Catalonia Suicide Risk Code Epidemiology (CSRC-Epi) study: protocol for a population-representative nested case-control study of suicide attempts in Catalonia, Spain.

INTRODUCTION: Suicide attempts represent an important public health burden. Centralised electronic health record (EHR) systems have high potential to provide suicide attempt surveillance, to inform public health action aimed at reducing risk for suicide attempt in the population, and to provide data-driven clinical decision support for suicide risk assessment across healthcare settings. To exploit this potential, we designed the Catalonia Suicide Risk Code Epidemiology (CSRC-Epi) study. Using centralised EHR data from the entire public healthcare system of Catalonia, Spain, the CSRC-Epi study aims to estimate reliable suicide attempt incidence rates, identify suicide attempt risk factors and develop validated suicide attempt risk prediction tools. METHODS AND ANALYSIS: The CSRC-Epi study is registry-based study, specifically, a two-stage exposure-enriched nested case-control study of suicide attempts during the period 2014-2019 in Catalonia, Spain. The primary study outcome consists of first and repeat attempts during the observation period. Cases will come from a case register linked to a suicide attempt surveillance programme, which offers in-depth psychiatric evaluations to all Catalan residents who present to clinical care with any suspected risk for suicide. Predictor variables will come from centralised EHR systems representing all relevant healthcare settings. The study's sampling frame will be constructed using population-representative administrative lists of Catalan residents. Inverse probability weights will restore representativeness of the original population. Analysis will include the calculation of age-standardised and sex-standardised suicide attempt incidence rates. Logistic regression will identify suicide attempt risk factors on the individual level (ie, relative risk) and the population level (ie, population attributable risk proportions). Machine learning techniques will be used to develop suicide attempt risk prediction tools. ETHICS AND DISSEMINATION: This protocol is approved by the Parc de Salut Mar Clinical Research Ethics Committee (2017/7431/I). Dissemination will include peer-reviewed scientific publications, scientific reports for hospital and government authorities, and updated clinical guidelines. TRIAL REGISTRATION NUMBER: NCT04235127.

Un índice de privación para reformar el modelo de financiación de la atención primaria en Cataluña / A deprivation index to reform the financing model of primary care in Catalonia (Spain)

OBJETIVO: Construir un índice de privación para la asignación del presupuesto de los equipos de atención primaria de Cataluña, válido tanto para entornos urbanos como rurales y actualizable con más frecuencia que los índices construidos con las variables censales. MÉTODO: A partir de la revisión de los índices de privación más comunes se seleccionaron las variables existentes de fuentes que permiten una actualización frecuente y que son representativas del ámbito territorial de las áreas básicas de salud. Se calcularon las correlaciones entre las variables escogidas y las variables de utilización de atención sanitaria y morbilidad. Se aplicó el análisis de componentes principales. Finalmente, se calcularon las correlaciones entre el índice construido y el índice MEDEA, y con variables de utilización de recursos y morbilidad para diferentes tramos de dispersión poblacional. RESULTADOS: Las variables de renta, ocupación y nivel de estudios son las que tienen más correlación con la utilización de atención sanitaria y la morbilidad. El índice socioeconómico compuesto (ISC) tiene un rango de −0,01 a 5,68, una media de 2,60 y una desviación estándar de 0,91. La correlación entre el ISC y el MEDEA es de 0,89. El ISC se correlaciona con la utilización de atención sanitaria tanto en los entornos urbanos como en los rurales, aunque en estos últimos la asociación es menor. CONCLUSIONES: El ISC se ha construido con datos que permiten una actualización frecuente, y se ha integrado en el modelo de asignación de recursos de la atención primaria a partir de 2017

OBJECTIVE: To build a deprivation index for the assignation of the budgets of the primary healthcare teams in Catalonia (Spain) valid for both urban and rural environments and updatable with greater frequency than indices built from census variables. METHOD: Starting from a review of the most common deprivation indices, variables were selected from sources that allow frequent updating and are representative at the territorial level of primary care. The correlations were calculated between the chosen variables and variables of need for healthcare and morbidity. principal components analysis was applied. Finally, the correlations of the index built with the MEDEA index and with variables of use of healthcare resources and morbidity was calculated stratifying by geographical dispersion. RESULTS: The variables of income, occupation and education are the ones with the highest correlation with the need for healthcare and morbidity. The composed socioeconomic index (CSI) ranges from −.01 to 5.68, with an average value of 2.60 and a standard deviation of .91. The correlation between the CSI and the MEDEA index is .89. The CSI correlates with use for healthcare in both urban and rural environments, although in rural environments the association is lower. CONCLUSIONS: The CSI was built with data that allow frequent updating and was integrated in the model for allocating resources to primary healthcare starting in 2017

[A deprivation index to reform the financing model of primary care in Catalonia (Spain)]. / Un índice de privación para reformar el modelo de financiación de la atención primaria en Cataluña.

OBJECTIVE: To build a deprivation index for the assignation of the budgets of the primary healthcare teams in Catalonia (Spain) valid for both urban and rural environments and updatable with greater frequency than indices built from census variables. METHOD: Starting from a review of the most common deprivation indices, variables were selected from sources that allow frequent updating and are representative at the territorial level of primary care. The correlations were calculated between the chosen variables and variables of need for healthcare and morbidity. principal components analysis was applied. Finally, the correlations of the index built with the MEDEA index and with variables of use of healthcare resources and morbidity was calculated stratifying by geographical dispersion. RESULTS: The variables of income, occupation and education are the ones with the highest correlation with the need for healthcare and morbidity. The composed socioeconomic index (CSI) ranges from -.01 to 5.68, with an average value of 2.60 and a standard deviation of .91. The correlation between the CSI and the MEDEA index is .89. The CSI correlates with use for healthcare in both urban and rural environments, although in rural environments the association is lower. CONCLUSIONS: The CSI was built with data that allow frequent updating and was integrated in the model for allocating resources to primary healthcare starting in 2017.

Socioeconomic inequalities in health and the use of healthcare services in Catalonia: analysis of the individual data of 7.5 million residents.

BACKGROUND: The aim of this study is to analyse the health status, the use of public healthcare services and the consumption of prescription drugs in the population of Catalonia, taking into consideration the socioeconomic level of individuals and paying special attention to vulnerable groups. METHODS: Cross-sectional study of the entire population resident in Catalonia in 2015 (7.5 million people) using administrative records. Twenty indicators are analysed related to health, the use of healthcare services and consumption of prescription drugs. Rates, frequencies and averages are obtained for the different variables stratified by age groups (under 15 years, 15-64 years and 65 years or older), gender and socioeconomic status (calculated on the basis of pharmacy copayment levels and Social Security benefits received). RESULTS: A socioeconomic gradient was observed in all the indicators analysed, in both sexes and in all age groups. Morbidity, use of mental healthcare centres, hospitalisation rates and probability of drug consumption among children is 3-7 times higher for those with low socioeconomic level respect to those with a higher one. In children and adults, the steepest gradient was found in the use of mental health services. Moreover, there are gender inequalities. CONCLUSION: There are significant socioeconomic inequalities in health status and in the use of healthcare services in the population of Catalonia. To respond to this situation, new policies on health and other areas, such as education and employment, are required, especially those that have an impact on early years.

Characterization of the CPAP-treated patient population in Catalonia.

There are different phenotypes of obstructive sleep apnoea (OSA), many of which have not been characterised. Identification of these different phenotypes is important in defining prognosis and guiding the therapeutic strategy. The aim of this study was to characterise the entire population of continuous positive airway pressure (CPAP)-treated patients in Catalonia and identify specific patient profiles using cluster analysis. A total of 72,217 CPAP-treated patients who contacted the Catalan Health System (CatSalut) during the years 2012 and 2013 were included. Six clusters were identified, classified as "Neoplastic patients" (Cluster 1, 10.4%), "Metabolic syndrome patients" (Cluster 2, 27.7%), "Asthmatic patients" (Cluster 3, 5.8%), "Musculoskeletal and joint disorder patients" (Cluster 4, 10.3%), "Patients with few comorbidities" (Cluster 5, 35.6%) and "Oldest and cardiac disease patients" (Cluster 6, 10.2%). Healthcare facility use and mortality were highest in patients from Cluster 1 and 6. Conversely, patients in Clusters 2 and 4 had low morbidity, mortality and healthcare resource use. Our findings highlight the heterogeneity of CPAP-treated patients, and suggest that OSA is associated with a different prognosis in the clusters identified. These results suggest the need for a comprehensive and individualised approach to CPAP treatment of OSA.

La atención al parto en diferentes países de la Organización para la Cooperación y el Desarrollo Económico (OCDE) / Childbirth care in different countries of the Organization for Economic Co-operation and Development (OECD)

El desarrollo científico-tecnológico ha comportado una progresiva medicalización del proceso de embarazo, parto y puerperio y la institucionalización de la atención al parto en los hospitales en la mayoría de países industrializados. Existen diferentes modelos organizativos y de atención al parto y se pueden encontrar diferencias en cuanto a los resultados de esta atención. OBJETIVO: Describir diferentes modelos organizativos y de atención al parto en países seleccionados de la Organización para la Cooperación y el Desarrollo Económico (OCDE) e identificar variaciones en la estructura organizativa de los modelos observados. METODOLOGÍA: Búsqueda bibliográfica y cuestionario a informantes clave de diferentes países para identificar los aspectos relevantes sobre financiación de los servicios, lugar en que se presta la atención y distribución de competencias. RESULTADOS: Se describe la organización y el modelo de atención al parto, en el contexto de los sistemas de salud de cada país. Países incluidos: Reino Unido, Australia, Holanda, Irlanda, Francia, España y Canadá. Se presentan indicadores de la OCDE sobre la actividad sanitaria, el comportamiento del sistema de salud y el estado de salud de la población. CONCLUSIONES: Se observan diferentes formas de organizar la atención a la maternidad entre los países seleccionados y se evidencian diferencias en los resultados de la atención. Existen varios tipos de localización para la atención a las mujeres con bajo riesgo obstétrico durante el proceso de maternidad. En los sistemas de salud observados, la atención a las muje-res durante el embarazo se suele realizar en un entorno no hospitalario, mientras que para la atención al parto existen diferentes opciones sobre los tipos de localización y de atención que, en algunos casos, pueden ser elegidos por las mujeres. Los indicadores seleccionados muestran un am-plio rango de resultados entre los países elegidos, y parece conveniente investigar la posible relación de esta variabilidad con el tipo de organiza-ción y de atención durante el proceso de maternidad, así como identificar criterios comunes sobre los aspectos específicos para la atención a las mujeres que no presentan riesgos obstétricos

Scientific and technological advances have entailed an increased influence of medicine in the process of pregnancy, childbirth and post-partum with the institutionalisation this entails for childbirth care in the hospitals of most industrialised countries. Several organisational and childbirth care models are in place and differences can be observed between them with regard to the outcomes of such care. AIM: To describe differing organisational and childbirth care models in the chosen countries of the Organization for Economic Co-operation and Development (OECD) and identify variations in the organisational structure of the models observed. METHODOLOGY: To conduct a bibliographical search and questionnaire on key informers from various countries to identify relevant aspects concerning service funding, care settings and distribution of authority in this sphere. RESULTS: A description is given of the organisation and childbirth care model on the context of the health systems of each country. The countries studed are: Australia, Canada, France, Ireland, the Netherlands, Spain and the United Kingdom. OECD indicators are presented on healthcare activity, the operation of the health system and the state of health of thepopulation. CONCLUSIONS: Several forms of organising maternity care have been observed from the countries chosen and differences have been identified in the outcomes of care. There are numerous kinds of settings for providing care to women with a low obstetric risk during the maternity process. In the healthcare systems analysed, care for women during pregnancy is often provided in a non-hospital setting; however, when it comes to childbirth care, several options are available in terms of the setting and care which can even be chosen by women themselves in certain cases. The indicators selected point to a broad range of results among the chosen countries and it would be appropriate to research the possible link between this variation in terms of the kind of organisation and care provided during maternity and, accordingly, to identify common criteria relating to specific aspects in care for women with low obstetric risks

Obstetric interventions in two groups of hospitals in Catalonia: a cross-sectional study.

BACKGROUND: Childbirth assistance in highly technological settings and existing variability in the interventions performed are cause for concern. In recent years, numerous recommendations have been made concerning the importance of the physiological process during birth. In Spain and Catalonia, work has been carried out to implement evidence-based practices for childbirth and to reduce unnecessary interventions.To identify obstetric intervention rates among all births, determine whether there are differences in interventions among full-term single births taking place in different hospitals according to type of funding and volume of births attended to, and to ascertain whether there is an association between caesarean section or instrumental birth rates and type of funding, the volume of births attended to and women's age. METHODS: Cross-sectional study, taking the hospital as the unit of analysis, obstetric interventions as dependent variables, and type of funding, volume of births attended to and maternal age as explanatory variables. The analysis was performed in three phases considering all births reported in the MBDS Catalonia 2011 (7,8570 births), full-term single births and births coded as normal. RESULTS: The overall caesarean section rate in Catalonia is 27.55% (CI 27.23 to 27.86). There is a significant difference in caesarean section rates between public and private hospitals in all strata. Both public and private hospitals with a lower volume of births have higher obstetric intervention rates than other hospitals (49.43%, CI 48.04 to 50.81). CONCLUSIONS: In hospitals in Catalonia, both the type of funding and volume of births attended to have a significant effect on the incidence of caesarean section, and type of funding is associated with the use of instruments during delivery.

Análisis del desempeño de los servicios sanitarios de Cataluña: evaluación de los primeros resultados del proyecto demostrativo / Performance assessment of health services in Catalonia (Spain): Evaluation of initial results of the Catalan healthcare service project

La medida del desempeño de los servicios sanitarios está recibiendo una mayor atención debido al aumento del gasto sanitario y de las expectativas de la población, y a la necesidad de obtener el máximo rendimiento de los recursos invertidos. En Cataluña, en el año 2005, aprovechando la experiencia previa de la Agència de Salut Pública de Barcelona y del Consorci Sanitari de Barcelona comparando los servicios sanitarios de Barcelona y Montreal, una beca de investigación de la Agència d’Avaluació de Tecnologia i Recerca Mèdiques, y el interés de planificación sanitaria del Departament de Salut, se puso en marcha el proyecto de análisis del desempeño de los servicios sanitarios de Cataluña. El objetivo de este artículo es presentar el desarrollo del proyecto, mostrar algunos ejemplos que ilustran el tipo de información que se ha podido obtener y el tipo de análisis que esta información permite, exponer posibles explicaciones de los resultados presentados y discutir algunas limitaciones e implicaciones. De hecho, el valor añadido de este proyecto es que permite conocer el desempeño del sistema sanitario en la consecución de sus objetivos, establecer un conjunto de indicadores homogeneizados de referencia y ser una pieza clave en el desarrollo de la Central de Resultats del Departament de Salut de la Generalitat de Catalunya (AU)

Performance assessment of healthcare services is receiving greater attention due to increasing health care expenditures, greater expectations among the population, and the need to obtain results from the invested resources. Taking advantage of the existing experience of the Agència de Salut Pública de Barcelona and the Consorci Sanitari de Barcelona, which compared the healthcare services of Barcelona and Montreal, a grant from the Agència d’Avaluació de Tecnologia i Recerca Mèdiques, and the health planning interest of the Departament de Salut, the performance assessment of the Catalan healthcare service project was started in Catalonia in 2005.This article aims to present the development of the project, to provide some examples that illustrate the kind of numerical and graphical information that could be obtained and the kind of analysis that could be performed, to provide possible explanations for the results shown, and to discuss some limitations and implications. Currently, the added value of this project is that it identifies the extent to which the healthcare system is achieving its objectives, establishes a set of homogeneous indicators that could be used in the future, and is a key tool in the development of the Central de Resultats del Departament de Salut de la Generalitat de Catalunya(AU)

[Performance assessment of health services in Catalonia (Spain): evaluation of initial results of the Catalan healthcare service project]. / Análisis del desempeño de los servicios sanitarios de Cataluña: evaluación de los primeros resultados del proyecto demostrativo.

Performance assessment of healthcare services is receiving greater attention due to increasing health care expenditures, greater expectations among the population, and the need to obtain results from the invested resources. Taking advantage of the existing experience of the Agència de Salut Pública de Barcelona and the Consorci Sanitari de Barcelona, which compared the healthcare services of Barcelona and Montreal, a grant from the Agència d'Avaluació de Tecnologia i Recerca Mèdiques, and the health planning interest of the Departament de Salut, the performance assessment of the Catalan healthcare service project was started in Catalonia in 2005. This article aims to present the development of the project, to provide some examples that illustrate the kind of numerical and graphical information that could be obtained and the kind of analysis that could be performed, to provide possible explanations for the results shown, and to discuss some limitations and implications. Currently, the added value of this project is that it identifies the extent to which the healthcare system is achieving its objectives, establishes a set of homogeneous indicators that could be used in the future, and is a key tool in the development of the Central de Resultats del Departament de Salut de la Generalitat de Catalunya.