Impacto de la capacitación en la mejora continua de la calidad del diagnóstico citológico

Los indicadores generales de la eficacia en los programas de prevencion del cancer cervical se mantienen altos en nuestro pais. Objetivos: Evaluar el impacto de la capacitacion tecnica en la mejora continua del diagnostico citologico del cuello uterino en el Hospital "Abel Santamaria Cuadrado", periodo 2005-2007. Diseno: Se realizo un estudio de intervencion-accion para medir el efecto de la capacitacion en la calidad del diagnostico de los citotecnologos, medido mediante la correlacion entre un primer diagnostico emitido por el personal tecnico y un segundo por un especialista en Anatomia Patologica, de una muestra de 22864 citologias. Se utilizaron las variables de concordancia en general y por el tipo de lesion, y aplico la estadistica descriptiva para variables cualitativas categoricas, expresadas en frecuencias absolutas y relativas porcentuales. Las comparaciones de frecuencias se verificaron mediante el estadigrafo de Ji cuadrado al 95 % de confianza y la prueba de kappa para la correlacion entre observadores. Resultados. Se encontro un incremento de la concordancia en el 2007 con relacion al periodo 2005-2006, resultado altamente significativo (X² = 75.0; gdl = 1; p = 0.00000001). La concordancia de acuerdo al diagnostico se incremento con la excepcion del NIC-III. Conclusion. Se comprobo que la capacitacion influyo en la mejoria continua de la calidad del diagnostico citologico.(AU) In our country general indicators to assess the effectiveness of Programs for the Prevention of Cervical Cancer keep high. Objectives: To evaluate the effects of the technical training for the continuous improvement of cytological diagnosis of the cervical cancer at "Abel Santamaria Cuadrado" University Hospital, during 2005-2007. Design: An intervention-action research was conducted in order to assess the effectiveness of the technical training process for improving quality in the diagnosis performed by the technicians of the specialty, measured through the correlation between the first diagnosis issued by technical personnel and a second one by the Pathologist, taken from a sample of 22864 cytologies. General concordance and the type of lesion were the variables used, applying descriptive statistics for categorical qualitative variables expressed in absolute frequencies and relative percentages. Frequency comparisons were verified by means of a chi square test, 95% of confidence and Kappa test for the correlation among observers. Results: An enhancement of concordance was found in 2007 in relation to the period of 2005-2006, highly significant (X² = 75.0; gdl =1; p = 0.00000001). Concordance regarding the diagnosis increased, except in NIC-III. Conclusion: It was proved that technical training process influenced on the continuous improvement of the quality for cytological diagnosis.(AU)