Avaliação em saúde: limites e perspectivas
01 Jan 1994-Cadernos De Saude Publica (Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz)-Vol. 10, Iss: 1, pp 80-91
TL;DR: The incorporation of evaluative procedures in health planning or health policy-making and administration is still limited in Brazil, particularly at the local level, and recent implementation of projects for the reorganization of the health services system raises the need for more appropriate strategies aimed at health care evaluation.
Abstract: This is a literature review of theoretical and methodological issues on health care evaluation of research and technical reports. Conceptual frameworks, approaches, subject matter, strategies, and study designs are identified and analyzed. Evaluative research designs are compared with epidemiological ones. A diverse terminology was encountered, and many methodological problems in the literature were examined. The incorporation of evaluative procedures in health planning or health policy-making and administration is still limited in Brazil, particularly at the local level. Recent implementation of projects for the reorganization of the health services system based on the administrative autonomy of Local Health Units raises the need for more appropriate strategies aimed at health care evaluation. Perspectives for the development of alternative strategies are indicated.
Citations
More filters
TL;DR: Nuclear criteria involved in the organization of all evaluation processes are identified, and articulated with the existing institutionalized evaluation practices in developed countries, that is, program evaluation, quality assessment and management and technology assessment.
Abstract: The field of program, services and technology evaluation in general, and in health care in particular, is going through an important growth and conceptual and methodological diversification. It is also the object of an increasing demand for its participation as an effective supportive instrument in the decision-making process, and a constant need in the dynamics of health systems and services. In this paper, based on literature review, nuclear criteria involved in the organization of all evaluation processes are identified, and articulated with the existing institutionalized evaluation practices in developed countries, that is, program evaluation, quality assessment and management and technology assessment. In conclusion, the incipient development of a methodological evaluation output in Brazil is analyzed.
192 citations
TL;DR: In this article, an exploracao sobre metodos potencialmente mais adequados for a avaliacao de services and programas is presented.
Abstract: Este texto realiza uma investigacao sobre metodos potencialmente mais adequados para a avaliacao de servicos e programas a partir das questoes apresentadas pela politica de desinstitucionalizacao em saude e pelas limitacoes da avaliacao ortodoxa. Percorremos diferentes concepcoes de avaliacao de programas e servicos e identificamos na proposta de avaliadores de quarta geracao (Guba & Lincoln, 1989) potencial capaz de superar alguns destes impasses e questoes. Finalmente propomos a aproximacao do Metodo Paideia (Campos, 2000-a) a abordagem de Avaliacao de Quarta Geracao, procurando estabelecer coerencia entre avaliacao e sistema de gestao participativa.
128 citations
TL;DR: This essay focuses on the evaluation of health programs and services, emphasizing the subjectivity emerging from the evaluation process, and recommends qualitative social research methodology as a productive instrument.
Abstract: This essay focuses on the evaluation of health programs and services, emphasizing the subjectivity emerging from the evaluation process. The text is a theoretical construction that targets the various meanings of evaluation, the influence of the positivist paradigm on the field of health program and service evaluation, the polysemous nature of the term "quality", and its close overlapping with subjectivity. In addition, the authors highlight the importance of studies that incorporate the perspectives of social actors into the evaluation processes, recommending qualitative social research methodology as a productive instrument.
124 citations
TL;DR: Reforcar tais especificidades e perspectivas de aproximacao, buscou-se nao somente registrar a amplitude e complexidade dos dispositivos e acoes propostos no âmbito do HumanizaSUS, como tambem fazer uma breve revisao of conceitos e componentes englobados na area of monitoramento e avaliacao.
Abstract: The purpose of this paper is to prompt discussions of the perspectives of the Evaluation of Brazil's National Health Humanization Policy being implemented by the Ministry of Health (PNH/HumanizaSUS). It strives to systemize some Health Evaluation benchmarks, distinguishing two key aspects of this evaluation: one examines methodologies for the definition of Humanization actions monitoring indicators; the other analyzes evaluatory surveys measuring the impacts of these actions. Both aspects were scored, highlighting specific characteristics that must be recognized in the approach and use of evaluation methodologies under the aegis of this Policy. In order to strengthen such specific characteristics and approach perspectives, it explores the extent and complexity of the tools and actions proposed in the field covered by this Policy, while also offering an brief review of the concepts and components encompassed by the Monitoring and Evaluation area.
90 citations
TL;DR: The methodology used in the Baseline Study that evaluated the effectiveness of the Family Health Strategy as compared to traditional primary health care units, including 41 municipalities with more than 100 thousand inhabitants each, included 41 municipalities from the South and Northeast of Brazil.
Abstract: The article presents the methodology used in the Baseline Study that evaluated the effectiveness of the Family Health Strategy as compared to traditional primary health care units The study included 41 municipalities with more than 100 thousand inhabitants each, 21 from the South and 20 from the Northeast of Brazil As the principal dependent variable and underlying premise for sampling in the Baseline Study, the effectiveness of program activities in the primary care units was analyzed in the population within the respective coverage areas, using an epidemiological survey The health care model in the primary care units was the principal independent variable Its effect on program activities was controlled according to geopolitical region, metropolitan area, and population size in the municipalities Coverage of the activities was characterized according to socioeconomic, demographic, and health-related factors The use of comparison groups, multiple-stage samples, standardized measures, adjustment for geographic and socio-demographic characteristics, and well-defined criteria for judging the findings are contributions by the methodology employed here for designing future studies to evaluate primary health care
81 citations
References
More filters
Journal Article•
TL;DR: Health care professionals must take into account patient preferences as well as social preferences in assessing and assuring quality.
Abstract: Seven attributes of health care define its quality: (1) efficacy: the ability of care, at its best, to improve health; (2) effectiveness: the degree to which attainable health improvements are realized; (3) efficiency: the ability to obtain the greatest health improvement at the lowest cost; (4) optimality: the most advantageous balancing of costs and benefits; (5) acceptability: conformity to patient preferences regarding accessibility, the patient-practitioner relation, the amenities, the effects of care, and the cost of care; (6) legitimacy: conformity to social preferences concerning all of the above; and (7) equity: fairness in the distribution of care and its effects on health. Consequently, health care professionals must take into account patient preferences as well as social preferences in assessing and assuring quality. When the two sets of preference disagree the physician faces the challenge of reconciling them.
589 citations
472 citations
TL;DR: The recent international data on trends in coronary heart disease mortality and morbidity and risk factor levels are reviewed and the possible explanations for the changes in mortality rates are assessed.
Abstract: This paper reviews the recent international data on trends in coronary heart disease mortality and morbidity and risk factor levels and assesses the possible explanations for the changes in mortality rates The implications of the trends and the associated investigations for the prevention and control of coronary heart disease and other noncommunicable diseases are discussed (EXCERPT)
254 citations
TL;DR: The aim of this work is to consider future directions for quality assessment research and the uses to which its products should be put, and that is the main focus of this article.
Abstract: more from integrating efficacy, effectiveness, variations in population-based rate of use, and quality of care into an operational model for policy, planning, and evaluation needs than from continuing to treat them as isolated subjects. We have been asked, however, specifically to consider future directions for quality assessment research and the uses to which its products should be put, and that is the main focus of this article. Nonetheless, our views of the directions research in this area should take are
230 citations
TL;DR: In this paper, an integrative model of the relations among health status, quality of care, and resource expenditure is presented, which defines medical care quality in terms of outcomes, measured as the expected improvements in health status attributable to care.
Abstract: This article presents an integrative model of the relations among health status, quality of care, and resource expenditure. It defines medical care quality in terms of outcomes, measured as the expected improvements in health status attributable to care. The consideration of how quality so defined i
204 citations