Submitted by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-10-17T12:42:28Z No. of bitstreams: 1 TES_PEDRO_HENRIQUE_SOARES_LEIVAS_COMPLETO.pdf: 1132784 bytes, checksum: 11c61ab6cd63f1363810d559ca598a23 (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-10-17T12:42:37Z (GMT) No. of bitstreams: 1 TES_PEDRO_HENRIQUE_SOARES_LEIVAS_COMPLETO.pdf: 1132784 bytes, checksum: 11c61ab6cd63f1363810d559ca598a23 (MD5) / Made available in DSpace on 2017-10-17T12:42:46Z (GMT). No. of bitstreams: 1 TES_PEDRO_HENRIQUE_SOARES_LEIVAS_COMPLETO.pdf: 1132784 bytes, checksum: 11c61ab6cd63f1363810d559ca598a23 (MD5) Previous issue date: 2017-08-11 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / This thesis presents three essays related to the quality of hospital care in Brazil, made using data from 2008 to 2014 from the Hospital Information System of the Unified Health System (SIH-SUS) and the National Registry of Health Establishments (CNES). In the first essay, the objective was to verify if the health outcome of patients undergoing hip replacement are better as the hospital performs more of this procedure. In other words, we tried to verify the existence of the so-called volume-outcome effect in the Brazilian hospital sector. Evidences pointed to the existence of a volume-outcome effect in Brazil. Exploring the geographical distribution of patient residences and hospitals as a source of exogenous variation for volume, we could identify that the effect is a result of the practice-makes-perfect hypothesis, occurring through static scale economies. In the second essay, the objective was to verify if the probability of death of patients submitted to percutaneous coronary intervention is lower if it was treated in a specialized hospital in cardiovascular diseases instead of general hospital. The use of the instrumental variables model allowed us to evaluate the relationship from a causal perspective. The findings pointed out that the health outcomes of patients treated in specialized hospitals are better than the results of patients treated in general hospitals. Finally, the third essay aimed to investigate the existence of a weekend effect in the Brazilian hospital sector. Considering the patients admitted in an emergency with a diagnosis of acute myocardial infarction (AMI), odds ratios for hospital death were estimated using logistic regression. The results were consistent with the existence of the weekend effect, even controlling a series of factors, including hospital effect. / Esta tese apresenta tr?s ensaios relacionados a qualidade do cuidado hospitalar no Brasil, os quais foram confeccionados utilizando dados de 2008 a 2014, provenientes do Sistema de Informa??es Hospitalares do Sistema ?nico de Sa?de (SIH-SUS) e do Cadastro Nacional de Estabelecimentos de Sa?de (CNES). No primeiro ensaio, o objetivo foi verificar se o resultado de sa?de dos pacientes submetidos a artroplastia de quadril s?o melhores ? medida que o hospital realiza mais desse procedimento. Em outras palavras, buscou-se verificar a exist?ncia do chamado volume-outcome effect no setor hospitalar brasileiro. As evid?ncias apontaram a exist?ncia do volume-outcome effect no Brasil. Explorando a distribui??o geogr?fica das resid?ncias dos pacientes e dos hospitais como fonte de varia??o ex?gena para o volume, fomos capazes de identificar que o referido efeito ? resultado da hip?tese de practice-makes-perfect, ocorrendo atrav?s de ganhos est?ticos de escala. No segundo ensaio, o objetivo foi verificar se a probabilidade de ?bito de pacientes submetidos a Interven??o Coron?ria Percut?nea ? menor se o mesmo foi tratado em hospital especializado em doen?as cardiovasculares ao inv?s de hospital geral. A utiliza??o do modelo de vari?veis instrumentais permitiu avaliar a rela??o sob uma perspectiva causal. Os achados apontaram que os resultados de sa?de dos pacientes tratados em hospitais especializados s?o melhores do que os resultados dos pacientes tratados em hospitais gerais. Por fim, o terceiro ensaio teve por objetivo investigar a exist?ncia de um weekend effect no setor hospitalar brasileiro. Considerando os pacientes internados em car?ter de urg?ncia com diagn?stico de Infarto Agudo do Mio?rdio (IAM), foram estimadas raz?es de chance para o ?bito hospitalar por meio de regress?o log?stica. Os resultados foram coerentes com a exist?ncia do weekend effect, mesmo controlando uma s?rie de fatores, inclusive efeito fixo de hospital.

Made available in DSpace on 2016-04-04T18:28:12Z (GMT). No. of bitstreams: 1 SARA REGINA MOREIRA PANSANI.pdf: 751373 bytes, checksum: c7721f15505511e8790d5110de9614c7 (MD5) Previous issue date: 2013-12-11 / The aim of this research was to grasp the experience of suffering of patients based on the experience of a psychologist in a unit for treatment of burned victims at a hospital located in the state of S?o Paulo. It was developed as a qualitative research phenomenologically based. A narrative was built by psychologist/researcher as a methodological strategy to capture significant elements experienced in the daily activities with patients, families and multidisciplinary team. It included memories, pictures, thoughts and feelings that made possible the emergence of some meanings: the context of the burns unit is an environment that offers, in addition to treatment, care to patients and their families. Over the period of hospitalization, patients go through extensive physical and psychological suffering: they feel vulnerable and unprotected; resent the absence of family and feel isolated. The way they signify the causes that led to the accident that hurt them is important in the recovery process, as well as how they face intense physical pain and addiction that required care. Family members play an important role in the recovery process of patients as they convey security and affection, in this sense, they end up being part of the team, assisting in the process of recovery of autonomy. The multidisciplinary team responds in a contradictory way to the patients complaints. The exhaustive routine seems to hamper their understanding and acceptance of the patient. On the other hand, they demonstrate willingness and commitment to carry out the procedures necessary for recovery. The researcher's experience allowed understanding of new meanings with regard to the relationship between pain and suffering. She noted the importance of specific psychological attention in that context and how it provides space for the patient to express feelings of loneliness, fear and anguish over the unknown. On the other hand, staff and family members also demand attention to be able to carry out the necessary care. We conclude that suffering severe burns and being hospitalized is an experience that requires from the patient a restructuring in their way of being and living that affects both the professionals who make up the team, as well as the families. / O objetivo desta pesquisa consistiu em apreender o sofrimento vivido por pacientes a partir da experi?ncia de uma psic?loga em uma unidade para tratamento de queimados de um hospital localizado no estado de S?o Paulo. Desenvolveu-se como uma pesquisa qualitativa de inspira??o fenomenol?gica. Uma narrativa foi constru?da como estrat?gia metodol?gica pela psic?loga/pesquisadora para apreender elementos significativos vividos no trabalho cotidiano com pacientes, familiares e equipe multiprofissional. Incluiu lembran?as, impress?es, imagens, sentimentos e pensamentos que possibilitaram a emerg?ncia de alguns significados: o contexto da unidade para queimados constitui um ambiente que oferece, al?m de tratamento, acolhimento aos pacientes e seus familiares. Ao longo do per?odo de hospitaliza??o, os pacientes passam por grande sofrimento f?sico e psicol?gico: sentem-se vulner?veis e desprotegidos; ressentem-se da aus?ncia dos familiares e do isolamento. A maneira como significam as causas que provocaram o acidente que os vitimou tem import?ncia no processo de recupera??o, assim como a forma como enfrentam a dor f?sica intensa e a depend?ncia por necessitarem de cuidados. Os familiares desempenham papel importante no processo de recupera??o dos pacientes ao transmitirem seguran?a e afeto; neste sentido, acabam por fazer parte da equipe, auxiliando no processo de retomada da autonomia. A equipe multiprofissional reage de maneira paradoxal ?s queixas dos pacientes. A rotina exaustiva parece dificultar a capacidade de compreender e acolher. Por outro lado, demonstram disponibilidade e empenho para realizar os procedimentos necess?rios ? recupera??o. A experi?ncia da pesquisadora possibilitou entrar em contato com novos significados no que se refere ? rela??o entre dor e sofrimento. Constatou a import?ncia de uma aten??o psicol?gica espec?fica naquele contexto capaz de disponibilizar ao paciente espa?o para expressar sentimentos de solid?o, medo e ang?stia face ao desconhecido. Por outro lado, a equipe e os familiares tamb?m demandam aten??o a fim de poderem desempenhar os cuidados necess?rios. Conclui-se que sofrer queimadura grave e ser hospitalizado constitui uma experi?ncia que imp?e ao paciente uma reestrutura??o no modo de ser e de viver que afeta tanto os profissionais que comp?em a equipe como tamb?m as fam?lias.