RESUMO
OBJECTIVE: To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. METHODS: Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient's medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. FINDINGS: Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. CONCLUSION: Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated.
Assuntos
Centros Comunitários de Saúde/economia , Atenção à Saúde/economia , Recursos em Saúde , Orçamentos , Criança , Custos e Análise de Custo , Feminino , Haiti , Humanos , GravidezRESUMO
The authors examined periventricular white matter, deep white matter, and subcortical magnetic resonance imaging (MRI) high-intensity signals in subjects with late-life depression, probable Alzheimer's disease (DAT), and healthy, age-matched controls. All subjects were healthy and free of major vascular risk factors, including hypertension. MRIs were performed using a 1.5-tesla GE Signa scanner. T2 and proton-density-weighted images were analyzed by a neuroradiologist blind to the clinical status of all subjects. There were no statistically significant differences on any of the MRI indices between the groups studied. These data demonstrate that late-life depression, like DAT, in the absence of major vascular risk factors, is not associated with a significant increase in MRI high-intensity signals when compared to healthy, control subjects.
RESUMO
The frontal lobe dementias (FLDs) are a group of disorders that have received considerable attention recently. Diagnosis is based on the presence of behavioral and cognitive disturbances associated pathologically with focal neuronal loss and gliosis without any inclusion bodies. Reports describing FLD differ regarding its clinical features, cognitive disturbances, and neurophysiological and neuropathological characteristics. The authors review the existing literature on FLD and emphasize the similarities and differences between reports. The heterogeneity of this condition as currently described is addressed, and arguments supporting the concept of FLD as a syndrome more appropriately called frontotemporal dementia are discussed. The authors present the development of a more rigid clinical definition of this syndrome using well-defined criteria as the first step toward understanding better this group of disorders.