Impact evaluation of the remote operation of computed tomography and magnetic resonance equipment in the context of the Public Unified Health System (SUS) in the State of São Paulo

• Grant number: 24/14231-9
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• Start date: September 01, 2024
• End date: August 31, 2026
• Field of knowledge: Applied Social Sciences - Economics
• Principal Investigator: Carolina Pedrosa Gomes de Melo
• Grantee: Ivan Goulart Prenhaca
• Host Institution: Instituto de Ensino e Pesquisa (Insper). São Paulo , SP, Brazil
• Associated research grant: 23/10085-5 - Impact evaluation of the remote operation of computed tomography and magnetic resonance equipment in the context of the Public Unified Health System (SUS) in the state of São Paulo, AP.PP

Abstract

This research project consists of an impact assessment of a public policy in the construction stage. It is proposed to evaluate the impact of a pilot project of remote operation shared between hospitals of computed tomography (CT) and magnetic resonance (MRI) equipment, with the objective of using the evidence produced for the elaboration of a plan to scale-up the technology to hospitals of the Public Unified Health System (SUS) in the State of São Paulo. In a context where there is a shortage of health professionals and the need to reduce costs, remote operation can make it possible to perform CT and MRI exams in a timely manner for SUS users in health regions where access is still limited. Through a randomized experiment at the level of the individual (patient), a pilot project of shared remote operation will be evaluated, between Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) - Partner Institution - and Hospital Alemão Oswaldo Cruz (HAOC) - Associate Institution -, of CT and MR equipment. It will be evaluated impacts on the quality of the operation (standardization of flows and protocols), the existence of unplanned intercurrences and/or interruptions during the exam, the presence of the team originally designated to operate the exam, the time spent in preparing and performing the exam (and the consequent associated cost), the quality of the service provided, and also the quality of the images produced. The estimated effects at the patient level will allow for the calculation of the marginal gains in productivity from the adoption of the remote operation at the level of a health unit and a SUS macro-region, as well as the marginal gain in years of (quality of) life provided by the adoption of the remote operation for a SUS patient and a health region in the State of São Paulo. The analysis of the quantitative results will be complemented with an analysis of qualitative data, in order to have a deeper and more complete understanding of the mechanisms through which the impacts of the remote operation occur in practice. The research results will be communicated both in the form of executive presentations and technical notes to health policymakers - aiming at the elaboration of a scale-up plan for SUS - and in the form of academic presentations at conferences and scientific articles to be submitted to peer-reviewed scientific journals. As a Partner Institution, HCFMUSP is responsible for establishing partnerships, such as those established with the Empresa Brasileira de Serviços Hospitalares (EBSERH), interested in the results of the research to implement the technology in its network of university public hospitals, and with the Health Secretariat of the State of São Paulo, which, in turn, demonstrates interest in considering the results of the work to enable the use of the technology as a solution for access to CT and MR exams in the state public health system. HAOC, as an Associated Institution, makes itself available to facilitate the pilot project of remote operation with sharing between hospitals, being a key player in the pilot project to be evaluated. With regard to the risks involved in the implementation of the impact assessment, the time for approval of the research by the Ethics Committee, the difficulty of reaching the adequate number of participants in the experiment, the difficulty in obtaining data from SUS necessary for estimation of the effects of remote operation at the more aggregated levels and potential limitations of external validity. In the dimension of the effective adoption of remote operation in public hospitals, there is a risk of poor communication of technical research results and resistance from health professionals to face a change in the way of operationalizing CT and MR exams in the field, with the adoption of new routines and protocols. (AU)