Municipalization and health services quality evaluation: a local analysis

Abstract

This study has as nuclear the analysis of quality indicators of ambulatorial care, in the context of the expanding municipal health service in Maringá (State of Paraná, Brazil), from 1980 until 1995. It tried to characterize the development of the organization of the health service available to the popultaion, analyze the profile of mortality throught selected avoidable causes (sentinel event) related to the quality of medical care, and evaluate the quality of the medical care provided to a sample of pregnant women and hipertense patients, using tracers. The literature review on the subject pointed toward the difficulties in investigating the quality of medical care and pointed pointed out the lack of such studies in the municipal health service systems. The quality analysis of the registers in three Integrated Health Centers revealed the unreliability of the medical registers as information source but indicated the possibility of drawing some indicators of quality from then, despite the insufficiency of information. An investigation was carried out. The data on mortality by avoidable causes showed a more significant decrease than those of other death causes. the enterviews with the women and the patients on their medical care and the examination of medical registers of the health services units which provided medical care for there same group revealed that most of the procedures regarded as necessary minimums in medical care are performed by the professionals, but they are not always registered. The present investigation, though not intending to be a comprehensive or all-inclusive study, leads to the conclusion that there is an improvement in the municipal health service.