Search

R E S U M O - Nos últimos anos, diferentes estudos têm demonstrado que um nível inadequado de literacia em saúde pode ter implicações significativas nos resultados em saúde, na utilização dos serviços de saúde e, consequentemente, nos gastos em saúde. O conceito de literacia em saúde evoluiu de uma definição meramente cognitiva para uma definição que engloba as componentes pessoal e social do indivíduo, assumindo-se como a capacidade de tomar decisões fundamentadas no seu dia-a-dia. O presente estudo transversal analítico teve como objetivo traduzir e validar para a população portuguesa o European Health Literacy Survey (HLS-EU). O HLS-EU-PT foi aplicado em todo o território nacional, incluindo as regiões autónomas, através de investigadores de uma rede académica. A recolha de dados foi realizada por entrevista presencial. A amostra final ficou constituída por 1.004 indivíduos com idades ≥ 16 anos. Este estudo disponibilizou o instrumento de avaliação do nível de literacia para a saúde em Portugal, tão importante na gestão da saúde. O HLS-EU-PT apresenta-se como um instrumento adequado para aferir o nível de literacia em saúde da população portuguesa e evidencia propriedades psicométricas comparáveis às versões utilizadas nos outros países. Em Portugal, 61% da população inquirida apresenta um nível de literacia geral em saúde problemático ou inadequado, situando-se a média dos 9 países em 49,2%. Relativamente à dimensão cuidados de saúde, apenas 44,2% apresenta um nível suficiente ou excelente de literacia em saúde. No que respeita à prevenção da doença, cerca de 45% dos inquiridos revela ter um nível suficiente ou excelente de literacia em saúde, comparativamente com a média dos 9 países, que nesta dimensão apresenta o valor de 54,5%. Na dimensão promoção da saúde, 60,2% da população auscultada apresenta um nível de literacia em saúde problemático ou inadequado, sendo que a média se situa nos 52,1%. Assim, considera-se fundamental e urgente a conceção e implementação de uma estratégia nacional de literacia em saúde. A B S T R A C T - In the last few years, several studies have shown that inadequate health literacy levels can have significant implications in health outcomes, in the use of health care services and, consequently, in health costs. The concept of health literacy has changed from a purely cognitive definition to a definition that includes the personal and social components of the individual, assuming the ability to make informed decisions in their everyday life. This analytical cross-sectional study aimed to translate and validate the European Health Literacy Survey (HLS-EU) to the Portuguese population. The HLS-EU-PT has been applied throughout the country, including the autonomous regions, through research of an academic network. Data collection was conducted by personal interview. The final sample was composed of 1004 individuals aged ≥ 16 years. This study provided the assessment tool of literacy level for health in Portugal, so important in health management. The HLS-EU-PT is an adequate instrument to measure the health literacy levels of Portuguese population and shows comparable psychometric properties to versions used in the other countries. In Portugal, 61% of the surveyed population has general health literacy level problematic or inadequate, reaching the average of the nine countries in 49.2%. Concerning the Healthcare dimension, only 44.2% have a sufficient or excellent level of health literacy. In terms of disease prevention, about 45% of respondents reveal a sufficient or excellent level of health literacy, and the average stands at 54.5%. In Health Promotion dimension about 60.2% of the auscultated population has an health literacy level problematic or inappropriate, and the average stands at 52.1%. Therefore, it is fundamental and urgent to design and implement a National Strategy for Health Literacy. info:eu-repo/semantics/publishedVersion

Background: In Portugal, colorectal cancer is the second most common type of cancer. With the increasing number of cancer survivors, follow-up is perceived as a chronic disease, with a significant impact on hospital care. Objective: To characterize colorectal patients in follow-up at Centro Hospitalar Lisboa Norte, EPE, and to determine the profile of economic resources consumed as well as the consultation workload. Materials and Methods: We characterized colorectal patients in follow-up at Centro Hospitalar Lisboa Norte, EPE, registered from 2008 until 2013 and the profile of economic resources consumed. Results: The Department of Oncology is responsible for 56.2% of colorectal patients’ follow- up. In this study, only 0.4% of cases had follow-up secured in primary care, which translates to a significant impact in terms of resources allocation and consultation management, especially if we consider that 41% of patients are in follow-up for longer than 3 years. The average annual adjusted cost of follow-up per patient is EUR 539.09. Patients who were alive on 31 January 2014 had generated 2,930 follow- up hospital appointments per year, representing 12% of the total number of oncology appointments reported in 2013. Discussion and Conclusions: The follow-up of colorectal cancer patients is associated with significant hospital resource allocation and physicians’ time consumption. Other follow-up models might emerge as an alternative to traditional hospital-centered follow-up, such as the shared-care follow-up, which requires a multidisciplinary and survivorcentered approach, ensuring that information and communication are shared between settings with a clear definition of responsibilities, a survivor care plan, and mechanisms for future referencing when justified. RESUMO - Introdução: Em Portugal o cancro colorretal é o segundo cancro mais frequente. Com o aumento do número de sobreviventes de cancro, o seguimento acaba por ser encarado como uma condição crónica, com impacto significativo nos cuidados assistenciais hospitalares. Objetivo: Caraterizar os doentes com cancro colorretal em seguimento no Centro Hospitalar Lisboa Norte, EPE. e determinar o perfil de recursos económicos consumidos, bem como a carga assistencial. Material e Métodos: Procedeuse à caraterização dos doentes com cancro colorretal em seguimento no Centro Hospitalar Lisboa Norte, EPE. registados de 2008 a 2013 e à determinação do perfil de recursos económicos consumidos. Resultados: A oncologia é responsável pelo seguimento em 56,2% dos doentes com cancro colorretal. Neste estudo, apenas 0,4% dos casos tiveram um seguimento nos Cuidados de Saúde Primários, o que se traduz num impacto significativo em termos dos recursos alocados e gestão de consultas, em especial se considerarmos que 41% dos doentes estão em seguimento há mais de 3 anos. O custo anual ajustado por doente é em média 539,09 €. Os doentes vivos a 31 janeiro de 2014 geraram 2930 consultas de seguimento por ano, equivalentes a 12% do total de consultas reportadas em 2013 pela oncologia. Discussão e Conclusão: O seguimento dos doentes com cancro colorretal está associado a uma alocação significativa de recursos hospitalares e consumo de tempo dos médicos. Outros modelos de seguimento, tais como o seguimento partilhado, poderão emergir como uma alternativa ao seguimento tradicional centrado no hospital, os quais requerem uma abordagem multidisciplinar e centrada no sobrevivente de cancro, assegurando que a informação e comunicação são partilhadas entre níveis de prestação de cuidados, com uma definição clara de responsabilidades, um plano de cuidados para o sobrevivente e mecanismos de referenciação futura se necessária. info:eu-repo/semantics/publishedVersion

RESUMO - Finalidade: Identificar as categorias da «Classificação Internacional da Funcionalidade, Incapacidade e Saúde» (CIF) para a classificação da funcionalidade dos utentes da Rede Nacional de Cuidados Continuados Integrados (RNCCI). Objetivo: Identificar os domínios e categorias da CIF mais referidos para classificar a população com as características dos utentes da RNCCI. Metodologia: Pesquisa efetuada através da EBSCO na CINAHL Plus with Full Text e MEDLINE with Full Text. Pesquisaram-se artigos científicos publicados em texto integral (março 2012) entre 2000/01/01 e 2012/03/31, utilizando o método de PI[C]O. Foram selecionados 15 artigos do total de 23 encontrados. Resultados: Foram identificadas 248 categorias que caracterizam a funcionalidade da população com as características dos utentes da RNCCI. Verificou-se que destas, 86 têm uma frequência de descrição igual ou superior a 50% e encontram-se divididas pelas 4 componentes da CIF. Conclusões: As categorias identificadas estão distribuídas da seguinte forma: 26 categorias da componente Funções do Corpo (32,56%) em 15 artigos; 5 categorias da componente Estruturas do Corpo (5,81%) em 13 artigos; 35 categorias da componente Atividades e Participação (40,70%) em 15 artigos; 18 categorias da componente Fatores Ambientais (20,93%) em 14 artigos. Esta revisão sistemática permite iniciar o processo de caracterização da funcionalidade dos utentes da RNCCI de acordo com a CIF. ABSTRACT - Purpose: Identify the categories of the “International Classification of Functioning, Disability and Health” (CIF) for the classification of functionality to users of the Rede Nacional de Cuidados Continuados Integrados (RNCCI). Objective: Identify ICF categories to classify the population with the characteristics of RNCCI users. Methodology: Research was conducted at EBSCO through CINAHL Plus with Full Text and MEDLINE with Full Text. Scientific articles published in Full Text (March 2012) between 01/01/2000 and 03/31/2012 were selected, using the PI [C]O method. Were selected 15 items of 23 matches. Results: 248 categories were identified which characterize the functionality of the population with the features of RNCCI users. It was found that from these, 86 have a frequency description of less than 50% and are divided by four ICF components. Conclusions: The identified categories are distributed as follows: 26 categories of the component Body Functions (32.56%) in 15 articles, 5 categories of the component Body Structures (5.81%) in 13 articles, 35 categories of the component Activities and Participation (40.70%) in 15 articles, 18 categories of the component Environmental Factors (20.93%) in 14 articles. This systematic review can begin the process of characterizing the functionality of users RNCCI according to ICF. info:eu-repo/semantics/publishedVersion

The article aims to provide an analytical understanding of hospitals as "learning organizations." It further analyzes the development of learning organizations as a way to enhance innovation and performance in the hospital sector. The article pulls together primary data on organizational flexibility, innovation, and performance from 95 administrators from hospital boards in Portugal, collected through a survey, interviews with hospital's boards, and a nominal group technique with a panel of experts on health systems. Results show that a combination of several organizational traits of the learning organization enhances its capacity for innovation development. The logistic model presented reveals that hospitals classified as "advanced learning organizations" have 5 times more chance of developing innovation than "basic learning organizations." Empirical findings further pointed out incentives, standards, and measurement requirements as key elements for integration of service delivery systems and expansion of the current capacity for structured and real-time learning in the hospital sector. The major implication arising from this study is that policy needs to combine instruments that promote innovation opportunities and incentives, with instruments stimulating the further development of the core components of learning organizations. Such a combination of policy instruments has the potential to ensure a wide external cooperation through a learning infrastructure.

This study was part of the 'Deepening our Understanding of Quality improvement in Europe (DUQuE)' project, funded by the EU 7th Research Framework Program [26]. Its aims and methods are described elsewhere [27]. The study used a multi-method, cross-sectional design to collect quality-related information from European hospitals between May 2011 and February 2012 [27]. Seven countries were included based on a mix of health and hospital system financing and organization criteria in different geographical areas in Europe. The participating countries comprised the Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. In each country, 30 hospitals were randomly recruited, subject to them having more than 130 beds and that they treat acute myocardial infarct, hip fracture, stroke and deliveries patients [27]. The study, "Deepening our Understanding of Quality Improvement in Europe (DUQuE)" has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 241822. Funding to pay the Open Access publication charges for this article was provided by European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 241822. Objective: To assess whether there is a relationship between having quality as an item on the board's agenda, perceived external pressure (PEP) and the implementation of quality management in European hospitals. Design: A quantitative, mixed method, cross-sectional study in seven European countries in 2011 surveying CEOs and quality managers and data from onsite audits. Participants: One hundred and fifty-five CEOs and 155 quality managers. Setting: One hundred and fifty-five randomly selected acute care hospitals in seven European countries (Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Main outcome measure(s): Three constructs reflecting quality management based on questionnaire and audit data: (i) Quality Management System Index, (ii) Quality Management Compliance Index and (iii) Clinical Quality Implementation Index. The main predictor was whether quality performance was on the executive board's agenda. Results: Discussing quality performance at executive board meetings more often was associated with a higher quality management system score (regression coefficient b = 2.53; SE = 1.16; P = 0.030). We found a trend in the associations of discussing quality performance with quality compliance and clinical quality implementation. PEP did not modify these relationships. Conclusions: Having quality as an item on the executive board's agenda allows them to review and discuss quality performance more often in order to improve their hospital's quality management. Generally, and as this study found, having quality on the executive board's agenda matters.

Objective. The assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery. Within the DUQuE project (Deepening our Understanding of Quality improvement in Europe), seven measures for QM were developed. This study investigates the relationships between the various quality measures. Design. It is a multi-level, cross-sectional, mixed-method study. Setting and Participants. As part of the DUQuE project, we invited a random sample of 74 hospitals in 7 countries. The quality managers of these hospitals were the main respondents. Furthermore, data of site visits of external surveyors assessing the participating hospitals were used. Main Outcome Measures. Three measures of QM at hospitals level focusing on integral systems (QMSI), compliance with the Plan-Do-Study-Act quality improvement cycle (QMCI) and implementation of clinical quality (CQII). Four measures of QM activities at care pathway level focusing on Specialized expertise and responsibility (SER), Evidence-based organization of pathways (EBOP), Patient safety strategies (PSS) and Clinical review (CR). Results. Positive significant associations were found between the three hospitals level QM measures. Results of the relationships between levels were mixed and showed most associations between QMCI and department-level QM measures for all four types of departments. QMSI was associated with PSS in all types of departments. Conclusion. By using the seven measures of QM, it is possible to get a more comprehensive picture of the maturity of QM in hospitals, with regard to the different levels and across various types of hospital departments.

The paper aims to identify the main drivers of innovation in the hospital sector. It further explores the mechanisms shaping how open hospitals are to external collaboration towards innovation. The paper pulls together data on organizational flexibility and innovation from 95 hospitals from the public sector in Portugal, collected through a survey and interviews to hospital boards. The main findings suggest that external cooperation is the major driver of innovation, while technology is rather seen as an enabler of innovation in hospitals. Results also highlight knowledge management, trust building, communication and focus on the user as the major mechanisms for opening up innovation. Within the context of open innovation, hospitals jointly with other health services, universities and users have the opportunity to shape policy and practice to accelerate innovation. Incentives are needed to drive systemic and cultural changes, as well as to establish a common platform for external.

In the last few years, several studies have shown that inadequate health literacy levels can have significant implications in health outcomes, in the use of health care services and, consequently, in health costs. The concept of health literacy has changed from a purely cognitive definition to a definition that includes the personal and social components of the individual, assuming the ability to make informed decisions in their everyday life. This analytical cross‐sectional study aimed to translate and validate the European Health Literacy Survey (HLS‐EU) to the Portuguese population. The HLS‐EU‐PT has been applied throughout the country, including the autonomous regions, through research of an academic network. Data collection was conducted by personal interview. The final sample was composed of 1004 individuals aged ≥ 16 years. This study provided the assessment tool of literacy level for health in Portugal, so important in health management. The HLS‐EU‐PT is an adequate instrument to measure the health literacy levels of Portuguese population and shows comparable psychometric properties to versions used in the other countries. In Portugal, 61% of the surveyed population has general health literacy level problematic or inadequate, reaching the average of the nine countries in 49.2%. Concerning the Healthcare dimension, only 44.2% have a sufficient or excellent level of health literacy. In terms of disease prevention, about 45% of respondents reveal a sufficient or excellent level of health literacy, and the average stands at 54.5%. In Health Promotion dimension about 60.2% of the auscultated population has an health literacy level problematic or inappropriate, and the average stands at 52.1%. Therefore, it is fundamental and urgent to design and implement a National Strategy for Health Literacy. publishersversion published

Made available in DSpace on 2018-03-01T23:05:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-09-01 publishersversion published

Scopus: 84931568323 SciELO: S0870-90252015000100010 Purpose Identify the categories of the "International Classification of Functioning, Disability and Health" (CIF) for the classification of functionality to users of the Rede Nacional de Cuidados Continuados Integrados (RNCCI). Objective Identify ICF categories to classify the population with the characteristics of RNCCI users. Methodology Research was conducted at EBSCO through CINAHL Plus with Full Text and MEDLINE with Full Text. Scientific articles published in Full Text (March 2012) between 01/01/2000 and 03/31/2012 were selected, using the PI [C]O method. Were selected 15 items of 23 matches. Results 248 categories were identified which characterize the functionality of the population with the features of RNCCI users. It was found that from these, 86 have a frequency description of less than 50% and are divided by four ICF components. Conclusions The identified categories are distributed as follows: 26 categories of the component Body Functions (32.56%) in 15 articles, 5 categories of the component Body Structures (5.81%) in 13 articles, 35 categories of the component Activities and Participation (40.70%) in 15 articles, 18 categories of the component Environmental Factors (20.93%) in 14 articles. This systematic review can begin the process of characterizing the functionality of users RNCCI according to ICF. publishersversion published

A contratualização desenvolvida na Estratégia Saúde da Família é um tema ainda pouco estudado. É introduzida no Brasil em diferentes modelos, de acordo com o ente federativo contratante e o estatuto jurídico do prestador de serviços contratado; e em Portugal, a partir de modelo único de contratualização público-público com as Unidades de Saúde Familiar. Apresenta-se neste artigo o panorama atual da contratualização nos dois países, por meio de estudo de casos, e discutem-se seus atributos de planejamento conjunto, responsabilização com autonomia e sistema de incentivos ao desempenho. As principais contribuições da contratualização são: melhor coordenação das organizações de saúde; substituição da lógica hierárquica de comando-controle pela de maior participação; e responsabilização dos profissionais com melhor desempenho das suas atividades. Conclui-se que um dos elementos facilitadores é sua construção gradual, em um ambiente de aprendizagem permanente, com o protagonismo dos profissionais de saúde; e que seus maiores desafios são a transparência na condução dos processos, o fortalecimento dos mecanismos de auditoria e dos sistemas de informação, bem como a revisão permanente dos indicadores de monitoramento e sua adequação às necessidades de saúde da população.

The study, "Deepening our Understanding of Quality Improvement in Europe (DUQuE)" has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no 241822. Funding to pay the Open Access publication charges for this article was provided by European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no 241822. Objective: The objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies. Design: A cross-sectional, multilevel study design that surveyed quality managers and department heads and data from an organizational audit. Setting: Randomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Participants: Hospital qualitymanagers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012. Main Outcome Measures: Four items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level. Results: Current levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies. Conclusions: There is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect.

The study, "Deepening our Understanding of Quality Improvement in Europe (DUQuE)" has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 241822. Funding to pay the Open Access publication charges for this article was provided by European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 241822. Objective: To define a checklist that can be used to assess the performance of a department and evaluate the implementation of quality management (QM) activities across departments or pathways in acute care hospitals. Design: We developed and tested a checklist for the assessment of QM activities at department level in a cross-sectional study using on-site visits by trained external auditors. Setting and participants: A sample of 292 hospital departments of 74 acute care hospitals across seven European countries. In every hospital, four departments for the conditions: acute myocardial infarction (AMI), stroke, hip fracture and deliveries participated. Main Outcome Measures. Four measures of QM activities were evaluated at care pathway level focusing on specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies and clinical review (CR). Results: Participating departments attained mean values on the various scales between 1.2 and 3.7. The theoretical range was 0-4. Three of the four QM measures are identical for the four conditions, whereas one scale (EBOP) has condition-specific items. Correlations showed that every factor was related, but also distinct, and added to the overall picture of QM at pathway level. Conclusion: The newly developed checklist can be used across various types of departments and pathways in acute care hospitals like AMI, deliveries, stroke and hip fracture. The anticipated users of the checklist are internal (e.g. peers within the hospital and hospital executive board) and external auditors (e.g. healthcare inspectorate, professional or patient organizations).

Purpose – Quantitative instruments to assess patient safety culture have been developed recently and a few review articles have been published. Measuring safety culture enables healthcare managers and staff to improve safety behaviours and outcomes for patients and staff. The study aims to determine the AHRQ Hospital Survey on Patient Safety Culture (HSPSC) Portuguese version's validity and reliability. Design/methodology/approach – A missing-value analysis and item analysis was performed to identify problematic items. Reliability analysis, inter-item correlations and inter-scale correlations were done to check internal consistency, composite scores. Inter-correlations were examined to assess construct validity. A confirmatory factor analysis was performed to investigate the observed data's fit to the dimensional structure proposed in the AHRQ HSPSC Portuguese version. To analyse differences between hospitals concerning composites scores, an ANOVA analysis and multiple comparisons were done. Findings – Eight of 12 dimensions had Cronbach's alphas higher than 0.7. The instrument as a whole achieved a high Cronbach's alpha (0.91). Inter-correlations showed that there is no dimension with redundant items, however dimension 10 increased its internal consistency when one item is removed. Originality/value – This study is the first to evaluate an American patient safety culture survey using Portuguese data. The survey has satisfactory reliability and construct validity.

© The Author 2014. Objective: To investigate the relationship between ISO 9001 certification, healthcare accreditation and quality management in European hospitals. Design: A mixed method multi-level cross-sectional design in seven countries. External teams assessed clinical services on the use of quality management systems, illustrated by four clinical pathways. Setting and Participants: Seventy-three acute care hospitals with a total of 291 services managing acute myocardial infarction (AMI), hip fracture, stroke and obstetric deliveries, in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Main Outcome Measure: Four composite measures of quality and safety [specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies (PSS) and clinical review (CR)] applied to four pathways. Results: Accreditation in isolation showed benefits in AMI and stroke more than in deliveries and hip fracture; the greatest significant association was with CR in stroke. Certification in isolation showed little benefit in AMI but had more positive association with the other conditions; greatest significant association was in PSS with stroke. The combination of accreditation and certification showed least benefit in EBOP, but significant benefits in SER (AMI), in PSS (AMI, hip fracture and stroke) and in CR (AMI and stroke). Conclusions: Accreditation and certification are positively associated with clinical leadership, systems for patient safety and clinical review, but not with clinical practice. Both systems promote structures and processes, which support patient safety and clinical organization but have limited effect on the delivery of evidence-based patient care. Further analysis of DUQuE data will explore the association of certification and accreditation with clinical outcomes.

The study, "Deepening our Understanding of Quality Improvement in Europe (DUQuE)" has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 241822. Funding to pay the Open Access publication charges for this article was provided by European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 241822. Objective: The aim of this study was to develop and validate an index to assess the implementation of quality management systems (QMSs) in European countries. Design: Questionnaire development was facilitated through expert opinion, literature review and earlier empirical research. A cross-sectional online survey utilizing the questionnaire was undertaken between May 2011 and February 2012. We used psychometric methods to explore the factor structure, reliability and validity of the instrument. Setting and participants. As part of the Deepening our Understanding of Quality improvement in Europe (DUQuE) project, we invited a random sample of 188 hospitals in 7 countries. The quality managers of these hospitals were the main respondents. Main Outcome Measure. The extent of implementation of QMSs. Results: Factor analysis yielded nine scales, which were combined to build the Quality Management Systems Index. Cronbach's reliability coefficients were satisfactory (ranging from 0.72 to 0.82) for eight scales and low for one scale (0.48). Corrected item-total correlations provided adequate evidence of factor homogeneity. Inter-scale correlations showed that every factor was related, but also distinct, and added to the index. Construct validity testing showed that the index was related to recent measures of quality. Participating hospitals attained a mean value of 19.7 (standard deviation of 4.7) on the index that theoretically ranged from 0 to 27. Conclusion: Assessing QMSs across Europe has the potential to help policy-makers and other stakeholders to compare hospitals and focus on the most important areas for improvement.

In 2009, we launched Deepening our Understanding of Quality Improvement in Europe (DUQuE), an ambitious study on the effectiveness of quality improvement systems of hospitals in eight European countries. We believe this to be the most comprehensive and detailed study of quality improvement systems to date in terms of the a priori development of a coherent theory to guide the measurement and analytical strategy, the diverse countries involved and the range of standardized data collected (including surveys, chart reviews, administrative data and organizational audit). The papers published in this supplement describe the key findings of the project so far [1]. Here we discuss the overarching lessons emerging from the study. Without the relentless efforts of healthcare professionals and patients to gather data, research on quality improvement would not be possible. Despite the demanding workload of the study, response rates and completion of data collection have been exceptional, reflecting the efforts of country and hospital coordinators. However, there were some lessons about feasibility as the field test was complex and challenging for two reasons. First, in some countries an increasing ‘quality burn-out’ (where professionals are overwhelmed by existing requirements to document and monitor aspects of quality and safety) made it difficult to motivate staff to take on yet another project. Secondly, restrictive research ethics criteria (appropriate for interventional studies, but questionable for observational research) led to substantial delays in advancing the study. These are serious issues of relevance for any …

The perspective of innovation as the strategic lever of organizational performance has been widespread in the hospital sector. While public value of innovation can be significant, it is not evident that innovation always ends up in higher levels of performance. Within this context, the purpose of the article was to critically analyze the relationship between innovation and performance, taking into account the specificities of the hospital sector. This article pulls together primary data on organizational flexibility, innovation, and performance from 95 hospitals in Portugal, collected through a survey, data from interviews to hospital administration boards, and a panel of 15 experts. The diversity of data sources allowed for triangulation. The article uses mixed methods to explore the relationship between innovation and performance in the hospital sector in Portugal. The relationship between innovation and performance is analyzed through cluster analysis, supplemented with content analysis of interviews and the technical nominal group. The main findings reveal that the cluster of efficient innovators has twice the level of performance than other clusters. Organizational flexibility and external cooperation are the 2 major factors explaining these differences. The article identifies various organizational strategies to use innovation in order to enhance hospital performance. Overall, it proposes the alignment of perspectives of different stakeholders on the value proposition of hospital services, the embeddedness of information loops, and continuous adjustments toward high-value services.

R E S U M O - Finalidade: Identificação das categorias da Classificação Internacional da Funcionalidade (CIF), incapacidade e saúde, para a classificação da funcionalidade da população com mais de 65 anos de idade. Objectivo: Identificar os domínios e as categorias da CIF mais referidos para classificar a população com mais de 65 anos de idade. Metodologia: Revisão da literatura efectuada na CINAHL (Plus with Full Text, MEDLINE with Full Text). Foram pesquisados artigos científicos publicados em Texto Integral (Fevereiro de 2010), entre 2000/01/01 e 2010/01/31, utilizando o método de PI[C]O e seleccionados 17 artigos do total de 505 encontrados. Resultados: Foram identificados 252 categorias que caracterizam a funcionalidade da população com mais de 65 anos de idade. Com a frequência de descrição ≥ a 30 %, observamos 79 categorias, que se encontram divididas em 3 dos 4 componentes da CIF. No componente das Funções do Corpo, as categorias identificadas foram: Funções mentais globais (b110, b114, b130, b134); Funções mentais específicas (b140, b144, b152, b167); Visão e funções relacionadas (b210); Funções auditivas e vestibulares (b230); Dor (b280); Funções da voz e da fala (b310); Funções do aparelho cardiovascular (b410, b420); Funções dos sistema hematológico e imunológico (b430, b435); Funções do aparelho respiratório (b440); Funções relacionadas com o aparelho digestivo (b510, b525). No Componente das Estruturas do Corpo, as categorias identificadas foram: Estruturas do sistema nervoso (s110); Estruturas do aparelho cardiovascular, do sistema imunológico e do aparelho respiratório (s410, s430); Estruturas relacionadas com o movimento (s760). No componente das Actividades e Participação, as categorias identificadas foram: Experiências sensoriais intencionais (d110); Aprendizagem básica (d155); Aplicação do conhecimento (d160, d166, d170, d175, d177); Tarefas e exigências gerais (d220, d230, d240); Comunicar e receber mensagens (d310, d315); Comunicar e produzir mensagens (d330, d335, d345); Conversação e utilização de dispositivos e de técnicas de comunicação (d350, d360); Mudar e manter a posição do corpo (d410, d415, d420); Transportar, mover e manusear objectos (d430, d440, d445); Andar e deslocar-se (d450, d460, d465); Auto cuidados (d540, d550, d560, d570); Aquisição do necessário para viver (d620); Tarefas domésticas (d640); Relacionamentos interpessoais particulares (d760); Vida comunitária, social e cívica (d910). Na componente dos factores ambientais as categorias mais referidas foram: Produtos e tecnologia (e110, e115, e120, e125, e150); Ambiente natural e mudanças ambientais feitas pelo homem (e260); Apoio e relacionamentos (e310, e315, e320, e355, e360); Atitudes (e410, e415, e420, e450, e455, e465); Serviços, sistemas e políticas (e570, e575, e580). Conclusões: Os totais de categorias identificadas distribuem-se do seguinte modo: 83 categorias do componente Funções do Corpo (32,93 %) em 12 artigos; 30 categorias do componente das Estruturas do Corpo (11,90 %) em 7 artigos; 82 categorias do componente das Actividades e Participação (32,53 %) em 16 artigos; 57 categorias do componente dos Factores Ambientais (22,61 %) em 15 artigos. A identificação desta categoria permite ter uma base de trabalho para iniciar o processo de caracterização da funcionalidade da população com mais de 65 anos no contexto nacional. A B S T R A C T Purpose: Identification of categories of the International Classification of Functioning (ICF), disability and health, for the classification of functioning in the population over 65 years of age. Objective: To identify the more referred areas and ICF categories to classify the population over 65 years of age. Methodology: Literature review performed in CINAHL (Plus with Full Text, MEDLINE with Full Text). We searched scientific papers published in Full Text (February 2010) between 01.01.2000 and 31.01.2010, using the IP [C] O. Of 505 articles retrieved, 17 articles were selected because they were the ones who made reference to the most representative ICF categories for the population over 65 years. Results: We identified 252 categories that characterize the functionality of the population over 65 years of age. With the frequency description of ≥ 30 %, 79 categories were observed, which are divided into three of the four ICF components. In the Body Functions component the identified categories were: Global mental functions (b110, b114, b130, b134); Specific mental functions (1-40, b144, b152, b167); Vision and related functions (b210); Hearing and vestibular functions (b230); Pain (b280); Voice and Speech Functions (b310); Cardiovascular functions (b410, b420); Haematological and immunologic functions (b430, b435); Respiratory system functions (b440); Digestive system related functions (b510, b525). In the Body Structures component the identified categories were: Nervous system structures (s110) Cardiovascular, immune and respiratory system structures (s410, s430); Movement related structures (s760). In the Activities and Participation component the identified categories were: Intentional sensory experiences (d110); Basic learning (d155); Knowledge application (d160, d166, d170, d175, d177); Tasks and general demands (d220, d230, d240); Communicate and receive messages (d310, d315); Communicate and produce messages (d330, d335, d345); Conversation and use of communication devices and techniques (d350, d360); Changing and maintaining body position (D410, d415, d420) Transporting, moving and handling objects (d430, d440, d445); Walking and travel (d450, d460, d465); Self care (d540, d550, d560, d570); Providing for the bare necessities of life (d620); Housekeeping (d640); Interpersonal relationships (d760); Community, social and civic life (d910). The most often mentioned categories in the environmental factors component were: Products and Technology (e110, e115, e120, e125, e150); Natural and man-made environmental changes (e260); Support and relationships (e310, e315, e320, e355, e360); Attitudes (e410, e415, e420, e450, e455, e465); Services, systems and policies (e570, e575, e580). Conclusions: The total of identified categories are distributed as follows: 83 categories of Body Functions component (32.93 %); 12 articles, 30 categories of Body Structures component (11.90 %); 7 articles, 82 categories of Activities and Participation component (32.53 %); 16 articles, 57 categories of Environmental Factors component (22.61 %) in 15 articles. The identification of these categories provides a working base to start the population over 65 year’s characterization process in the national context. info:eu-repo/semantics/publishedVersion

R E S U M O – A revisão da literatura indica que a avaliação da autoperceção da saúde oral através doGOHAI é cientificamente reconhecida e utilizada a nível mundial. Considera-se por issofundamental traduzir e validar este instrumento para a língua portuguesa.Objetivo: Tradução e validação da versão portuguesa do questionário Geriatric Oral HealthAssessment Index (GOHAI).Métodos: Este trabalho foi baseado nos processos de tradução e validação clássicos.A tradução do questionário seguiu a metodologia tradução e retroversão. A validação foiobtida pela análise da fiabilidade das 12 perguntas que compõem o questionário, utilizandoo alfa de Cronbach como coeficiente de consistência interna e o Kaiser-Meyer-Olkin (KMO)para validação do constructo. O questionário foi aplicado a 162 idosos, com idade igual ousuperior a 65 anos, inscritos no Agrupamento de Centros de Saúde de Lisboa Norte.Resultados: Obteve-se um coeficiente alfa de Cronbach de 0,768. Na análise fatorial, 3 fatoresexplicaram 51,81% da variação total. A medida de KMO foi de 0,726 e o teste de esfericidadede Bartlett foi 505,769 com 66 graus de liberdade (p < 0,001).Conclusão: O questionário revelou-se um instrumento válido para medir a qualidade devida da saúde oral dos idosos na população portuguesa, verificando-se valores elevadosna validação de constructo e consistência interna. A B S T R A C T - After reviewing the literature, we found that the evaluation of self-perception of oral health through GOHAI is increasingly recognized and used worldwide. It is therefore essential to translate and validate this instrument into Portuguese. Objective: Translation and validation of the Portuguese version of the questionnaire GOHAI (Geriatric Oral Health Assessment Index). Methods: This work was based in the translation and classical validation process. The trans- lation of the questionnaire followed the translation and retroversion methodology and, the validation was obtained by the analysis of the reliability of the 12 questions that com-pose the questionnaire, using the Cronbach alpha as coefficient of internal consistency and the Kaiser-Meyer-Olkin (KMO) for validation of the construct. The questionnaire was applied to 162 elderly inscribed in Agrupamento de Centros de Saúde de Lisboa Norte. Results: It obtained a Cronbach alpha coefficient of 0,768. In the factorial analysis, three factors explained 51,81% of the total variance. The KMO measure was 0,726 and the Bartlett’s sphericity test was 505,769 with 66 degrees of freedom (p < 0,001). Conclusion: The questionnaire revealed itself a valid instrument to measure the quality of life of the oral health of the elderly for the Portuguese population, verifying high values in the validation of the construct and in the validation of internal consistency. info:eu-repo/semantics/publishedVersion