ABSTRACT
INTRODUCCIÓN: En 2010 el Grupo Español de Estudio de SIDA (GeSIDA) desarrolló 66 indicadores de calidad asistencial. Nuestro objetivo es determinar cuáles de estos indicadores se asocian a mortalidad y/o ingreso, y realizar una evaluación preliminar de la utilidad de un índice predictor de mortalidad e ingreso. MÉTODOS: Estudio de cohortes retrospectivo realizado en el Hospital Universitario Son Espases. Los pacientes con infección por el virus de la inmunodeficiencia humana incluidos fueron aquellos que iniciaron seguimiento en consultas entre el 1 de enero de2000 y el 31 de diciembre de 2012. Se realizó análisis descriptivo de las variables demográficas y de los indicadores, y un estudio de regresión logística para valorar la asociación entre los indicadores y riesgo de mortalidad/ingreso. Se calcularon índices predictores de mortalidad e ingreso para pacientes en seguimiento y en tratamiento. RESULTADOS: Fueron incluidos 1.944 pacientes (media de edad: 37 años, el 78,8% varones). En el análisis multivariante relativo a mortalidad, los indicadores asociados en pacientes en seguimiento fueron el 7, 16 y 20 y en pacientes en tratamiento se añaden el 35 y 38. En el análisis multivariante relativo a ingreso, los indicadores asociados en pacientes en seguimiento fueron los mismos que para mortalidad, además del 31, y en el grupo de pacientes en tratamiento se asociaban los indicadores 7, 16, 20, 35, 38 y 40. CONCLUSIÓN: Se han identificado varios indicadores de calidad que pueden estar relacionados con ingreso hospitalario y mortalidad. Estos indicadores hacen referencia fundamentalmente al retraso diagnóstico, seguimiento regular, prevención de las infecciones y control de comorbilidades
INTRODUCTION: In 2010, the AIDS Study Group (Grupo de Estudio del SIDA [GESIDA]) developed 66 quality care indicators. The aim of this study is to determine which of these indicators are associated with mortality and hospital admission, and to perform a preliminary assessment of a prediction rule for mortality and hospital admission in patients on treatment and follow-up. METHODS: A retrospective cohort study was conducted in the Hospital Universitario Son Espases (Palma de Mallorca, Spain). Eligible participants were patients with human immunodeficiency syndrome≥18 years old who began follow-up in the Infectious Disease Section between 1 January 2000 and 31 December 2012. A descriptive analysis was performed to evaluate anthropometric variables, and a logistic regression analysis to assess the association between GESIDA indicators and mortality/admission. The mortality probability model was built using logistic regression. RESULTS: A total of 1,944 adults were eligible (median age: 37 years old, 78.8% male). In the multivariate analysis, the quality of care indicators associated with mortality in the follow-up patient group were the items 7, 16 and 20, and in the group of patients on treatment were 7, 16, 20, 35, and 38. The quality of care indicators associated with hospital admissions in the follow-up patients group were the same as those in the mortality analysis, plus number 31. In the treatment group the associated quality of care indicators were items 7, 16, 20, 35, 38, and 40. CONCLUSIONS: Some GeSIDA quality of care indicators were associated with mortality and/or hospital admissions. These indicators are associated with delayed diagnosis, regular monitoring, prevention of infections, and control of comorbidities
Subject(s)
Humans , Quality Indicators, Health Care/statistics & numerical data , Acquired Immunodeficiency Syndrome/mortality , HIV Infections/mortality , Hospitalization/statistics & numerical data , Retrospective Studies , Time-to-Treatment/statistics & numerical data , ComorbidityABSTRACT
INTRODUCTION: In 2010, the AIDS Study Group (Grupo de Estudio del SIDA [GESIDA]) developed 66 quality care indicators. The aim of this study is to determine which of these indicators are associated with mortality and hospital admission, and to perform a preliminary assessment of a prediction rule for mortality and hospital admission in patients on treatment and follow-up. METHODS: A retrospective cohort study was conducted in the Hospital Universitario Son Espases (Palma de Mallorca, Spain). Eligible participants were patients with human immunodeficiency syndrome≥18 years old who began follow-up in the Infectious Disease Section between 1 January 2000 and 31 December 2012. A descriptive analysis was performed to evaluate anthropometric variables, and a logistic regression analysis to assess the association between GESIDA indicators and mortality/admission. The mortality probability model was built using logistic regression. RESULTS: A total of 1,944 adults were eligible (median age: 37 years old, 78.8% male). In the multivariate analysis, the quality of care indicators associated with mortality in the follow-up patient group were the items 7, 16 and 20, and in the group of patients on treatment were 7, 16, 20, 35, and 38. The quality of care indicators associated with hospital admissions in the follow-up patients group were the same as those in the mortality analysis, plus number 31. In the treatment group the associated quality of care indicators were items 7, 16, 20, 35, 38, and 40. CONCLUSIONS: Some GeSIDA quality of care indicators were associated with mortality and/or hospital admissions. These indicators are associated with delayed diagnosis, regular monitoring, prevention of infections, and control of comorbidities.
Subject(s)
HIV Infections/mortality , HIV Infections/therapy , Patient Admission , Quality Indicators, Health Care , Acquired Immunodeficiency Syndrome/mortality , Acquired Immunodeficiency Syndrome/therapy , Adult , Cohort Studies , Female , Humans , Male , Retrospective StudiesABSTRACT
Introducción Los test de detección in vitro de Interferón-gamma frente a Mycobacterium tuberculosis (MTB) podrían ser una herramienta útil en el diagnóstico de enfermedad tuberculosa activa. Métodos Se realiza el test QuantiFERON-TB-Gold test in Tube (QFG-IT) en la sangre de 118 pacientes con tuberculosis pulmonar activa y se compara el resultado con la prueba de tuberculina. Resultados El estudio de QFG-IT fue positivo en 94 casos (79,7%), negativo en 17 (14,4%) e indeterminado en 7 (5,9%). QFG-IT negativo o indeterminado fue más frecuente en pacientes más ancianos (p=0,017) y en los casos de baciloscopia (..) (AU)
Introduction: The Interferon-gamma in vitro detection tests could be a useful tool in the diagnosis of active tuberculosis compared to Mycobacterium tuberculosis (MTB). Methods: The QuantiFERON-TB-Gold in Tube (QFG-IT) test was performed on the blood of 118 patients with active tuberculosis and the results compared with the tuberculin test. Results: The QFG-IT test was positive in (..) (AU)
Subject(s)
Humans , Tuberculosis/microbiology , Tuberculosis, Pulmonary/microbiology , Mycobacterium tuberculosis/isolation & purification , Tuberculin Test/methods , Interferon-gamma/isolation & purificationABSTRACT
INTRODUCTION: The Interferon-γ in vitro detection tests could be a useful tool in the diagnosis of active tuberculosis compared to Mycobacterium tuberculosis (MTB). METHODS: The QuantiFERON-TB-Gold in Tube (QFG-IT) test was performed on the blood of 118 patients with active tuberculosis and the results compared with the tuberculin test. RESULTS: The QFG-IT test was positive in 94 cases (79.7%), negative in 17 (14.4%) and indeterminate in 7 (5.9%). A negative or indeterminate QFG-IT test was more common in older patients (P=0.017) and in cases with negative smear tests (P=0.041). The kappa agreement between the tuberculin and QFG-IT tests was 74.5% with a kappa value of 0.45 (SE:0.136). Thirteen of the patients studied were infected with HIV and the tuberculin was positive in 5 of the 12 cases (38.5%) in whom it was performed, with the QFG-IT being positive in 9/13 (69.2%). CONCLUSIONS: The QFG-IT test may be a useful complimentary tool to the tuberculin test in the diagnosis of tuberculosis.
