Quality of hospital databases in Brazil: some elements

Machado, Juliana Pires; Martins, Mônica; Leite, Iuri da Costa

doi:10.1590/1980-5497201600030008

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 19 (03) • Jul-Sep 2016 • https://doi.org/10.1590/1980-5497201600030008 copy

Quality of hospital databases in Brazil: some elements

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Introduction:

The use of secondary data for health service research has been increasingly common, having the advantage of acquiring information faster and cheaper, in addition to its larger population, temporal and geographical amplitude.

Objectives:

The aim of this study was to describe problems in the quality of information about hospitals characteristics and hospitalizations in Brazil.

Methods:

The National Database on Health Units (CNES), the Public Hospital Information System (SIH), and the Private Hospital Information System (CIH) were analyzed. We explored "coverage," "completeness," "consistency," and "validity" as quality dimensions.

Results:

There are complete and consistent basic registration data for hospitals, and most of them sent some information about the production of hospitalization. CIH covered 55% of admissions, and SIH exceeded 100%. The inadequate filling of the "procedure," "main," and "secondary diagnosis" fields is higher than expected, especially for CIH.

Conclusion:

Improvements in databases are required to qualify the analysis and increase its potential use, contributing with strategic studies that support decision-making in the planning of hospitals and health care networks.

Keywords:
Database; Hospital information systems; Hospitalization; Evaluation; Health care quality; Access and evaluation; Information dissemination

Region/State	Hospitals*				Beds**
Region/State	Total	Public	Private	Private working with SUS	Existing	SUS
Brazil	100.3	98.8	101.4	105.3	112.2	110.1
North region	95.5	95.6	95.2	105.3	114.7	105.8
Rondônia	97.9	105.7	88.4	114.3	112.4	124.5
Acre	90.9	100.0	57.1	50.0	112.1	113.0
Amazonas	103.6	93.4	152.6	162.5	125.9	112.5
Roraima	73.7	76.5	50.0	100.0	107.4	113.9
Pará	95.2	96.9	93.7	102.2	116.0	99.9
Amapá	109.5	94.1	175.0	100.0	113.5	108.6
Tocantins	83.8	90.7	57.1	100.0	92.1	93.6
Northeast region	105.3	103.0	108.6	113.1	114.0	111.7
Maranhão	98.5	93.5	114.5	109.8	116.5	114.4
Piauí	105.6	102.2	113.6	118.2	108.9	107.5
Ceará	111.7	98.8	131.0	128.6	124.7	115.1
Rio Grande do Norte	112.1	109.7	116.4	118.9	114.7	118.4
Paraíba	127.7	127.9	127.5	143.1	130.4	128.2
Pernambuco	102.4	106.6	96.2	115.3	118.4	114.6
Alagoas	94.2	93.0	95.7	100.0	109.4	108.7
Sergipe	123.9	137.5	116.7	136.4	116.9	117.4
Bahia	99.1	100.3	97.8	96.0	101.6	101.7
Southeast region	98.2	94.1	99.6	102.5	111.2	109.3
Minas Gerais	94.2	83.4	97.9	104.0	105.6	105.4
Espírito Santo	95.8	103.4	93.4	93.3	109.0	118.0
Rio de Janeiro	108.7	94.6	115.9	103.3	115.5	114.9
São Paulo	95.9	100.9	94.5	102.2	108.4	108.0
South region	97.1	101.9	95.6	100.6	107.3	109.1
Paraná	103.7	103.7	103.7	106.6	112.4	115.3
Santa Catarina	92.1	92.9	92.0	98.7	103.5	104.5
Rio Grande do Sul	91.8	103.5	89.8	96.1	104.7	106.0
Center-West region	101.5	91.8	108.4	110.7	120.8	114.4
Mato Grosso do Sul	94.0	87.2	97.7	98.3	106.8	100.1
Mato Grosso	102.5	81.1	120.2	122.8	126.8	116.2
Goiás	104.0	98.3	108.6	106.1	118.7	110.9
Distrito Federal	98.4	85.7	104.7	214.3	135.2	139.1

Main problems identified	n	%
CNES (hospitals)
CNPJ not filled out in CNES	2,134	29.7
Working only with SUS in CNES X Present in RPS as a plan network	304	4.2
Inactive in CNES X Has hospitalization informed by SIH or CIH (2008)	162	2.3
Inactive in CNES X Has hospitalization informed by SIH or CIH (2009)	97	1.3
Only private services in CNES X Has hospitalization informed by SIH	94	1.3
Inactive in CNES X Has hospitalization informed by SIH or CIH (2010)	68	0.9
Working only with SUS in CNES X Has hospitalization informed by CIH	15	0.2
SIH
Non filling out of the hospital's CNPJ	7,397,056	22.3
Non filling out of the secondary diagnosis	29,354,013	88.4
Invalid CNES for vinculation with the CNES database	446,023	1.3
Invalid CNPJ for vinculation with the CNES database	2,095,428	6.3
Hospitalizations with poorly defined causes	423,754	1.3
CIH
Non filling out of the hospital's CNPJ	312,734	5.0
Non filling out of the secondary diagnosis	5,181,953	82.7
Non filling out of ICU days	256,340	4.1
Invalid CNES for vinculation with the CNES database	65,699	1.1
Invalid CNPJ for vinculation with the CNES database	151,185	2.4
Hospitalizations with poorly defined causes	418,523	6.7
Hospitalizations with unspecific procedure	550,834	8.8

Characteristics of structure	Hospital
	Existing	Informed hospitalization
	n	n	(%)
Total	7,161	5,643	78.8
Juridical nature
Public	2,905	2,617	90.1
Private and nonprofit	1,773	1,673	94.4
Private and for-profit	2,483	1,353	54.5
Type
General hospital	5,199	4,305	82.8
Specialized hospital	1,072	682	63.6
Mixed unit	764	582	76.2
General emergency room	70	45	64.3
Specialized emergency room	56	29	51.8
Size (beds)
Up to 49	4,198	3,050	72.7
50 to 149	2,140	1,828	85.4
150 to 299	635	588	92.6
300 or more	188	177	94.1

Region/State	Sending of information about hospitalizations from the hospitals*			Volume of hospitalizations informed**
Region/State	Total	SIH	CIH	Total	SIH	CIH
Brazil	78.8	92.1	39.0	93.2	116.4	43.3
North region	77.8	94.0	10.1	80.2	100.0	6.0
Rondônia	64.4	89.7	16.0	64.7	96.2	4.6
Acre	87.1	96.4	13.3	116.4	155.9	17.2
Amazonas	80.3	94.9	-	79.1	95.0	1.0
Roraima	88.2	100.0	-	75.0	86.1	1.3
Pará	81.4	95.3	14.2	80.5	100.4	7.3
Amapá	45.8	64.7	-	183.2	238.5	1.4
Tocantins	83.9	98.1	-	70.9	82.3	3.3
Northeast region	78.9	87.9	11.9	85.4	100.5	16.1
Maranhão	84.3	92.9	5.1	72.1	83.0	4.6
Piauí	79	84.6	6.2	81.8	91.9	21.7
Ceará	81.2	92.1	21.9	84.2	98.8	24.5
Rio Grande do Norte	80.5	83.8	3.1	74.4	88.3	13.2
Paraíba	70.9	75.8	14.1	88.4	99.6	35.1
Pernambuco	77.8	90.7	1.9	88.0	110.4	0.6
Alagoas	84.7	92.2	-	116.7	136.2	1.0
Sergipe	61.7	69.8	46.2	80.8	96.0	33.6
Bahia	78.7	89.8	15.1	89.6	105.2	17.5
Southeast region	76.4	94.3	50.0	101.9	130.7	61.2
Minas Gerais	84.5	95.9	51.4	83.5	109.1	26.4
Espírito Santo	76.2	95.6	36.4	74.6	98.7	29.7
Rio de Janeiro	52.4	90.9	11.5	72.3	134.5	5.5
São Paulo	84.9	94.4	71.4	125.0	148.8	96.6
South region	87.8	95.4	62.4	102.4	133.8	44.0
Paraná	86.8	94.0	48.4	96.2	129.7	33.2
Santa Catarina	86.3	99.0	75.0	104.3	130.9	53.1
Rio Grande do Sul	90.2	95.3	70.8	108.2	140.0	50.7
Center-West region	74.0	93.1	24.9	75.9	109.8	12.8
Mato Grosso do Sul	78.9	95.9	42.9	72.7	98.8	12.9
Mato Grosso	77.1	93.2	35.2	76.2	92.9	34.4
Goiás	73.8	93.3	14.2	63.4	100.4	2.5
Distrito Federal	58.0	82.9	21.7	123.6	196.2	22.0

Region	Deaths*			Births**
Region	Total	Non-SUS (CIH)	SUS (SIH)	Total	Non-SUS (CIH)	SUS (SIH)
Brazil	56.8	50.4	57.8	76.1	32.0	87.5
North region	45.5	8.4	47.6	79.8	4.8	86.5
Northeast region	49.5	25.5	51.2	82.5	7.6	90.3
Southeast region	58.8	54.3	59.8	72.6	39.6	88.8
South region	66.8	66.9	66.8	72.4	35.9	83.0
Center-West region	49.6	20.4	52.3	70.1	13.9	78.3

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[1] Corresponding author: Juliana Machado. Agência Nacional de Saúde Suplementar. Diretoria de Desenvolvimento Setorial. Avenida Augusto Severo, 84, 8º andar, Glória, CEP: 20021-040, Rio de Janeiro, RJ, Brasil. E-mail: juliana.pm@gmail.com