atendido e propensão para indicar o Amce a outras pessoas. Os dados foram analisados por intermédio de uma matriz importância versus desempenho, sendo que todos os construtos permaneceram no quadrante superior direito (quadrante B), para o qual é sugerido que se mantenha o bom serviço. Foram realizadas análises estatísticas adicionais, as quais mostraram que as principais variáveis em estudo apresentaram diferenças significativas entre suas médias. Com análise dos resultados foi possível detectar que há um espaço para a realização de melhorias nos serviços prestados no desempenho dos serviços ambulatoriais. / The aim of this work was to measure the importance and the quality of some specific topics (performance) offered by a secondary health care Out-patient Clinic as perceived by the patients. It had the purpose of generating data that can help to develop strategic planning to manage the clinical services. This study was carried out at the Central Out-patient Clinic (Amce) of the University of Caxias do Sul (UCS). The Amce has been playing an important role in providing health care (medicine, nursing, psychology, physiotherapy, nutrition and social service) to the population of Caxias do Sul and neighborhood areas. To implement this study a quantitative research was performed, giving a questionnaire to a sample of patients of Amce (Phase A reception and clinical assistance, phase B - carrying out of complementary exams and phase C exams results and clinical follow up). The key variables of the study included: accessibility to the Amce, reception and waiting room, building conditions, behavior of the healthcare professional, confidence on the self-recovery, acceptance to be treated by a healthcare professional and students together, quickness to handle pacient´s demands, and readiness to indicate Amce services to other people. The data was analyzed by using a matrix method correlating importance versus performance. Additional statistical analyses were carried out, which indicated significant differences between means of the main research variables. With this study it was possible to verify that the importance and performance had relevant results. Therefore, the Acme may have room to improve the rendering of health care services.