[Practical considerations for implementing health outcomes measurement projects within a healthcare organization: Delphi Expert Consensus Study]. / Consideraciones prácticas para la implementación de proyectos de medición de resultados en salud en una organización sanitaria: Estudio Delphi de consenso de expertos.

INTRODUCTION: Measuring health outcomes and costs per patient is an essential element of value-based healthcare (VBHC). The aim of the study was to generate expert consensus on the activities required to implement it. METHODS: A two-round modified Delphi study with healthcare professionals, quality and clinical management methodologists and managers with academic and/or practical experience in outcome measurement projects. A median equal to or greater than 4 and a relative interquartile range (RIQR) equal to or greater than 25% were established as consensus criteria. RESULTS: Consensus was obtained on 91% of the items (N=74/81). In terms of feasibility, the items that received the highest score and consensus were the existence of data protection guarantees (median=5; mean=4.8; RIQR=0%), the vision and motivation of healthcare professionals (median=5; mean=4.7; RIQR=20%), the existence and availability of ICT tools (or systems) for data recording (median=5; mean=4.5; RIQR=20%), and having sufficient funding to undertake the project (median=5; mean=4.2; RIQR=20%). The most highly rated factors adding complexity were the number of units or departments involved in the care process for the clinical condition (median=5; mean=4.4; RIQR=20%), having an accepted set of monitoring indicators for the condition (median=5; mean=4.4; RIQR=20%), and the involvement of several levels of care in the project (median=5; mean=4.3; RIQR=20%). CONCLUSIONS: We describe practical aspects for the application of systematic outcomes measurement in routine clinical practice. These results can serve as a tool for prioritising, sizing, resource planning, and estimating implementation costs.

[Opinions on the organisation of health care in strokes. A survey among hospital medical directors in Spain]. / Opinión sobre la organización asistencial en el ictus. Encuesta a directores médicos hospitalarios en España.

INTRODUCTION: Therapy to treat strokes has changed dramatically. Around 70 years ago, it could not be treated and today it is a medical emergency. Awareness of this change has still not reached many layers of the medical or health care professions or of society itself. AIM: To use a survey to evaluate the attitudes of medical directors and hospital specialists towards the problems involved in the inpatient care of stroke patients. Materials and methods. A survey was carried out by means of a pilot study in hospitals in Madrid with specific sub-surveys for medical managers in charge of neurology departments, neurosurgery services and stroke units. These surveys were sent out to 108 acute care hospitals with over 250 beds in 2003-2004. RESULTS: Only the results of the survey administered by medical directors are analysed. Finally, 52 surveys were obtained from 108 hospitals. Information was collected about several aspects of stroke patients, including care in hospital emergency department, admission to hospital, rehabilitation treatment and staffing in stroke units. Care of stroke patients was given a significantly more positive score (better stroke care) by medical directors than by hospital neurologists. CONCLUSIONS: The survey revealed a great care burden from stroke in hospital emergency departments and from hospital admissions, deficits in neurological duty services and in the capacity to perform fibrinolysis and, above all, in stroke units. The data obtained show that medical directors should improve their attitudes with regard to the care of stroke patients.

Opinión sobre la organización asistencial en el ictus. Encuesta a directores médicos hospitalarios en España / Opinions on the organisation of health care in strokes. A survey among hospital medical directors in Spain

Introducción. La terapia del ictus ha cambiado dramáticamente. Hace 70 años no tenía tratamiento y, en la actualidad, es una urgencia médica. La conciencia de este cambio no ha llegado a muchos estamentos médicos o sanitarios ni a la sociedad. Objetivo. Evaluar las actitudes, mediante encuesta, de directores médicos y de especialistas médicos hospitalarios hacia la problemática asistencial hospitalaria del paciente con ictus. Materiales y métodos. Se desarrolló una encuesta por medio de un estudio piloto en hospitales de Madrid con subencuestas específicas para directores médicos, responsables de los servicios de neurología, neurocirugía y de las unidades de ictus. Se remitieron estas encuestas a 108 hospitales de enfermos agudos mayores de 250 camas en 2003-2004. Resultados. Sólo se analizan los resultados de la encuesta a los directores médicos. Se obtuvieron 52 encuestas de 108 hospitales. Se obtuvo información sobre varios aspectos de los pacientes con ictus: atención en la urgencia hospitalaria, ingreso en el hospital, tratamiento de rehabilitación y dotación de unidades ictus. La atención al paciente con ictus mereció una valoración por parte de los directores médicos significativamente más positiva (mejor atención al ictus) que por parte de los neurólogos hospitalarios. Conclusiones. La encuesta mostró gran carga asistencial de ictus en urgencias hospitalarias y de ingresos hospitalarios, déficit de guardias neurológicas y de capacidad para la realización de fibrinólisis y, sobre todo, de unidades de ictus. Los datos obtenidos indican que los directores médicos deberían mejorar sus actitudes sobre la asistencia al paciente con ictus (AU)

Introduction. Therapy to treat strokes has changed dramatically. Around 70 years ago, it could not be treated and today it is a medical emergency. Awareness of this change has still not reached many layers of the medical or health care professions or of society itself. Aim. To use a survey to evaluate the attitudes of medical directors and hospital specialists towards the problems involved in the inpatient care of stroke patients. Materials and methods. A survey was carried out by means of a pilot study in hospitals in Madrid with specific sub-surveys for medical managers in charge of neurology departments, neurosurgery services and stroke units. These surveys were sent out to 108 acute care hospitals with over 250 beds in 2003-2004. Results. Only the results of the survey administered by medical directors are analysed. Finally, 52 surveys were obtained from 108 hospitals. Information was collected about several aspects of stroke patients, including care in hospital emergency department, admission to hospital, rehabilitation treatment and staffing in stroke units. Care of stroke patients was given a significantly more positive score (better stroke care) by medical directors than by hospital neurologists. Conclusions. The survey revealed a great care burden from stroke in hospital emergency departments and from hospital admissions, deficits in neurological duty services and in the capacity to perform fibrinolysis and, above all, in stroke units. The data obtained show that medical directors should improve their attitudes with regard to the care of stroke patients (AU)

[An analysis of complaints received in a Neurology Service]. / Análisis de reclamaciones en un servicio de neurología.

AIMS: To determine the number of complaints received by the Neurology Service in one year, to carry out a qualitative analysis, and to examine how they are dealt with in order to provide patients with a solution. MATERIALS AND METHODS: The work involved a retrospective study of the complaints from patients in the Neurology Service throughout the year 2004, using the information provided by the Patient Advice and Liaison Service. The following quality indicators were used to evaluate how these claims were managed: the percentage of complaints that were attended in less than 30 days after being received and the percentage of complaints that were resolved. RESULTS: Throughout the period under study a total of 183 complaints were received: 1/478 hospital admissions (0.21%), 71/43,841 medical visits (0.16%), 110/5,522 neurophysiological studies (2%) and 3 due to other reasons. It was found that 90.2% of all complaints had to do with waiting lists, 3.3% were related to dealings with staff and the rest were due to other causes. 86.3% of the complaints were resolved, 10.2% were dismissed and the others were passed on or shelved. 77.5% of the claims were attended within 30 days (quality parameter), the mean delay being 21.3 days (standard deviation: 11.3). CONCLUSIONS: Our rate of complaints is low, although improvements must be introduced both quantitatively and in their management. Practically no data has been published to date concerning these aspects of clinical management in neurology services.

Gestión de la calidad de un servicio de cirugía general / Quality management in a general surgery service

La gestión adecuada de la calidad permite a los servicios sanitarios y unidades planificar, controlar y mejorar sus actividades asistenciales. Faculta, por tanto, a los profesionales para la mejora continua de sus procesos clínicos. En los distintos servicios quirúrgicos que conforman nuestro entorno existe un interés variable por la gestión de la calidad. Desde unos servicios en los que el único control existente se limita a la realización de sesiones clínicas y el análisis no sistemático de la información externa recibida sobre actividad, rendimiento de quirófano y consumo de estancias, hasta otros con mayor preocupación por la calidad en los que se han implantado protocolos, "vías clínicas" (clinical pathways), se realizan evaluaciones periódicas sobre temas clave (infección, mortalidad, etc.), se monitorizan y analizan indicadores relevantes y se recoge la opinión del paciente. Sin embargo, se precisa poner en práctica un sistema que permita la planificación y el desarrollo estructurados, según los criterios de la calidad total. En la actualidad existen motivos determinantes para que los servicios asuman esta forma de trabajar, como son: la variabilidad en el funcionamiento y en los resultados no justificada científicamente, la tendencia evidente hacia la competitividad entre unidades clínicas, las exigencias cada vez mayores de los usuarios y de las autoridades sanitarias, sin olvidar lo que debería ser el motivo principal: la propia ética profesional que nos orienta a ofrecer lo mejor a nuestros pacientes. Todos estos aspectos llevan a la necesidad de organizarse para medir, evaluar y establecer la mejora continua de nuestros procesos quirúrgicos. Los requisitos básicos precisos para llevar a cabo un adecuado programa de calidad son: apoyo comprometido de la dirección del centro y de los mandos de los servicios quirúrgicos, formación básica y asesoramiento en gestión de calidad, participación activa de los profesionales, disponer de información suficiente y fiable acerca de los procesos y fomentar la motivación de los profesionales (reconocimiento, económica, formación, promoción, etc.).Para el desarrollo del programa de calidad se deben cumplir una serie de etapas, que básicamente se podrían resumir en las siguientes: creación de un grupo de gestión de la calidad del servicio, formación de los equipos de mejora de los diferentes procesos, monitorización de indicadores y actividades y autoevaluación del propio programa (AU)