Coordinación de la asistencia entre un hospital comarcal y su centro de referencia: evaluación de dos modelos de atención neumológica / Coordination Between a District Hospital and a Reference Hospital: Evaluation of Chest Disease Care Models

No está bien definida el tipo de asistencia especializada que deben dar los hospitales comarcales. Paraevaluar diferentes opciones, se analizó retrospectivamente la atención neumológica en el año 2008 endos áreas comarcales de Galicia: Barbanza y Cee, con características poblacionales similares. El hospitalde Barbanza dispone de consulta de neumología atendida por especialistas del hospital de referencia 3días/semana, mientras que en Cee la atienden internistas del propio centro. En ambos casos, la hospitalizaciónestá a cargo del servicio de Medicina Interna. Los datos fueron proporcionados por los serviciosadministrativos de los hospitales y autonómicos.Las estancias medias para el agrupador CDM4 fueron similares en los dos comarcales, pero inferioresa las de los centros de referencia. No hubo diferencias en comorbilidad (Charlson) ni en reingresos almes de alta. Se realizaron más exploraciones funcionales en pacientes del Barbanza, tanto en el propiocentro (957 espirometrías vs 21; p < 0,0001) como en el hospital de referencia (214 determinaciones devolúmen/difusión vs 99; p < 0,001). La prevalencia de tratamientos con CPAP fue más elevada en el áreade Barbanza (3,9 vs 2/1.000 habitantes; p < 0,0001). No encontramos diferencias en la prevalencia deoxigenoterapia ni en ventilación mecánica domiciliaria. La mortalidad por patología respiratoria el año2007 fue similar en las dos áreas.Estos datos sugieren que en un modelo de hospital comarcal con neumólogos consultores, la consultaambulatoria facilita el acceso a una asistencia más especializada, más completa y, probablemente, de máscalidad, que los comarcales sin este tipo de consultoría(AU)

Specialised medical care at district hospitals has not been thoroughly defined. Respiratory care data from2008 in Barbanza and Cee hospitals (Galicia, Spain), were analysed to evaluate different approaches,as they are both similar. Barbanza hospital has a chest diseases clinic run by specialist doctors fromthe reference hospital three days per week, while Cee hospital is operated by the staff on site. In bothcases hospitalisation is the responsibility of the Internal Medicine department. Data was provided by theadministrative departments of each hospital and the regional government.Average CDM4 stays were similar for both district hospitals; however, they were lower than in thereference hospital. Charlson scores and re-admissions a month after discharge were similar in both.Barbanza’s hospital carried out more functional explorations, both at the centre (957 spirometries vs21; P<.0001) and at the reference hospital (214 volume/diffusion tests vs 99; P<.001). CPAP treatments were more prevalent in the Barbanza area (3.9 vs 2/1,000 habitants; P<.0001). No differences were foundin oxygen therapy and home mechanical ventilation. Mortality due to respiratory disease in 2007 wassimilar in both regions.Data suggests that in a district hospital scheme supported by chest disease consultants and outpatientclinics gives easier access to specialised, comprehensive and probably, higher quality care than districthospitals without them(AU)

Coordination between a district hospital and a reference hospital: evaluation of chest disease care models.

Specialised medical care at district hospitals has not been thoroughly defined. Respiratory care data from 2008 in Barbanza and Cee hospitals (Galicia, Spain), were analysed to evaluate different approaches, as they are both similar. Barbanza hospital has a chest diseases clinic run by specialist doctors from the reference hospital three days per week, while Cee hospital is operated by the staff on site. In both cases hospitalisation is the responsibility of the Internal Medicine department. Data was provided by the administrative departments of each hospital and the regional government. Average CDM4 stays were similar for both district hospitals; however, they were lower than in the reference hospital. Charlson scores and re-admissions a month after discharge were similar in both. Barbanza's hospital carried out more functional explorations, both at the centre (957 spirometries vs 21; P<.0001) and at the reference hospital (214 volume/diffusion tests vs 99; P<.001). CPAP treatments were more prevalent in the Barbanza area (3.9 vs 2/1,000 habitants; P<.0001). No differences were found in oxygen therapy and home mechanical ventilation. Mortality due to respiratory disease in 2007 was similar in both regions. Data suggests that in a district hospital scheme supported by chest disease consultants and outpatient clinics gives easier access to specialised, comprehensive and probably, higher quality care than district hospitals without them.