Banca de DEFESA: TELMA RÉGIA BEZERRA SALES DE QUEIROZ

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : TELMA RÉGIA BEZERRA SALES DE QUEIROZ
DATE: 10/04/2024
TIME: 11:30
LOCAL: Ambiente virtual (Google Meet)
TITLE:

IMPROVEMENT OF QUALITY OF CARE FOR CERVICAL CANCER IN SECONDARY REFERENCE UNIT IN CEARÁ

KEY WORDS:

Total Quality Management; Secondary Prevention; Excision Margins; Cervical Neoplasia; Quality Indicators. 

PAGES: 102
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUBÁREA: Saúde Pública
SUMMARY:

Introduction: Cervical cancer represents the second highest incidence of malignancy among women in the State of Ceará. Access to diagnosis and qualified treatment contribute to the prevention and effective control of this disease. In 2021, a quality improvement program was initiated in the cervical pathology service of the Cancer Prevention Institute, a state secondary reference unit for the prevention and early detection of cancer of the cervix, endometrium, breast and skin. Objective: To carry out a Quality Improvement Cycle in the health care service for women suspected of having cervical cancer. Methodology: Quasi-experimental study to evaluate the level of service quality, before and after the intervention. The Improvement Cycle followed the steps of Identification and Analysis of the improvement opportunity (OM), using the techniques of Brainstorm, Nominal Group, Prioritization Matrix and Ishikawa Diagram. Five quality criteria (C) were defined: C1 - Waiting time for excision of precursor lesions. C2 - Surgical margins free of neoplasia. C3 - First follow-up up to 6 months after excision of precursor lesions. C4 - Referral within 30 days after diagnosis of invasive lesions. C5 - Percentage of service promoters (client satisfaction). The initial assessment was retrospective, using data from the first half of 2021 from reports of the pathological anatomy laboratory and the Ars Vitae electronic medical record system. The intervention took place in the second half of 2021, using the techniques of Affinity Diagrams and Gantt, focusing on the dimensions of opportunity (access), technicalscientific quality and satisfaction. The post-intervention evaluation used data from the first half of 2022. Data analysis involved calculating the levels of compliance with the criteria in both assessments, and the 95% Confidence Intervals, in addition to estimating the absolute and relative improvements in compliance with each criterion and the statistical significance of the differences found. The analysis also used the Pareto Diagram before-after the intervention. Results: The levels of compliance with each criterion in the two assessments were respectively: C1: 75.0 (95% CI ± 7.0) and 93.0 (95% CI ± 6.0) (p= 0.005). C2: 40.0 (95% CI ± 8.0) and 62.0 (95% CI ±10.0) (p= 0.007). C3: 29.0 (95% CI ± 9.0) and 31.0 (95% CI ±10.0) (p=0.59). C4: 86.0 and 87.0 (p= 0.55). C5: 94.0 (95% CI ± 7,0) and 94.0 (95% CI ± 8,5) (p=0.5). For criterion C4 n=N. The Pareto Diagram analysis demonstrated that criteria C2 and C3 corresponded to 77% and 84.6% of the total non-conformities, in the first and second assessment, respectively. The initial assessment identified irregularities in the service's actions, with flaws in the internal and external regulation of patients, in the standardization of management, in the integration of teams and in monitoring actions. After the intervention, a significant improvement in criteria C1 and C2 was observed. In the case of C4 and C5 there was no difference between the two assessments, however the level of compliance remained high. No statistically significant improvement was observed in the level of compliance with C3. Conclusions: Training of health teams, using participatory methodologies, aimed at meaningful learning and interprofessional work, as well as the creation of the “regulation sector”, were essential elements for the success of the intervention. To increase C3 compliance levels, it is necessary to increase the number of medical professionals, develop and review protocols and continuously improve processes in the regulation and appointment scheduling sectors. To maintain the improvements achieved, continuing education and monitoring actions must be prioritized. 

COMMITTEE MEMBERS:
Interna - 1195933 - ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA
Externa à Instituição - JULIANA FLORINDA DE MENDONCA REGO
Presidente - 2171948 - PAULO JOSE DE MEDEIROS