[Evidence-based health care]. / Asistencia sanitaria basada en la evidencia.

Health care evidence based is a 90's trend of health professionals interested in the scientific development of effectiveness and efficiency research into the health management and introducing scientific evidence into the health decision-making process. The development of health services research, outcome management and evidence based medicine, makes possible the new orientation of heath systems toward health care evidence based. That means health services provided with the maximum quality, effectiveness, appropriateness and taking into account the informed patients preferences. If we want to see health care evidence based fully working among managers and clinicians, we need the development of information systems directed to the measurement of clinical outcomes in terms of effectiveness and efficiency, as well as specific plus tailored training programs and, pushing focused research areas into the improvement of health services provided at hospital and primary care levels.

[Analysis of opinions, attitudes and knowledge of physicians of health centers of Valencia concerning efficacy and efficiency of drug prescriptions]. / Análisis de las opiniones, actitudes y conocimientos de los médicos de los centros de salud de Valencia sobre la eficacia y la eficiencia en la prescripción de medicamentos.

OBJECTIVE: To find the views, attitudes and knowledge of Primary Care doctors concerning the efficacy and efficiency of medical prescription. DESIGN: Descriptive, crossover study. SETTING: 10 Health Centres in the city of Valencia. PARTICIPANTS: The 115 doctors, both general and family practitioners, working at these centres. INTERVENTIONS: A survey gathered information on the doctors' views about the appropriateness of considering price when prescribing, on their assessment of ten strategies aimed at improving prescription efficiency, and their understanding of the efficacy and cost of certain medicines used in Primary Care. RESULTS: 1. 81% of those surveyed stated that prescription costs had to be considered at the moment of deciding patient treatment. 2. 70.4% of their opinions of the efficacy of medicines, as measured by the Intrinsic Therapeutic Value, were accurate. 3. 41% of the prices estimated by doctors were correct. There was a tendency to undervalue prices and to eliminate differences between products of identical composition. 4. In the area of strategies to improve prescription efficiency, doctors clearly favoured training strategies (prescription guidelines or in-work training) over strategies involving "assuming economic risks" (pharmacy self-management...).

[Avoidable hospitalization using ambulatory surgery in the Community of Valencia: a Delphi study]. / Hospitalizaciones evitables por cirugía sin ingreso en la Comunidad Valenciana: un estudio Delphi.

BACKGROUND: To estimate the number of hospital admittance's avoidable by means of ambulatory surgery, according to surgeons and anaesthetists who currently work with the National Health System (NHS). METHOD: By means of a Delphi procedure of 25 surgeons or anaesthetists of the Valencia Health Survey (AServei Valencià de la Salut-SVS), a consensus was reached as to the objective criteria for excluding patients that could be treated outside a hospital and the percentage of certain operations that could be performed under day surgery. These criteria were applied to the Minimum Basic Data Set on hospital discharge within the Autonomous Region of Valencia in order to estimate the figure of hospital admittance and stays avoidable by means of ambulatory surgery in a selection of 29 surgery processes. RESULTS: 83% of medical personnel responded to the Delphi questionnaires. The median of the surveyed group's estimation on the proportion of cases that could be treated by means of external surgery varied from 40% for abdomen wall hernias or laparoscopic cholecystectomy and 90% for perianal tissue excision, anastomosis for dialysis or ganglionectomy. Application of the results of the Delphi survey would have meant that the SVS could have avoided 12,558 admittances in 1994, 75% of the operations surveyed, which is almost the same figure resulting from applying the medical personnel's opinion of the CMBD. CONCLUSIONS: SVS professionals consider it feasible to perform a much higher number of ambulatory operations than those currently carried out, and that it is likely that the causes for the lack of such operations lie in SNS financing and incentive criteria, rather than medical issues.

[What does the average stay say about the diagnosis-related groups?]. / Qué mide la estancia media de los grupos relacionados de diagnóstico?

BACKGROUND: The systems for classifying patients into homogeneous groups of resource consumption such as diagnosis related groups (DRG) use mean stay (MS) as the principal predictive variable of this consumer entity. The standard of MS for each DRG is usually defined as the MS of this DRG in one group of hospitals. This method omits the existence of unnecessary days of hospitalization which are added to the standard and may be identified by review of hospitalary use. METHODS: A retrospective review of the clinical need for 933 days of hospitalization (190 days of admission plus 743 successive stays for the same) in 190 cases of 167 DRG (appendicectomy without complications or comorbidity in those under the age of 70 years) in 8 public hospitals in Valencia (Spain) was performed by the Appropriateness Use Evaluation Protocol. RESULTS: Four days of admission (2.1%) and 284 successive stays (38.2%) were considered unnecessary from a clinical point of view. Necessary MS was estimated as 3.4 days for GRD vs the 5.1 days of MS observed. CONCLUSIONS: The common construction of standards of mean stay per disease demonstrates an important proportion of unnecessary use of hospitalization, the correction of which would allow a reduction in the mean costs of the process without a reduction in the quality of care.

[Prospective payment per case and length of stay at coordinated private hospitals]. / Pago prospectivo por caso y duración de la estancia en hospitales privados concertados.

BACKGROUND: In 1991 the Valencian Health Service (SVS) introduced a system of prospective payment per process to reimburse some surgical interventions to coordinated private hospitals which, until then, had invoiced by retrospective payment per hospital stay. The impact of this change on the mean length of stay in seven groups of surgical interventions is evaluated. METHODS: Retrospective analysis of the mean stay of 2025 admissions in private hospitals coordinated under both systems of payment (payment per process 66%, October 91 to February 92; payment by stay 64%, March 91 to February 92) for seven groups of surgical procedures: cataract surgery, cholecystectomy, hernioraphy, prostate resection, tonsillectomy-adenoidectomy, varicose vein and proctologic procedures was carried out. RESULTS: Mean hospital stay decreased (mean = 5.4 days; p < 0.001) in all the groups reimbursed under PRP (from 72% in proctologic conditions to 43% for adenoidectomy-tonsillectomy) avoiding 8727 stays. The coinciding period under both systems demonstrated a decrease of mean hospital stay similar to the total period. CONCLUSIONS: The coordinated hospitals demonstrated a surprisingly rapid capacity to modify their organizative behaviour or influence the styles of clinical practice or both to adopt the patterns of length of stay which optimize profits according to the system of payment used by the SVS.