The search for quality in health care has evolved from being a clinical ideal to become a strategic necessity for the sustainability of the health system. In this context, attributes such as accessibility, timeliness, relevance, safety and continuity are fundamental components not only for patient satisfaction, but also for institutional efficiency. These attributes should be integrated into care models through clinical tools that facilitate a timely and evidence-based response, especially in conditions that require immediate intervention, such as complex infectious syndromes.

Timely and complete diagnosis can reduce the interval between the onset of symptoms and the initiation of specific therapy. In the case of severe infections, such as meningitis, sepsis or nosocomial pneumonia, diagnostic delay can increase mortality by 6-8% for every hour without adequate treatment (Kumar et al., 2006). This factor becomes a critical determinant both in patient survival and in the rational use of health care resources.

The relevance seen as “Guarantee that users receive the services they require” (Ministry of Health and Social Protection) allows to focus the efforts of medical institutions in using resources such as rapid diagnosis in cases where there is a high risk of complications of patients and where timely intervention is the key to achieve, not only reducing costs by avoiding the optimization of health resources, but also achieving recovery with the least possible number of sequelae in patients in the shortest possible time and it is at this point where we talk about timeliness in care, diagnosis times, days of hospitalization, duration of treatment and other factors that affect the health system.

In addition, accurate diagnosis in reduced times allows for improved clinical and financial risk management. More efficient care has a direct impact on indicators such as hospital stay, readmission rates, use of intensive care units and consumption of broad-spectrum antibiotics, which are associated with higher costs and greater likelihood of adverse events or healthcare-associated infections (HAIs) (Gómez-Ramírez et al., 2022).

In this sense, efficiency in health is understood as achieving objectives by choosing alternatives that can provide the greatest benefit. It is the relationship between resources/results under real conditions (Lam Díaz et al, 2008), which allows diagnostic tools that reduce future risks, higher treatment costs and palliation costs to be an alternative increasingly used by institutions and applied in the health system, in order to achieve the efficiency on which the limited resources available depend.

In this sense, the strengthening of Antibiotic Optimization Programs (AOPs) is of fundamental value. These programs benefit greatly from early diagnosis by allowing a faster transition from empirical to targeted therapies, which reduces the selective pressure on microorganisms and, therefore, the generation of antimicrobial resistance (Rodríguez-Baño et al., 2020). Furthermore, from the point of view of patient safety, the appropriate use of antimicrobials prevents toxic effects such as nephrotoxicity, hepatotoxicity or ototoxicity, especially in vulnerable populations such as oncological patients, immunosuppressed patients, neonates or older adults.

For the World Health Organization (WHO), the implementation of antibiotic optimization programs is an urgent and priority need to achieve cost-effective infection prevention and control, thus integrating the objectives of the PROA with timely diagnosis by achieving a synergy focused on resource efficiency and patient safety programs.

The institutional implementation of clear diagnostic routes, based on Clinical Practice Guidelines (CPG) adapted to the risk profile of each patient and population, favors the pertinence in the use of tests and improves the traceability of medical decisions. Likewise, it facilitates clinical auditing and effective recovery by payers, reducing claims and optimizing institutional cash flows. In this way, the algorithms for the use of diagnostic tests should be elaborated, reviewed, disclosed, understood and adapted to each institution based on medical criteria and understanding the reasonableness and relevance of the request for tests and thus protocolize clinical behaviors based on diagnostic tools with a high predictive value of the patient scenario to achieve targeted treatments and with a lower risk for each of them.

In this way, health quality attributes such as access to services and diagnostic tools in a timely manner are integrated in order to make medical decisions based on the reliability of the tests performed and the type of patient who requires them and for whom it is pertinent to perform them, thus ensuring continuity in the provision of services and user satisfaction, which are linked to non-quality costs such as the reputation of the institutions, user loyalty and better quality of the services provided by the institutions.

Modern healthcare management cannot be separated from the concept of diagnosis as a planning tool. Its proper incorporation not only contributes to the fulfillment of the quality attributes required by the General System of Social Security in Health, but also becomes a transversal component to achieve superior clinical results, greater institutional productivity and economic sustainability, which in these times of change and where health has been affected by the mismanagement of resources are a fundamental tool to achieve the objectives of the system and better health and treatment for all.

Bibliography

Gómez-Ramírez, O., Arbeláez, M. P., & Hernández, D. C. (2022). Impact of bacterial resistance on clinical and economic outcomes in high complexity hospitals in Colombia. Revista Colombiana de Infectología, 26(3), 123-131. https://doi.org/10.22354/in.v26i3.1348

Kumar, A., Roberts, D., Wood, K. E., Light, B., Parrillo, J. E., Sharma, S., … & Cheang, M. (2006). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine, 34(6), 1589-1596. https://doi.org/10.1097/01.CCM.0000217961.75225.E9

Rodríguez-Baño, J., Paño-Pardo, J. R., Alvarez-Rocha, L., Asensio, Á., Calbo, E., Cercenado, E., … & Garnacho-Montero, J. (2020). Antimicrobial use optimization programs (PROA) in Spanish hospitals: GEIH-SEIMC, SEFH and SEMPSPH consensus document. Spanish Journal of Chemotherapy, 33(2), 102-119 . https://doi.org/10.37201/req/019.2020.

Ministerio de Salud y Protección Social. (2008). The quality of health care in Colombia: Principles, dimensions and challenges. https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/calidad-salud-colombia-principios-2008-pars.pdf

Are the terms efficiency, efficacy and effectiveness synonymous in healthcare? Dr. Rosa María Lam Díaz; DrC. Prof. Porfirio Hernández Ramírez, Institute of Hematology and Immunology. Havana City, Cuba. Rev Cubana Hematol Inmunol Hemoter v.24 n.2 Havana City May-Aug. (2008)