Avaliação do sistema informático perinatal (SIP CLAP OPS) no monitoramento da assistência hospitalar perinatal em Minas Gerais

Abstract

Objective: To assess the quality of information and some perinatal indicators of the Perinatal Information System of the Latin-American Center of Perinatology (SIP-CLAP) of the Pan American Health Organization, and their use to monitor perinatal hospital care inMinas Gerais. The research was carried out in three stages: 1) analysis of the quality of the SIP-CLAP information in reference maternity hospitals focused on perinatal care in Belo Horizonte (Article 1); 2) analysis of some maternal and neonatal indicators collected by the SIP-CLAP of the Hospital of Clinics of the University of Minas Gerais (HC-UFMG) in twoperiods, 1995-98 and 2003-06 (Article 2); 3) identification of the State maternity hospitals that have implemented the program and assessment of its use by the healthcare professionals in these maternity hospitals (Article 3). Methodology: In order to assess the quality of the SIP-CLAP information, systematic random samples of perinatal clinical histories (HCP-SIP) were analyzed, as well as their corresponding medical records collected during the medical assistance (completion component) and after the information was stored in the SIP-CLAP`s electronic database (reliability component) in two maternity hospitals of Belo Horizonte where the program was set up in 2004. Maternal and neonatal indicators generated by SIP-CLAP were then analyzed in one of these maternity hospitals, the HC-UFMG, in two periods, 1995-1998 and2003-2006, before and after the changes in the flow of perinatal hospital care in the city. To identify the use of SIP-CLAP in the maternity hospitals of Minas Gerais, a designed questionnaire was applied to the managers, and later to a random sample of 142 professionals of the hospital birth care area in three perinatal care reference maternity hospitals of Belo Horizonte where SIP-CLAP/OPS was implemented in 2005. Results: The completion rate of the selected HCP-SIP variables during the medicalassistance was 72 % on average in Hospital 1 and 86 % in Hospital 2. After the survey using the medical records, the average gain rate in the total record of information was 18% and 7 % respectively. On the whole, reliability of the information stored in the electronic database showed excellent agreement rates in both hospitals. The analysis of the population profile as well as of the major perinatal health indicators generated by SIP-CLAP at HCUFMG enabled us to acknowledge that, despite the considerable increase in the volume of medical assistance after the changes in the structure of the hospital flow of perinatal care inBelo Horizonte, the characteristics of the population remained generally stable, with significant decrease in neonatal and hospital mortality, mainly of underweight newborns. In 2005, the program had been set up in only three hospitals in Minas Gerais. Nearly all professionals interviewed at these hospitals acknowledged the importance of recording the systematized information during birth medical assistance. Most of them define HCP-SIP as a tool which stores the basic necessary information for individual care, but they do not fully meet the needs of clinical records during the assistance process, a limitation that has beenidentified mainly by pediatricians. It was noted that two-thirds of the professionals recorded the information during the medical assistance, but only 37% used HCP-SIP with the main purpose of defining clinical procedures, and just 19% utilized the electronic database generated by the program. Sixty-six percent of the interviewed professionals were qualified to fill out the HCP-SIP form, but only one-quarter of these were qualified to handle the electronic analysis programs. Conclusions: The quality of the SIP-CLAP information assessed by filling out the HCP-SIPform during the medical assistance, and the reliability of the information stored in the SIPCLAP electronic database added to the characteristics of the program indicate that the Perinatal Information System can be a good tool for monitoring hospital birth care aiming at improving the quality of perinatal care. The fact that most professionals acknowledge the importance of systematized record of essential information based on basic indicators of health care identified the possibility of setting up an information system for monitoring perinatal care integrated with the health care activities in the Minas Gerais hospital network. The flaws identified in the process of setting up the program in the studied hospitals may be used as support for institutions and managers in the implementation of programs to improve health care standards.