Chilean Experience Management Model
- Strategic Planning Dashboard Knowledge Management Talent Management Competency Management Quality Management: Malcolm Baldridge Award Intellectual Capital Management
CONCEPTS ASSOCIATED WITH
INTEGRAL MANAGEMENT
THE PLANNING: It consists of setting the specific course of action to be followed, establishing the principles that will guide it, the sequence of operations to carry it out and the determination of time and numbers necessary for its realization.
CONCEPTS ASSOCIATED WITH INTEGRAL MANAGEMENT
PERFORMANCE EVALUATION : The performance of all members of the organization is evaluated in order to rate individual productivity and see what can be done to increase it.
WHAT DO THE OBJECTIVES OF THE ORGANIZATION INDICATE?
They indicate results and ends that the company must achieve in a given time and that provide the basic guidelines and guidelines towards where to direct efforts and resources.
What are Public Policies and what are they for?
They are a "set of objectives, decisions and actions carried out by a Government to solve the problems that, at a given moment, citizens, and the Government itself , consider to be a priority"
A public policy supposes a government action program in a sector of society or in a geographic space; It is not done in isolation but by developing a plan, that is, a problem is structured through the development of a program by introducing the rational element (element of order)
WHAT IS A PROJECT?
It is a special set of activities that must be carried out within a generally specified period in the workplace.
WHAT IS A PROCESS?
It is a set of consecutive activities ordered according to progress or contribution of added value of the good or services to be delivered to a client.
Process is a set of mutually related activities or that when interacting transform input elements and convert them into results
HISTORY OF PUBLIC HEALTH IN CHILE
Since the beginning of the 19th century, different institutions were created whose objective was to structure the health sector in Chile, among which the Vaccine Board (1808) and the Hospital Board of Directors (1832) stood out.
Towards 1850 there was an already organized movement in Chile, formed by Sociedades de Socorros Mutuos (SSM), entities that formed solidarity systems of private savings destined to grant mainly health and welfare benefits to their members.
For its part, the State began to incorporate the fulfillment of public hygiene tasks, within the functions entrusted to various ministries.
This is how in 1887 when there were seven ministries - what related to public welfare and cemeteries was entrusted to the Ministry of the Interior.
This portfolio created in 1907 a section of sanitary administration that would be in charge of everything related to hygiene and public welfare.
Around 1924, the Ministry of Hygiene, Assistance and Social Welfare was created, which will be in charge of public hygiene tasks. Within the framework of the restructuring of Ministries carried out in 1927, the creation by decree of the portfolio of
Social Welfare, whose functions would be:
- The public hygiene and social welfare and welfare service, the high labor and housing inspectorate, the inspection of welfare funds, the supervision of social laws.
EVIDENCE-BASED MEDICINE
The primary goal of EBM is that everyday medical activity is based on scientific data and not on assumptions or beliefs.
Basic tools on which the EBM methodology is based are the critical reading of the biomedical literature and the rational methods of clinical or therapeutic decision-making. two
The practice of MBE requires the integration of individual clinical experience with the best objective data when making a therapeutic decision.
The most widely used scientific data derive from controlled clinical trials, secondary research studies, post-marketing pharmacological surveillance investigations, meta-analyzes, systematic reviews or economic analysis, but above all statistical and probabilistic contrasting.
INDICATORS IN PUBLIC HEALTH
What is Management Control?
Controlling is not Following, nor Monitoring, nor Restricting, but rather it is Directing, Guiding, Measuring, Correcting.
Management Control is a process of observation and measurement through the systematic comparison of the planned objectives with the results obtained.
It is a continuous and dynamic process, which must be aligned with the strategy and organizational structure. That is, align it to the Objectives
WHAT IS AN INDICATOR?
- Variable whose function is to objectify changes for decision-making in Public Health
CHARACTERISTICS OF A GOOD INDICATOR:
- AVAILABILITY
Availability: the basic data for the construction of the indicator must be easily obtained without restrictions of any kind.
- SIMPLICITY
Simplicity: the indicator must be easy to prepare.
- VALIDITY
Validity: the validity of the indicators means that they must have the capacity to actually measure the phenomenon to be measured and not others
- SPECIFICITY
Specificity: if an indicator does not really measure what it is desired to measure, its value is limited, since it does not allow the true evaluation of the situation by reflecting characteristics that belong to another parallel phenomenon.
- RELIABILITY
Reliability: the data used to construct the indicator must be reliable (satisfactory information sources.
- SENSITIVITY
Sensitivity: the indicator must be able to identify the different health situations even in areas with different particularities, regardless of their magnitude in the community
- SCOPE
Scope: the indicator must synthesize the largest possible number of conditions or different factors that affect the situation described by said indicator. As far as possible, the indicator should be globalizing.
When measuring the level of health, an attempt is made to estimate how the health-disease process manifests itself in a population.
Despite the development and advances made in research on positive health indicators, today the information that is available resorts to the use of negative health indicators, based on the loss of health.
Despite the limitations of working with part of the health disease phenomenon (damage), these are the most useful indicators in health
Utility of absolute numbers
• Estimation of requirements (beds, HR)
- Births -> provision of beds Consultations -> staff of professionals
• Stable denominators -> estimate risk
The rate is a coefficient that expresses the relationship between the quantity and the frequency of a phenomenon or a group of phenomena. It is used to indicate the presence of a situation that cannot be measured directly
Composed by:
- Numerator
Classic risk indicator • Denominator
- Amplifier
TMG 1957 = 12.9 deaths per 1,000 inhab in Chile, 1957
Sex-specific mortality rate
- Numerators: 690 h 36,567 m Denominators 336,118 7,485,596
Rate mh = 5.95 x 1,000 men, 1998
Rate mm = 4.89 x 1,000 women, 1998
Specific mortality rate place of residence
- Numerators: 146 urb 13,111 rural Denominators 623,059 2,198,655
Rate m.urb = 5.31 x 1,000 inhab, 1998
Rural m. Rate = 5.96 x 1,000 inhabitants, 1998
Rate mh = 5.95 x 1,000 men, 1998
Rate mm = 4.89 x 1,000 women, 1998
Overmortality index = 1.22
- They express magnitude of excess risk or protection Their reading is “times more” or times less ”They lack Units of measurement Used to relate rates
Reasons
- Little used • They establish a relationship between 2 events
- Numerator and denominator: not related
Eg masculinity ratio
- Widely used They establish a relationship between 2 events
- numerator and denominator: related
% Cardiovascular deaths = (22,057 / 80,257) = 27.5%
% deaths Tumors = (17,472 / 80,257) = 21.8%
% deaths Bad def. = (3,502 / 80,257) = 4.4%
SOURCES OF INFORMATION IN HEALTH
- Demography: Ordinary records of health services
(care, hospital discharges…)
- Epidemiological surveillance data (ENO) Sample surveys (population surveys) Disease registries (communicable, cancer or others) Other data sources (economic, political, other sectors).
DEMOGRAPHY
Definition:. study of the size, geographic distribution and composition of the population, its variations and the causes of said variations that can be identified with:
- Natality, Mortality, Territorial Movements and Social Mobility.. "
Vital Statistics: information collected, compiled, processed and published in numerical form on:
VITAL FACTS
Live births, deaths, fetal deaths (stillbirths), marriages, divorces, adoptions, legitimations, recognitions, annulments and separations.
In a word, all the events related to the beginning and end of the individual's life and to the changes in his marital status that may occur during his existence.
SOURCES OF DEMOGRAPHIC INFORMATION
STATIC
- Censuses Record of events Vital demographic surveys (Vital Statistics sampling system in Chile: INE-MINSAL-
SRCEI).
- Continuous population records (Futura
RUN tab)
MAIN DEMOGRAPHIC INDICATORS
- Population size (estimates, population density) Composition (age, sex, education, economic activity, marital status…) Demographic variables (Birth, Mortality, Growth and Migration, described according to differentials)
HEALTH-RELATED INDICATORS
- Health policy Socio-economic conditions Benefits, health care Health status or level of the population
HEALTH LEVEL INDICATORS
- Birth (primary data) Mortality (primary data) Morbidity (primary data and estimates) Quality of life (complex estimates)
COMPLEX INDICATORS
- Life expectancy AVPP (Years of Potential Life Lost) Quality of life indicators DALY´S -AVISA or DALY (years of life adjusted by disability)
INTEGRATED INDICATORS
• DALY'S-AVISA or DALY
Relative importance of health problems from the quantification of healthy life lost.
- It integrates several indicators: mortality, morbidity, disability. Estimates the social burden of disease caused by early death and disability.
PREMISES
WHAT CANNOT BE MEASURED CANNOT BE CONTROLLED
WHAT CANNOT BE CONTROLLED CANNOT BE DIRECTED
WHAT CANNOT BE DIRECTED CANNOT BE IMPROVED
What are REMs?
The Monthly Statistical Summaries are the basic and generic information that must be provided by each Health Institution in Chile, in order to reflect the progress and local situations regarding the Health programs developed and generated centrally.
Responsible for reporting REM
It corresponds to the Statistics Unit of the establishments that make up the healthcare network, with the collaboration of the person in charge of the Health Program in verifying the activities reported in each form (daily sheet).Finally, the director of the establishment is responsible for the information contained and reported in the REM.
REM process
The Statistics Unit of the establishments collects, summarizes and fills out the REM monthly. After reviewing the filling and consistency of the data, it is sent to the Health Services Statistics Departments or Units, within the deadlines established by them.
The Services, in turn, consolidate the information of all the establishments of their dependency, review and validate their content, and then process them into a large database accumulated month by month.
Finally, the information converted to a database is sent to the DEIS, on the 15th business day of each month, with the data corresponding to the previous month (1 month lag)
DEIS FUNCTIONS
Department of Health Statistics and Information
Generate relevant, reliable and timely statistical information
Participates in the design and implementation of control and evaluation mechanisms that support the formulation of Health policies
Your data supports the planning and execution of the various health actions at the National level
EXAMPLE OF USE OF REM CENTRALIZED INFORMATION
RELEVANT DATA
Health information system: set of components and procedures organized with the aim of generating information that improves decisions for health management at all levels of the health system
Public health information systems should collect not only data on the determinants of health, health outcomes, the performance of the health system and the health infrastructure, but also information on health inequalities around the determinants, coverage and use of services, including some key stratifiers such as gender, socioeconomic status, ethnic group, and geographic location (PAHO).
MONTHLY STATISTICAL SUMMARY REM-A.02
NOMINAL AND OPERATIONAL DEFINITION OF REM-A.02 VARIABLES
SECTION A: DEFINITION EMP PERFORMED BY PROFESSIONAL.
NOMINAL DEFINITIONS SECTION A:
EMP performed by a professional: corresponds to the application of guaranteed health actions (AUGE Clinical Guide) periodically (every 3 years in the Public System, or annually if requested by the user) of health monitoring and evaluation throughout the cycle vital, in order to reduce morbidity and mortality associated with those preventable or controllable diseases or conditions. Includes conducting exams and / or applying risk assessments.
The EMP's actions aimed at the elderly population aim to investigate, prevent and delay the loss of independence and autonomy, therefore, differentiating between healthy and sick is not the priority in this age group, since in its great Most older people will have a chronic or degenerative disease
It is important to highlight that it is stipulated in Law 19,966, that it is a professional (preferably a doctor) who, after carrying out an EMP and the results of the examinations and evaluations, if these are altered, is the one who gives a diagnosis; giving directions to the person or referring them where appropriate.
OPERATIONAL DEFINITIONS SECTION A:
The EMPs will be recorded, according to the sex of the patients attended, broken down by professional who performs the activity. The record corresponds to the EMP performed, that is, the patient has been evaluated in the exam, classified by nutritional status, application of scales and request for exams, regardless of their results. Later, when the patient returns to control the exams previously indicated in EMP, this activity is recorded as Professional Consultation Medical or Non-Medical Section A and B. REM 04. Later, the patient can be referred for admission to Programs if a chronic pathology is detected and / or morbidity if necessary
Later, the patient can be referred for admission to Programs if a chronic pathology and / or morbidity is detected if necessary.
The EMPs that must be registered as a paramedic technician will correspond only to those carried out in rural or isolated areas, where it cannot be carried out by a health professional.
If due to lack of human resources in the establishment or other reasons of force majeure, it is the paramedic technician who performs the preventive medicine examinations in urban areas, it must be recorded in this section and justify the argument of this record in the "Control" sheet. of Serie A.
SECTION B: EMP PERFORMED ACCORDING TO NUTRITIONAL STATUS RESULTS.
NOMINAL DEFINITIONS SECTION B:
EMP according to the nutritional status result: Corresponds to the Preventive Medicine Exams performed, according to the categories of the nutritional status detected in people in relation to the Body Mass Index (BMI), which are classified as Normal, Low Weight, Overweight and Obesity.
OPERATIONAL DEFINITIONS SECTION B:
The number of EMP performed will be recorded, classified by categories of nutritional status according to BMI, disaggregated by sex and age of those attended.
In the case of older adults, to whom EMPAM is applied annually, it must be registered in the corresponding age group, regardless of whether they already belong to the Cardiovascular Health Program or another Program of
Health.
The sum of the EMPs by nutritional status of Section B must be equal to the total of the EMPs performed by the professional of Section A.
SECTION C: DEFINITION OF EMP RESULTS ACCORDING TO HEALTH STATUS.
NOMINAL DEFINITIONS SECTION C:
EMP result according to health status: Corresponds to the results of each EMP performed, according to the health status of the people at the time of applying the
Preventive medicine. The results are classified as:
- Smoking: Includes daily and occasional smokers. High Blood Pressure: corresponds to people with blood pressure equal to or greater than 140/90 mmHg in 2 measurements with at least 5 minutes of difference during EMP.
OPERATIONAL DEFINITIONS SECTION C:
The risk factors detected at the time of applying the EMP will be recorded in relation to the presence of smoking and high blood pressure (equal to or greater than 140/90 mmHg) according to the age and sex of the people attended.
The results of the AUDIT Alcohol Consumption evaluation, as well as the interventions carried out, must be recorded in SECTION D1 of REM A03.
The results are exclusive, so this record is NOT consistent with sections A and B, since 1 EMP can present the 2 results described in this section or none.
SECTION D: DEFINITION OF EMP RESULTS ACCORDING TO HEALTH STATUS (LABORATORY EXAMS) NOMINAL DEFINITIONS SECTION D:
EMP result according to health status: Corresponds to the results of each EMP performed, according to the health alteration that people present, confirmed through a laboratory test. These results are:
Altered Glycemia: corresponds to people with fasting venous glycemia (taken in the laboratory) equal to or greater than 100 mg / dl; this alteration must be confirmed in a second examination.
High Cholesterol: corresponds to people with total cholesterol equal to or greater than 200 mg / dl
OPERATIONAL DEFINITIONS SECTION D:
The results of the tests requested in the EMP will be recorded, classified according to altered glycemia and high cholesterol confirmed through a laboratory test, according to the age and sex of the people treated. The sum of the results are exclusive, so this information is NOT consistent with sections A and B, since 1 EMP can present the 2 results described in this section or none, in addition to being out of date from the moment the test was applied. EMP, and the final result delivered by the laboratory, therefore, the EMP must be recorded in the month it was carried out and the result of the examination at the time of obtaining it.
MONTHLY STATISTICAL SUMMARY REM-A.06
MENTAL HEALTH PROGRAM PRIMARY CARE AND SPECIALTIES SECTION A.1: CONSULTATIONS.
NOMINAL DEFINITIONS SECTION A.1:
Mental Health Consultation: It is the individual outpatient intervention performed by the trained health professional or by members of the specialty team in mental health and psychiatry.
This intervention is performed on consulting people, their relatives and / or caregivers, or people with risk factors for developing mental disorders. It includes counseling, psychosocial and clinical diagnostic evaluation, indication of treatment, control and follow-up for evolution, psychoeducation, among others. This care must be recorded in the patient's Clinical File.
MONTHLY STATISTICAL SUMMARY REM-A.06
MENTAL HEALTH PROGRAM PRIMARY CARE AND SPECIALTIES
It has a throughput of two queries per hour.
Psychodiagnosis: It is the evaluation given by an accredited clinical psychologist to a referred patient to complement the psychological diagnosis. Includes application of psychological tests, their analysis and preparation of the corresponding report.
This care must be recorded in the patient's Clinical File. It has a variable performance of 1 to 3 hours depending on the test applied.
OPERATIONAL DEFINITIONS SECTION A.1:
Section A.1: consultations by a general practitioner, psychologist, nurse, midwife, social worker, occupational therapist, other technical paramedical and mental health professionals are recorded, carried out at the primary level, according to the nominal definitions specified in the preceding paragraphs, disaggregated by sex and age groups.
In the last column the number of consultations made to beneficiaries is noted
SECTION A.2: MENTAL HEALTH CONSULTANCY.
NOMINAL DEFINITIONS SECTION A.2:
It corresponds to the joint and interactive activity between the mental health and psychiatry specialty team and the PHC general health team, with the purpose of enhancing the resolution capacity of the primary level, improving the referral and counter-referral of patients between both levels of care and ensure shared care and continuity of care for patients with mental health problems or complex mental disorders.
The schedule with the frequency and dates of consultancies must be planned jointly between the teams that receive the activity (primary level) and the one that grants them (specialty level). This care must be recorded in the patient's Clinical File.
It has a performance of a consulting session in 4 hours, for a minimum of 8 patients.
Consultancies Received: corresponds to consultancies received in the APS establishment, granted by the specialty team in mental health and psychiatry at the specialty level.
Cases Reviewed: corresponds to the clinical history of the people analyzed in the mental health consulting session together, between the health team of the APS facility and the specialty level mental health and psychiatry team.
OPERATIONAL DEFINITIONS SECTION A.2:
Section A.2: The number of consultations received by the mental health specialty team is recorded and not by each member of said team, the activity is recorded by the general health team of the PHC facility that receives the Consultation
SECTION A.3: QUERIES IN HOURLY EXTENSION ACCORDING TO THE DAY.
NOMINAL DEFINITIONS SECTION A.3:
Hours Extension: consists of the activity that takes place outside the normal business hours of the Establishment in order to provide access to health care until 8:00 p.m. from Monday to Friday or when, due to specific circumstances, it is necessary to provide care on Saturdays, Sundays or holidays.
OPERATIONAL DEFINITIONS SECTION A.3:
Section A.3: the consultations made in the establishment by a doctor and other professionals are registered, through the Time Extension Program, according to the type of working day and sex of those attended. The consultations registered in this section must be included in section A.1 of the REM.
SECTION B. ATTENTION OF SPECIALTIES
SECTION B.1: CONSULTATIONS
NOMINAL DEFINITIONS SECTION B.1:
Mental Health Consultation: It is the individual outpatient intervention carried out by members of the specialty team in mental health and psychiatry in specialty establishments, this intervention is carried out to consulting people, their relatives and / or caregivers. It includes anamnesis, physical and mental examination, hypothesis and diagnostic confirmation, therapeutic indication, request for examinations, issuance of reports (except forensic) and all diagnostic and therapeutic procedures that are carried out as indicated by the specialist.
This care must be recorded in the patient's Clinical File. The actions to be carried out in this care are: clinical evaluation, formulation of psychiatric diagnosis, indication of treatment (includes various treatment modalities), control and monitoring of indications and evolution, psychoeducation, response to outpatient consultations, against referral to primary care, indication referral and discharge.
It has a throughput of two queries per hour.
Psychodiagnostic: It is the evaluation given by an accredited clinical psychologist to a referred patient to complement the psychological diagnosis. Includes application of psychological tests, their analysis and preparation of the corresponding report. This care must be recorded in the patient's Clinical File.
Individual Psychotherapy: It is the specialized therapeutic intervention, given by a psychiatrist or clinical psychologist with certified training in psychotherapy, to people with a diagnosis of a mental disorder, according to an individual comprehensive treatment plan. This care must be recorded in the patient's Clinical File.
Has a performance of an individual psychotherapy session in 45 minutes
OPERATIONAL DEFINITIONS SECTION B.1:
Section B.1: the consultations by general practitioner, psychologist, nurse, occupational therapist, social worker and other professionals, carried out at the level of specialties, according to the nominal definitions specified in the preceding paragraphs, disaggregated by sex and age groups.
In the last column the number of consultations made to beneficiaries is noted.
The consultation of a psychiatrist must be registered in REM A07 (Attention to Specialties), section A.1, psychiatry, to avoid double registration. This consultation is a care provided by a specialist doctor.
SECTION B.2: GROUP ACTIVITIES (NUMBER OF SESSIONS).
NOMINAL DEFINITIONS SECTION B.2:
Group Psychotherapy: It is the specialized therapeutic intervention, given by a clinical professional with certified training in psychotherapy, to a group of 4 to 10 people with a diagnosis of mental disorder, according to an individual comprehensive treatment plan. Depending on the characteristics and complexity of the group, it is carried out with or without a co-therapist, (a mental health professional with the same training). This care must be recorded in the patient's Clinical File.
It has a performance of a group psychotherapy session in 2 hours. Family Psychotherapy: It is the specialized therapeutic intervention, given by a clinical professional with certified training in family psychotherapy, to members of the same family group of a person with a diagnosis of mental disorder, according to an individual comprehensive treatment plan. Depending on the characteristics and complexity of the group, it is carried out with or without a co-therapist, (a mental health professional with the same training).
This care must be recorded in the patient's Clinical File.
It has a yield of one family psychotherapy session per hour.
OPERATIONAL DEFINITIONS SECTION B.2: Section B.2: the total number of sessions performed by a psychiatrist and clinical psychologist is recorded.
SECTION B.3: REHABILITATION PROGRAM (PEOPLE WITH PSYCHIATRIC DISORDERS).
NOMINAL DEFINITIONS SECTION B.3:
Type I and Type II Rehabilitation Program: It is a set of outpatient activities that support the psychosocial rehabilitation process of people with mental disorder and moderate mental disability (type I) and severe mental disability (type II), granted by a health team trained and trained general or by specialty team in mental health and psychiatry.
It includes:
Personalized monitoring of the Individual Plan
Comprehensive treatment.
Individual, family and group sessions aimed at recovering and reinforcing capacities and skills for an autonomous life.
Activities focused on daily life inside the home, in the community and on socio-labor reintegration.
SECTION B.4: FORENSIC PSYCHIATRY ACTIVITIES FOR PEOPLE IN CONFLICT WITH THE JUSTICE.
NOMINAL DEFINITIONS SECTION B.4:
Judicial Psychiatric Expertise: Evaluation carried out by a professional from the team specialized in mental health and psychiatry in response to the request of a Judge, to determine the psychic functioning of a person with legal status as an accused, focusing on the relevant psychic aspects and their relationship with the crime under investigation.. Diagnosis, prognosis, and treatment suggestion are established if appropriate It includes a review of the file on the cause under investigation, clinical interview, application of psychological tests, preparation of an expert report, attendance at oral proceedings, among other activities.
It must be performed by a professional other than the treating professional and has a performance of one to four hours
Preliminary Drug Examination for Imputed / Convicted Adolescents: Screening activity carried out on an outpatient basis by a trained professional to an adolescent offender of the juvenile criminal responsibility law, in whom abuse or dependence on illicit substances is suspected in order to rule out or recommend a diagnostic evaluation for minors. Includes mental health consultation, application of screening instruments and preparation of report according to official format.
It has a performance of 3 exams per hour.
Clinical Evaluation for Adolescents Charged with Drug Use: Activity requested by the judge or prosecutor when there is suspicion of drug use carried out by the mental health and drug team.
Preliminary Mental Examination of Imputed Persons: It is an outpatient screening activity carried out by a trained professional, to a person imputed by criminal law in whom the existence of a mental disorder is suspected, with the purpose of obtaining a first opinion or clinical impression about the state of mental health and establish the relevance of a judicial psychiatric expert opinion. It corresponds only to clinical screening, it has no procedural effect. It includes mental health consultation, application of a screening instrument and preparation of a report.
It has a performance of 3 exams per hour.
Drug Expertise: Evaluation carried out by a professional from the team specialized in mental health and psychiatry in response to the request of a Judge, to confirm or rule out drug use and / or dependence in a person with legal status as a defendant according to Law 20,000. It includes review of the file on the cause under investigation, psychiatric consultation, preparation of a report and assistance to oral proceedings.
It must be performed by a professional other than the treating professional and has a performance of one hour.
Attention to aggressors derived from Courts (Intrafamily Violence Law): It is the attention of the specialized team in mental health and psychiatry in response to the opinion of the judge of a Family Court to a convicted person of intrafamily violence not constituting a crime. It includes mental health consultation, psychological consultation, application of diagnostic confirmation instruments and preparation of a treatment plan, if applicable, and preparation of a report to the court.
It has one hour performance.
OPERATIONAL DEFINITIONS SECTION B.4:
Section B.4: forensic psychiatry activities performed by a general practitioner, psychiatrist, psychologist, nurse, social worker or other professionals are recorded, according to the nominal definitions specified in the preceding paragraphs, disaggregated by groups of age and sex. In the last column the number of activities carried out to beneficiaries is noted
SECTION B.5: MENTAL HEALTH DEVICES. NOMINAL DEFINITIONS SECTION B.5:
Protected Home: Corresponds to the days of permanence of a patient in a community instance of accommodation and housing, enabled to house a number no greater than 8 people who are compensated for their psychiatric pathology.
Includes: Basic care of monitors with professional supervision, Accommodation and food, Support and protection for activities of daily living, Training in self-care, social and domestic skills.
The days that patients are temporarily absent for vacation reasons, visits to relatives, short-stay hospitalizations, among others are included.
Protected Residence: Corresponds to each day of permanence of a patient in a residential instance enabled to house a number no greater than 12 people with a severe mental disorder who present a high degree of mental disability and dependence, which requires a therapeutic environment with a high level of protection and nursing care. The days that patients are temporarily absent for vacation reasons, visits to relatives, short-stay hospitalizations, among others are included.
Includes: Basic care by technical personnel with professional supervision; Accommodation and feeding; Support and protection for activities of daily living; Access to rehabilitation activities
Day Psychiatric Hospital: Corresponds to each day of daytime psychiatric hospitalization of people with mental disorders in crisis situations, but who can be treated on a semi-outpatient basis.
It considers all the diagnostic, therapeutic and psychiatric rehabilitation procedures that are performed on the patient during their stay in the establishment, including the necessary drugs. The days that patients are temporarily absent for therapeutic reasons, physical disability or other justified reasons are included.
Privative of Liberty Center: Corresponds to the high intensity Comprehensive Clinical Care granted to male or female adolescents aged 14 years or over who are in provisional hospitalization or serving a sentence by court order in a Privy Center, which as a consequence of decompensation of their clinical picture, require 24 hour care. in a closed psychiatric inpatient unit located within the Privative Center of Liberty, with a maximum use day / bed / person of 60 days. Includes psychiatric and psychological consultation, liaison consultation, individual and / or group-family psychosocial intervention, pharmacological treatment, complete nutrition, diagnostic and therapeutic support, among other activities.
Number of people served: Corresponds to the number of people served broken down into those under 20 years of age and over 20 years of age.
Number of Discharges: Corresponds to the number of people who have graduated from the devices, broken down into those under 20 years of age and over 20 years of age.
People on the Waiting List: Corresponds to the number of people who are on the waiting list to enter the different types of devices.
SECTION C. COMMON ACTIVITIES IN BOTH TYPES OF CARE.
SECTION C.1: GROUP ACTIVITIES.
NOMINAL DEFINITIONS SECTION C.1:
Group Psychosocial Intervention: It is the therapeutic intervention carried out by members of the trained general health team or members of the specialty team in mental health and psychiatry, with a group of between two and twelve people. Its objective is to provide emotional support, education for self-care, development of skills and capacities, reinforcement of adherence to treatment, reinforcement of the family's capacities to care for the patient and for themselves, support for psychosocial rehabilitation and social reintegration and labor.
It can be carried out in outpatient health establishments, in hospital units, in community facilities (day centers, clubhouses, social integration clubs, others) or in community spaces. Includes: Psychoeducation, Skill development workshops (assertive communication, stress management, parenting standards, personal development, conflict resolution, etc.), Skills training activities (awareness of disorder and adherence to treatment, cognitive such as, attention, concentration, memory and higher functions, for daily life such as self-care and instrumental, social, occupational and work), Training activities in self-help behaviors, Motivational activities for social and community participation.
This care must be recorded in the user's Clinical File.
It has a performance of a group psychosocial intervention session in 2 hours.
SECTION C.3: REPORTS TO COURTS.
NOMINAL DEFINITIONS SECTION C.3:
Corresponds to the preparation of reports made at the request of a Court (any of its interveners).
OPERATIONAL DEFINITIONS SECTION C.3:
Section C.3: the number of reports prepared according to the court to which it is addressed is recorded, in the month of the report.
MONTHLY STATISTICAL SUMMARY REM-.07
MEDICAL ATTENTION OF SPECIALTIES
NOMINAL AND OPERATIONAL DEFINITION VARIABLES OF REM-A.07
Generalities: REM-A.07 is for use by all establishments with medical attention of specialties: Therapeutic Diagnostic Center (CDT), Attached Center of Hospital Specialties (CAE), Health Reference Center (CRS), Community Center for Mental Health (COSAM) and the PRAIS (teams that serve the beneficiary population of the Comprehensive Health Care and Repair Program, who have a specialty of psychiatry). Also, all PHC establishments that have a specialist doctor.
SECTION A.1: MEDICAL CONSULTATIONS.
NOMINAL DEFINITIONS SECTION A.1:
Specialty Medical Consultation: It is the professional care given by a specialist doctor to a patient in a place designated for those purposes. This benefit includes anamnesis, physical examination, diagnostic hypothesis, with or without prescription of examinations or therapeutic measures. It will be understood included in it some minimum and usual procedures in a medical consultation such as measurement of blood pressure, otoscopy, measurement of weight and height.
The delivery of this service may be carried out remotely through the participation of two professionals who achieve communication through Information and Communication Technologies, providing information about the patient who may or may not be present, generating a Diagnostic and Therapeutic approach from this link.
Obstetrics Consultation: includes the consultation of High Obstetric Risk (Secondary Level)
Gynecological Consultation: includes Gynecological Consultation (Secondary Level), Excludes Reproduction Specialty Consultation and Gynecological Oncology Consultation, there are two other rows for these specializations.
Ophthalmology Consultation at UAPO: refers to that consultation by an ophthalmologist made in a Primary Ophthalmology Care Unit. The UAPOs, preferably located in primary care establishments, improve the resolution capacity of the Assistance Network, improving accessibility, timeliness and resolution with technical quality, enhancing Primary Care in its promotional, preventive, care, diagnostic relevance and referral, framed in the Comprehensive Health Model with a Family Approach.
New Consultations according to Origin: It is the first attention generated by an episode of a disease, through which the health problem may or may not be resolved.
The referral is classified according to origin from Primary Health Care (PHC), from another specialty (CDT / CAE / CRS) and from the Emergency Department, for presenting health alterations that can be diagnosed and / or resolved in that specialty.
Each first medical care of a patient generated by an interconsultation is a new consultation in the specialty that the care is performed, regardless of whether the patient has been treated on another occasion (s) in the same specialty.
Pertinent Consultation: A pertinent consultation is understood to be one that complies with the reference protocols that safeguard the level of care under which the patient must solve their health problem, being the reason for referral feasible to solve at the level of care to which it is referred and considering the terms in which the benefit must be granted.
The relevance in the reference to specialty will be understood as that from Primary Care to Specialty Care, for which it will be measured on the total of New Consultations whose origin is PHC.
The record of relevance will be made by the Specialist Physician, at the time the patient is cared for.
The relevance of a query will be measured according to two criteria:
Reference Protocol: corresponding to referrals that are made to the level of care that must solve the patient's health problem, as established in the Network's agreements, validated in CIRA.
Established Times: corresponding to referrals, in which the benefit to the patient is carried out in the times defined by the Healthcare Network and validated in the CIRA.
Non-attendance at Medical Consultation (NSP): It is the non-attendance to an attention with a previous appointment. Corresponds to consultations (new and repeated) to which the patient did not appear, regardless of whether the quotas were filled by other patients.
Abbreviated Consultation: Corresponds to the execution of actions destined to repeat the prescription of patients who are being treated in the establishment, or to the reading of exams. This activity is not considered as a Morbidity Consultation itself, since, in general, there is no direct medical attention and its performance is 12 consultations per doctor hour.
Interconsultations to Hospitalized: It is the care of specialist doctors who perform hospitalized patients, in the ward. For this, the records of Hospitalized Hospitalized patients kept by the Functional Units will be used as a source of information. This activity cannot be considered as an outpatient medical consultation for billing purposes, since its value is included in the bed day.
SECTION A.2: CONSULTATIONS MADE ACCORDING TO
METHOD OF FINANCING, INFORMED IN SECTION A.1
NOMINAL DEFINITIONS SECTION A.2:
Specialist Physicians hired for Fees: Corresponds to consultations carried out at the secondary level, by specialist physicians hired in the form of lump sum fees, in the specialties for which they were hired.
Specialist Physicians hired as Call Consultants: Corresponds to consultations made at the secondary level, by specialist physicians, hired, occasionally and temporarily, as traffickers or consultants in specific situations of support to the care work of the establishment. The consultations must correspond to the specialty for which they were hired.
OPERATIONAL DEFINITIONS SECTION A.2:
Section A.2 The inquiries made according to the financing modality are recorded, and they are also recorded in section A.1 (broken down by age and sex).
In consultations "For fees" it is necessary to record the care of the doctors hired by this modality, to make up for the lack of professional specialists in the establishment.
In consultations "By call consultants", those professionals hired occasionally and temporarily to support assistance in the establishment must be registered.
Both must be informed in Section A.1, this section is only to specify how many of the consultations reported in A.1 were financed by these 2 mechanisms.
SECTION A.3: INQUIRIES MADE IN APS E
INFORMED IN SECTION A.1
NOMINAL DEFINITIONS SECTION A.3:
Specialist Physicians hired by the establishment: Corresponds to the care provided by specialist physicians, hired directly by the Primary Care establishment.
Hospital Specialist Physicians: Corresponds to the care provided by specialist physicians from the Network Hospitals or specialty centers (CDT, CRS, etc.) and that by intra-service agreement are performed at the primary level of care establishment.
OPERATIONAL DEFINITIONS SECTION A.3: Section A.3 The consultations made in PHC by doctors "Hired by the Establishment" or "Hospital Specialists" are recorded, which must also be noted according to age group, condition of beneficiaries and sex in the section A.1, since they are part of the production of the APS establishment.
In the case of Hospital Specialists, despite being part of the hospital staff of the agreement, in this situation the statistical principle prevails, where the action is recorded.
New inquiries by origin and those of no-shows should also be considered when appropriate. The level of care (APS or specialty is determined by the facility code).
The consultations made by an ophthalmologist in the Primary Ophthalmology Care Unit (UAPO) must be registered in this section, if applicable, in addition to registering them according to age, pension status and sex.
SECTION A.4: INQUIRIES MADE BY PURCHASE OF SERVICE (DO NOT INCLUDE IN SECTION A.1) NOMINAL DEFINITIONS SECTION A.4:
Purchase of Service (APS): This component considers the purchase of specialty consultation services by the APS, through the financing allocated for this purpose by the “Resolutivity Program”, “GES” or specific APS programs.
Purchase of Specialty Care Service: Corresponds to inquiries that secondary level establishments buy from other agencies, entities or persons other than the Health Service, in order to reduce waiting lists or to resolve GES problems.
SECTION A.5: MEDICAL CONSULTATIONS CARRIED OUT BY OPERATORS (DO NOT INCLUDE IN SECTION A.1)
NOMINAL DEFINITIONS SECTION A.5:
Medical care operation: it is a massive care modality, given in a limited time, that brings the population together in a defined place to be treated by a specialist doctor, who provides specific benefits. Services are delivered in an extraordinary way and does not guarantee continuity of the care defined for the corresponding pathology. Eventually it needs to be supplemented with subsequent follow-ups by formal care devices.
SECTION A.6: TOTAL INTERCONSULTATIONS GENERATED IN APS FOR REFERRAL OF
SPECIALTY.
NOMINAL DEFINITIONS SECTION A.6:
Medical consultation: it is the activity through which, at the request of a doctor, another doctor reviews the patient's medical history, explores and makes recommendations on patient care and treatment. Generally, the consultation is directed to a specialist doctor.
This section corresponds only to establishments that have a primary care level and that refer a patient to a particular specialty through an interconsultation at the secondary level.
SECTION B: CONSULTATIONS AND CONTROLS BY OTHERS
PROFESSIONALS IN SPECIALTY
SECUNDARY LEVEL
NOMINAL DEFINITIONS SECTION B:
Nurse Consultation: It is the care provided by the professional Nurse (or) at the secondary level of care that includes: assessment, nursing diagnosis, determination of the action plan, execution of actions according to the plan, evaluation, registration and summons to new consultations in case of need. It includes those follow-up and / or diagnostic support consultations.
Control and Consultation by Midwife: It is the follow-up care performed by a Midwife provided in Specialized Centers (CDT, Attached Hospital Clinics, CRS, etc.) to the pregnant woman derived from the primary level who presents some pathology or factor of maternal-perinatal risk referred to High Obstetric Risk (ARO), or other patients referred to gynecology consultations, or STI / AIDS, or Infertility consultations.
Consultation by Nutritionist: It is the care provided in a Specialties Office, by a Nutritionist, to a patient referred by a Medical professional when presenting some type of nutritional alteration.
Consultation by a Psychologist: It is the care provided in a Specialties Office by a Psychologist, to a patient referred by a Medical professional, for problems not included in the Mental Health Program with the purpose of recovering or rehabilitating health, using techniques and procedures of their profession.
Consultation by a Speech Therapist: It is the care provided in a Specialties Office, by a Speech Pathologist, to a patient referred by a Medical professional, for the purpose of recovering or rehabilitating health, using techniques and procedures typical of their profession.
Consultation by a Kinesiologist: It is the care provided, in a Specialties Office, to a patient who has been referred by a Medical professional in which the (the) kinesiologist (a) performs, before starting treatment, an evaluation on the osteomuscular state of the patient and prepares the plan of sessions to be carried out. The performance of the procedures established in the therapeutic plan does not constitute consultations, which must be registered as comprehensive care sessions in REM 17 and 18, as appropriate.
Consultation by Occupational Therapist: It is the care provided in a Specialties Office, by an occupational therapist, to a patient referred by a Medical professional, with the purpose of supporting their recovery or rehabilitation, using techniques and procedures typical of their profession.
Consultation by Medical Technologist: It is the care provided by a medical technologist in Refractive Vices, Cataracts, Retinopathies, etc.
Consultation by Social Worker: It is the social care that is carried out to people in a Specialties Office, with the purpose of promoting, protecting and recovering health, through the diagnosis and identification of social risk factors that affect the morbidity and mortality of the same.
In addition, this section must be informed of the controls carried out by these professionals for the purposes described above and that are already incorporated in the age groups and in the total.
OPERATIONAL DEFINITIONS SECTION B: Section B: The number of consultations made in secondary level establishments by the professionals listed in the REM will be recorded, disaggregated by age groups, sex and beneficiaries.
In the last column, only the Total number of controls performed according to professional is recorded.
MONTHLY STATISTICAL SUMMARY REM-A.19b
SOCIAL PARTICIPATION ACTIVITIES
NOMINAL AND OPERATIONAL DEFINITION VARIABLES OF REM-A.19b
SECTION A: ATTENTION INFORMATION OFFICES (INTEGRAL SYSTEM OF ATTENTION TO USERS) NOMINAL DEFINITIONS SECTION A:
Information offices, complaints and suggestions: They are spaces for citizen attention and participation in public services that facilitate the population's access to information, provide timely, clear, transparent and quality care to all people without discrimination, allow to establish coordination with other public agencies and receives and manages all citizen requests, becoming a space for participation.
Activities such as public service, complaints and suggestions management, supervision of the operation of the OIRs, analysis of the information registered in the OIRS and others are carried out.
Claim: it is that request in which the citizen demands, claims or demands a solution to a situation in which he considers his citizens' rights in health have been violated. Eg: quality of care, access, financial coverage, improper provision of a health service, untimely attention to a request, etc.
Claims are classified into:
Treatment: All those user complaints that refer to the attitude of the establishment's officials are considered in this category, in relation to treatment, language, respect for privacy and confidentiality, identification of officials, reception, attention, delivery of information and communication.
Technical Competence: All user complaints related to technical procedures or decisions adopted by any member of the health team in relation to the pathology consulted or under treatment are considered within this category. It is important to note that this does not imply a judgment or audit of the actions of the health team, although in certain situations it may give rise to it, but we are simply accepting that from the point of view of the user or their family
Infrastructure: In this area, all claims made by users regarding the structural and environmental conditions of the health facility are considered in relation to: access, security conditions of the establishment in relation to emergencies, equipment maintenance conditions, waiting rooms, public toilets, etc., temperature and ventilation conditions, hygienic and aesthetic conditions of buildings, patios and gardens, comfort and safety of beds, cots and transfer stretchers, comfort conditions for the relatives of hospitalized patients, security of the belongings of patients and relatives.
Waiting Time (in waiting room): This item considers all types of claims related to Waiting times in waiting rooms (emergency, medical consultations, pharmacy, laboratory, Imaging, etc.)
Waiting time for specialty consultation (Waiting List): All claims related to Waiting times for a specialist consultation are considered in this item.
Waiting Time for Surgery (Waiting List): All claims related to Waiting Times for a Surgical Intervention are considered in this item.
Information: In this area, those opinions related to the transmission of information and communication actions of the health team with users are considered, both with respect to the content and the form used in the delivery of the information. Elements such as language, opportunity, understanding, ability to respond to user requirements should be considered considering the personal characteristics of the individual and their health condition.
It also considers the Informed Consent and the right for the patient and direct family to obtain the data they require from the Clinical File.
Administrative Procedures: All user claims related to processes, procedures or administrative operation of the establishment will be classified within this category, such as the following: admission and collection processes, procedures or procedures during the stay at the institution, operation of the establishment in relation to service hours, administrative procedures upon discharge, referral and / or referral procedures. In general, any process that involves the operation of the Organization.
Administrative Probity: Administrative Probity will be understood to act honestly in the fulfillment of official activities, a principle that can deteriorate or be damaged by dishonest actions.
All complaints related to the procedures or decisions adopted by any member of the health team in relation to dignity in the performance of their position will be classified within this category.
Explicit Health Guarantees (GES): Claims are considered in this category, in which according to the information the user has, the guarantees to which they are entitled have NOT been respected and which are established in the regulations of Law No. 19,966, on explicit health guarantees.
Consultation: corresponds to requests for guidance and information on rights and benefits, procedures, access points, etc. They can be resolved immediately in the OIRS itself. (Regarding the access points (bathroom, exit, box, etc.) it will not be considered valid for statistical registration)
Suggestion: it is that proposal, idea or initiative, offered or presented by a citizen to influence or improve a process whose purpose is related to the provision of a service. It is important to disseminate it to managers to be considered in making decisions about technical and administrative modifications aimed at improving the quality of services and user satisfaction.
Congratulations: concrete expression of gratitude or congratulations to an official or team of officials of an Institution for the quality of the service provided. Like the suggestions, it is important to be aware of the managers, teams and officials involved.
Requests: specific requests for help or concrete assistance to solve a problem of specific need or lack. It requires specific management by the OIRS official and eventually in coordination with another Unit or
Service.
Requests Law 20,285 (Transparency Law): specific requests on transparency and access to public information of the institution, based on the principles promulgated by this law (transparency of the public function, right of access to information of the organs of the Administration of the State, procedures for the exercise of the right and for its protection, exceptions to the publicity of the information).
OPERATIONAL DEFINITIONS SECTION A:
Attention activities will be recorded in the Information Offices, such as complaints, queries, suggestions, congratulations and requests; The claims that are presented in relation to the service to which the office belongs or with respect to any of its officials, that express any type of irregularity that affects the interests of the user, the queries in relation to the delivery of information and guidance to the user about the establishment in which it is located, regarding its functions, its organization, also regarding the deadlines, documents and formalities required to access in an expeditious and timely manner to the various services, the suggestions that they present to improve the operation of that service or distribution, the congratulations received. Claims, inquiries, suggestions,congratulations and requests made in the month, differentiated by sex of the person who raises it.
You must register:
The number of "responses for the month delivered within the legal deadlines (15 business days)" of claims generated in the month and claims generated in the previous month.
The number of "claims answered outside the legal deadlines", (greater than 15 days), in the reported month.
The number of "pending claims" of pending responses within the legal period and pending responses outside the legal period.
In "pending claims, pending responses within the legal period", the number of claims is recorded according to type, which are received at the establishment during the month, but remain pending for resolution the next month, as they are within the stipulated legal period (15 working days). Eg a claim for treatment received on February 25, has a deadline to be answered with a solution until March 18. This claim will be recorded in the statistics for the month of February as "pending claim within the term" and in the statistics for the month of March, if answered, it will be recorded as "response of the month within the legal terms, claims generated in the previous month".
In "pending claims, pending responses outside the legal deadline", the number of claims is recorded according to type, which are still pending in the month of the report, but the legal deadline for responding with a solution has already been met (greater than 15 business days).
SECTION B: ACTIVITIES BY STRATEGY / LINE OF ACTION OR SPACE / INSTANCE OF PARTICIPATION
SOCIAL.
NOMINAL DEFINITIONS SECTION B
Community and intersectoral work activities: It is a set of programmed activities carried out by the health team in conjunction with the community, its organizations and / or with institutions from different sectors, aimed at developing different strategies and spaces for participation that contribute to the identification problems, needs and expectations of the population, arrange resources and implement initiatives that allow them to be addressed jointly and comprehensively and that aim to improve health care and quality of life for individuals, families and the community.
Classification of Activities:
Administration and / or management activities: These are all those activities such as information registration, preparation of meetings and activities, bibliographic review, team meetings, spaces for reflection, telephone coordination, review and response of emails, reading of documents, study of themes, among others.
Interview: Corresponds to an interaction where information is shared between one or more representatives of the health team and representatives of the community or of an institution with a previously established objective (does not include direct attention to users).
Coordination and work meetings in the intrasector: It refers to the instance of exchange of information, ideas and opinions for the design, planning, monitoring and evaluation of various actions and joint tasks of the various actors in the health sector.
Coordination meetings and intersectoral work: Refers to the instance of exchange of ideas and opinions and of coordination at the local level where the actors of the health team, the organized community and state or private institutions interrelate to enhance their work and develop joint actions for common goals.
Monitoring Activities: Corresponds to all actions in order to monitor and evaluate the implementation of the various participation strategies, it also includes the gathering of information, information analysis, and instrument design.
Technical Advice: It refers both to the training actions, formation and delivery of technical - methodological guidance that allow the development of competencies and skills as well as the supervisory actions aimed at accompanying and guiding the processes of implementation of social participation strategies, according to planned.
Days of exchange of experiences: These are all those actions that contribute to the exchange of experiences of social participation that generate spaces for learning, reflection and training of people. They can be Seminars, Conferences, Internship or other.
Dissemination and social communication activities: It is the set of actions that aim to deliver general information or specific educational content in a massive way through different written or audiovisual communication media. Eg: peripheral, steering wheel, city squares, others.
Community Education and Training: It is a training technique of a group and community nature that aims to develop skills or abilities that contribute to the promotion, prevention, recovery of their health, as well as the development of capacities for active participation in the diagnosis, execution and evaluation of health actions and initiatives, protection of rights and exercise of active citizenship, through seminars, workshops, training.
Massive events: Are those activities of a massive nature with the assistance of users representing the local level, both institutional and civil society, to raise awareness, disseminate, communicate, consult, exchange information, carry out social, cultural, sports or other recreational activities that aim to improve the quality of care and the health situation of the population. Through Assemblies, Town Halls, citizen squares, cultural, sports or recreational activities, walks, others.
Indigenous Peoples Activities: These are all those activities carried out by professionals and technicians of the health teams, including intercultural facilitators, that involve indigenous people, families, communities, groups and / or associations belonging to the 9 indigenous peoples recognized by the Indigenous Law. Nº 19,253: Aymará, Quechua, Atacameño, Diaguita, Colla, Rapanui or Pascuense, Mapuche, Kawashkar or Alacalufe, and Yámana or Yagan.
Social participation activities by paramedic technician: paramedic technicians carry out certain activities that are intended to include in the implementation and execution of strategies to improve health conditions and quality of life
Classification of spaces or instances of participation:
Citizen consultations: Spaces for citizen consultation on issues related to health that require information about the opinion of citizens, support and social legitimacy.
In general, activities such as: citizen panels, focus groups, councils, surveys, open spaces and social dialogues are carried out
Consultative Councils, Development Councils and Local Committees: These are bodies created in order to facilitate social control of public management, contribute to the proper functioning of the Public Health Network and provide adequate responses to users' demands. Activities such as: citizen panels, focus groups, councils, surveys, open spaces, social dialogues are carried out.
Territorial Tables: Joint work instance associated with a delimited territory such as a local micro network, Health Service network or the commune for the exchange of information, ideas and opinions for the design, planning, monitoring and evaluation of various actions and joint tasks related to the functioning, articulation of the health network, formation and operation of social protection networks, articulation of local policies for health, among others.
The activities involved are: convocation of the micro-network actors to be included in the table, meetings of the Territorial Tables, actions derived from the agreements of the Territorial Tables, drafting of Minutes of agreements or Reports.
Tripartite Tables / Dialogues: Joint work instance between managers, the health team and the organized community for the exchange of information, ideas and opinions for the design, planning, monitoring and evaluation of various actions and joint tasks linked to common objectives and interests. It involves activities such as: convocation of the actors to be incorporated into the table, meetings of the Tripartite Tables, actions derived from the agreements of the tripartite Tables, drafting of Minutes of agreements or Reports.
Intercultural Health Tables: Interculturality in health defines in a certain way the complementarity of medical systems, which does not constitute a mandatory relationship nor is it expected to be simultaneous. These tables are a formal instance of participation whose purpose is to deepen the participation of indigenous peoples in the management of public policies. It is the job of SEREMI to promote, convene and coordinate the regional tables and their link with the intersector. Complementarity will only be possible to the extent that there is a rapprochement between the systems; this by creating strategies among health teams with the work carried out by specialists in indigenous medicine.
In the case that the tables are provincial and communal, they are the responsibility of the Health Services and respond to instances that favor the participation of indigenous people in the planning, implementation and evaluation of strategies aimed at improving the state of health, accessibility, quality and relevance of health actions aimed at this population.
Classification of Strategies and spaces for participation:
Accountability (Public Accounts): The public account is a tool for the democratization of health information and the transparency of public management. It gives an account of the achievements in health matters, investments and improvements in the management of the Health Services and establishments of the Assistance Network. Consider activities like:
Coordination meetings between Directors, Representatives of the Health Team and the Leaders of the Organized Community for the preparation and analysis of the Account.
Call to community, local authorities, representatives of institutions to the ceremony of delivery of the Public Account
Delivery of the Public Account to the community in general.
Participatory Budgeting: It is a deliberative process in which the public decides on the use of public resources in Health, and develops a control and monitoring of budget execution, supported by the transparency of public management and the exercise of democracy.
The implementation process requires developing a series of activities such as:
Health team work meetings
Work meetings with representatives of the territorial community
Training sessions on the participatory budgeting methodology
Dissemination activities
Call for territorial delegates
Territorial Assemblies for the generation of proposals and voting
Meetings to analyze the feasibility of proposals
Ceremony of delivery of proposals selected by the territorial delegates.
Evaluation and systematization.
User Satisfaction: Refers to the degree of compliance by the health system with respect to user expectations in relation to the services it offers.
They are those activities that make it possible to know the quality of care and management problems seen by users and complement the technical diagnosis of the health team; such as: User Satisfaction Measurement Instruments, application of surveys and questionnaires, focus groups, incognito users, telephone surveys and the analysis of information and preparation of recommendations.
Health co-responsibility: Health co-responsibility aims to strengthen the links between the health team and community organizations through joint work strategies between both social actors, such as the recognition and visibility of the competencies of community organizations, the formalization of collaborative work and financial support for various proposals and activities of these organizations.
Humanization of Care: These are actions or activities aimed at achieving humanized health care and an improvement in the treatment of the user, such as: support for the participation of parents in childbirth, extension of the daily visiting hours, application of the informed consent, family participation in the feeding of hospitalized people, coordination of activities related to spiritual assistance to people and their families, pediatric and elderly hospitalization, organization of a mobile library, information and dissemination about people's rights, among other.
Participatory Local Planning: Corresponds to the instance in which a group made up of representatives of the health team, the community and public and private institutions meet in order to identify, prioritize problems and prioritize needs in order to contribute to the preparation of the Health Plan of the establishment and the commune, and specific projects that tend to improve the care and health situation of the population.
Activities are developed such as meetings with managers, the health team, the organized community and representatives of public and private institutions for the development of the following stages of the local planning process: Participatory Diagnosis, Joint Programming, Joint Execution, Participatory Evaluation and Systematization.
SECTION C: SENIOR MEETINGS. NOMINAL DEFINITIONS SECTION C:
Clinical Meeting: this is the activity carried out by the doctor, nurse and the members of the health team who care for the elderly, in order to analyze the cases of frail older adults who, despite their treatment, do not improve their decompensation, and together develop a A common strategy for the comprehensive management of the patient, in order to prevent the person from losing self-valence and moving to the group of dependent elderly adults.
Clinical Meetings with long-stay institutions: these are activities carried out by the members of the health team, with representatives of the long-stay institutions that care for older adults assigned to the territorial jurisdiction of the establishment, with the purpose of jointly preparing the strategies that allow to improve the quality of life of the elderly.
MONTHLY STATISTICAL SUMMARY REM-A.24
MATERNITY CARE
NOMINAL AND OPERATIONAL DEFINITION VARIABLES OF REM-A.24
SECTION A: DELIVERY AND ABORTION INFORMATION
CATERED
NOMINAL DEFINITIONS SECTION A:
Corresponds to births and abortions attended in establishments belonging to the National System of Health Services.
Normal Delivery: «It is the unique physiological process with which the woman ends her pregnancy at term, in which psychological and sociocultural factors are involved. Its onset is spontaneous, develops and ends without complications and low risk, culminates with the birth and does not imply any intervention other than comprehensive and respectful support. The fetus is born spontaneously in a cephalad position between 37 to 42 completed weeks
Dystocic Vaginal Delivery: Abnormal delivery or dystocic delivery
(literally “difficult labor or difficult delivery”) occurs when there are anatomical or functional abnormalities of the fetus, the mother's pelvis, the uterus and the cervix and / or some combination of these, which interfere with the normal course of labor and delivery. The diagnosis and management of dystocic delivery is a major health problem. Abnormal labor describes a slower than normal process (a prolongation disorder) or a cessation of the abnormal or pathological labor process, abnormal labor due to fetal or maternal causes through the vaginal canal and / or through the use of maneuvers, instruments ex. Forceps. OR
Surgical interventions.
Cesarean delivery: It is the surgical procedure by which the fetus is produced and extracted, when uterine delivery is not possible due to some complication, it is through an abdominal and uterine incision. It can be done through elective or emergency surgery.
Abortion: The loss of the embryo or fetus before it has reached a sufficient development that allows it to live independently is understood. The termination of pregnancy from the moment of conception until the end of the 6th month is considered abortion.
Normal Vertical Delivery: Delivery in which the pregnant woman is placed in a vertical position (standing, sitting, supporting one or two knees, or squatting).
Delivery outside the establishment: Delivery carried out outside a health institution, without professional care
Uncontrolled pregnancy delivery: Corresponds to the Pregnant Woman without admission to prenatal control.
Epidural anesthesia: Medical procedure that corresponds to the administration of anesthetic through an indwelling catheter, causing caudal epidural block.
Spinal Anesthesia: Medical procedure that corresponds to the administration of anesthetic in the sub-arachnoid space at the level of the L / 3-L / 4 vertebrae, causing a spinal block, anesthetizing practically all the structures located under the waist, the perineum, the pelvic floor and the birth canal.
General Anesthesia: Medical procedure that corresponds to the administration of general anesthetics.
Local Anesthesia: Procedure that corresponds to the administration of infiltrative anesthesia, for episiotomy sutures or tears.
Inhalation Analgesia: Corresponds to the administration of analgesics by inhaling concentrated vapors through the use of a mask (eg Nitrous Oxide). Eliminate the pain of childbirth while preserving the consciousness of the mother.
Non-Pharmacological Analgesic Measures: Corresponds to the application of other labor analgesia measures
such as heat, massage, relaxation and others
Precocious attachment contact greater than 30 minutes (NB weighing less than or equal to 2,499 grams): It is the physical contact that must be established between the newborn and its mother in the first half hour after delivery or as soon as possible in case of cesarean sections. In this case, the newborn has a weight less than or equal to 2,499 grams.
The Health Establishments should promote this moment of intimacy between the mother and her baby, provided that the health conditions of both allow it, since this favors the affective bond and facilitates the beginning of Breastfeeding.
Precocious attachment contact greater than 30 minutes (NB weighing more than 2,500 grams or more): It is the physical contact that must be established between the newborn and its mother in the first half hour after delivery or as soon as possible in case of cesarean sections. In this case the newborn has a 2,500 grs. or more.
The Health Establishments should promote this moment of intimacy between the mother and her baby, provided that the health conditions of both allow it, since this favors the affective bond and facilitates the beginning of Breastfeeding.
MONTHLY STATISTICAL SUMMARY REM-BS.17A
SUPPORT BENEFIT BOOK
DIAGNOSIS and THERAPEUTIC
NOMINAL AND OPERATIONAL DEFINITION VARIABLES OF REM-BS.17A
GENERALITIES: This rem is for the exclusive use of the establishments that make up the national health services system, whether they depend on the Ministry of Health or public or private entities with which the health services or Fonasa have entered into an agreement that establishes that financing It is for benefits granted.
REM-B.17A includes the benefits granted to beneficiaries in the establishment, through the “Institutional Care Modality” (MAI).
REM-BS17A
Total Activities: Corresponds to the total number of services carried out in the health establishment.
Activities by beneficiary condition: Corresponds to the total number of benefits carried out according to the type of beneficiary of Law 18,469.
The Total and Beneficiary is registered, Non Beneficiary is automatically generated from the subtraction of the total and beneficiaries.
Surgical Interventions: Registration only for beneficiaries and non-beneficiaries, billing at 100, 50 and 75%.
The registry of surgical interventions according to the percentage of billing is generated when the same team and in the same surgical act, two or more interventions of different code are performed, either for the same incision or for different ones, for which it will correspond to charge 100% to the one with the highest tariff and surgical interventions at 50%, correspond to the one with the second highest subsidized value (50%).
In cases of bilateral surgery of the same benefit, by the same team, it will proceed to charge 100% of the tariff value of one intervention and 50% of the other, unless the Tariff expressly specifies a different procedure.
When two or more operations are performed on the same patient simultaneously or successively by different teams of surgeons, through the same or different incisions, 100% of the value of each of the interventions carried out.
Surgical interventions at 75%, when it is necessary to surgically remove endoprosthesis or internal osteosynthesis elements in the specialty of trauma (Group 21), will be charged through benefits 21-06001, 21-06-002 and 21-06-003. In those cases in which the removal of elements does not have a specific code for this purpose and provided that the tariff does not establish a different procedure, 75% of the value of the intervention of the placement of the respective element will be charged.
Elective Outpatient Major Surgical Interventions (CMA): in these columns it will correspond to record all those Interventions that meet the Elective CMA requirement, according to the definitions described in the REM 17 Section F instructions, the Total disaggregated by age groups (<15 years, 15 and over) and Beneficiaries. Therefore, the sum of the surgeries, according to age group, must coincide with the Total of the Interventions carried out in the establishment.
Origin: The data must be recorded according to its origin, that is, where the service was made, these can be for: Closed Attention, Open Attention or Emergency.
Intra Hospital Production: By Fees and / or Call Consultants, corresponds to the number of activities carried out by the establishment and in particular for surgical interventions, by surgeons or anesthetists, outside normal hours, hired in lump sum fees in the specialties for those who were hired or as call consultants. These should be included in Activities (100%), Total column and Beneficiaries.
Operational: The number of activities that have been carried out by this modality is recorded, they are NOT included in Activities (100%) because they are NOT production of the
establishment
Service Sale: number of procedures carried out by the establishment through the sale of services to other health centers, are included in the establishment's Total Activities as production, but not for billing to FONASA, since it receives other income from such a concept. (Example: municipal PHC offices, private care centers.)
Transfer: It refers to the tariff values of the current benefits, according to the current Resolution. Total invoiced: Refers to the amount calculated by the unit tariff value for the number of activities carried out to the beneficiaries of Law 18,469.
Validation: Contains automatic validations for each service.
MONTHLY STATISTICAL SUMMARY REMA.27 HEALTH EDUCATION
NOMINAL AND OPERATIONAL VARIABLES DEFINITION OF REM SECTION D: EDUCATION GROUP A.27 A HIGH RISK OBSTETRIC PREGNANT (secondary) NOMINAL DEFINITIONS SECTION D:
It corresponds to education for pregnant women, with different perinatal obstetric risk factors, focused on the field of pathologies that affect their gestation period, care and care for the preparation of childbirth, and a prenatal education workshop.
OPERATIONAL DEFINITIONS SECTION D:
It corresponds to register the total number of sessions in group education that are carried out to Pregnant Women who are in control of High Obstetric Risk at the secondary level, in the topics of Self-care according to their pathologies, in the preparation for childbirth and in the scheduled workshops for prenatal education.
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