Impact of multicomponent intervention on hospitalized clinical patient outcomes: A pre-post study in a university hospital.

BACKGROUND AND OBJECTIVE: Hospitalization significantly interferes with the individual's well-being and it occurs both during and after the hospitalization period. Different approaches to minimize morbidity related to hospitalization and the post-discharge period have been proposed, especially to those aimed at reducing readmission rates. The aim of this study is to evaluate the effect of multicomponent intervention (MI) on operational indicators and continuity of care outcomes. MATERIALS AND METHODS: A quasi-experimental study conducted in a Brazilian university hospital in order to compare the impact of the intervention with usual care. The MI was the implementation of multidisciplinary rounds, the inclusion of the role of the navigator nurse, and care transition actions with half of the Internal Medicine teams in a clinical unit of a general hospital. Adult patients hospitalized were included in 2 periods and divided in 3 groups - Group A: before the intervention; Group B: after and with MI; Group C after and without MI. RESULTS: A total of 2333 hospitalizations were evaluated. There was a reduction in the rate of intensive care transfers to intensive care unit (ICU) and in the length of stay (LOS). LOS, discharge before noon, and transfers to ICU improved when comparing before and after the intervention, but were not different in post-intervention groups with and without MI. CONCLUSION: These results reflect the improvement of care provided by MI, an effect that could be due to cross contamination also to teams without the intervention.

Cultura de segurança em unidades de terapia intensiva na perspectiva da equipe multiprofissional: Estudo multicêntrico / Cultura de seguridad en unidades de terapia intensiva en la perspectiva del equipo multiprofesional: Estudio multicéntrico / Safety Culture in intensive care units from multiprofessional team perspective: A multicenter study

Resumo Introdução: A Cultura de Segurança do Paciente é considerada um importante componente estrutural dos serviços, que favorece a implantação de práticas seguras e a diminuição da ocorrência de eventos adversos. Objetivo: Identificar os fatores associados à cultura de segurança do paciente nas unidades de terapia intensiva adulto em hospitais de grande porte da região Sudeste do Brasil. Método: Estudo transversal do tipo survey e multicêntrico. Participaram 168 profissionais de saúde de quatro unidades (A, B, C e D) de terapia intensiva adulto. Foi utilizado o questionário "Hospital Survey on Patient Safety Culture". Considerou-se como variável dependente o nível de cultura de segurança do paciente e variáveis independentes aspectos sociodemográficos e laborais. Foram usadas estatísticas descritivas e para a análise dos fatores associados foi elaborado um modelo de regressão logística múltipla. Resultados: Identificou-se associação entre tipo de hospital com onze dimensões da cultura de segurança, quanto à função a categoria profissional médico, técnico de enfermagem e enfermeiro foram relacionadas com três dimensões; o gênero com duas dimensões e tempo de atuação no setor com uma dimensão. Conclusão: Evidenciou-se que o tipo de hospital, categoria profissional, tempo de atuação no setor e gênero foram associados às dimensões de cultura de segurança do paciente.

Resumen Introducción: La cultura de seguridad del paciente se considera un componente estructural importante de los servicios, que favorece la aplicación de prácticas seguras y la reducción de la aparición de acontecimientos adversos. Objetivo: Identificar los factores asociados a la cultura de seguridad del paciente en unidades de terapia intensiva adulto en hospitales de la región Sudeste del Brasil. Metodología: Estudio transversal de tipo encuesta y multicéntrico. Participaron 168 profesionales de salud de cuatro unidades (A, B, C y D) de terapia intensiva adulto. Se utilizó el cuestionario "Hospital Survey on Patient Safety Culture". Se consideró como variable dependiente el nivel de cultura de seguridad del paciente y variables independientes los aspectos sociodemográficos y laborales. Fueron usadas estadísticas descriptivas y, para analizar los factores asociados, fue elaborado un modelo de regresión logística múltiple. Resultados: Se identificó asociación entre tipo de hospital con once dimensiones de cultura de seguridad del paciente. En relación a la función, personal médico, técnicos de enfermería y personal de enfermería fueron asociados con tres dimensiones, el género con dos dimensiones y tiempo de actuación con una dimensión en el modelo de regresión. Conclusión: Se evidenció que el tipo de hospital, función, tiempo de actuación en el sector y género fueron asociados a las dimensiones de la cultura de seguridad del paciente.

Abstract Introduction: Patient safety culture is considered an important structural component of the services, which promotes the implementation of safe practices and the reduction of adverse events. Objective: To identify the factors associated with patient safety culture in adult intensive care units in large hospitals in Belo Horizonte. Method: Cross-sectional survey and multicenter study. A total of 168 health professionals from four units (A, B, C and D) of adult intensive care participated. The questionnaire "Hospital Survey on Patient Safety Culture" was used. The patient's level of safety culture was considered as a dependent variable, and sociodemographic and labor aspects were the independent variables. Descriptive statistics were used and a multiple logistic regression model was developed to analyze the associated factors. Results: An association was identified between the type of hospital and eleven dimensions of the safety culture. In terms of function, the doctors, nursing technicians, and nurse were related to three dimensions; gender with two dimensions, and time working in the sector with one dimension. Conclusion: It was evidenced that the type of hospital, function, time working in the sector, and gender were associated with the dimensions of patient safety culture.

Desempenho da atenção primária à saúde no estado de São Paulo, Brasil, no período de 2010-2019 / Performance of primary health care in São Paulo state, Brazil, during the period 2010-2019

Resumo O artigo apresenta uma análise do desempenho da APS no estado de São Paulo na última década, em contexto de crise econômica e retração dos investimentos em saúde. Utilizaram-se indicadores de desempenho, determinantes em saúde e sistema de saúde, em série temporal (2010 a 2019), a partir de matriz conceitual adaptada. Foram calculadas variações percentuais anuais (VPA) de cada indicador em modelo log-linear. Os indicadores de desempenho apresentaram, no geral, evolução favorável; no entanto, ocorreu piora em indicadores relacionados à qualidade do cuidado (sífilis congênita, partos cesáreos e rastreamento de câncer de colo uterino). Verificou-se, ainda, um potencial aumento das demandas ao SUS (envelhecimento da população e redução da cobertura da saúde suplementar) e aumento das despesas em saúde em contexto de redução do PIB per capita.

Abstract This article presents the results of an analysis of the performance of primary health care in São Paulo state over the last decade against a backdrop of financial crisis and health funding cuts. We conducted a time series analysis (2010-2019) of performance indicators across the following dimensions based on an adapted conceptual framework: health service performance, health system, and determinants of health. Annual percentage change was calculated for each indicator using a log-linear model. Performance across the indicators was generally positive; however, there was a decline in performance across indicators of quality of care (congenital syphilis, cesarean section rate and cervical cancer screening). The findings also show a potential rise in demand for public services (due to population aging and a reduction in the percentage of the population with private health insurance) and increase in health expenditure against a backdrop of falling GDP per capita.

Asociación de la salud cardiometabólica de preescolares y sus padres con características nutricionales y sociodemográficas familiares / Association of cardiometabolic health of preschoolers and their parents with family sociodemographic characteristics

Introducción: Existe escaso conocimiento sobre la asociación entre marcadores cardiometabólicos en preescolares con características nutricionales y sociodemográficos familiares. Objetivo: Determinar la asociación entre marcadores cardiometabólicos de preescolares y sus padres con las características nutricionales y sociodemográficas familiares. Materiales y Métodos: Estudio de corte transversal, de asociación y correlación entre variables Padre-Hijo/a de carácter multicéntrico, en el cual participaron 140 sujetos (70 preescolares y su respectivo padre o madre). Las variables fueron estado nutricional, composición corporal, fuerza prensil y presión arterial de padres/madres y sus hijos/as preescolares y variables sociodemográficas de las familias. Resultados: Existió diferencia significativa al 5% respecto de la obesidad de los padres con la de los hijos/as, se presentó correlación positiva (0,397) entre las variables "porcentaje de grasa" padres e hijos/as. En relación al "nivel de escolaridad de la madre" hubo diferencia significativa con el "porcentaje de grasa" de los hijos/as (p<0,011). Existió similarmente diferencia significativa (p=0,033) entre la variable "tener hermanos" respecto a la variable "porcentaje de grasa" de los hijos/as. Finalmente se presentó asociación entre "usa Tablet" (dispositivo audiovisual) y "presión arterial" de los hijos/as (p=0,030). La variable "usa Tablet" se asoció significativamente con la "fuerza prensil" de los hijos/as (p=0,044). Conclusiones: Padres obesos con alto porcentaje de grasa tienen hijos/as preescolares con bajo perfil cardiometabólico; las variables nivel educacional inferior de la madre y tener hermanos se asociaron a un mayor porcentaje de grasa en los hijos/as, conjuntamente el uso de Tablet en preescolares mostró mayores niveles de presión arterial y menor fuerza prensil(AU)

Introduction: Little is known about the association between cardiometabolic markers in preschoolers with family nutritional and socio- demographic characteristics. Objective: To determine the association between cardiometabolic markers in preschoolers and their parents with family nutritional and sociodemographic characteristics. Materials and methods: cross-sectional study of association and correlation between parent-child variables, multicenter, 140 subjects participated (70 preschoolers and their respective parents). The variables were nutritional status, body composition, prehensile strength and blood pressure of parents and their preschool children and sociodemographic variables of the families. Results: There was a significant difference at 5% between parents' obesity and children's obesity, with a positive correlation (0.397) between the variable "percentage of fat" parents/children. In relation to the "mother's level of schooling" there was a significant difference with the "percentage of fat" of the children (p<0.011). Similarly, there was a significant difference (p=0.033) between the variable "Having siblings" with respect to the variable "percentage of fat" of the children. Finally, there was an association between "Tablet use" (audiovisual device) and "blood pressure" of the children (p=0.030). The variable "Tablet use" was significantly associated with the "prehensile strength" of the children (p=0.044). Conclusions: Obese parents with a high percentage of fat have preschool children with a low cardiometabolic profile; the variables lower educational level of the mother and having siblings were associated with a higher percentage of fatness in children; together, the use of Tablet in preschoolers showed higher levels of blood pressure and lower prehensile strength(AU)

Adherence to quality indicators for emergency department treatment of acute poisoning according to patient sex. / Grado de cumplimiento de los indicadores de calidad según el sexo del paciente en las intoxicaciones agudas en urgencias.

OBJECTIVES: To study differences in the emergency department treatment of acute poisoning according to biological sex of patients and to assess adherence to care quality indicators. MATERIAL AND METHODS: Retrospective observational study including all cases of acute poisoning diagnosed in patients over the age of 14 years treated in a tertiary care hospital emergency department over a period of 4 years. We analyzed demographic variables, substance type and reason for acute poisoning, degree of adherence to quality indicators, and discharge destination. RESULTS: A total of 1144 cases were included; 710 patients (62.1%) were female and 434 (37.9%) were male. The proportion of deliberate self-poisoning was higher in females (52.3% vs 41.4% in males; P .001); unintentional poisoning was less frequent in females (in 24.9% vs in 30.3% of males; P = .047). Benzodiazepine poisoning was more frequent in females (in 49.6% vs 41.2%; P = .007). Street drug and alcohol poisoning was less common in females. Adherence to quality indicators was high (> 85%) for both sexes. CONCLUSION: The epidemiologic profile of poisoning is different in females and males. General emergency department adherence to quality indicators can be considered optimal. We detected no qualitative sex-related differences in the care of patients with acute poisoning.

OBJETIVO: Estudiar las diferencias dependiendo del sexo en la atención de pacientes con intoxicaciones agudas en urgencias y en el grado de cumplimiento de los indicadores de calidad (IC). METODO: Estudio observacional y retrospectivo, que incluyó todos los casos de intoxicación aguda de pacientes mayores de 14 años atendidos en el servicio de urgencias de un hospital terciario durante 4 años. Se analizaron variables demográficas, tipo de tóxicos y causa de la intoxicación, el grado de cumplimiento de los IC y destino al alta. RESULTADOS: Se registraron 1.144 casos, un 62,1% (n = 710) eran mujeres. Las mujeres tuvieron mayor número de intoxicaciones voluntarias (52,3% vs 41,4%; p 0,001) y menos de manera accidental (24,9% vs 30,3%; p = 0,047). Los fármacos más frecuentes en mujeres fueron las benzodiacepinas (49,6% vs 41,2%; p = 0,007), y las intoxicaciones por drogas de abuso y alcohol fueron menores que en hombres. Hubo un alto grado de cumplimiento en la mayoría de los IC (> 85%) en ambos sexos. CONCLUSIONES: El perfil epidemiológico de la intoxicación aguda en mujeres es diferente al de los hombres. En general se puede considerar como óptimo el cumplimiento de los IC en urgencias. No existen diferencias cualitativas en la asistencia del paciente intoxicado con respecto a su sexo.

Diseño de un panel de indicadores para programas de optimización del uso de antimicrobianos en los Servicios de Urgencias / Design of a panel of indicators for antibiotic stewardship programs in the Emergency Department

Objetivo: desarrollar un panel de indicadores para monitorizar la actividad de los programas de optimización del uso de antimicrobianos en los servicios de urgencias. Métodos: un grupo multidisciplinar formado por expertos en el manejo de la infección en urgencias y en la implantación de programas de optimización de uso de antimicrobianos (PROA) evaluó una propuesta de indicadores utilizando una metodología Delphi modificada. En una primera ronda, cada uno de los expertos clasificó la relevancia de cada indicador propuesto en 2 dimensiones (repercusión asistencial y facilidad de implantación) y 2 atributos (nivel de priorización y periodicidad de medida). La segunda ronda se realizó a partir del cuestionario modificado de acuerdo con las sugerencias planteadas y nuevos indicadores sugeridos por los participantes. Los expertos efectuaron modificaciones en el orden de priorización y calificaron los nuevos indicadores propuestos de la misma manera que en la primera ronda. Resultados: se propusieron un total de 61 potenciales indicadores divididos en 4 grupos: indicadores de consumo, microbiológicos, de proceso y de resultado. Tras el análisis de las puntuaciones y los comentarios realizados en la primera ronda, 31 indicadores fueron clasificados como de alta prioridad, 25 de prioridad intermedia y 5 de baja prioridad. Además se generaron 19 nuevos indicadores. Tras la segunda ronda, se mantuvieron los 61 indicadores inicialmente propuestos y adicionalmente se incorporaron 18 nuevos: 11 como de alta prioridad, 3 como de intermedia y 4 como de baja prioridad. Conclusiones: los expertos consensuaron un panel de indicadores PROA adaptado a los servicios de urgencias priorizados por nivel de relevancia como un elemento de ayuda para el desarrollo de estos programas, que contribuirá a monitorizar la adecuación del uso de antimicrobianos en estas unidades.(AU)

Objective: To develop a panel of indicators to monitor antimicrobial stewardship programs activity in the emergency department. Methods: A multidisciplinary group consisting of experts in the management of infection in emergency departments and the implementation of antimicrobial stewardship programs (ASP) evaluated a proposal of indicators using a modified Delphi methodology. In the first round, each expert classified the relevance of each proposed indicators in two dimensions (healthcare impact and ease of implementation) and two attributes (prioritization level and frequency). The second round was conducted based on the modified questionnaire according to the suggestions raised and new indicators suggested. Experts modified the prioritization order and rated the new indicators in the same manner as in the first round. Results: 61 potential indicators divided into four groups were proposed: consumption indicators, microbiological indicators, process indicators, and outcome indicators. After analyzing the scores and comments from the first round, 31 indicators were classified as high priority, 25 as intermediate priority, and 5 as low priority. Moreover, 18 new indicators were generated. Following the second round, all 61 initially proposed indicators were retained, and 18 new indicators were incorporated: 11 classified as high priority, 3 as intermediate priority, and 4 as low priority. Conclusions: The experts agreed on a panel of ASP indicators adapted to the emergency services prioritized by level of relevance. This is as a helpful tool for the development of these programs and will contribute to monitoring the appropriateness of the use of antimicrobials in these units.(AU)

Design of a panel of indicators for antibiotic stewardship programs in the Emergency Department / Diseño de un panel de indicadores para programas de optimización del uso de antimicrobianos en los Servicios de Urgencias

Objetivo: desarrollar un panel de indicadores para monitorizar la actividad de los programas de optimización del uso de antimicrobianos en los servicios de urgencias. Métodos: un grupo multidisciplinar formado por expertos en el manejo de la infección en urgencias y en la implantación de programas de optimización de uso de antimicrobianos (PROA) evaluó una propuesta de indicadores utilizando una metodología Delphi modificada. En una primera ronda, cada uno de los expertos clasificó la relevancia de cada indicador propuesto en 2 dimensiones (repercusión asistencial y facilidad de implantación) y 2 atributos (nivel de priorización y periodicidad de medida). La segunda ronda se realizó a partir del cuestionario modificado de acuerdo con las sugerencias planteadas y nuevos indicadores sugeridos por los participantes. Los expertos efectuaron modificaciones en el orden de priorización y calificaron los nuevos indicadores propuestos de la misma manera que en la primera ronda. Resultados: se propusieron un total de 61 potenciales indicadores divididos en 4 grupos: indicadores de consumo, microbiológicos, de proceso y de resultado. Tras el análisis de las puntuaciones y los comentarios realizados en la primera ronda, 31 indicadores fueron clasificados como de alta prioridad, 25 de prioridad intermedia y 5 de baja prioridad. Además se generaron 19 nuevos indicadores. Tras la segunda ronda, se mantuvieron los 61 indicadores inicialmente propuestos y adicionalmente se incorporaron 18 nuevos: 11 como de alta prioridad, 3 como de intermedia y 4 como de baja prioridad. Conclusiones: los expertos consensuaron un panel de indicadores PROA adaptado a los servicios de urgencias priorizados por nivel de relevancia como un elemento de ayuda para el desarrollo de estos programas, que contribuirá a monitorizar la adecuación del uso de antimicrobianos en estas unidades.(AU)

Objective: To develop a panel of indicators to monitor antimicrobial stewardship programs activity in the emergency department. Methods: A multidisciplinary group consisting of experts in the management of infection in emergency departments and the implementation of antimicrobial stewardship programs (ASP) evaluated a proposal of indicators using a modified Delphi methodology. In the first round, each expert classified the relevance of each proposed indicators in two dimensions (healthcare impact and ease of implementation) and two attributes (prioritization level and frequency). The second round was conducted based on the modified questionnaire according to the suggestions raised and new indicators suggested. Experts modified the prioritization order and rated the new indicators in the same manner as in the first round. Results: 61 potential indicators divided into four groups were proposed: consumption indicators, microbiological indicators, process indicators, and outcome indicators. After analyzing the scores and comments from the first round, 31 indicators were classified as high priority, 25 as intermediate priority, and 5 as low priority. Moreover, 18 new indicators were generated. Following the second round, all 61 initially proposed indicators were retained, and 18 new indicators were incorporated: 11 classified as high priority, 3 as intermediate priority, and 4 as low priority. Conclusions: The experts agreed on a panel of ASP indicators adapted to the emergency services prioritized by level of relevance. This is as a helpful tool for the development of these programs and will contribute to monitoring the appropriateness of the use of antimicrobials in these units.(AU)

Grado de cumplimiento de los indicadores de calidad según el sexo del paciente en las intoxicaciones agudas en urgencias / Adherence to quality indicators for emergency department treatment of acute poisoning according to patient sex

Objetivos. Estudiar las diferencias dependiendo del sexo en la atención de pacientes con intoxicaciones agudas en urgencias y en el grado de cumplimiento de los indicadores de calidad (IC). Método. Estudio observacional y retrospectivo, que incluyó todos los casos de intoxicación aguda de pacientes mayores de 14 años atendidos en el servicio de urgencias de un hospital terciario durante 4 años. Se analizaron variables demográficas, tipo de tóxicos y causa de la intoxicación, el grado de cumplimiento de los IC y destino al alta. Resultados. Se registraron 1.144 casos, un 62,1% (n = 710) eran mujeres. Las mujeres tuvieron mayor número de intoxicaciones voluntarias (52,3% vs 41,4%; p < 0,001) y menos de manera accidental (24,9% vs 30,3%; p = 0,047). Los fármacos más frecuentes en mujeres fueron las benzodiacepinas (49,6% vs 41,2%; p = 0,007), y las intoxicaciones por drogas de abuso y alcohol fueron menores que en hombres. Hubo un alto grado de cumplimiento en la mayoría de los IC (> 85%) en ambos sexos. Conclusiones. El perfil epidemiológico de la intoxicación aguda en mujeres es diferente al de los hombres. En general se puede considerar como óptimo el cumplimiento de los IC en urgencias. No existen diferencias cualitativas en la asistencia del paciente intoxicado con respecto a su sexo. (AU)

Objective. To study differences in the emergency department treatment of acute poisoning according to biological sex of patients and to assess adherence to care quality indicators. Methods. Retrospective observational study including all cases of acute poisoning diagnosed in patients over the age of 14 years treated in a tertiary care hospital emergency department over a period of 4 years. We analyzed demographic variables, substance type and reason for acute poisoning, degree of adherence to quality indicators, and discharge destination. Results. A total of 1144 cases were included; 710 patients (62.1%) were female and 434 (37.9%) were male. The proportion of deliberate self-poisoning was higher in females (52.3% vs 41.4% in males; P < .001); unintentional poisoning was less frequent in females (in 24.9% vs in 30.3% of males; P = .047). Benzodiazepine poisoning was more frequent in females (in 49.6% vs 41.2%; P = .007). Street drug and alcohol poisoning was less common in females. Adherence to quality indicators was high (> 85%) for both sexes. Conclusions. The epidemiologic profile of poisoning is different in females and males. General emergency department adherence to quality indicators can be considered optimal. We detected no qualitative sex-related differences in the care of patients with acute poisoning. (AU)

El registro continuado de los efectos adversos mejora los resultados quirúrgicos / Continuous monitoring of adverse effects improves surgical outcomes

Antecedentes: Se ha debatido mucho sobre las ventajas e inconvenientes del uso de bases administrativas o de registros clínicos en los programas de mejora de la atención médica. El objetivo de este estudio ha sido revisar la implementación y los resultados de una política de evaluación continua, mediante un registro mantenido por profesionales de un Servicio de Cirugía. Material y métodos: Se incluyeron, de forma prospectiva, todos los pacientes ingresados en el servicio entre los años 2003 y 2022. Se anotaron todos los efectos adversos (EA) acaecidos durante el ingreso, la estancia en centros de convalecencia o en su domicilio durante un periodo mínimo de 30 días tras el alta. Resultados: De 60.125 registros, en 16.802 (27,9%) se registraron 24.846 EA. Hubo un aumento progresivo del número de EA registrados por ingreso (1,17 en 2003 vs. 1,93 en 2022) con una disminución de 26% de los registros con EA (35% en 2003 hasta 25,8% en 2022), de 57,5% en las reoperaciones (de 8 a 3,4%, respectivamente), y de 80% en la mortalidad (de 1,8 a 1%, respectivamente). Es de remarcar la reducción significativa de los EA graves, observada entre los años 2011 y el 2022 (56 vs. 15,6%). Conclusión: Un registro prospectivo de EA creado y mantenido por profesionales del servicio, junto con la presentación y discusión abierta y trasparente de los resultados, produce una mejora sostenida de los resultados en un servicio quirúrgico de un hospital universitario.(AU)

Background: There has been significant debate about the advantages and disadvantages of using administrative databases or clinical registries in healthcare improvement programs. The aim of this study was to review the implementation and outcomes of an accountability policy through a registry maintained by professionals of the surgical department.Materials and methods: All patients admitted to the department between 2003 and 2022 were prospectively included. All adverse events (AEs) occurring during the admission, convalescent care in facilities, or at home for a minimum period of 30 days after discharge were recorded. Results: Out of 60,125 records, 24,846 AEs were documented in 16,802 cases (27.9%). There was a progressive increase in the number of AEs recorded per admission (1.17 in 2003 vs. 1.93 in 2022) with a 26% decrease in entries with AEs (from 35% in 2003 to 25.8% in 2022), a 57.5% decrease in reoperations (from 8.0% to 3.4%, respectively), and an 80% decrease in mortality (from 1.8% to 1%, respectively). It is noteworthy that a significant reduction in severe AEs was observed between 2011 and 2022 (56% vs. 15.6%). Conclusion: A prospective registry of AEs created and maintained by health professionals, along with transparent presentation and discussion of the results, leads to sustained improvement in outcomes in a surgical department of a university hospital.(AU)

Indicadores de uso del conocimiento científico para la evaluación de las publicaciones científicas seriadas de Ciencias Sociales y Humanísticas

El escenario de las nuevas tecnologías de la información y la comunicación han transformado los modos de evaluar la publicación científica. Variedad instrumentos e indicadores impactan en los procesos de evaluación. El objetivo de este trabajo es ofrecer una valoración de los procedimientos utilizados en base al uso del conocimiento. Se evidencia a necesidad de avanzar en cuanto a indicadores que combinen métricas cuantitativas con las cualitativas que reflejen los procesos de apropiación del conocimiento y el impacto social; denominadas métricas responsables, además de velar por la calidad de la gestión, y de políticas institucionales mesuradas que guían la valoración y evaluación de la actividad científica.

The scenario of new information and communication technologies has transformed the ways of evaluating scientific publication. Variety of instruments and indicators impact the evaluation processes. The objective of this work is to offer an assessment of the procedures used based on the use of knowledge. There is a need to advance in terms of indicators that combine quantitative metrics with qualitative ones that reflect the processes of knowledge appropriation and social impact; called responsible metrics, in addition to ensuring the quality of management, and measured institutional policies that guide the assessment and evaluation of scientific activity.

Propuesta de indicadores para la selección de atletas en poomsae para el alto rendimiento. Validación práctica

La investigación propuesta, en el área de selección de talentos en el alto rendimiento, específicamente en la modalidad de poomsae, en su evento free style, representa un estudio estratégico, pues se encontraron limitaciones en el proceso de selección en dicha modalidad deportiva. Por lo que este trabajo presentó como objetivo evaluar los indicadores técnicos para la selección de atletas con respecto a la modalidad de poomsae en su evento free style. Esta selección se realiza acorde con las exigencias reglamentarias competitivas actuales, aplicadas por la Federación Mundial de este deporte. Se utilizaron métodos de nivel teórico inductivo-deductivo, analítico-sintético, así como histórico y del nivel empírico, la revisión documental y la medición. Se midieron los ángulos de los indicadores propuestos, a través del software biomecánico Kinovea. La técnica estadística utilizada fue el procesador estadístico SPSS 20. Se definieron y evaluaron de forma práctica los indicadores flexibilidad (splits central, lateral izquierdo, lateral derecho) con una media de 10.25 puntos; técnicas de pateo (pateos básicos, mantención, pateos con giro en el aire) con resultados de media de 2.5; 1,9 y 1.87 puntos; saltos acrobáticos (saltos en horcajadas, saltos en splits izquierdo, saltos en splits derecho) y los elementos acrobáticos con resultados de media de 8.69 y 2.21 puntos, para el proceso de selección de las escuelas de iniciación deportiva escolar en la modalidad de poomsae en su evento free style.

A pesquisa proposta, na área de seleção de talentos no alto rendimento, especificamente na modalidade poomsae, em sua prova de estilo livre, representa um estudo estratégico, uma vez que foram encontradas limitações no processo de seleção na referida modalidade esportiva. Portanto, este trabalho apresentou o objetivo de avaliar os indicadores técnicos para seleção de atletas no que diz respeito à modalidade poomsae em sua prova de estilo livre. Esta seleção é feita de acordo com os requisitos regulamentares competitivos em vigor, aplicados pela Federação Mundial desta modalidade. Foram utilizados métodos de nível teórico indutivo-dedutivo, analítico-sintético, bem como de nível histórico e empírico, revisão documental e mensuração. Os ângulos dos indicadores propostos foram medidos através do software biomecânico Kinovea. A técnica estatística utilizada foi o processador estatístico SPSS 20. Os indicadores de flexibilidade (abertura central, lateral esquerda, lateral direita) foram definidos e avaliados de forma prática com média de 10,25 pontos; técnicas de chutes (chutes básicos, segurar, chutes com giro no ar) com resultados médios de 2,5; 1,9 e 1,87 pontos; saltos acrobáticos (saltos de passada, saltos divididos à esquerda, saltos divididos à direita) e elementos acrobáticos com resultados médios de 8,69 e 2,21 pontos, para o processo seletivo das escolas de iniciação esportiva escolar na modalidade poomsae em sua prova de estilo livre.

The proposed research, in the area of talent selection in high performance, specifically in the poomsae modality in its free style event, represents a strategic study, since limitations were found in the selection process in said sporting modality. Therefore, this work presented the objective of evaluating the technical indicators for the selection of athletes with respect to the poomsae modality in its free style event. This selection is made in accordance with the current competitive regulatory requirements, applied by the World Federation of this sport. Theoretical level methods like inductive-deductive, analytical-synthetic and historical were used and from the empirical level, documentary review and measurement, and the angles of the proposed indicators were measured through the Kinovea biomechanical software. The statistical technique used was the SPSS 20 statistical processor. There were defined and evaluated in a practical way the indicators of flexibility (central, left lateral, right lateral splits ) with an average of 10.25 points; kicking techniques (basic kicks, holding, kicks with spin in the air) with average results of 2.5; 1.9 and 1.87 points; acrobatic jumps (stride jumps, left split jumps , right split jumps ) and acrobatic elements with average results of 8.69 and 2.21 points, for the selection process of school sports initiation schools in the poomsae modality in their free style event .

El diagnóstico pedagógico personalizado del luchador, en la etapa de perfeccionamiento básico

Conocer las manifestaciones del comportamiento del luchador en la etapa inicial de ejecución del entrenamiento deportivo permite caracterizar, proyectar y controlar el proceso, con una dirección científica. Por ello la presente investigación plantea como objetivo proponer indicadores para el diagnóstico pedagógico personalizado del luchador, en la etapa de perfeccionamiento básico y lograr la efectividad en la formación integral de su personalidad. Ante la situación presentada se realizaron observaciones al comportamiento de los luchadores en el ambiente familiar, escolar, social y deportivo; además de encuestas y entrevistas que permitieron caracterizar el proceso investigado y pronosticar los posibles resultados, para luego desarrollar una eficiente intervención formativa. Las conclusiones derivadas del estudio y análisis de los resultados evidenciaron que los indicadores de diagnóstico pedagógico personalizado del luchador, en la etapa de perfeccionamiento básico contribuyeron con efectividad, en la formación integral de su personalidad.

Conhecer as manifestações do comportamento do lutador na etapa inicial do treinamento esportivo permite caracterizar, projetar e controlar o processo, com uma direção científica. Por essa razão, o objetivo desta pesquisa é propor indicadores para o diagnóstico pedagógico personalizado do lutador, na etapa de aperfeiçoamento básico, e alcançar a eficácia na formação integral de sua personalidade. Diante da situação apresentada, foram feitas observações do comportamento dos lutadores no ambiente familiar, escolar, social e esportivo; além de pesquisas e entrevistas que permitiram caracterizar o processo investigado e prever os possíveis resultados, para então desenvolver uma intervenção formativa eficiente. As conclusões derivadas do estudo e da análise dos resultados mostraram que os indicadores do diagnóstico pedagógico personalizado do lutador, na etapa de aperfeiçoamento básico, contribuíram efetivamente para a formação integral de sua personalidade.

Knowing the manifestations of the wrestler's behavior in the initial stage of sports training execution allows to characterize, project and control the process, with a scientific direction. Therefore, the objective of this research is to propose indicators for the personalized pedagogical diagnosis of the wrestlers, in the basic improvement stage and to achieve effectiveness in the comprehensive formation of his personality. Given the situation presented, observations were made of the behavior of the wrestlers in the family, school, social and sports environment; in addition to surveys and interviews that allowed to characterize the investigated process and predict possible results, to then develop an efficient training intervention. The conclusions derived from the study and analysis of the results showed that the personalized pedagogical diagnosis indicators of the wrestler, in the basic improvement stage, contributed effectively to the comprehensive formation of his personality.

La pandemia COVID-19 y la administración de la salud: el caso de la región Puno / The COVID-19 pandemic and health administration: the case of the Puno Regione / A pandemia de COVID-19 e a administração da saúde: o caso da região de Puno

El objetivo de la investigación fue analizar el impacto de la pandemia del COVID-19 en la administración de los servicios de salud y en la atención al paciente, caso de la región Puno, reflejados en los indicadores del sistema de gestión de calidad en cuanto al manejo de recursos desde los distintos puntos o pilares elementales dentro de la administración de salud. Materiales y métodos. se amparó bajo una investigación documental observacional con diseño de análisis descriptivo. La muestra proviene de un análisis que se llevó a cabo en 31 indicadores de actividad (IA) pertenecientes a 7 áreas del Servicio. En su mayoría, estos indicadores experimentaron un aumento tanto en marzo (20%) como en abril (25%). Conclusiones: indican que se observó un incremento en los ensayos clínicos relacionados con el tratamiento del SAR-Cov-2, los cuales abarcaron las unidades de cuidados intensivos (UCI) y las salas de urgencias (SU). Esto incluyó la dispensación de dosis individuales y el inicio y preparación de las salas de urgencias.

The objective of the research was to analyze the impact of the COVID-19 pandemic on the administration of health services and patient care, in the case of the Puno region, as reflected in the indicators of the quality management system in terms of resource management from the different points or elemental pillars within the health administration. Materials and methods. was based on an observational documentary research with a descriptive analysis design. The sample comes from an analysis carried out on 31 activity indicators (AI) belonging to 7 areas of the Service. Most of these indicators experienced an increase in both March (20%) and April (25%). Conclusions indicate that an increase was observed in clinical trials related to SAR-Cov-2 treatment, which spanned intensive care units (ICU) and emergency rooms (ED). This included single-dose dispensing and ED initiation and preparation.

O objetivo da investigação foi analisar o impacto da pandemia da COVID-19 na administração dos serviços de saúde e na assistência aos doentes na região de Puno, tal como se reflecte nos indicadores do sistema de gestão da qualidade em termos de gestão de recursos a partir dos diferentes pontos ou pilares básicos da administração da saúde. Materiais e métodos. baseou-se numa investigação documental observacional com um desenho de análise descritiva. A amostra provém de uma análise efectuada sobre 31 indicadores de atividade (IA) pertencentes a 7 áreas do Serviço. A maioria destes indicadores registou um aumento tanto em março (20%) como em abril (25%). Conclusões. indicam que houve um aumento dos ensaios clínicos relacionados com o tratamento do SAR-Cov-2, que abrangeu as unidades de cuidados intensivos (UCI) e os serviços de urgência (SU). Isto incluiu a distribuição de doses únicas e a iniciação e preparação de EDs.

Evaluación del manejo y seguimiento de los pacientes diabéticos en la prevención de la retinopatía diabética / Evaluation of the management and follow-up of diabetic patients in the prevention of diabetic retinopathy

Fundamentos: La diabetes mellitus es una enfermedad crónica con alta morbimortalidad que afecta a 537 millones de adultos en el mundo. España es el segundo país europeo en prevalencia, con un 14,8% en población de veinte-setenta y nueve años, con 11,6 casos por cada 1.000 personas/año. La retinopatía diabética (RD) es la quinta causa de pérdida de visión a nivel mundial y la séptima causa de ceguera/discapacidad visual entre afiliados a la Organización Nacional de Ciegos de España (ONCE). La detección precoz de RD previene la ceguera en diabéticos y está condicionada por la hemoglobina glicosilada. El objetivo de este trabajo fue analizar el manejo de los pacientes diabéticos en la comarca del Aljarafe (Sevilla) e identificar oportunidades de mejora en la coordinación de su seguimiento entre el médico de Atención Primaria y el médico oftalmólogo. Métodos: Se realizó un estudio observacional retrospectivo (2016-2019) con los pacientes registrados en el censo de diabéticos de los veintiocho municipios del Aljarafe. Se consultó la historia de salud de Atención Primaria y Hospital, así como el programa de Telemedicina. En cuanto al análisis estadístico, para variables cualitativas se calcularon totales y porcentajes; para variables cuantitativas, media y distribución estándar (si distribución normal), y la mediana y cuartiles (distribución no normal). Resultados: Se registraron 17.175 diabéticos en el Aljarafe (5,7% de población); 14.440 pacientes (84,1%) tenían alguna determinación de hemoglobina durante el periodo, 9.228 (63,9%) las tenían todas en rango adecuado. Tenían control fundoscópico 12.040 diabéticos (70,1%), y de los que no, 346 (10,6%) tenían todas fuera de rango. Hubo 1.878 (10,9%) pacientes sin control fundoscópico ni metabólico, 1.019 (54,3%) eran mujeres, 1.219 (64,9%) menores de sesenta y cinco años, 1.019 (54,3%) con comorbilidad grave...(AU)

Background: Diabetes mellitus is a chronic disease with high morbidity and mortality, affecting 537 million adults worldwide. Spain is the second European country in prevalence, with 14.8% in the population aged twenty/seventy-nine years; with 11.6 cases per 1,000 people/year. Diabetic retinopathy (DR) is the fifth cause of vision loss worldwide and the seventh cause of blindness/visual impairment among members of the National Organization of the Blind in Spain (ONCE). Early detection of DR prevents blindness in diabetics and is conditioned by glycosylated hemoglobin. The aim of this paper was to analyze the management of diabetic patients in Aljarafe region (Seville) and identify opportunities for improvement in the coordination of their follow-up between the Primary Care physician and the ophthalmologist. Methods: A retrospective observational study (2016-2019) was carried out, with patients registered in the diabetic census of the twenty-eight municipalities of Aljarafe. The primary care and hospital health history, and telemedicine program were consulted. About statistical analysis, for qualitative variables, totals and percentages were calculated; for quantitative variables, mean and standard devia-tion (if normally distributed) and median and quartiles (if non-normally distributed). RESULTS // There were 17,175 diabetics registered in Aljarafe (5.7% of the population); 14,440 patients (84.1%) had some determi-nation of hemoglobin during the period, 9,228 (63.9%) had all of them in the appropriate range. Fundoscopic control was performed on 12,040 diabetics (70.1%), and of those who did not, 346 (10.6%) had all of them out of range. There were 1,878 (10.9%) patients without fundoscopic or metabolic control, 1,019 (54.3%) were women, 1,219 (64.9%) were under sixty-five years of age, 1,019 (54.3%) had severe comorbidity...(AU)

[Quality of health information in Mexico in the OECD context: 2017-2021]. / Calidad de la información en salud de México en el contexto de la OCDE: 2017-2021.

OBJECTIVE: To evaluate the health information system (HIS) of Mexico according to the information reported to the Organization for Economic Co-operation and Development (OECD). The ultimate goal is to identify the improvements that should be considered. METHOD: Health indicators published by the OECD (2017 to 2021) are analyzed according to 11 thematic groups. Coverage (quantity and type of indicators reported by thematic group) and quality of information were assessed, according to OECD guidelines. RESULTS: Mexico reported annually 14 of 378 indicators (3.7%), and discontinuously 204. In no group were all indicators reported annually, except for the two on COVID-19. Three out of 88 were reported annually on use of services; and none on health status, quality of care and pharmaceutical market. Twelve indicators (5.5% of those reported by Mexico, 3.2% of the full OECD set) had optimal quality and annual reporting. 57.7% of the reported indicators had at least one quality defect. CONCLUSIONS: Within the framework of the standards set by the OECD, of which Mexico is a member, the Mexican HIS presents significant deficits in coverage and quality of information. These results should be considered to implement improvement initiatives.

Variations in the Financing of Primary Health Care in Bahia: An analysis of the Previne Brasil Program / Variações no Financiamento da Atenção Primária à Saúde na Bahia: Uma análise sobre o Programa Previne Brasil

The Previne Brasil Program was created as a new financing model for Primary Care. It is a mixed method that involves weighted funding, payment for performance and incentives for strategic actions. This study aims to identify and analyze variations in financial transfers in Primary Health Care, imposed by the Previne Brasil Program, in selected municipalities in Bahia. This is a case study with a quantitative approach, divided into three stages: a) selection of three municipalities with the best and three municipalities with the worst averages of the Final Synthetic Indicator, between 2020 and 2022, from each Regional Health Center from Bahia; b) a database was created with the financial transfers of these selected municipalities, between the years 2017 and 2022; c) analysis of financial losses and gains. The results showed that the Previne Brasil Program emerged with difficult operationalization, requiring the publication of flexible ordinances to mitigate its negative effects. In Bahia, municipalities with a smaller population achieved better results in performance indicators and cities with high coverage of the Family Health Strategy expanded their budgets. In short, there was an increase in financial transfers to most municipalities in Bahia, but Previne Brasil was not able to solve the historical problem of underfunding. Therefore, it is necessary to review the Primary Health Care financing program and increase its proportion of resources in relation to medium and high complexity.

O Programa Previne Brasil foi criado como um novo modelo de financiamento da Atenção Básica. É um método misto que envolve a captação ponderada, o pagamento por desempenho e o incentivo para as ações estratégicas. Este estudo tem o objetivo identificar e analisar as variações dos repasses financeiros na Atenção Primária à Saúde, impostas pelo Programa Previne Brasil, em municípios selecionados da Bahia. Trata-se de um estudo de caso com uma abordagem quantitativa, dividida em três etapas: a) seleção de três municípios com as melhores e três municípios com as piores médias do Indicador Sintético Final, entre 2020 e 2022, de cada Núcleo Regional de Saúde da Bahia; b) foi elaborado um banco de dados com os repasses financeiros desses municípios selecionados, entre os anos de 2017 a 2022; c) análise das perdas e ganhos financeiros. Os resultados evidenciaram que o Programa Previne Brasil surgiu com uma difícil operacionalização, demandando que fossem publicadas portarias de flexibilizações para amenizar seus efeitos negativos. Na Bahia, os municípios com menor população conseguiram melhores resultados nos indicadores de desempenho e as cidades com uma alta cobertura da Estratégia de Saúde da Família ampliaram seus orçamentos. Em suma, houve aumento no repasse financeiro para a maioria dos municípios baianos, mas o Previne Brasil não foi resolutivo no problema histórico do subfinanciamento. Portanto, é necessário rever o Programa de financiamento da Atenção Primária à Saúde e aumentar sua proporção de recursos em relação à média e alta complexidade.

The comfort perception in the critically ill patient from the Kolcaba theoretical model.

BACKGROUND: The stay in a critical care unit (CCU) has a serious impact on physical condition causing numerous discomfort factors such as pain or difficulty in communicating. All of these are associated with possible sequelae following discharge from the Intensive Care Unit (ICU) named post-ICU syndrome. The Kolcaba Comfort Theory allows, from a holistic approach, to identify care needs from the patient's perspective using instruments such as the General Comfort Questionnaire (GCQ). OBJECTIVES: To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors. METHODS: Cross-sectional descriptive observational prospective study. POPULATION: 580 patients admitted to adult CCU of two high complexity hospitals from June 2015 to March 2020 with stay ≥24 h were interviewed. Descriptive analysis, Student's t-test and ANOVA and multivariate analysis were performed using SPSS v26 and STATA v16. RESULTS: The mean age was 52,62 (16,21), 357 (61,6%) were male and 434 (74,8%) were believers. The type of admission was planned in 322 (55,5%) and the most prevalent reason for admission was surgical 486 (83,8%). The median pain score (NRS) was 3,00 [0-4] and severity score (APACHE II) was 13,26 (5,89), the median length of stay was 4,00 [2-7] days. The mean comfort level was 3,02 (0,31) showing the highest value Reanimation 3.02 (0.30) and the lowest Trauma and Emergency Unit 2.95 (0.38). Statistically significant differences were found between the units in the comfort level of patients >65 years of age (p = 0.029). The Relief comfort type obtained the lowest mean 2.81 (0.33) and the physical context 2.75 (0.41) in the three units. In the multivariate analysis, statistically significant differences were found between the comfort level and the pain level: no pain (p = 0,000) OR 4,361 CI [2,184-8,707], mild pain (p = 0,000) OR 4,007 CI [2,068-7,763], moderate pain (p = 0,007) OR 2,803 CI [1,328-5,913], and the APACHE II score equal to or greater than 10 (p = 0,000) OR 0,472 CI [0,316-0,705]. CONCLUSIONS: The comfort level showed high scores in all three units. The physical and environmental contexts and the relief comfort type negatively affected the perception of comfort. The variables that explained comfort were pain and severity of illness. The evaluation of comfort from the patient's perspective through the GCQ could be considered an indicator of quality of nursing interventions.

Continuous monitoring of adverse effects improves surgical outcomes.

BACKGROUND: There has been significant debate about the advantages and disadvantages of using administrative databases or clinical registry in healthcare improvement programs. The aim of this study was to review the implementation and outcomes of an accountability policy through a registry maintained by professionals of the surgical department. MATERIALS AND METHODS: All patients admitted to the department between 2003 and 2022 were prospectively included. All adverse events (AEs) occurring during the admission, convalescent care in facilities, or at home for a minimum period of 30 days after discharge were recorded. RESULTS: Out of 60,125 records, 24,846 AEs were documented in 16,802 cases (27.9%). There was a progressive increase in the number of AEs recorded per admission (1.17 in 2003 vs. 1.93 in 2022) with a 26% decrease in entries with AEs (from 35.0% in 2003 to 25.8% in 2022), a 57.5% decrease in reoperations (from 8.0% to 3.4%, respectively), and an 80% decrease in mortality (from 1.8% to 1.0%, respectively). It is noteworthy that a significant reduction in severe AEs was observed between 2011 and 2022 (56% vs. 15.6%). CONCLUSION: A prospective registry of AEs created and maintained by health professionals, along with transparent presentation and discussion of the results, leads to sustained improvement in outcomes in a surgical department of a university hospital.

Indicadores antropométricos como predictores de la masa libre de grasa en basquetbolistas universitarios 3 x 3 / Anthropometric indicators as predictors of fat-free mass in college 3-on-3 basketball players

Introducción: En varios de los deportes la composicióncorporal (CC) es una característica importante que se evalúaperiódicamente en los atletas, al ser considerada un indicadorimportante de la condición física. Objetivo: Identificar los índices antropométricos que permiten predecir la masa libre de grasa (MLG) en seleccionados universitarios de basquetbol 3x3 pertenecientes a Federación Internacional del Deporte Universitario (FISU). Metodología: Se diseñó un estudio descriptivo transversal en jóvenes basquetbolistas de 5 selecciones universitarias pertenecientes a la FISU (Argentina, Brasil, Chile, Colombia, Costa Rica, El Salvador, México y Perú). Participaron de formavoluntaria 46 basquetbolista (24 hombres y 22 mujeres) conun rango de edad de 18 a 23 años. Se evaluó el peso, la es-tatura y la MLG por biompedancia eléctrica. Se calculó el índice de masa corporal (IMC), índice tri-ponderal (IPT), y elárea de superficie corporal (ASC). Resultados: El promedio de edad de los hombres fue21.1±1.9 años y de mujeres 21.3±2.0 años. El poder de ex-plicación entre MLG con el ASC en ambos sexos fueron elevados (hombres R2= 79%, y en mujeres 80<%). El IMC y elITP mostraron valores inferiores que oscilaron desde R2=0.07 hasta R2= 36%). Lolos mejores ajustes del RMSE fueronpara el ASC y en ambos sexos (RMSE= 3,2 hasta 4,3). Conclusión: Los resultados del estudio han evidenciado que el ASC es el mejor predictor de la MLG en relación al IMCe ITP. Estos hallazgos sugieren el uso del ASC para estimar la MLG en jóvenes basquetbolistas 3x3 de ambos sexos.(AU)

Introduction: In several sports, body composition (BC) isan important characteristic that is periodically evaluated inathletes, as it is considered an important indicator of physicalcondition.Objective: To identify the anthropometric indices thatallow predicting fat-free mass (FFM) in selected university 3x3basketball players belonging to the International University Sports Federation (FISU). Methodology: A descriptive cross-sectional study was de-signed in young basketball players from 5 university teamsbelonging to FISU (Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Mexico and Peru). Forty-six basketball pla-yers (24 males and 22 females) with an age range of 18 to 23 years participated voluntarily. Weight, height and FFM wereevaluated by electrical bioimpedance. Body mass index (BMI),tri-ponderal index (TPI), and body surface area (BSA) werecalculated. Results: The mean age of males was 21.1±1.9 years andof females 21.3±2.0 years. The explanatory power betweenFFM with BSA in both sexes were high (males R2= 79%, andin women 80<%). BMI and TPI showed lower values rangingfrom R2= 0.07 to R2= 36%). The best fits of the RMSE werefor BSA and in both sexes (RMSE= 3.2 to 4.3). Conclusion: The results of the study have shown that ASCis the best predictor of FFM in relation to BMI and TPI. Thesefindings suggest the use of BSA to estimate the FFM in young3x3 basketball players of both sexes.(AU)

Quality indicators for the diagnosis and treatment of breast cancer integrated assistance: A critical appraisal / Indicadores de calidad para el diagnóstico y tratamiento del cáncer de mama en el proceso asistencial integrado de cáncer de mama

Introduction Quality indicators (QIs) are essential for adequate control of the health care management process, recognizing areas of improvement and providing solutions. We aimed to evaluate the Integrated Breast Cancer (BC) Care Process QIs. Methods We studied 487 consecutive BC cases diagnosed from November 1st, 2013, to November 30th, 2019, in a Spanish healthcare area, and we estimated the associated QIs. Results Four indicators did not meet the standards and were analysed based on related sociodemographic and clinical variables. The surgical delay after a multidisciplinary team discussion (mean 64%, IQR 59.6–68.5) was lower in elder people (p=0.027), and early histological grades (p=0.019) and stages (p=0.008). The adjuvant treatment delay (mean 55.7%, IQR 51.1–60.3) was lower in advance stages (p=0.002) and when there was no reoperation (p=0.001). The surgical delay after inclusion (mean 83.2%, IQR 79.3–87.2) was lower in early histological grades (p=0.048). The immediate reconstruction (mean 42.3%, IQR 34.0–50.5) reached 72.3% in young women compared to 11.8% in older than 70 years (p=0.001) and it was higher in early stages (45.3% vs 36.2%; p=0.049). Conclusion The study of QIs evaluated their compliance and analysed the variables influencing them to propose improvement measures. Not all the indicators were equally valuable. Some depended on the available resources, and others on the mix of patients or complementary treatments. It would be essential to identify the specific target populations to estimate the indicators or provide standards stratified by the related variables (AU)

Introducción Los indicadores de calidad (IC) son esenciales para el adecuado control del proceso asistencial en el sistema sanitario, permitiendo el reconocimiento de áreas de mejora y proporcionando soluciones. Nuestro propósito ha sido evaluar los IC en el proceso asistencial integrado cáncer de mama (CM). Métodos Se estudiaron 487 casos consecutivos de CM diagnosticados desde noviembre de 2013 hasta 2019 en un área sanitaria de España y se estimaron los IC asociados. Resultados Cuatro indicadores no cumplieron los estándares de calidad y fueron analizados en función de las variables sociodemográficas posiblemente relacionadas. El retraso quirúrgico tras el comité multidisciplinar (media 64%, rango intercuartílico [IQR] 59,6-68,5) fue menor en pacientes más mayores (p=0,027), y en grados histológicos (p=0,019) y estadios (p=0,008) más tempranos. El retraso en el tratamiento adyuvante (media 55,7%, IQR 51,1-60,3) fue menor en estadios más avanzados (p=0,002) y cuando no hubo necesidad de rescisión (p=0,001). El retraso quirúrgico tras la inclusión en lista de espera (media 83,2%, IQR 79,3-87,2) fue menor en grados histológicos más tempranos (p=0,048). La reconstrucción inmediata (media 42,3%, IQR 34,0-50,5) se realizó en un 72,3% de las mujeres jóvenes comparado con tan solo un 11,8% de las mayores de 70 años (p=0,001) y fue mayor en estadios tempranos (45,3% vs. 36,2%; p=0,049). Conclusión El estudio de los IC evaluó su cumplimiento y analizó las variables que los influencian para proponer medidas que los mejoren. No todos los indicadores pudieron evaluarse de igual forma. Algunos dependieron de los recursos disponibles, otros del tipo de paciente y otros de los tratamientos complementarios. Sería necesario identificar las poblaciones diana para estimar los IC más adecuados o proporcionar estándares estratificados por las variables relacionadas (AU)