Gerencia de la Calidad y Auditoría en Salud
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Ítem Acceso abierto Riesgo de suicidio en el personal militar y veteranos durante la pandemia de COVID-19 y cuáles fueron las estrategias para su atención(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Pereira, 2024-02-20) Carrillo Betancourt , Paula Ximena; Sánchez Restrepo , Yuri Andrea; Vargas Vergara , NataliaThe SARS COV-2 infection was declared a pandemic in 2020 as a result of cases of pneumonia due to an unknown pathogen since December 2019 in China, which presented rapid spread, generating a greater impact on people with underlying diseases and older adults with an increase in mortality. During a systematic mapping, it was possible to demonstrate the increase in cases of mental conditions triggered by stressful situations due to the measures generated for the mitigation and spread of the virus such as; social isolation, interruptions to daily life, job uncertainty, lack of protocols for the comprehensive management of infected patients, leading to an increase in cases of suicidal ideation, anxiety, depression, post-traumatic stress and exacerbation of underlying mental pathologies. That is why in the bibliographic review, the findings focused on military personnel identified a mental health problem that was oriented towards the search for strategies such as psychological support for resilience during virtual isolation and contagion.Publicación Acceso abierto Indicaciones médicas y eventos adversos en Uci’s de Colombia, 2023(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoría en Salud, Pereira, 2023-12-18) Caballero Granados, Licenia Cristina; Castaño Guzman, Magerly; Jiménez Patiño, Daniela; Tamayo Bustamante, Marlon Alexander; Sandra Yolima Gómez OtálvaroMedical indications are generated by the treating professional in the ICU and subsequently executed by the nursing care staff. In this process, adverse events may occur that have an impact on patient safety. A systematic mapping of literature on poor medical indications and adverse events in ICU in health institutions at a national and international level in 2023 was used as a methodology. Inclusion criteria indexed in the ProQuest Health & Medical, Virtual Library databases were considered. in health and Scielo from 2016 to 2023, finding little evidence of articles referring to the aforementioned topic that provide a clear overview of the adverse events associated with errors in medical indications.Publicación Acceso abierto Deshumanización en el personal asistencial del servicio de urgencias(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Pereira, 2023-12-18) Bolivar Perea, Sofía Carolina; García González, Laura Tatiana; Moreno Guerrero, Arianny Yiseth; Sánchez Piedrahita, Natalia; Villarreal Rojas, Carlos Alberto; Gómez Otálvaro, Sandra YolimaHumanization in the field of medical care is a fundamental pillar to guarantee quality and excellence in the provision of health services. In the interaction between health professionals and patients, personalized care emerges as an essential component that goes beyond clinical protocols.'Dehumanization, understood as the blurring and reification of the being, which has consequences such as: low work performance, poor communication and staff reduction for nurses; On the other hand, diagnoses and therapies are frequently omitted, the perception of care is of low quality, and patients' recovery time and stay are prolonged. There are different factors that influence dehumanization, such as: long waiting times, some organizational components, the mental health of staff is affected, there is ineffectiveness in nurse-patient communication, insensitivity during invasive procedures, superficial advice, lack of empathy. and speed, etc. (Buitrago Buitrago., et.al, p.3). Objective: To raise awareness of the importance of implementing a strategic plan in emergency services that identifies critical areas of deficiency in the humanization of medical care in the institution, with the purpose of transforming the institutional culture and guaranteeing quality care. sensitive, patient-centered and with a good work environment. Methodology: Systematic mapping in which 21 national and international articles were reviewed, related to the emergency service, first level of care in Spanish, English, and Portuguese, published in the last 10 years in bibliographic databases such as: Pubmed, Scielo, Virtual Health Library, ClinicalKey and Google Scholar. Results: 21 articles met the objective of the search, the articles found were distributed in the following years: 1 articles in 2013, 1 articles in 2014, 1 articles in 2015, 5 articles in 2017, 2 articles in 2018, 4 articles in 2019, 2 articles in 2020, 5 in 2021 and 2 in 2022. Conclusions: Dehumanization in patient care is a complex problem that requires urgent action. Improving working conditions and addressing staff demotivation are crucial steps to ensure that healthcare is more humane, patient-centred and respectful of the dignity of those seeking help. Only through a comprehensive and collaborative approach can the humanitarian essence of medicine be restored.Publicación Acceso abierto Calidad en la atención odontológica percibida por los usuarios de la clínica salud vital I.P.S.(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Neiva, 2023-03-04) de La Hoz de la Cruz, Eva Isabel; Galindo Ramírez, Sandra Milena; Giraldo Osorio, Luz Andrea; Gonzalez Hernández, AlfredisThe general objective of this research project was to determine the perception that users have about the quality of care in the dentistry service of Clínica Salud Vital I.P.S. It was a descriptive research, with a cross-sectional design, the sample was made up of 40 users, who participated voluntarily, the SERVQUAL questionnaire was applied, where five dimensions are proposed for the collection of information, it is determined by the difference between the expected by the user and what is actually received. For the analysis of the results, descriptive statistics were used, through figures in percentages, where a satisfaction rating for the tangible dimensions of 70% is appreciated, security with a valuation of 75%, empathy 71% where only 22% of users feel satisfied in relation to the solution to complaints and claims, the response capacity 73% and lastly the reliability with 70%. It was concluded that the main strengths are in the dimensions of security and responsiveness, the most dissatisfied users are found in the dimensions of tangible and reliability.Publicación Acceso abierto Barreras de acceso en la prestación de los servicios de salud en los municipios de Tarqui, gigante y Neiva(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Neiva, 2023-03-04) Núñez Alvarado, Juan Camilo; Charry Silva, Nelson; Morales Alvarado, Carla YojanaThe current project aims to identify the access barriers in the provision of health services in the municipalities of Tarqui, Gigante and Neiva perceived by users of the subsidized regime and users of the contributory regime, to identify weaknesses and strengths. The result of this study will allow the barriers and determinants to be clearly established, and in this way an improvement plan will be executed to reform the weaknesses and enhance the strengths in favor of a good service.Publicación Acceso abierto Adherencia al tratamiento por hipertensión arterial en pacientes del hospital san José de Isnos-Huila en el año 2015(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Neiva, 2023-03-04) Chávez Criollo, Jhoan Andres; Ordoñez, Yolanda; Barajas, Jerónimo; Cala Martínez, Dorian YiselaObjective: To determine the characteristics that intervene in the adherence to the pharmacological treatment of arterial hypertension in patients enrolled in the program for chronic patients of the state social enterprise of low complexity ESE San José de Isnos-Huila. Methodology: cross-sectional descriptive design, with a quantitative approach, with a population of 1007 people who attended the outpatient service to control hypertension. Results: The study shows indicators of 50.2% non-adherent behavior and 49.8% adherent behavior in the population. There is an important relationship between sociodemographic characteristics and compliance with treatment. There was a participation of 66% of women and 33% of men, with an age range between 18 and 80 years, the main reason for non-compliance according to the Morisky test is forgetting to take the medications with a 39.1%. Conclusions: The appearance of arterial hypertension prevails in patients aged 40 years or older, linked to factors of acquired and congenital appearance, in addition, there are coexisting dimensions linked to the patient that do not favor the control of the disease and therefore affect adherence to the disease. pharmacological treatment of arterial hypertension, important aspects to be taken into account by health personnel for the characterization of the population.Publicación Acceso abierto Glosas del servicio de cirugía de la clínica Medilaser sucursal Florencia de abril a septiembre del 2014(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Neiva, 2023-03-04) Nivia López, Angelica Lorena; Quintero Sánchez, Dayana; Jiménez Torres, Libia AndreaThe present investigation of the Medilaser Clinic in the city of Florence; sample, in a retrospective descriptive study, of the analysis of the generation of glosses in the semester of April-September 2014, in the surgery service; The compilation of information was made with the medical records that had some type of gloss, secondary sources obtained from medical records that describe the forms that the gloss is generated and the failures that caused them; In addition, a survey was applied to the administrative staff of the billing department to find reasons for the glosses such as: lack of authorization of procedures, gloss of the procedure for not being described in the surgical report, lack of epicrisis support, overbilling, invoice belongs to other payer, relevance not described and higher value charged. In most medical records there are glosses for minimum amounts, costs ranging from fifty pesos to five eighty thousand pesos, which would seem insignificant but in volume they become financially representative amounts. The survey helped to detect the lack of knowledge of the correct completion of forms, the lack of support in systematic tools due to lack of updates in the programs; The staff recognizes the importance of generating the Prefecture since there is a decrease in errors with its preparation; A continuous improvement plan was carried out, which will help mitigate shortcomings with proposals to minimize the reasons that generate glosses by a number.Publicación Acceso abierto Verificación del cumplimiento de requisitos mínimos en el servicio de urgencia E.S.E. Carmen Emilia Ospina(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Neiva, 2023-03-02) Cabrales Montaño, Lina Isabel; Jiménez Socarras, Yoleidis del Rosario; Vallejo Cerra, Andreina Patricia; Sánchez, Diana BricyidPublicación Acceso abierto Causas de la no-adherencia al tratamiento farmacológico de enfermedades crónicas no transmisibles(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Neiva, 2023-03-02) Trujillo Garay, José Marino; Graffe Serrano, Jeimy Magnolia; Toro Hurtado, Yoany; Arroyo España, Laura EvelynIn the context of health care, therapeutic adherence is worked on as an important concept that refers to the degree to which a person's behavior coincides with the recommendations provided by their treating physician and / or by those who provide health care. However, not all patients follow medical instructions; It is from there that the term non-adherence is generated, understood as the failure to comply with the medical indications, either voluntarily or through simple carelessness; This is a problem that occurs without distinction of age and that generates important consequences worldwide, such as losing control over the disease, increased costs for the health system due to admissions, hospital readmissions and loss of quality of life , among others. For this reason, this research addresses the issue, with the aim f identifying factors that could be related to non-adherence to pharmacological treatments. A descriptive and cross-sectional methodology was chosen and the causes of non-adherence were evaluated using an adapted and validated instrument based on the Morisky-Gereen-Levine test. According to the final analysis, it was possible to establish that demographic factors such as level of education and socio-economic condition influence adherence to treatment; Factors associated with drug dosage, adverse reactions, goals or expectations, and emotional aspects were also identified as relevant; highlighting the complex relationship between themPublicación Acceso abierto Verificación cumplimiento estándares de habilitación resolución 2003 de 2014 toma de muestras y laboratorio clínico E.S.E. Carmen Emilia Ospina sede Palmas Neiva- Huila(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Neiva, 2023-03-03) Zulma Lorena, Hermosa Flor; Yepes Artunduaga, Sandra BeatrizPublicación Desconocido Factores que influyen en la toma de decisión frente a la realización del examen de citología cérvico uterina, en usuarias entre 25 y 59 años de edad en la empresa social del estado "Manuel. Castro Tovar “del municipio de Pitalito (Huila) durante el año 2014(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Neiva, 2023-02-24) Cárdenas Soto, Sandra Patricia; Castro Bermeo, Leidy Cristina; Rubiano Daza, HenryAbstract Cervical carcinoma is the second most common type of cancer in the world and it is also one of the deadliest forms, but it is also one of the easiest to prevent. In Colombia, a health goal is to increase the population's access to taking and reading cervical-uterine cytology, and to improve adherence to the early detection scheme for cervical cancer and its treatment. Cervical uterine cytologies with the first detection procedure in time for pre-neoplastic lesions; however, despite the proven benefits, there are multiple limitations to achieving adequate coverage. It is necessary to recognize the own factors of the users: social, and institutions, that intervene in the taking of the exam.The objective of this research was to identify factors that influence decision-making regarding the performance of the cervical cytology examination, in users between 25 and 59 years of age in the "Manuel Castro Tovar" State Social Enterprise (ESE) of the municipality from Pitalito (Huila) during 2014. A cross-sectional, descriptive, quantitative study was carried out; using a sample of 120 women who had not undergone cytology in 2014. Social and institutional factors that affect the final decision to have a cytology in women were identified; It was found that the cross-sectional axis related to the perception of risk plays a fundamentalPublicación Acceso abierto Barreras de accesibilidad a los servicios odontológicos del ESE hospital María Inmaculada del centro de salud del municipio de Morelia – Caquetá durante el primer semestre de 2015(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Neiva, 2023-02-24) Córdoba Ome, Nely Johana; Montenegro Perafan, Mauricio; Vásquez, Juan Manuel; Ome Osorio, IvánMorelia, is a municipality that is located in the department of Caquetá in southern Colombia, and has 3813 inhabitants, of which approximately 1894 live in the urban perimeter and the remaining 1919 live in the dispersed rural area that extends in 465 square kilometers. Due to its size, Morelia has a single level 1 complex health center, which is in charge of providing health care to the entire population of the municipality, regardless of the insurance regime to which it belongs, and is in charge of offering health services preventive and curative within the framework of the General System of Social Security in Health (hereinafter SGSSS). The objective of this research was to identify the accessibility barriers that arise in the framework of dental care provided by the María Inmaculada Social Enterprise Health Center (E.S.E.) to the people of the municipality of Morelia, Caquetá; following the methodology from a descriptive quantitative approach; an instrument for evaluating accessibility to mental health services (Ome & Sandoval, 2013) was adapted to identify accessibility barriers in oral health services; The instrument was applied to a sample of 350 users, randomly selected; Finally, the information obtained in the statistical processing program SPSS V.20 was systematized, where the data was processed obtaining graphs and tables that were analyzed to respond to the objectives set in the studyPublicación Desconocido Calidad de la atención odontológica en personas con limitación en la actividad de la Ipsi Comfamiliar Neiva II – 2012(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Neiva, 2023-02-24) González Marquínez, Holman; Hernández Rendon, Olga Teresa; Montero González, Constanza Patricia; Quesada Espinosa, Diana Marcelathe quality of the dental service is measured using the SERVQUAL instrument, with one purpose, the continuous improvement of the service offered by the IPS Comfamiliar, where a standard questionnaire is applied, which assesses the quality of care, along five dimensions: reliability , responsiveness, security, empathy and tangible elements. It is made up of a multiple response scale designed to understand customer expectations for a service. It allows evaluating, but it is also an instrument or a sensitive indicator of improvement, to design and implement improvement programs for the company. Goals. To evaluate the quality of care in the dental service in people with limitation in the activity of the IPS Comfamiliar Neiva, II - 2012. Method. A quantitative, observational descriptive study, the population consisted of 2815 users. The SERVQUAL questionnaire was applied to a sample of 35 people for convenience, using the database provided by the IPS Comfamiliar de Neiva. Inclusion and exclusion criteria of the study. Being affiliated with Comfamiliar Neiva, using the dentistry service during the second semester of 2012, having permanent limitation in mobility activities due to any etiology, agreeing to participate in the study by signing the informed consent. Results. Regarding the sociodemographic aspect, more participation of women was observed, the highest level of studies reached was secondary, most of the surveyed population is salaried and they are currently married. Regarding the SERVQUAL dimensions with the greatest gap, they were empathy and responsiveness. Low average scores were found in dimensions such as security and tangiblesPublicación Acceso abierto Caracterización de las adolescentes embarazadas y madres adolescentes atendidas en una institución de salud del municipio de Oporapa-Huila(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Neiva, 2023-02-24) Bravo Muñoz, Lina Cristina; Méndez Ortiz, Ana Mayely; Méndez Ortiz, Ricardo Javier; España Arroyo, Laura EvelynThe present investigation is based on a problem identified in the Municipality of Oporapa, a population of 10,812 inhabitants, located south of the Department of Huila; the high rate of teenage pregnancies and adolescent mothers (27.6% of the total female population between 13 and 18 years old, reported in 2014) who demand the health service in the only State Social Enterprise (ESE) of the municipality's health system. According to a first approximation to the problem, it can be established that the vast majority are unplanned or unwanted pregnancies and that neither in the educational system, nor in the municipality's health system, are there in a planned and systematic way, plans and programs for sexual and sexual education. reproductive, which turns the phenomenon into a public health problem. Therefore, the purpose of the research is to identify characteristics related to psychosocial and sociodemographic components, also identifying outstanding elements in the family structures and relationships of pregnant adolescents and adolescent mothers attended at the David Molina Muñoz ESE in the municipality of Oporapa Huila, in order to be able to build a baseline that serves as a reference to design and apply prevention, promotion and sexual and reproductive health care plans and programsPublicación Acceso abierto Calidad del dato del sistema de información en Colombia y otros países(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Pereira, 2022-12-13) Herrera Rodríguez, María Alexandra; Hurtado Salcedo, Angela Cristina; Parra Rincón, Stefany; Moreno Cano, Mauricio AlexanderThis article compares the research carried out in other countries about health information systems and the work geographically located in Colombia, in order to find convergences and differences in the quality of the data. At the international level, it was found that Colombia has a broader information system in coverage and adherence to the quality of the data unlike the other countries compared (Peru, Spain, Mexico, Cuba, Chile). The report of the quality of the data corresponds according to the model of health care in each country, where the forms of government influence. Through the analysis of the articles, the current situation in Colombia was compared and from it different solutions were recommended.Publicación Acceso abierto Seguridad del paciente desde un enfoque de acreditación(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Pereira, 2022-12-14) Flórez Giraldo, David Steven; Ledesma Murillo, Darithza Minelly; Mezu González, Francy Elena; Moreno Cano, MauricioPatient safety from an accreditation approach is analyzed from different national and international references, the documentation found shows important examples of strategies applied in countries of the American and European continents in order to take the IPS from the authorization to the accreditation for the improvement of its processes with quality thinking and thus achieve the reduction of adverse events, thus achieving safe care that reduces the risks for the patient and avoids the generation of cost overruns due to the legal sanctions to which poor care can lead.Publicación Acceso abierto Seguridad del paciente y cultura institucional(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Pereira, 2022-12-14) Osorio Rincon, Angela Marcela; Hurtado López, Lina Marcela; Santa Rodas, Brandon Stiven; Moreno Cano, MauricioThe culture of patient safety has become a critical issue today, since due to its non-implementation, adverse events can occur, which becomes a public health problem that for this work was classified into four different groups, damage to the patient, lack of reports, death of patients and negative effects on the health system, the high prevalence that occurs worldwide of these adverse events have forced institutions to take actions that allow monitoring, control and evaluation of the indicators creating a reporting culture and forcing higher education to migrate to new ways of acquiring knowledge such as simulation, to provide health professionals with a more real vision of a work environment and thus be able to make decisions that protect patient safety reducing the consequences of adverse events, accepting the mistake made is not easy and an environment is needed and non-punitive labor where the culture of patient safety is a priority to reduce adverse events which bring physical, economic and emotional consequences not only for the patient and their families but also for the health personnel associated with care.Publicación Acceso abierto Adherencia al programa de seguridad del paciente(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Pereira, 2022-12-13) Correa Hernández, Laura Marcela; García Flórez, Vanessa; Garay Jaramillo, Laura Juliana; Moreno Cano, MauricioObjective: Identify strategies and/or activities to improve adherence to the patient's second-rate policy and achieve safe and quality care. Method: A bibliographic search was carried out on adherence to the patient safety program, through the use of specific databases such as: Proguest, scelo, Dialnet, repositono uce and through the Mendeley reference manager. Conclusion: Effective and sustainable strategies can be carried out to improve patient safety at the level of each health institution. These strategies can be given to the patients themselves (improvement of individualized care plans), to specialists (training and approach of safe practices, hand hygiene, safe use of medicines, patient identity, improvements in communication or teamwork), or in the direction of the organization (protocolization of movements, registration systems or improvements in transitions).Publicación Acceso abierto Insatisfacción de los prestadores de servicios de salud frente al ejercicio de la verificación de condiciones de habilitación(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Pereira, 2022-12-13) Salazar Castaño, Yesenia; Arroyave Medina, Silvia Tatiana; Aguirre Osorio, Mayra Alejandra; Moreno Cano, MauricioIn Colombia the ministry of health and social protection has the responsibility to establish the rules, and conditions for health service providers, always looking for the safety of all users. These conditions are found in resolution 3100 of 2019 (Resolución 3100 Del 2019). It is set as the mandatory resolution for institutions that provide health services and companies that administer benefit plans that seek to supply their services in the national territory. The main component of the mandatory quality assurance system is the Habilitation System and it is the main source for an institution to guarantee that services are provided with the minimum standards of quality and safety to users. To guarantee such compliance, the ministry makes use of the departmental secretaries and their verification groups; and although the actions of inspection, surveillance and control (Ruiz Gómez et al., n.d.) must be based in the standards of the resolution since it is quite explicit for each service, modality and complexity. In the guidelines for verification it seeks to unify the audit and verification mode at national level. Despite the fact that there was no evidence of articulation in the results of the application of the audit by different groups of verifiers in an equitable and unflattering manner, this is the reason that some health providers believe that it is only an excessive demand by the ministry. (Manco, 2019)Publicación Acceso abierto Diseño de un sistema piloto de costeo ABC como herramienta para la toma de decisiones en una empresa de servicios, el caso de la agencia Ecoturismo Putumayo(Universidad Cooperativa de Colombia, Facultad de Ciencias Económicas, Administrativas y Contables, Especialización en Gerencia de la Calidad y Auditoria en Salud, Popayán, 2018-11-30) Meneses Cerón, Luis Ángel; Rueda, Linz ShirleyCurrently, cost management in the com-pany is a relevant issue in the context of global markets. Some organizations adopted the Activity Based Costing System, since it efficiently addresses the costs incurred for the provision of services, from a perspective that en-compasses the economic aspects related to each of the activities carried out, generating valuable information that constitutes a support tool for decision-making, allowing companies to be at the forefront in the face of environmental changes. The objective of the work is to design a system of abc costs in the Ecoturismo Putumayo agency. In this regard, a descriptive methodology was used to collect the information, pro-cess it and propose the costing system. Finally, it was possible to identify and standardize, through a pilot model, the resources incurred in the provision of the service, determining the cost of the tour packages that the agency offers to the market.