Niveles de complejidad asistencial en pacientes con códigos diagnósticos de insuficiencia cardiaca en una población / Complexity levels in patients with heart failure diagnostic codes in a population

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Self-rated health and hospital services use in the Spanish National Health System: a longitudinal study.

BACKGROUND: Self-rated health is a subjective measure that has been related to indicators such as mortality, morbidity, functional capacity, and the use of health services. In Spain, there are few longitudinal studies associating self-rated health with hospital services use. The purpose of this study is to analyze the association between self-rated health and socioeconomic, demographic, and health variables, and the use of hospital services among the general population in the Region of Valencia, Spain. METHODS: Longitudinal study of 5,275 adults who were included in the 2005 Region of Valencia Health Survey and linked to the Minimum Hospital Data Set between 2006 and 2009. Logistic regression models were used to calculate the odds ratios between use of hospital services and self-rated health, sex, age, educational level, employment status, income, country of birth, chronic conditions, disability and previous use of hospital services. RESULTS: By the end of a 4-year follow-up period, 1,184 participants (22.4%) had used hospital services. Use of hospital services was associated with poor self-rated health among both men and women. In men, it was also associated with unemployment, low income, and the presence of a chronic disease. In women, it was associated with low educational level, the presence of a disability, previous hospital services use, and the presence of chronic disease. Interactions were detected between self-rated health and chronic disease in men and between self-rated health and educational level in women. CONCLUSIONS: Self-rated health acts as a predictor of hospital services use. Various health and socioeconomic variables provide additional predictive capacity. Interactions were detected between self-rated health and other variables that may reflect different complex predictive models, by gender.

[C-section rate in low-risk women: a useful indicator to compare hospitals attending deliveries with different risks]. / Porcentaje de cesáreas en mujeres de bajo riesgo: un indicador útil para comparar hospitales que atienden partos con riesgos diferentes.

BACKGROUND: the C-section rate has been criticized as a performance indicator for not considering that different hospitals manage deliveries with diverse risks. In this work we explore the characteristics of a new indicator restricted to low C-section risk deliveries. METHODS: retrospective cohort of all births (n=214,611) in all public hospitals during 2005-2010 in the Valencia Region, Spain (source: minimum basic dataset). A low-risk subpopulation consisting of women under-35, no history of c-section, between 37 and 41 gestational weeks, and with a single fetus, with cephalic presentation and normal weight (2500-3999 g) was constructed. We analyzed variability in the new indicator, its correlation with the crude indicator and, using multilevel logistic regression models, the presence of residual risks. RESULTS: a total of 117 589 births (58.4% of the whole deliveries) were identified as low C-section risk. The c-section rate in these women was 11.9% (24.4% for all deliveries) ranging between hospitals from 7.0% to 28.9%. The c-section rate in low-risk and total deliveries correlated strongly (r=0.88). The remaining risks in the population of low risk did not alter the hospital effect on the c-section rate. CONCLUSION: the percentage of C-section in low risk women include a high volume of deliveries, correlated with the crude indicator and residual risks are not differentially influenced by hospitals, being a useful indicator for monitoring the quality of obstetric care in the National Health System.

Porcentaje de cesáreas en mujeres de bajo riesgo: Un indicador útil para comparar hospitales que atienden partos con riesgos diferentes (*) / C-Section rate in low-risk women: a useful indicator to compare hospitals attending deliveries with different risks

Fundamentos: el uso del "porcentaje de cesáreas" como indicador de calidad ha sido criticado por no considerar que los hospitales atienden partos con riesgos diferentes que podrían justificar su variabilidad. El objetivo de este trabajo es explorar las características de un indicador restringido al porcentaje de cesáreas en partos de bajo riesgo. Métodos: cohorte retrospectiva de todos los partos atendidos en hospitales públicos de la Comunidad Valenciana durante el periodo 2005- 2010 (n=214.611; fuente: Conjunto mínimo de datos básicos), en la que se identificaron los partos de bajo riesgo (edad menor 35 años, sin antecedentes de cesárea, duración de las gestación entre 37-41 semanas, y feto único, presentación cefálica y normopeso. Se analizó la variabilidad en el indicador, su correlación con el indicador bruto y, mediante modelos de regresión logística multinivel, la presencia de riesgos remanentes. Resultados: un total de 117.589 (58,4% del total) partos fueron identificados como de bajo riesgo. El porcentaje de cesáreas en este subgrupo fue del 11,9% (24,4% para el total) con un rango entre hospitales del 7,0% al 28,9%. El porcentaje de cesáreas en bajo riesgo y total se correlacionaron fuertemente (r=0,88). El ajuste de los riesgos remanentes en la población de bajo riesgo no alteró el efecto hospital sobre el porcentaje de cesáreas. Conclusiones: el porcentaje de cesáreas en partos de bajo riesgo incluye un alto volumen de partos, correlaciona con el indicador bruto y los riesgos remanentes no están influidos diferencialmente por los hospitales, monitorizar la calidad de la atención obstétrica en el Sistema Nacional de Salud (AU)

Background: the C-section rate has been criticized as a performance indicator for not considering that different hospitals manage deliveries with diverse risks. In this work we explore the characteristics of a new indicator restricted to low C-section risk deliveries. Methods: retrospective cohort of all births (n=214,611) in all public hospitals during 2005-2010 in the Valencia Region, Spain (source: mini- mum basic dataset). A low-risk subpopulation consisting of women under- 35, no history of c-section, between 37 and 41 gestational weeks, and with a single fetus, with cephalic presentation and normal weight (2500-3999 g) was constructed. We analyzed variability in the new indicator, its correlation with the crude indicator and, using multilevel logistic regression models, the presence of residual risks. Results: a total of 117 589 births (58.4% of the whole deliveries) were identified as low C-section risk. The c-section rate in these women was 11.9% (24.4% for all deliveries) ranging between hospitals from 7.0% to 28.9%. The c-section rate in low-risk and total deliveries correlated strongly (r=0.88). The remaining risks in the population of low risk did not alter the hospital effect on the c-section rate. Conclusion: the percentage of C-section in low risk women include a high volume of deliveries, correlated with the crude indicator and residual risks are not differentially influenced by hospitals, being a useful indicator for monitoring the quality of obstetric care in the National Health System (AU)