The importance of auditing as a tool for improving the quality of services for patients with chronic kidney disease: A time series study of renal replacement therapy in the Southeast region of Brazil (2015-2024).
Health Audit; Chronic kidney disease; Substitute renal therapy; Health Management.
Chronic kidney disease represents one of the biggest challenges for public health in Brazil, characterized by its high prevalence, impact on quality of life and high cost for the Unified Health System with substitute kidney therapy. In this context, the audit carried out by the SUS National Department of Audit emerges with a strategic management tool, essential to ensure the quality and efficiency in the application of public resources. This project aims to analyze the effect and evolution of the audit process of substitute renal therapy in the southeastern region of Brazil, through an ecological time -series study with mixed methods approach. The methodology involves the comparative documentary analysis of the 2017 and 2023 audit protocols, the extraction of data from audit system audit reports, and the survey of financial, production and capacity installed indicators from the National Health Fund, outpatient information system and national health establishments, focusing from 2015 to 2024. In the information regarding the State of Rio de Janeiro, it reveals an evolution in the audit instrument, such as the immediate result of the audit as a corrective tool, inducing managers and providers to adapt their processes to comply with the standards. However, the research has also identified critical findings about the process: a potential selection bias, which, by focusing recurrently on higher production establishments, may neglect units with other welfare risks; and an apparent gap in the control cycle, regarding the lack of systematic monitoring of the recommendations issued. This study points out that SUS audit is an effective and indispensable instrument, but whose potential can be expanded. The research will contribute by proposing the incorporation of new selection criteria for audits, such as mortality rates and efficiency indicators, aiming at more strategic planning. Thus, it is expected to provide subsidies for the continuous improvement of the audit cycle, strengthening the quality and sustainability of patient care with chronic kidney disease in Brazil.