Central de Resultados del ámbito sociosanitario en Cataluña. Evolución 2013-2018 / Results Centre of Social and Health Care Network in Catalonia. Evolution 2013–2018

Objetivo : La Central de Resultados (CdR) nace con la misión de medir, evaluar y difundir los resultados alcanzados por los diferentes agentes del sistema sanitario, en base a medidas relevantes. El objetivo de este trabajo es describir la evolución de los indicadores utilizados en la CdR del ámbito sociosanitario (CdR-SS), incluyendo algunos indicadores sensibles a la práctica enfermera.Método: Estudio observacional, descriptivo y transversal de los 6 informes de CdR-SS (2013-2018). Se analizan indicadores que incluyen actividad realizada, días de estancia, consecución de objetivos rehabilitadores, altas a domicilio, mortalidad y úlceras por presión.Resultados: Hubo un aumento de la actividad en las diferentes líneas y una disminución en los días de estancia. Los resultados mostraron heterogeneidad entre centros. La mejora funcional y las altas a domicilio mostraron una tendencia creciente, mientras que la mortalidad tendió a disminuir. Se mantuvo estabilidad en la prevalencia de úlceras por presión de grados iii-iv.Conclusiones: La CdR-SS ha incluido diferentes indicadores en los diversos informes para mejorar la capacidad de evaluación y benchmarking sociosanitario. Los informes de CdR-SS aportan transparencia y rendimiento de cuentas del ámbito e invitan a profundizar en la mejora de este sector, mostrando que evoluciona hacia la atención intermedia con la entrada de subagudos y la mayor eficiencia de convalecencia. La incorporación de indicadores sensibles a la práctica enfermera contribuye a visibilizar los cuidados y al colectivo enfermero. (AU)

Objective: The Results Centre's (RC) mission is to measure, evaluate and disseminate the results achieved by the different agents of the health system, based on relevant measures. The purpose of this research is to describe the evolution of indicators used in the social and health care network RC (RC-SH), including some indicators sensitive to nursing practice.Method: Observational, descriptive cross-sectional study based on data from 6 RC-SH reports (2013–2018). Indicators including activity carried out, days of stay, achievement of rehabilitation goals, discharge to home, mortality and pressure ulcers are analysed.Results: There was an increase in activity on the different social and health resources and days of stay decrease. Results were heterogeneous between centres. Functional improvement and home discharge showed an increasing trend, while mortality tended to decrease. The prevalence of grade III–IV pressure ulcers was maintained.Conclusions: RC-SH reports have included different indicators to improve the capacity of evaluation and benchmarking for social and health network. These reports provide transparency and accountability in the field and invite further improvement in this sector. Also RC-SH results show that social and health network evolves towards intermediate care with the entry of subacute resources and the greater efficiency of convalescence. The incorporation of indicators sensitive to nursing practice contributes to making nurses and nursing care visible. (AU)

[Results Centre of Social and Health Care Network in Catalonia. Evolution 2013-2018]. / Central de Resultados del ámbito sociosanitario en Cataluña. Evolución 2013-2018.

OBJECTIVE: The Results Centre's (RC) mission is to measure, evaluate and disseminate the results achieved by the different agents of the health system, based on relevant measures. The purpose of this research is to describe the evolution of indicators used in the social and health care network RC (RC-SH), including some indicators sensitive to nursing practice. METHOD: Observational, descriptive cross-sectional study based on data from 6 RC-SH reports (2013-2018). Indicators including activity carried out, days of stay, achievement of rehabilitation goals, discharge to home, mortality and pressure ulcers are analysed. RESULTS: There was an increase in activity on the different social and health resources and days of stay decrease. Results were heterogeneous between centres. Functional improvement and home discharge showed an increasing trend, while mortality tended to decrease. The prevalence of grade III-IV pressure ulcers was maintained. CONCLUSIONS: RC-SH reports have included different indicators to improve the capacity of evaluation and benchmarking for social and health network. These reports provide transparency and accountability in the field and invite further improvement in this sector. Also RC-SH results show that social and health network evolves towards intermediate care with the entry of subacute resources and the greater efficiency of convalescence. The incorporation of indicators sensitive to nursing practice contributes to making nurses and nursing care visible.

Advance directives and real-world end-of-life clinical practice: a case-control study.

BACKGROUND: Advance directives (ADs) have been legally regulated to promote autonomy over health decisions among patients who later lose decision-making capacity. AIMS AND OBJECTIVES: To analyse the differences in clinical practice at end of life among people who had completed an AD versus those who had not. METHODS: Retrospective case-control study (1:2), matched by age, sex, year, cause of death and region of residence. The data sources used were the ADs registry, central registry of insured persons, hospital discharge, pharmacy and billing databases, and the mortality registry. Conditional logistic regression models (crude and adjusted by socioeconomic level) were performed. The outcome variable was the frequency of medical procedures performed during the last year of life. RESULTS: 1723 people with ADs who died in Catalonia during 2014-2015 were matched with 3446 dead controls (without ADs). Thoracentesis was the procedure with the greatest reduction among women with an AD (adjusted OR (ORadj) 0.54, 95% CI: 0.32 to 0.89) in conjunction with artificial nutrition (ORadj 0.54, 95% CI: 0.31 to 0.95). Intubation was the procedure with the greatest reduction (ORadj 0.56, 95% CI: 0.33 to 0.94) among men. Slight differences could be seen in the case of cancer deaths. There were no relevant differences when adjusting by socioeconomic level. CONCLUSIONS: ADs are an effective tool to adjust the realisation of some procedures at end of life. These results can help better plan for the treatment of patients with ADs, as well as increase the awareness among clinical personnel, families and the general population.

Uso de recursos y gasto en servicios sanitarios de personas con enfermedades crónicas avanzadas en Cataluña / The use of resources and health expenditures by people with advanced chronic diseases in Catalonia

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Recursos sociosanitarios en Cataluña. Situación actual / Social and health resources in Catalonia. Current situation

La red sociosanitaria ha evolucionado desde su creación adaptando los recursos o creando nuevos servicios bajo el impulso de los respectivos planes de salud. En este artículo se presenta el estado de los diferentes recursos sociosanitarios de Cataluña, así como los principales cambios que se han producido en los últimos años, más concretamente en el periodo del Plan de Salud 2011-2015. Esta etapa se caracteriza por una adecuación de la red sociosanitaria en el marco de la atención de la cronicidad, en la que ha tomado mayor relevancia el desarrollo de recursos de atención intermedia. Paralelamente, se plantea la necesidad de crear un único sector de larga duración en el que esté garantizada una atención sanitaria de calidad. También se impulsa la atención integral y transversal en el sistema sanitario, mediante una mayor coordinación entre los diferentes niveles asistenciales, en el que el ámbito sociosanitario, por su trayectoria y expertez, juega un papel determinante en la calidad de la atención a las personas con necesidades sociales y sanitarias (AU)

The network of social and health care has advanced since its inception. Furthermore, news services have been created and some resources have been adapted within the framework of respective health plans. This article presents the current situation of the different social and health resources in Catalonia, as well as the main changes that have occurred in recent years, more specifically in the period of the Health Plan 2011-2015. This period is characterised by an adaptation of the social and health network within the context of chronic care, for which the development of intermediate care resources has become the most relevant aspect. There is also a need to create a single long-term care sector in which the health care quality is guaranteed. Moreover, in this period, integral and cross-care level is promoted in the health system through a greater coordination between all different levels of care. The social and health network, due to its trajectory and expertise, plays a key role in the quality of care for people with social and medical needs (AU)

[Social and health resources in Catalonia. Current situation]. / Recursos sociosanitarios en Cataluña. Situación actual.

The network of social and health care has advanced since its inception. Furthermore, news services have been created and some resources have been adapted within the framework of respective health plans. This article presents the current situation of the different social and health resources in Catalonia, as well as the main changes that have occurred in recent years, more specifically in the period of the Health Plan 2011-2015. This period is characterised by an adaptation of the social and health network within the context of chronic care, for which the development of intermediate care resources has become the most relevant aspect. There is also a need to create a single long-term care sector in which the health care quality is guaranteed. Moreover, in this period, integral and cross-care level is promoted in the health system through a greater coordination between all different levels of care. The social and health network, due to its trajectory and expertise, plays a key role in the quality of care for people with social and medical needs.

Evaluación del ambiente de trabajo de las enfermeras en las unidades sociosanitarias de atención intermedia de Cataluña / Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia

Introducción. Un ambiente laboral favorable facilita que las enfermeras realicen su trabajo con mayor satisfacción y en mejores condiciones, hecho que podría influir en la calidad de los resultados obtenidos en los centros sociosanitarios. Los objetivos del estudio fueron: 1) Identificar la tipología de centros en función del ambiente laboral percibido por las enfermeras; y 2) describir las características individuales de las enfermeras relacionadas con dicha valoración. Métodos. Estudio observacional, descriptivo, prospectivo y transversal, multicéntrico realizado el último trimestre de 2014. Se administró a las enfermeras de las unidades de atención intermedia un cuestionario con el Practice Environment Scale of the Nursing Work Index (PES-NWI), que evalúa 5 factores del entorno laboral mediante 31 ítems. Se recogieron también variables sociodemográficas, laborales/profesionales y formativas. Resultados. De 501 enfermeras en 14 centros participaron 388 (77% de respuesta). La puntuación media del PES-NWI fue 84,75. Nueve centros obtuvieron una valoración del entorno laboral «favorable» y 5 «mixto». El factor mejor valorado fue «relaciones laborales» y el peor «dotación/adecuación de recursos». El turno de trabajo rotativo, trabajar en varias unidades, tener responsabilidades de gestión y tener máster universitario fueron características de las enfermeras que se relacionaron con una mejor percepción del entorno. Conclusiones. En la mayoría de los centros el ambiente laboral fue percibido como favorable. Algunas características laborales/profesionales y formativas se relacionaron con la valoración del entorno laboral (AU)

Introduction. A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. Methods. An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. Results. From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a 'favourable' working environment and five 'mixed'. The best valued factor was 'work relations' and the worst was 'resource provision/adaptation'. Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. Conclusions. In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment (AU)

Competencias avanzadas en las enfermeras de atención intermedia / Advanced competences in intermediate care nurses

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[Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia]. / Evaluación del ambiente de trabajo de las enfermeras en las unidades sociosanitarias de atención intermedia de Cataluña.

INTRODUCTION: A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. METHODS: An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. RESULTS: From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a "favourable" working environment and five "mixed". The best valued factor was "work relations" and the worst was "resource provision/adaptation". Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. CONCLUSIONS: In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment.

Complejidad asistencial en la atención al final de la vida: criterios y niveles de intervención en atención comunitaria de salud / Complexity of end-of-life care: criteria and levels of intervention in community health care

OBJETIVO: Definir la complejidad en la atención al final de la vida y los criterios relacionados y proponer, en función de su agrupación por niveles de complejidad, un modelo marco de intervención de los profesionales de la atención primaria de salud y de los recursos paliativos específicos. MATERIAL Y MÉTODOS: Estructura: grupo técnico interdisciplinario de consenso formado por 10 profesionales expertos en la atención al final de la vida (áreas contempladas: atención primaria de salud, paliativa específica, geriátrica, oncológica, trabajo social, bioética y espiritualidad) y la colaboración externa de 2 profesionales expertos en psicooncología y medicina interna. METODOLOGÍA: consenso de los profesionales mediante un procedimiento cualitativo tipo Delphi. Las etapas de consenso corresponden a los apartados de los RESULTADOS: El trabajo se realiza bajo la coordinación de la Sociedad Catalano-Balear de Cuidados Paliativos, la colaboración de la Sociedad Catalana de Medicina Familiar y Comunitaria (CAMFIC) y la dirección del Plan Director Sociosanitario del Departamento de Salud de la Generalitat de Catalunya. RESULTADOS: Definición: la complejidad resulta de la emergencia de procesos que interactúan cumpliendo las propiedades de los sistemas complejos. Modelo de referencia: se parte del modelo de necesidades de pacientes y familias, obteniendo 6 áreas de complejidad: necesidades físicas, psicoemocionales, sociofamiliares, espirituales, relacionadas con la muerte (situación de últimos días y duelo) y aspectos éticos. Áreas y criterios de complejidad: en cada área se describen: conceptos, situaciones habitualmente complejas y criterios de complejidad agrupados en 3 niveles de complejidad (baja, media y alta). Modelo de intervención: la propuesta es baja complejidad, intervención del equipo de referencia y puntualmente del equipo paliativo específico; complejidad media: atención compartida de intensidad pactada; alta complejidad: intervención prioritaria del equipo específico. Ingreso hospitalario. CONCLUSIONES: Resulta necesario diferenciar entre situaciones habitualmente complejas y criterios de complejidad. Aquellas se comportan frecuentemente como proceso emergente, mientras que los criterios corresponderían a la propia emergencia o su resultado. El modelo de intervención propuesto puede resultar útil para facilitar la colaboración asistencial entre los equipos referentes y paliativos específicos, ya que se trata de un modelo corresponsable y dinámico que no parcela la intervención

OBJECTIVE: To define the complexity in end-of-life care and the criteria of complexity, and depending on their grouping within these levels of complexity, to propose a model of intervention that will allow different levels of care to be established, and the framework within which the professionals of primary health care and the palliative team should work. MATERIAL AND METHODS: Structure: a technical and interdisciplinary group of consensus formed by ten professional experts in end of life care in the areas of: community health care, palliative care, geriatric care, oncology, social work, bioethics and spirituality; with external collaboration from two professionals of psycho-oncology and internal medicine. METHODOLOGY: we established a Delphi type qualitative method to obtain a consensus of all the professionals. The different stages of consensus correspond to the points described in the results. The work took place under the coordination of the Catalan-Balearic Society of Palliative Care, with the collaboration of the Catalan Society of Family and Community Medicine (CAMFIC), and the Directorate of the Social-Health Master Plan of the Health Department of the Generalitat of Catalonia. RESULTS: Definition: the complexity is caused by the emerging of processes that, when they interact, fulfil the criteria to be defined complex systems. Reference model: our base model is modelled on the needs of patients and families, thus obtaining six areas of complexity: physical needs, psycho-emotional, socio-family, spiritual, an area related directly with death (situation in the last days, grief), and an area of ethical aspects. Areas and criteria of complexity: in each area the following are obtained: base definitions, situations usually creating complexity, and criteria of complexity grouped in three levels: low medium and high. Model of intervention: the proposal is: low complexity: intervention of the community health care team with occasional intervention by the palliative care team. Medium complexity: shared caring decided between the community health care team and the palliative team. High complexity: main intervention by the palliative team. Hospital admission. CONCLUSIONS: It is necessary to differentiate between situations that are usually complex and the criteria of complexity. The first are those situations that often behave as an emerging process, whereas the criteria of complexity correspond to the actual emergence or its results. The intervention model proposed should improve the collaboration between community care and the palliative care team, as this is a co-responsibility and dynamic model that does not divide the intervention