Measuring population health using health expectancy estimates from morbidity and mortality databases.

The progressive incorporation of quality of life indicators in health planning meets a critical need: The evaluation of the performance of health services, which are under stress by multiple causes, but in particular by an ageing population. In general, national health plans rely on health expectancies obtained using the Sullivan method. The Sullivan health expectancy index combines age-specific mortality rates and age-specific prevalence of healthy life, obtained from health surveys. The objective of this work is to investigate an equivalent estimation, using available information from morbidity and mortality datasets. Mortality and morbidity information, corresponding to years 2016 and 2017, was obtained for the population of the county of Baix Empordà (Catalonia), N = 91,130. Anonymized individual information on diagnoses, procedures and pharmacy consumption contained in the individual clinical record (ICD and ATC codes), were classified into health states. Based on the observed health transitions and mortality, life expectancies by health state were obtained from a multistate microsimulation model. Healthy life expectancies at birth and 65 years for females and males were respectively HLE0female = 39.94, HLE0male = 42.87, HLE65female = 2.43, HLE65male = 2.17. These results differed considerably from the Sullivan equivalents, e.g., 8.25 years less for HLE65female, 9.26 less for HLE65male. Point estimates for global life expectancies at birth and 65 years of age: LE0female = 85.82, LE0male = 80.58, LE65female = 22.31, LE65male = 18.86. Health indicators can be efficiently obtained from multistate models based on mortality and morbidity information, without the use of health surveys. This alternative method could be used for monitoring populations in the context of health planning. Life Expectancy results were consistent with the standard government reports. Due to the different approximation to the concept of health (data-based versus self-perception), healthy life expectancies obtained from multistate micro simulation are consistently lower than those calculated with the standard Sullivan method.

Prevalencia de las enfermedades reumáticas en el Baix Empordà / Prevalence of rheumatic diseases in Baix Empordà

Introducción: En España, la prevalencia de diferentes enfermedades reumáticas se conoce principalmente a través de los estudios EPISER coordinados desde la Sociedad Española de Reumatología y que parten de encuestas en una muestra poblacional. Nuestro estudio tiene por objetivo describir la prevalencia en 2016 de las distintas enfermedades reumáticas en la población residente en el Baix Empordà según registros de codificación asistencial. Materiales y métodos: Estudio observacional, descriptivo y transversal realizado sobre la población residente durante los años 2016-2017 en la comarca del Baix Empordà, donde una organización sanitaria integrada (Serveis de Salut Integrats Baix Empordà) gestiona todos los dispositivos asistenciales públicos con un sistema de información unificado. Se seleccionaron los pacientes ≥ 20 años y se analizó la codificación CIE-9-CM de sus contactos asistenciales en función de 11 agrupaciones diagnósticas de 28 enfermedades reumáticas. Las agrupaciones fueron: poliartritis, espondiloartritis, artritis microcristalinas, artrosis (excepto localización vertebral), reumatismos de partes blandas, fibromialgia, dolor vertebral crónico (incluyendo artrosis), osteoporosis, enfermedades del tejido conectivo, vasculitis y otros. La población estudiada se asignó a tres categorías: «con enfermedad reumática», «posible enfermedad reumática» y «sin enfermedad reumática». Resultados: La muestra final fue de 71.785 personas, así distribuidas: «con enfermedad reumática» (n=25.990; 36,2%); «posible enfermedad reumática» (n=4.406; 6,1%) y «sin enfermedad reumática» (n=41.389; 57,7%). El grupo «con enfermedad reumática» mostró un predominio de mujeres (59,8% vs. 44,9%) y mayor edad (59,1±17,7 vs. 45,1±16,2; p<0,001) en comparación al grupo «sin enfermedad reumática». Conclusiones: El 36,2% de nuestra población presenta algún tipo de enfermedad reumática.(AU)

Background: In Spain, the prevalence of different rheumatic diseases is known mainly through the EPISER studies coordinated by the Spanish Society of Rheumatology and based on surveys in a population sample. The aim of our study is to describe the prevalence in 2016 of different rheumatic diseases in the population residing in Baix Empordà according to healthcare coding records. Materials and methods: Observational, descriptive and cross-sectional study carried out on the population attended from 2016-2017 in Serveis de Salut Integrats del Baix Empordà, an organizational service that includes all the healthcare facilities in the Baix Empordà area with a unique information system. Patients ≥ 20 years of age were selected and the ICD9-CM coding of all their healthcare contacts was analysed according to 11 entities and 28 diseases. The entities were: polyarthritis, spondyloarthritis, microcrystalline arthritis, osteoarthritis, soft tissue rheumatism, fibromyalgia, chronic spinal pain, osteoporosis, connective tissue diseases, vasculitis and others. The studied population was assigned to the categories: “with rheumatic disease”, “possible rheumatic disease” and “without rheumatic disease”. Results: In total, 71,785 patients were distributed as: 36.2% “with rheumatic disease (n=25,990); 6.1% with “possible rheumatic disease” (n=4,406) and 57.7% “without rheumatic disease” (n=41,389). The group “with rheumatic disease” showed a predominance of women (59.8% vs. 44.9%) and older age (59.1±17.7 vs. 45.1±16.2; P <.001) compared to the group “without rheumatic disease”. The presence of rheumatic disease increased progressively with age, being maximum in the group between 55-75 years. Conclusions: 36.2% of our population has some type of rheumatic disease.(AU)

Prevalence of rheumatic diseases in Baix Empordà.

BACKGROUND: In Spain, the prevalence of different rheumatic diseases is known mainly through the EPISER studies coordinated by the Spanish Society of Rheumatology and based on surveys in a population sample. The aim of our study is to describe the prevalence in 2016 of different rheumatic diseases in the population residing in Baix Empordà according to healthcare coding records. MATERIALS AND METHODS: Observational, descriptive and cross-sectional study carried out on the population attended from 2016 to 2017 in SIBBE (Serveis de Salut Integrats del Baix Empordà), an organizational service that includes all the healthcare facilities in the Baix Empordà area with a unique information system. Patients ≥ 20 years of age were selected and the ICD9-CM coding of all their healthcare contacts was analysed according to 11 entities and 28 diseases. The entities were: polyarthritis, spondyloarthritis, microcrystalline arthritis, osteoarthritis, soft tissue rheumatism, fibromyalgia, chronic spinal pain, osteoporosis, connective tissue diseases, vasculitis and others. The studied population was assigned to the categories: "with rheumatic disease", "possible rheumatic disease" and "without rheumatic disease". RESULTS: In total, 71,785 patients were distributed as: 36.2% "with rheumatic disease (n = 25,990); 6.1% with "possible rheumatic disease" (n = 4406) and 57.7% "without rheumatic disease" (n = 41,389). The group "with rheumatic disease" showed a predominance of women (59.7% vs. 44.9%) and older age (59.1 ±â€¯17.7 vs. 45.1 ±â€¯16.2; p < .001) compared to the group "without rheumatic disease". The presence of rheumatic disease increased progressively with age, being maximum in the group between 55-75 years. CONCLUSIONS: 36.2% of our population has some type of rheumatic disease. The estimated prevalence of some rheumatic diseases in the Baix Empordà population is partially consistent with that estimated by the EPISER 2016 study. Rheumatic disease affects women in a greater proportion and is more frequent in patients over 45 years of age.

Morbilidad y estado de salud autopercibido, dos aproximaciones diferentes al estado de salud / Morbidity and self-perception of health, two different approaches to health status

OBJETIVO: Determinar el grado de asociación entre el estado de salud percibido y el obtenido a partir de información sobre morbilidad atendida. MÉTODO: Se estudió la población de cuatro áreas básicas de salud de la comarca del Baix Empordà (N=91.067), en el año 2016, con una muestra de 1202 personas a las que se realizó una encuesta de salud. Paralelamente, las personas encuestadas se clasificaron en estados de salud mediante el agrupador Clinical Risk Groups. El grado de asociación se analizó mediante regresión logística. RESULTADOS: Un 27% de las personas con más de dos enfermedades crónicas mayores o con condiciones de salud complejas afirmaron tener buena salud. Se detectó asociación entre percepción de salud y carga de enfermedad. El sexo, la situación laboral, la clase social y especialmente la edad también mostraron asociación con la percepción de salud. CONCLUSIONES: La inferencia del estado de salud a partir de registros clínicos sobre morbilidad atendida aproxima la percepción subjetiva de la salud, y viceversa. No obstante, determinados factores sociodemográficos modulan la percepción individual. Los resultados obtenidos son esperanzadores en relación con el desarrollo de nuevas metodologías de cálculo de indicadores de calidad de vida

OBJECTIVE: To determine the degree of association between perceived health status and that obtained from information on attended morbidity. METHOD: The population of four health areas of the Baix Empordà region (Catalonia, Spain) (N=91,067) was studied in 2016, by means of a sample of 1202 individuals. A health survey was conducted on sample individuals. At the same time, the respondents were classified by health status through the Clinical Risk Groups system. The degree of association was analysed by logistic regression. RESULTS: 27% of patients with more than two major chronic diseases or with complex health conditions stated they were in good health. An association was detected between health perception and disease burden. Sex, work situation, social class and especially age also showed association with the perception of health. CONCLUSIONS: The inference of health status from clinical records on attended morbidity approximates to the subjective perception of health and vice versa. However, certain sociodemographic factors modulate individual perception. The results obtained are encouraging in relation to the development of new methodologies for calculating quality of life indicators

[Morbidity and self-perception of health, two different approaches to health status]. / Morbilidad y estado de salud autopercibido, dos aproximaciones diferentes al estado de salud.

OBJECTIVE: To determine the degree of association between perceived health status and that obtained from information on attended morbidity. METHOD: The population of four health areas of the Baix Empordà region (Catalonia, Spain) (N=91,067) was studied in 2016, by means of a sample of 1202 individuals. A health survey was conducted on sample individuals. At the same time, the respondents were classified by health status through the Clinical Risk Groups system. The degree of association was analysed by logistic regression. RESULTS: 27% of patients with more than two major chronic diseases or with complex health conditions stated they were in good health. An association was detected between health perception and disease burden. Sex, work situation, social class and especially age also showed association with the perception of health. CONCLUSIONS: The inference of health status from clinical records on attended morbidity approximates to the subjective perception of health and vice versa. However, certain sociodemographic factors modulate individual perception. The results obtained are encouraging in relation to the development of new methodologies for calculating quality of life indicators.

Survival, effect measures, and impact numbers after dementia diagnosis: a matched cohort study.

BACKGROUND: Knowledge on survival after diagnosis is important for all stakeholders. We aimed to estimate the survival and life expectancy after a dementia diagnosis, and to quantify the impact of dementia subtypes on mortality. METHODS: Retrospective matched cohort study using a linkage between a dementia-specific registry and two primary care electronic medical records databases. Between 1 January 2007 and 31 December 2015 there were 5,156 subjects aged 60 years and over registered by the Registry of Dementia of Girona and matched to 15,468 age-sex and comorbidity individuals without dementia attended by general practitioners in the province of Girona (Catalonia, Spain). RESULTS: The median survival was 5.2 years (95% CI 5.0 to 5.4), the median life expectancy was 74.7 years (95% CI 71.9 to 76.5), and there were differences by gender. The mortality rate was 127.1 per 1,000 person-years (95% CI 121.6 to 132.7), and the hazard ratio for mortality in persons with dementia ranged between 1.63 (95% CI 1.52 to 1.76) for Alzheimer's disease and 2.52 (95% CI 1.90 to 3.35) for Parkinson-plus syndromes. There was one death per year attributable to dementia for every 18.6 persons with dementia, and for every 2.4 persons with dementia who die, one death was attributable to dementia. CONCLUSION: The prognosis after dementia diagnosis is conditioned by demographic and clinical features. Although survival is larger for women, they also experience a higher number of years of life lost. Parkinson-plus syndromes and dementia due to multiple etiologies are among the most malignant subtypes regarding mortality.

Ageing and healthcare expenditures: Exploring the role of individual health status.

In 1999, Zweifel, Felder, and Meiers questioned conventional wisdom on ageing and healthcare expenditure (HCE). According to these authors, the positive association between age and HCE is due to an increasing age-specific mortality and the high cost of dying. After a weighty academic debate, a new consensus was reached on the importance of proximity to death when analysing HCE. Nevertheless, the influence of individual health status remains unknown. The objective of our study is to analyse the influence individual health status has on HCE, when compared to proximity to death and demographic effects and considering a comprehensive view of healthcare services and costs. We examined data concerning different HCE components of N = 61,473 persons aged 30 to 95 years old. Using 2-part models, we analysed the probability of use and positive HCE. Regardless of the specific group of healthcare services, HCE at the end of life depends mainly on the individual health status. Proximity to death approximates individual morbidity when it is excluded from the model. The inclusion of morbidity generally improves the goodness of fit. These results provide implications for the analysis of ageing population and its impact on HCE that should be taken into account.

Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes.

BACKGROUND: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care. METHODS: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain) for the year 2012 (N = 92,498 individuals). A set of individual cost models as a function of sex, age and morbidity burden were adjusted and individual healthcare costs were calculated using a retrospective full-costing system. The individual morbidity burden was inferred using the Clinical Risk Groups (CRG) patient classification system. RESULTS: Depending on the characteristics of the data, and according to the algorithm criteria, the choice of model was a linear model on the log of costs or a generalized linear model with a log link. We checked for goodness of fit, accuracy, linear structure and heteroscedasticity for the models obtained. CONCLUSION: The proposed algorithm identified a set of suitable cost models for the distinct groups of services integrated care entails. The individual morbidity burden was found to be indispensable when allocating appropriate resources to targeted individuals.

Late rectal and bladder toxicity following radiation therapy for prostate cancer: Predictive factors and treatment results.

AIM: This study aimed at investigating factors associated to late rectal and bladder toxicity following radiation therapy and the effectiveness of Hyperbaric Oxygen Therapy (HBOT) when toxicity is grade ≥2. BACKGROUND: Radiation is frequently used for prostate cancer, but a 5-20% incidence of late radiation proctitis and cystitis exists. Some clinical and dosimetric factors have been defined without a full agreement. For patients diagnosed of late chronic proctitis and/or cystitis grade ≥2 treatment is not well defined. Hyperbaric Oxygen Therapy (HBOT) has been used, but its effectiveness is not well known. MATERIALS AND METHODS: 257 patients were treated with radiation therapy for prostate cancer. Clinical, pharmacological and dosimetric parameters were collected. Patients having a grade ≥2 toxicity were treated with HBOT. Results of the intervention were measured by monitoring toxicity by Common Toxicity Criteria v3 (CTCv3). RESULTS: Late rectal toxicity was related to the volume irradiated, i.e. V50 > 53.64 (p = 0.013); V60 > 38.59% (p = 0.005); V65 > 31.09% (p = 0.002) and V70 > 22.81% (p = 0.012). We could not correlate the volume for bladder. A total of 24 (9.3%) patients experienced a grade ≥2. Only the use of dicumarinic treatment was significant for late rectal toxicity (p = 0.014). A total of 14 patients needed HBOT. Final percentage of patients with a persistent toxicity grade ≥2 was 4.5%. CONCLUSION: Rectal volume irradiated and dicumarinic treatment were associated to late rectal/bladder toxicity. When toxicity grade ≥2 is diagnosed, HBOT significantly ameliorate symptoms.

Hybrid risk adjustment for pharmaceutical benefits.

This paper analyses the application of hybrid risk adjustment versus either prospective or concurrent risk adjustment formulae in the context of funding pharmaceutical benefits for the population of an integrated healthcare delivery organisation in Catalonia during years 2002 and 2003. We apply a mixed formula and find that, compared to prospective only models, a hybrid risk adjustment model increases incentives for efficiency in the provision for low risk individuals in health organisations, not only as a whole but also within each internal department, by reducing within-group variation of drug expenditures.

[Nursing care in women with breast disease: organization of a specific nurses' clinic]. / Cuidados de enfermería a la mujer con patología mamaria: organización de una consulta específica.

Breast surgery can be highly stressful for women due to the high symbolic value that it represents in bio-psycho-social terms. Before setting up a nurses' breast disease clinic, nurses felt that women were being discharged after surgery with excessive worries and doubts. The aim of this study was to describe the organization, structure, functions, and activities of the nurses' breast disease clinic in Hospital Palmós (Gerona, Spain) between 2002-2005, as well as to promote this kind of clinic. The clinic provides postsurgical care, health education, and psychological support, thus contributing to the integral care of women with this important health problem. The clinic is a resource for the follow-up of patients with breast disease. Moreover, it facilitates outpatient surgical treatment and early discharge and reduces mean length of hospital stay.

Cuidados de enfermería a la mujer con patología mamaria: organización de una consulta específica / Nursing care in women with breast disease: organization of a specific nurses' clinic

La cirugía de mama puede resultar muy estresante para la mujer por la elevada carga simbólica que representa a nivel biopsicosocial. Antes de la puesta en marcha de la consulta, la enfermera tenía la sensación de que la mujer era dada de alta, después del proceso quirúrgico, con excesivas preocupaciones y dudas. El objetivo de este trabajo es presentar la organización, estructura, funciones y actividad de la consulta de enfermería de patología mamaria durante los años 2002-2005 en el Hospital de Palamós (Girona), así como promover la existencia de este tipo de consultas. En la consulta se realizan cuidados posquirúrgicos, educación sanitaria y soporte psicológico que benefician la atención integral de la mujer que presenta este importante problema de salud. La consulta es un recurso para el seguimiento de las pacientes con patología mamaria, que facilita la cirugía ambulatoria, el alta precoz y la disminución de la estancia media hospitalaria

Breast surgery can be highly stressful for women due to the high symbolic value that it represents in bio-psycho-social terms. Before setting up a nurses' breast disease clinic, nurses felt that women were being discharged after surgery with excessive worries and doubts. The aim of this study was to describe the organization, structure, functions, and activities of the nurses' breast disease clinic in Hospital Palmós (Gerona, Spain) between 2002-2005, as well as to promote this kind of clinic. The clinic provides postsurgical care, health education, and psychological support, thus contributing to the integral care of women with this important health problem. The clinic is a resource for the follow-up of patients with breast disease. Moreover, it facilitates outpatient surgical treatment and early discharge and reduces mean length of hospital stay

Reflujo vesico-ureteral en pediatría: ¿ha cambiado el papel de la cistografía? / Vesicoureteral reflux in pediatrics: has the role of voiding cystourethrogram changed?

Fundamento. El diagnóstico precoz del reflujo vesicoureteral(RVU) puede ayudar a evitar el desarrollo deReflux vesicoureteral en pediatria: ha canviat elpaper de la cistografia?Ester Parada, Nabil Abu-Hadwan, Francesc Mir, José Maria Inoriza, Teresa Carrión,Joan Manel Torres, Joan Agulló, Pere Plaja.Hospital de Palamós. Palamós (Girona)nefropatía de reflujo pero a la vez puede condicionar eluso demasiado generalizado de exploraciones complementariasinvasivas. Es necesario valorar periódicamente elrendimiento de las exploraciones complementarias que solicitamosen el marco de la mejora de las técnicas de diagnóstico,tanto prenatal como postnatal.Objetivo. Valorar las indicaciones y el rendimiento dela CUMS en el estudio de alteraciones renales de diagnósticoprenatal y en el seguimiento de las infecciones deltracto urinario (ITU).Método. Revisión retrospectiva de las historias clínicasde pacientes de 0-4 años en los que se ha realizado unaCUMS en nuestro hospital entre enero de 2001 y agosto de2004.Resultados. Se han estudiado 128 pacientes, en el 75%de los cuales se solicitó CUMS a raíz del diagnóstico de ITUy en el resto como seguimiento de alteraciones renales dediagnóstico prenatal. Se detectó RVU en el 17.2% de lospacientes: el 12.9% de los estudiados por diagnóstico prenataly el 18.7% por ITU. Dos de los pacientes presentaronuna infección de orina post-CUMS.Conclusiones. A pesar de los avances en el diagnósticoprenatal, la presencia de RVU en el 18.7% de los pacientescon antecedente de ITU avala el papel de la CUMS en el estudiode estos pacientes

Background. The early diagnosis of vesicoureteral reflux(VUR) is important for the prevention of its progressionto reflux nephropathy; however, invasive and uncomfortabletechniques are required. The use of suchprocedures ought to be assessed periodically in the evolvingscenario of technological advances in prenatal andpostnatal diagnosis.Objective. To assess the yield of voiding cystourethrogram(VCUG) in the evaluation of congenital renal abnormalitiesand urinary tract infections (UTI).Method. We retrospectively reviewed the medicalcharts of patients younger than 4 years of age who underwentVCUG between January 2001 and August 2004 at ourhospital.Results. One-hundred and twenty-eight patients underwentVCUG during the study period, 75% of them aftera UTI and the rest because of prenatal diagnosis of renalmalformations. RVU was diagnosed in 17.2% of thepatients: 12.9% of patients with renal malformations and18.7% of patients with history of UTI. Two patients developeda UTI after the VCUG was performed. DMSA scanwas performed in 18 of the 22 patients with VUR, and 12of them were found to have renal scarring. Conclusions. Despite the improvements in prenataldiagnosis of renal malformations, the detection of VUR ina significant proportion of patients as a result of a UTIconfirms the importance of VCUG in the evaluation ofpatients with UTI