Exploring the Relationship Between Surgical Capacity and Output in Ghana: Current Capacity Assessments May Not Tell the Whole Story.
Exploring the Relationship Between Surgical Capacity and Output in Ghana: Current Capacity Assessments May Not Tell the Whole Story.
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DOI：
10.1007/s00268-018-4589-7
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发表时间：
2018-10
影响因子：
2.6
通讯作者：
Mock C
中科院分区：
文献类型：
--
作者：
Stewart BT;Gyedu A;Gaskill C;Boakye G;Quansah R;Donkor P;Volmink J;Mock C
在没有详细登记册的低收入和中等收入国家，能力评估可作为手术产出的替代指标。在加纳对外科手术能力和产出之间的关系进行了评价，以确定是否需要对能力评估数据进行更严格的解释，并以此为基础开展卫生系统加强举措。标准化的外科手术能力评估在全国37家医院使用世卫组织的指导方针; 25个基本资源和能力的可用性被用来创建一个综合能力得分，范围从0（没有基本资源的可用性）到75（恒定的可用性）为每家医院。还收集了关于1年内进行的基本手术数量、可用外科专科、医院床位和功能手术室的数据。探讨了生产能力与产量的关系。中位手术能力评分为37 [四分位数间距（IQR）29-48;范围20-56]。一级医院每年基本手术的中位数为1 480例（IQR 736-1932）;转诊医院为1 545例（IQR 984-2452）;三级医院为11 757例（IQR 3769- 21 256）。手术量与手术量无相关性（p > 0.05）。与目前的理解相反，手术能力评估可能无法准确评估手术输出。为了提高手术能力评估的有效性，促进最大限度地利用现有资源，还应考虑影响产出的其他因素，包括需求方因素;供应方因素和过程要素;以及卫生行政和管理因素。
Capacity assessments serve as surrogates for surgical output in low- and middle-income countries where detailed registers do not exist. The relationship between surgical capacity and output was evaluated in Ghana to determine whether a more critical interpretation of capacity assessment data is needed on which to base health systems strengthening initiatives. A standardized surgical capacity assessment was performed at 37 hospitals nationwide using WHO guidelines; availability of 25 essential resources and capabilities was used to create a composite capacity score that ranged from 0 (no availability of essential resources) to 75 (constant availability) for each hospital. Data regarding the number of essential operations performed over 1 year, surgical specialties available, hospital beds, and functional operating rooms were also collected. The relationship between capacity and output was explored. The median surgical capacity score was 37 [interquartile range (IQR) 29–48; range 20–56]. The median number of essential operations per year was 1480 (IQR 736–1932) at first-level hospitals; 1545 operations (IQR 984–2452) at referral hospitals; and 11,757 operations (IQR 3769–21,256) at tertiary hospitals. Surgical capacity and output were not correlated (p > 0.05). Contrary to current understanding, surgical capacity assessments may not accurately reh1ect surgical output. To improve the validity of surgical capacity assessments and facilitate maximal use of available resources, other factors that inuence output should also be considered, including demand-side factors; supply-side factors and process elements; and health administration and management factors.
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