Effectiveness of the Mobile Emergency Medical Services (SAMU): use of interrupted time series

被引:5
作者
Martins Oliveira, Catia C. [1 ]
Dutih Novaes, Hillegonda Maria [1 ,2 ]
Alencar, Airlane Pereira [3 ]
Santos, Itamar S. [4 ]
Damasceno, Maria Cecilia T. [5 ]
de Souza, Heraldo Possolo [4 ]
机构
[1] Fundacao Oswaldo Cruz, Inst Rene Rachou, Coordenacao Agenda 2030, Belo Horizonte, MG, Brazil
[2] Univ Sao Paulo, Dept Med Prevent, Programa Posgrad Saude Colet, Sao Paulo, SP, Brazil
[3] Univ Sao Paulo, Inst Matemat & Estat, Dept Estat, Sao Paulo, SP, Brazil
[4] Univ Sao Paulo, Fac Med, Dept Clin Med, Sao Paulo, SP, Brazil
[5] Fac Med ABC, Fac Med, Dept Clin Med, Sao Paulo, SP, Brazil
来源
REVISTA DE SAUDE PUBLICA | 2019年 / 53卷
关键词
Mobile Health Units; Myocardial Infarction; Hospital Mortality; Efficacy-Effectiveness Evaluation of Interventions; Interrupted Time Series Analysis; CARE; SIMULATION; PROGRAM;
D O I
10.11606/s1518-8787.2019053001396
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
OBJECTIVE: To evaluate the performance of the Mobile Emergency Medical Services (SAMU) in the ABC Region, using myocardial infarction as tracer condition. METHODS: The analysis of interrupted time series was the approach chosen to test immediate and gradual effects of the intervention on the study population. The research comprised adjusted monthly time series of the hospital mortality rate by myocardial infarction in the period between 2000 and 2011. Data were extracted from the Mortality Information System (SIM), using segmented regression analysis to evaluate the level and trend of the intervention before and after its implementation. To strengthen the internal validity of the study, a control region was included. RESULTS: The analysis of interrupted time series showed a reduction of 0.04 deaths per 100,000 inhabitants in the mortality rate compared to the underlying trend since the implementation of the Emergency Medical Services (p = 0.0040; 95%CI: -0.0816 - -0.0162) and a reduction in the level of 2.89 deaths per 100,000 inhabitants (p = 0.0001; 95%CI: -4.3293 - -1.4623), both with statistical significance. Regarding the control region, Baixada Santista, the difference in the result trend between intervention outcome and post-intervention control of -0.0639 deaths per 100,000 inhabitants was statistically significant (p = 0.0031; 95%CI: -0.1060 - -0.0219). We cannot exclude confounders, but we limited their presence in the study by including control region series. CONCLUSIONS: Although the analysis of interrupted time series has limitations, this modeling can be useful for analyzing the performance of policies and programs. Even though the intervention studied is not a condition that in itself implies effectiveness, the latter would not be present without the former, which, integrated with other conditions, generates a positive result. SAMU is a strategy that must be expanded when formulating and consolidating policies focusing on emergency care.
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页数:11
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