Browsing by Author "Carvalho, Henrique"
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- Care4Value: medição de valor em saúde em Unidades de Cuidados Continuados IntegradosPublication . Reis, Catarina I.; Maximiano, Marisa; Ferreira, Pedro Henrique; Querido, Ana; Sargento, Ana Lúcia Marto; Carvalho, Henrique; Leal, Susana Cristina Henriques; Oliveira, Sandra Margarida Bernardes deObjetivo: Desenvolver uma plataforma digital para a otimização do processo de coleta de dados de escalas clínicas e monitoramento desses dados com vista à medição do valor em saúde. Métodos: Por meio de uma metodologia de investigação-ação, o desenvolvimento da plataforma incluiu abordagens qualitativas e quantitativas, em três fases: grupos focais com uma equipe multidisciplinar de investigadores e profi ssionais de saúde da UCCI do estudo-piloto; análise dos dados clínicos em formato de pré-teste de uma amostra de 21 usuários da UCCI para categorizar diferentes graus de complexidade; e, análise de informação fi nanceira, aos custos operacionais da UCCI, relativa ao momento de permanência dos mesmos 21 usuários. O desenvolvimento iterativo e incremental da plataforma permitiu coletar feedback dos usuários como forma de melhoria. Resultados: A plataforma inclui 3 módulos: aplicativo móvel; dashboard; e módulo de importação. A plataforma centraliza os dados coletados e disponibiliza-os por meio de um dashboard. Os dados são coletados por aplicativo móvel e/ou por um módulo de importação que consome dados de sistemas clínicos existentes. Conclusão: O aplicativo móvel está apto a ser utilizado por profi ssionais de saúde e cuidadores, e o dashboard apresenta informações de acompanhamento clínico dos usuários e monitoramento dos seus ganhos em saúde.
- Defining clinical conditions in long-term healthcare as a first step to implement Time-Driven Activity Based Costing (TDABC)Publication . Querido, Ana; Sargento, Ana; Santos, Isa; Carvalho, Henrique; Reis, Catarina; Frederico, Manuela; Maximiano, Marisa; Oliveira, Sandra; Leal, SusanaBackground Increasing healthcare costs is a concern of all developed countries. In Long-Term Healthcare (LTH) this is reinforced by population ageing and corresponding prevalence of chronic diseases. Thus, it is fundamental to accurately measure costs and outcomes in healthcare, improving value created for patients, i.e., patientcentred health outcomes per monetary unit of cost [1, 2]. TDABC methodology applied to healthcare allows identifying the cost for each clinical condition in the full cycle of care, mapping processes, activities, resources and allocated time [3–5]. It has been mostly applied in acute-care settings, partly due to complexity of defining chronic condition [6]. Objective This paper focuses on the cost component of a larger on-going research project (CARE4VALUE), aiming to enhance value creation in LTH providers and applied to a partner LTH unit. Specifically, the main objective is to define clinical conditions in the context of LTH, as a first step in the implementation of TDBAC. Methods Mixed qualitative and quantitative methods were applied, including: 1) three focus groups conducted with the health team of the LTH unit (physician, nurses, physiotherapist, psychologist, social assistant) to select, discuss and validate the criteria to define clinical conditions; 2) construction of a composite indicator and testing it over a sample of anonymized clinical data from 21 patients; 3) structured observation of processes taken throughout the full cycle of care of patients in different conditions. Qualitative data was submitted to content analysis and validated among participants. Quantitative data used in the composite indicator, based on validated scales, was subject to normalization, aggregation and sensitivity analysis. Results One consensual outcome of the focus groups was that, in LTH, the disease or cause of entrance is less relevant to costs than the overall complexity of the patient, entailing psychical, social, spiritual and psychic-mental dimensions. Accordingly, a multidimensional classification model of patients in four complexity levels was delivered, after being validated and receiving consensus from the LTH team. Additionally, it will include a logging tool and dashboard to integrate separate patient-centred information and aid patient classification in complexity conditions. BMC Health Services Research 2018, 18(Suppl 2):684 Page 75 of 183 Conclusions The completion of this step allowed progressing in the design and implementation of the cost model, which, in turn, will support value measurement, and enhancing of the focus LTH unit. Besides, all involved professionals stated that their engagement in this phase of the project generated exceptional opportunities for interdisciplinary meetings and debate, contributing to closer ties between different areas of LTH.
- Health outcomes in long-term healthcare units: the case of the Care4Value project.Publication . Leal, S.; Oliveira, S.; Querido, Ana; Sargento, Ana; Carvalho, Henrique; Reis, Catarina I.; Maximiano, Marisa; Frederico, M.
- Time-driven activity based costing (TDABC) in long-term healthcare (LTH)-A practical applicationPublication . Sargento, Ana; Santos, Isa; Carvalho, Henrique; Querido, AnaStatement of the Problem: This paper focuses the cost component of a larger ongoing action-research project (CARE4VALUE), aiming to enhance value creation (patient-centered health outcomes per unit of cost) in LTH providers. The main objective is to share the experience of designing and implementing TDABC in a Portuguese LTH unit. TDABC methodology applied to healthcare allows identifying the cost per patient, for each clinical condition, in the full cycle of care, mapping processes, activities, resources and time allocated. The cost model was developed in a close cooperation with the clinical and management staff of the partner LTH unit. Mixed qualitative and quantitative methods were applied, involving: Three focus groups and anonymized clinical data analysis to categorize different complexity degrees of patients; structured observation of the full cycle of care; analysis and rearrangement of accounting records and cost calculation per patient and activity. Despite the difficulties found, mainly concerning the adaptation of the existing management accounting system to the requirements of TDABC, the implementation in a real LTH setting proved successful. A recording tool and dashboard was also developed, to integrate multidimensional patient-centred information, prompting embeddedness of the model into daily practice.The cost model represents an important advance for the focus LTH unit, as it allows uncovering the cost per patient, according to his/her degree of complexity. Although applied to a specific LTH unit, it is replicable to similar units, generating valuable information for managers, policy-makers and funding.