Brazilian Health Information System Research Articles

Incomplete recording of race/colour in health information systems in Brazil: time trend, 2009-2018.

This ecological study of time trends and multiple groups evaluated incompleteness in the race/colour field of Brazilian health information system records and the related time trend, 2009-2018, for the diseases and disorders most prevalent in the black population. The Romero and Cunha (2006) classification was applied in order to examine incompleteness using secondary data from Brazil's National Notifiable Diseases System, Hospital Information System and Mortality Information System, by administrative regions of Brazil, while percentage underreporting and time trend were calculated using simple linear regression models with Prais-Winsten correction (p-value<0.05). All records scored poorly except those for mortality from external causes (excellent), tuberculosis (good) and infant mortality (fair). An overall downward trend was observed in percentage incompleteness. Analysis by region found highest mean incompleteness in the North (30.5%), Northeast (33.3%) and Midwest (33.0%) regions. The Southeast and Northeast regions showed the strongest downward trends. The findings intended to increase visibility on the implications of the race/color field for health equity.

Tendência temporal da incompletude do registro da raça/cor nos sistemas de informação em saúde do Brasil, 2009-2018

Abstract This ecological study of time trends and multiple groups evaluated incompleteness in the race/colour field of Brazilian health information system records and the related time trend, 2009-2018, for the diseases and disorders most prevalent in the black population. The Romero and Cunha (2006) classification was applied in order to examine incompleteness using secondary data from Brazil’s National Notifiable Diseases System, Hospital Information System and Mortality Information System, by administrative regions of Brazil, while percentage underreporting and time trend were calculated using simple linear regression models with Prais-Winsten correction (p-value&lt;0.05). All records scored poorly except those for mortality from external causes (excellent), tuberculosis (good) and infant mortality (fair). An overall downward trend was observed in percentage incompleteness. Analysis by region found highest mean incompleteness in the North (30.5%), Northeast (33.3%) and Midwest (33.0%) regions. The Southeast and Northeast regions showed the strongest downward trends. The findings intended to increase visibility on the implications of the race/color field for health equity.

Maternal health surveillance panel: a tool for expanding epidemiological surveillance of women's health and its determinants.

To present the methodology used in the development of two products for maternal health surveillance and its determinants and discuss their possible uses. Based on a theoretical model of the determinants of maternal death and databases of Brazilian health information systems, two free products were developed: an interactive panel "surveillance of maternal health" and an educational material "Aparecida: a story about the vulnerability of Brazilian women to maternal death", both available on the website of the Brazilian Obstetric Observatory. More than 30 indicators were calculated for the period 2012-2020, containing information on socioeconomic conditions and access to health services, reproductive planning, prenatal care, delivery care, conditions of birth and maternal mortality and morbidity. The indicators related to severe maternal morbidity in public hospitalizations stand out, calculated for the first time for the country. The panel allows analysis by municipality or aggregated by health region, state, macro-region and country; historical series analysis; and comparisons across locations and with benchmarks. Information quality data are presented and discussed in an integrated manner with the indicators. In the educational material, visualizations with national and international data are presented, aiming to help in the understanding of the determinants of maternal death and facilitate the interpretation of the indicators. It is expected that the two products have the potential to expand epidemiological surveillance of maternal health and its determinants, contributing to the formulation of health policies and actions that promote women's health and reduce maternal mortality.

Suppression of HIV in the first 12 months of antiretroviral therapy: a comparative analysis of dolutegravir- and efavirenz-based regimens.

To compare viral suppression in treatment-naïve adults starting antiretroviral therapy with dolutegravir (50mg)- and efavirenz (600mg)-based regimens. We analyzed secondary data from Brazilian health information systems of people living with human immunodeficiency virus who started antiretroviral therapy between 2015 and 2017 in Minas Gerais, Brazil. The outcome was viral suppression, defined as the achievement of the first viral load <50 copies/mL within 12 months after initiating antiretroviral therapy. This outcome was also compared with viral load <1,000 copies/mL and analyzed in two scenarios: intention-to-treat versus per-protocol. Time to viral suppression and adjusted odds ratio accompanied by 95% confidence intervals were estimated. Of the 2,599 participants enrolled, 77.5% were men, and the median age was 34 years. In the intention-to-treat analysis, viral suppression was 58.1% for efavirenz and 76.7% for dolutegravir. People living with HIV on dolutegravir-based regimen were more likely to achieve viral suppression (aOR: 2.44; 95%CI: 2.01-2.95) and had a shorter median time to viral suppression (p<0.0001). Antiretroviral therapy initiation within <120 days, baseline CD4⁺T-cells ≥200 cells/mm3, and viral load <100,000 copies/mL had higher odds of viral suppression. According to the per-protocol analysis, viral suppression ≥90% was observed by considering viral load <1,000 copies/mL. Our study demonstrated that viral suppression improved after introducing dolutegravir, although the proportion of patients with viral load <50 copies/mL was lower than expected. Improved access to routine viral load examinations and continuous surveillance of the effectiveness of antiretroviral therapy should be considered.

Salus Platform: A Digital Health Solution Tool for Managing Syphilis Cases in Brazil-A Comparative Analysis.

(1) Introduction: Syphilis is a sexually transmitted infection (STI) that constitutes a serious public health problem in Brazil and worldwide; (2) Methods: This was a descriptive and exploratory study that sought to analyze and compare the characteristics of Brazilian health systems with a new platform (Salus) developed by the Laboratory of Technological Innovation in Health in the scope of notification and management of disease data, including syphilis. In addition, this analysis aimed to assess whether Salus fully meets the necessary data management fields and can be indicated as a tool to improve health management in the context of syphilis in Brazil. (3) Results: In this study, the Salus functionalities were demonstrated and compared with the current Brazilian systems by discovering the existing gaps in the evaluated systems. The gaps found may explain the delay in meeting demands, the difficulty of making routine therapeutic follow-ups, in addition to interference with the vital purpose of follow-up in the epidemiological surveillance of diseases. As a result, Salus demonstrates functionalities that surpass all others and meet case management demands in a superior way to the systems currently used in the country. (4) Conclusions: The Brazilian health information systems related to the response to syphilis do not fulfill the purpose for which they were developed. Instead, they contribute to the fragmentation of health data and information, delays in diagnosis, incomplete case management, and loss of data due to inconsistencies and inadequate reporting. In addition, they are systems without interconnection, which do not articulate epidemiological surveillance actions with primary health care. All these factors may be obscuring accurate data on syphilis in Brazil, resulting in high and unnecessary public spending and late care for users of the Unified Health System (SUS).

A call for the urgent and definitive inclusion of gender identity and sexual orientation data in the Brazilian health information systems: what can we learn from the monkeypox outbreak?

In this document, we present to the scientific community a proposal on how to deal with the challenge imposed on surveillance and health actions in Brazil regarding monkeypox, including points and directions that have the potential to support learning and enable advances in the current scenario.

Social disparities in Southeastern Brazil and the burden of cervical cancer.

e18511 Background: Cervical cancer (CC) is the fourth most common malignancy in women worldwide and around 85% of the cases currently diagnosed are in underdeveloped countries. According to the National Cancer Institute of Brazil (INCA), in the year 2021, 16.590 new cases are expected with an estimated risk of 15.43 cases per 100,000 women and unfortunately numbers are not decreasing. Low socioeconomic status is been known to be associated with inferior cancer survival. Although Brazil’s publicly funded Unified Health System (SUS) increased access to health care, the universal access is still a problem. Brazil is a country of continental dimensions with widespread regional and social inequalities. The CC differs enormously by regions in the Brazilian country. Here, we use a population-based cancer registry to explore sociodemographic characteristics and CC in Southeastern Brazil. Methods: We collected retrospective data of patients with CC registered in the regional cancer reference center from the south of Espirito Santo (ES) the Hospital Evangélico de Cachoeiro de Itapemirim (HECI). We used the brazilian Health Information System - SISRHC from 2010 to 2017. Characteristics such as educational level (years of study), age, race, type of health insurance for treatment (SUS or private) and disease stage at diagnosis were recorded. Results: Among 3272 women diagnosed with cancer in the period analyzed, 286 had a diagnosis of CC.The educational level of 44,61% was less than 9 years, 16,43% between 10 and 12 years and 3,15% more than 12 years (36,01% without information).Mean age at diagnosis was 49 years, and 50 % were younger than 50 years. As for race, 50% of the women self-declared as non-white and 40,91% as white (9,09% without information), and 89,9% were treated by SUS and 10,1% treated by private health system. The distribution of CC stages at diagnosis was 0 (13,99%), I (15,03%), II (23,08%), III (18,53%) and IV (3,5%). Stage status was missing for 35,87% of CC cases. Conclusions: The majority of the women in the study where non-white, had low education level , used public health system (SUS) for treatment and had advanced disease. We also found that Brazilian SISRHC needs more attention to be a reliable cancer source data. These findings reinforce that social determinants affects access to diagnosis and treatment of CC patients in Southeastern Brazil. Future health awareness and preventive interventions must target less-educated communities to reduce delays in seeking medical care for cancer.

Omeprazole use and risk of chronic kidney disease evolution.

In recent years, the use of proton pump inhibitors (PPI), especially omeprazole, has been associated with development of chronic kidney disease (CKD). These drugs are widely used worldwide. Although some studies have found an association between the use of PPI and the onset of acute renal failure and CKD. This study aims to analyze the association between the continuous use of omeprazole and the progression of CKD in adult and elderly individuals. A retrospective cohort study was conducted with patients followed up at a nephrology clinic in Brazil, in 2016 and 2017. Information about clinical and sociodemographic data, health behaviors, and medication use were collected from all patients diagnosed with CKD through consultation of medical charts and the Brazilian health information system (SIS). The participants were allocated into two groups: users and non-users of omeprazole, and the progression of CKD was then evaluated for each group. In the bivariate analysis, the Mann-Whitney U test to compare the quantitative variables between groups, and the Pearson/Fisher two-tailed chi-square test to compare the categorical variables were applied. Multivariate analysis was performed using Cox regression. A total of 199 CKD patients were attended in the polyclinic, and of these, 42.7% were omeprazole users. There was a higher percentage of CKD progression in users (70.6%) compared to non-users (10.5%). The hazard ratio was 7.34 (CI: 3.94-13.71), indicating a higher risk of progression to worse stages of CKD in omeprazole users than in non-users. As for the other variables, no statistically significant difference was found between groups (p > 0.05). An association between omeprazole use and progression of CKD stage was identified, showing a higher risk of disease evolution among omeprazole users.

Cost-effectiveness analysis of universal adult immunization with tetanus-diphtheria-acellular pertussis vaccine (Tdap) versus current practice in Brazil

BackgroundA pertussis outbreak occurred in Brazil from 2011 to 2014, despite high coverage of whole-cell pertussis containing vaccines in early childhood. Infants were the most affected. This study aimed to evaluate the cost-effectiveness of introducing universal adult vaccination with Tdap into the National Immunization Program in Brazil. MethodsEconomic evaluation using a dynamic model to compare two strategies: (1) universal vaccination with single dose of Tdap at 20 years of age and (2) current practice (only pregnant women pertussis vaccination). The health system perspective was adopted. Temporal horizon was 10 years. Discount rate of 5% was applied to costs and benefits. Vaccine effectiveness (VE) was obtained from a population-based observational study. Epidemiological, resource utilization and cost estimates were obtained from the Brazilian Health Information Systems. The primary outcome was cost per life year saved (LYS), based on life expectancy at birth in Brazil in 2015. Univariate and multivariate sensitivity analysis were performed. ResultsAdult vaccination with VE of 82.6% and coverage of 40%, at price of US$7.01 per dose, and assuming herd protection would avoid 167 infant deaths by pertussis, saving 12,325 years of life and costing a total of US$105495891.61, from the health system perspective. The universal immunization would result in ICER of US$8459.13. The results were highly sensitive to disease incidence. ConclusionsThe results suggest that universal adult vaccination with Tdap would not be a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.

PNS23 EPIDEMIOLOGY OF MYELOPROLIFERATIVE DISORDERS: REAL WORLD DATA STUDY IN BRAZIL

Myelofibrosis (MF), Polycythemia Vera (PV) and Essential Thrombocythemia (ET) are 3 classic myeloproliferative neoplasms diseases. Real world studies are crucial to support decision-making process in health care in Brazil. The objective of this study was to estimate prevalence using real world data Brazil health insurance claims databases. Data was extracted from DATASUS database of patients with ICD D471 (Chronic myeloproliferative disease) treated from 2008 to 2017 and performed are cord-linkage of inpatient and out patient settings. Eligible patients were all with at least one claim of ICD D471 or D478 in out patient and/or in patient setting. Treatment regimens were then classified and, subsequently, treatment patterns and resource utilization data summarized using descriptive statistics. Considering all diseases contained in ICD D471 (Chronic myeloproliferative disease), we could evaluate the progressive and gradual increase of number of patients affected. 2008: 1545 (Female: 57%), 2009: 1842 (Female: 56%), 2010: 2131 (Female: 56%), 2011: 2457 (Female: 55%), 2012: 2819 (Female: 55%), 2013: 3139 (Female: 56%), 2014: 3356 (Female: 57%), 2015: 3557 (Female: 57%), 2016:3707 (Female: 57%) and 2017: 4012 (Female: 56%). This study presents some limitations due to its descriptive and retrospective characteristic, also, limited clinical information due to administrative data source usage. DATASUS is an important part of Brazilian health information system, and is a useful tool to support decision-making process in health care in Brazil.

Health impact and cost-effectiveness of introducing the vaccine (Bexsero) against MenB disease into the Brazilian immunization programme

Invasive meningococcal disease (IMD) is associated with a high mortality and severe sequelae. The aim of the present study was to evaluate the potential cost-effectiveness of the Bexsero vaccine in Brazil. We used a cohort model to compare routine vaccination against MenB disease with no vaccination. Epidemiological and cost estimates were obtained from the Brazilian Health Information System. The cost per disability-adjusted life year (DALY) averted and incremental cost-effectiveness ratio (ICER) was estimated assuming a 3-dose vaccination schedule, at R$90 (£ 20.50) per vaccine dose, 82.0% vaccine efficacy against MenB disease and a vaccine uptake of 90.0%. We estimated that 1,527 MenB cases would be prevented and 78 deaths averted. This strategy would cost R$ 762,381, 000 (£ 174,059,503) with a R$ 4,364,280 (£ 996,410) reduction in disease treatment costs. However, at an ICER of 372,256 (£ 84,990) per DALY averted, a vaccination programme is unlikely to be cost-effective.

Reporting of HIV-infected pregnant women: estimates from a Brazilian study.

ABSTRACTOBJECTIVE:To estimate the coverage of the reporting of cases of HIV-infected pregnant women, to estimate the increase in the coverage of the reporting with the routine search of data in other Brazilian health information systems, and to identify missed opportunities for identification of HIV-infected pregnant women in Brazilian maternity hospitals.METHODS:This is a descriptive study on the linkage of Brazilian databases with primary data from the “Nascer no Brasil” study and secondary database collection from national health information systems. The “Nascer no Brasil” is a national-based study carried out in 2011–2012 with 23,894 pregnant women, which identified HIV-infected pregnant women using prenatal and medical records. We searched for cases of HIV-infected pregnant women identified in the “Nascer no Brasil” study in the Information System of Notifiable Diseases, the Control System for Laboratory Tests of the National CD4+/CD8+ Lymphocyte Count and HIV Viral Load Network, and the Logistics Control System for Medications. We used the OpenRecLink software for the linkage of databases. We estimated the notification coverage, with the respective confidence interval, of the evaluated Brazilian health information systems.RESULTS:We estimated the coverage of the reporting of HIV-infected pregnant women in the Information System of Notifiable Diseases as 57.1% (95%CI 42.9–70.2), and we located 89.3% of the HIV-infected pregnant women (95%CI 81.2–94.2) in some of the Brazilian health information systems researched. The search in other national health information systems would result in an increase of 57.1% of the reported cases. We identified no missed opportunities for the diagnosis of HIV+ in pregnant women in the maternity hospitals evaluated by the “Nascer no Brasil” study.CONCLUSIONS:The routine search for information in other Brazilian health information systems, a procedure carried out by the Ministry of Health for cases of AIDS in adults and children, should be adopted for cases of HIV in pregnancy.

PCN49 - Real World Data on Multiple Myeloma Treatment Patterns: First and Second-Line Treatment in the Brazilian Public Health System

Multiple Myeloma (MM) is a bone marrow-based plasma cell neoplasm; data regarding current treatment patterns in Brazil are scarce. Brazilian Public Healthcare System (SUS) defines two procedures for first (1L) and second-line (2L) treatment for MM and reimburses it through High Complexity Procedures Authorization (APAC) System. The objective of this analysis was to analyze 1L and 2L treatment patterns in MM reimbursed during 2012-2016 by SUS and compare them to current Brazilian treatment guideline (PCDT). All APACs for procedures 03.04.03.018-0 (1L) and 03.04.03.019-8 (2L) during 2012-2016 considering the International Classification of Disease Code (ICD-10) C90.0 were extracted from the ambulatory care information system (SIA/SUS) from the Brazilian Health Information System. A key for decoding all chemotherapy inputs was developed by two health professionals and validated by one oncologist and fuzzy matching method was applied. Patient characteristics and treatments were assessed using summary statistics. Overall, 118,177 (1L) and 58,044 (2L) APACs were obtained, corresponding to 11,594 (1L) and 5,569 (2L) patients. Mean number of APACs per patient were 10.43±8.99 (1L) and 10.19±8.93 (2L). After Jan-2012, 8,947 patients in 1L and 3,486 in 2L were diagnosed with MM. Median time from first to last APAC was 7 months for 1L (IQR:2-13) and 6 months for 2L (IQR:2-13). Among patients in 1L, 48.6% were men; overall median age was 64 years (IQR:57-72). Drugs from 90.1% (1L) and 87.5% (2L) APACs could be decoded. Most used drug combinations reported for 1L-treatment were cyclophosphamide monotherapy (8.6%), cyclophosphamide+dexamethasone+thalidomide (7.7%) and melphalane+prednisone (4.9%); for 2L-treatment, cyclophosphamide monotherapy (9.7%), bortezomibe (6.3%) cyclophosphamide+dexamethasone+thalidomide (5.2%) were the most frequent. The most reported drug was a monotherapy not included in the PCDT recommendations, all other frequent combinations were coherent with the current PCDT. The results found are limited by the uncertainty in data input in the database.

Outcomes of lupus and rheumatoid arthritis patients with primary dengue infection: A seven-year report from Brazil.

We described the clinical profile and outcomes of patients with SLE and RA diseases reported to the Brazilian Health Information System with primary dengue infection. Databases from the Brazilian Public Health Informatics System (SUS) were linked as the source of information. Three databases comprising different longitudinal information of lupus or rheumatoid arthritis (RA) patients under treatment and care through the Brazilian Health System were linked. Patients who had lupus ICD-9 code or RA ICD-9 code and their treatment approved by SUS were included in the study. In Study 1, we described the clinical characteristics of RA/lupus patients who had dengue infection. In Study 2, we compared RA/lupus patients with or without dengue for hospitalization rates after index dengue diagnosis for dengue-exposed or matching date for dengue-unexposed. We included 69 SLE and 301 RA patients with dengue. In the RA/lupus with dengue case series, hospitalization was found in 24.6% of lupus subjects and of 11.2% of RA subjects. It differed by geographic region (p = 0.03), gender (p = 0.05) and the use of azathioprine (p = 0.02). Dengue was the most frequent reason for hospitalization reported (43.0%). Hospitalization due to dengue was noted in 12 (42.9%) dengue-exposed patients (p = 0.02), while rheumatoid arthritis was reported as the cause of hospitalization in 22.2% of dengue-unexposed (p = 0.005). Five deaths were reported among the dengue-exposed and none among dengue-unexposed. Bacterial infection was the most frequent cause of death. We found that the dengue exposure was associated with an increased risk of hospitalization outcome in RA and lupus patients (RR = 6.2; 95% CI: 2.99-12.94). We found that when comparing RA/lupus patients with or without dengue, dengue-exposed patients had an increased rates of hospitalization and death.

The role of Brazilian National Health Information Systems in assessing the impact of Zika virus outbreak.

The Zika virus (ZIKV) epidemic has become a public health emergency following its association with severe neurological complications. We aim to discuss how the Brazilian National Health Information Systems can help to assess the impact of the ZIKV epidemic on health outcomes potentially related to ZIKV. Health outcomes potentially related to ZIKV infection were described based on a literature review of published studies on ZIKV infection outcomes and on recent protocols developed and published by the Brazilian Ministry of Health for different stages of the life cycle. These outcomes were correlated with the International Classification of Diseases 10th Revision (ICD-10) classification system, as this is the diagnostic classification registered in the Health Information System. A suggested list of 50 clinical manifestations, dispersed into 4 ICD chapters, and their information sources was created to help monitor the ZIKV epidemics and trends. Correlation of these selected ICD-10 codes and the HIS, as well as, a review of the potentialities and limitations of health information systems were performed. The potential of the Health Information System and its underutilization by stakeholders and researchers have been a barrier in diagnosing and reporting ZIKV infection and its complications. The ZIKV outbreak is still a challenge for health practice and the Brazilian Health Information System.

THE DISTRIBUTION AND EVOLUTION OF INDICATORS OF HOSPITAL MORBIDITY AND MORTALITY FOR THYROID CANCER IN BRAZIL

INTRODUCTION: Thyroid cancer is the most common endocrine neoplasm, representing approximately 1% of all malignant tumors in western countries. It is three times more common in women than in men. AIMS: To analyze the changes in the rates of hospital morbidity and mortality from thyroid cancer in Brazil during the period from 2000 to 2012. MATERIAL AND METHODS: This is an ecological study, with data from the Brazilian Health Information Systems. Data regarding hospital morbidity and mortality from thyroid cancer (CID 10 C73) were collected as well as variables such as schooling, ethnicity and age group. RESULTS: This study identified 39,191 hospitalizations for thyroid cancer and 6,914 deaths from the same cause in the period investigated, with the occurrence and deaths much higher in women. Furthermore, the number of cases is also greater in subjects with incomplete basic schooling, and among individuals aged between 40-49 years. DISCUSSION: The findings are supported by other studies, although some of the characteristics of the patients have never been evaluated previously. CONCLUSION: Over the 13 year period assessed, there was an increase in the rates of hospital morbidity and mortality from thyroid cancer for both men and women in Brazil. More research on this subject is needed as well as health policies to increase awareness of the population about thyroid cancer and improve access to health services.

Informational behavior and public information policies: theoretical considerations arising from the case of DATASUS in Brazil

ABSTRACT The information age requires information policies to guide its global articulation. Brazil has attempted to answer this call with policies that despite their good intentions have not obtained desired results. datasus , the Brazilian health information system, operates under policies that seem to be designed without considering the latest discoveries of Information Science regarding the informational nature of humans. This article discusses several information behavior models and theories that must be considered when formulating information policies and proposes an “Information Field” model containing guideposts for their construction.

Cost-effectiveness analysis of universal maternal immunization with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in Brazil

BackgroundPertussis incidence has increased significantly in Brazil since 2011, despite high coverage of whole-cell pertussis containing vaccines in childhood. Infants <4 months are most affected. This study aimed to evaluate the cost-effectiveness of introducing universal maternal vaccination with tetanus-diphtheria-acellular pertussis vaccine (Tdap) into the National Immunization Program in Brazil. MethodsEconomic evaluation using a decision tree model comparing two strategies: (1) universal vaccination with one dose of Tdap in the third trimester of pregnancy and (2) current practice (no pertussis maternal vaccination), from the perspective of the health system and society. An annual cohort of newborns representing the number of vaccinated pregnant women were followed for one year. Vaccine efficacy were based on literature review. Epidemiological, healthcare resource utilization and cost estimates were based on local data retrieved from Brazilian Health Information Systems. Costs of epidemiological investigation and treatment of contacts of cases were included in the analysis. No discount rate was applied to costs and benefits, as the temporal horizon was one year. Primary outcome was cost per life year saved (LYS). Univariate and best- and worst-case scenarios sensitivity analysis were performed. ResultsMaternal vaccination of one annual cohort, with vaccine effectiveness of 78%, and vaccine cost of USD$12.39 per dose, would avoid 661 cases and 24 infant deaths of pertussis, save 1800 years of life and cost USD$28,942,808 and USD$29,002,947, respectively, from the health system and societal perspective. The universal immunization would result in ICERs of USD$15,608 and USD$15,590 per LYS, from the health system and societal perspective, respectively. In sensitivity analysis, the ICER was most sensitive to discounting of life years saved, variation in case-fatality, disease incidence, vaccine cost, and vaccine effectiveness. ConclusionThe results indicate that universal maternal immunization with Tdap is a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.

Integrating Brazilian health information systems in order to support the building of data warehouses

IntroductionThis paper's aim is to develop a data warehouse from the integration of the files of three Brazilian health information systems concerned with the production of ambulatory and hospital procedures for cancer care, and cancer mortality. These systems do not have a unique patient identification, which makes their integration difficult even within a single system.MethodsData from the Brazilian Public Hospital Information System (SIH-SUS), the Oncology Module for the Outpatient Information System (APAC-ONCO) and the Mortality Information System (SIM) for the State of Rio de Janeiro, in the period from January 2000 to December 2004 were used. Each of the systems has the monthly data production compiled in dbase files (dbf). All the files pertaining to the same system were then read into a corresponding table in a MySQL Server 5.1. The SIH-SUS and APAC-ONCO tables were linked internally and with one another through record linkage methods. The APAC-ONCO table was linked to the SIM table. Afterwards a data warehouse was built using Pentaho and the MySQL database management system.ResultsThe sensitivities and specificities of the linkage processes were above 95% and close to 100% respectively. The data warehouse provided several analytical views that are accessed through the Pentaho Schema Workbench.ConclusionThis study presented a proposal for the integration of Brazilian Health Systems to support the building of data warehouses and provide information beyond those currently available with the individual systems.

QUALISIS-Br: An Approach to Improve the Quality of Brazilian Health Information Systems

The main source of Brazilian health information comes from health information systems. Consequently, in order to obtain a reliable and secure information from this health system the data quality insurance are an essential step. This paper presents the QUALISIS-BR, an approach to guide the improvement of the quality in health information systems. This approach were conducted in a well-known Brazilian health information system named SINAN. This first conduction produced information, in catalog format, about the problems and possible solutions from SINAN. Experts, in the area of quality and health information system, performed an experiment validation using questionnaires to discover how applicable the problems and solutions are. The outcome from this experiment showed good preliminary results. Therefore, the QUALISIS-BR is the first step toward to achieve the goal of conducting the data quality improvement of Brazilian health information system.