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1.
Med. paliat ; 27(1): 24-43, ene.-mar. 2020. tab
Article in Spanish | IBECS | ID: ibc-194822

ABSTRACT

INTRODUCCIÓN: Existe una necesidad creciente de cuidados paliativos a nivel mundial en parte debido a la mayor prevalencia de enfermedades no transmisibles y al envejecimiento poblacional. La OMS instó a las naciones a trabajar en el desarrollo, fortalecimiento y monitorización de los cuidados paliativos aún insuficientes. En Argentina, en 2014 se desarrolló un panel de 23 indicadores de calidad (10 de Estructura, 12 de Proceso, 1 de Resultado) para evaluar recursos (etapa 1). El objetivo actual fue la aplicación de dicho panel (etapa 2) en las 5 regiones del país, probando su factibilidad para identificar áreas de mejora. MÉTODO: Estudio exploratorio, prospectivo, observacional, de identificación y auditoría, transversal en 6 fases (julio 2016-julio 2018) utilizando el panel desarrollado con estándares preestablecidos. Se realizó el análisis descriptivo por indicador y recurso. RESULTADOS: Fase 1, Censo de 128 recursos; Fase 2, Cartografía y categorización de los recursos en niveles de organización (38 % de respuestas); Fase 3, Capacitación del grupo investigador; Fase 4, Auditoría en terreno. Participaron 22 recursos. Se auditaron 30 historias clínicas de pacientes oncológicos fallecidos y actividades programadas, gestión, docencia, investigación; Fase 5, Análisis: los equipos de nivel 3 alcanzaron y superaron el estándar deseable para 3 indicadores de proceso (identificación del cuidador principal, plan farmacoterapéutico y emergencias); Fase 6, Interpretación y comunicación de las áreas de mejora. CONCLUSIONES: La aplicación del panel de indicadores fue factible y se lograron identificar áreas de mejora. Un sistema de monitorización de la calidad promovería estándares asistenciales y facilitaría la planificación de acciones de capacitación y fortalecimiento institucional en Argentina


INTRODUCTION: There is a growing need for palliative care worldwide, due to a higher prevalence of non-communicable diseases and the aging of the population. The WHO urged nations to work on palliative care development, strengthening, and monitoring, which remain inadequate as of today. In 2014 a 23-quality indicator panel (10 for structure, 12 for process, 1 for outcome) was developed in Argentina to evaluate resources (stage 1). Our objective was to use this panel (stage 2) in 5 country regions to test its viability and to identify areas for improvement. METHOD: An exploratory, prospective, cross-sectional, observational study for identification and audit purposes along 6 phases (July 2016-July 2018) using the developed panel with preset standards. A descriptive analysis by indicator and resource was carried out. RESULTS: Phase 1: Census of 128 palliative care resources; Phase 2: Mapping and categorization of resources in levels of organization (38 % of answers); Phase 3: Group training; Phase 4: On-site audit. 22 resources participated. The medical records of 30 deceased patients, as well as scheduled management, teaching, and research activities were audited; Phase 5: Analysis: level-3 teams reached and even surpassed the desired standards for 3 process indicators (pharmacological plan, main caregiver identification, emergency instructions); Phase 6: Interpretation and communication of areas for improvement. CONCLUSIONS: The implementation of the indicator panel was found to be feasible and areas for improvement were identified. A quality monitoring system would boost up healthcare standards and ease planning for training and institutional strengthening actions in Argentina


Subject(s)
Humans , Indicators of Health Services/methods , Communicable Diseases/epidemiology , Indicators of Health Services/statistics & numerical data , Prospective Studies , Cross-Sectional Studies , Management Audit/statistics & numerical data , Surveys and Questionnaires , Decision Making , Argentina
2.
Natal; s.n; 20200000. 313 p. ilus, tab, graf.
Thesis in Portuguese | LILACS, BBO - Dentistry | ID: biblio-1451119

ABSTRACT

Monitorar a qualidade e segurança da assistência ao parto é essencial para o controle da morbimortalidade materna e neonatal persistente no Brasil. No entanto, os serviços obstétricos, em geral, não possuem um sistema de monitoramento de indicadores obstétricos. Para melhorar a qualidade do cuidado no parto, a Organização Mundial de Saúde (OMS) desenvolveu o checklist para parto seguro. As evidências demonstram seu potencial efeito sobre a melhoria das boas práticas, porém novos estudos precisam avaliar seu impacto sobre as complicações do parto e eventos adversos. Objetivou-se avaliar e comparar a adesão a Boas Práticas (BP) e a incidência de Eventos Adversos (EA) em maternidades do Brasil e do México; desenvolver e avaliar a usabilidade de um software de monitoramento de indicadores obstétricos e neonatais; e analisar a adesão e o efeito da implementação do checklist para parto seguro sobre a qualidade assistencial. Trata-se de um estudo que faz parte de uma pesquisa multicêntrica maior desenvolvida em dois hospitais brasileiros e cinco mexicanos, integrantes do programa "Safe Childbirth Checklist Colaboration" da OMS. Realizou-se um desenho metodológico misto: estudo seccional de avaliação da linha de base; estudo metodológico de validação de um software; e estudo quase-experimental de série temporal não-controlado para intervenção com checklist. Revisou-se, retrospectivamente, 1.440 prontuários de partos no Brasil e 2.707 no México, durante 24 medições quinzenais sucessivas, no período de 2015-2016. A análise principal incluiu associações de qui-quadrado e gráficos de controle estatístico da qualidade. O software desenvolvido auxilia no monitoramento de indicadores, emitindo relatórios de avaliação contendo tabelas descritivas e gráficos de acompanhamento longitudinal e transversal das estimativas. Antes da implementação do checklist, identificou-se uma baixa adesão às BP e alta incidência de EA nas instituições de ambos os países, especialmente nos hospitais brasileiros (26,8% de BP e 16,0% de EA) e naqueles de alta complexidade (24,5% de BP e 27,2% de EA). Após sua implementação nos serviços brasileiros, mesmo com um nível de preenchimento baixo (20,7%), encontrou-se um aumento significativo (p<0,001) na conformidade geral com nove BP recomendadas pelo checklist (manejo dos distúrbios hipertensivos e cuidados imediatos para a mãe e bebê) (45,4% antes e 49,2% pós-intervenção; melhoria relativa de 7,0%). Observou-se também uma redução significativa (p<0,05) na taxa de partos com distúrbios hipertensivos graves, hemorragia e EA e na incidência de ruptura uterina, hemorragia obstétrica e hipertensão grave. A utilização da Plataforma QualiParto (qualiparto.ccs.ufrn.br) pelos serviços contribuiu para a atividade de controle da qualidade, sendo positivamente avaliada nas dimensões de conteúdo, funcionamento, utilidade e satisfação. Este estudo sinaliza problemas na adesão a BP e EA evitáveis em maternidades brasileiras e mexicanas. Monitorar indicadores neste tema é uma atividade essencial para a gestão da qualidade, e o software QualiParto descrito e testado pode auxiliar no controle destas medidas. A intervenção multifacetada com base no checklist foi efetiva para melhorar BP e EA em maternidades brasileiras com diferentes perfis. Apesar de que a adoção desta tecnologia parece ser promissora na indução de práticas baseadas em evidências, a adesão parcial à sua utilização possivelmente limitou os seus benefícios (AU).


Monitoring the quality and safety of childbirth care is essential to control persistent maternal and neonatal morbidity and mortality in Brazil. However, obstetric services, in general, do not have a system for monitoring indicators of childbirth care. To improve the quality of care in childbirth, the World Health Organization (WHO) developed the Safe Childbirth Checklist (SCC). The evidence demonstrates its potential effect on the improvement of good practices, however new studies need to assess its impact on the childbirth complications and adverse events. The objective was to evaluate and compare adherence to Good Practices (GP) and the incidence of Adverse Events (AE) in maternity hospitals in Brazil and Mexico; develop and evaluate the usability of a software for monitoring obstetric and neonatal indicators; and to analyze adherence and the effect of implementing of the SCC on the quality of care. This is a study that is part of a larger multicenter study carried out in two Brazilian and five Mexican hospitals, members of the WHO "Safe Childbirth Checklist Collaboration" initiative. A mixed methodological design was carried out: sectional study of baseline assessment; methodological study of software validation; and quasi-experimental study of uncontrolled time series for intervention with checklist. We retrospectively reviewed 1,440 birth records in Brazil and 2,707 in Mexico during 24 successive two-week periods in the 2015-2016 period. The main analysis included chi-square associations and statistical quality control charts. The software developed in this study is useful in monitoring indicators, presenting evaluation reports containing descriptive tables and graphs of longitudinal and transversal monitoring of estimates. Before the implementation of the checklist, a low adherence to GP and a high incidence of AE was identified in institutions in both countries, especially in Brazilian hospitals (26.8% of GP and 16.0% of AE) and in those of third level of complexity (24.5% GP and 27.2% AE). After its implementation in Brazilian services, even with a low level of filling of the checklist (20.7%), a significant increase (p <0.001) was found in the general compliance with nine GP recommended by the checklist (management of hypertensive disorders and immediate care for mother and baby) (45.4% before and 49.2% post-intervention; relative improvement of 7.0%). There was also a significant reduction (p <0.05) in the rate of deliveries with severe hypertensive disorders, hemorrhage, AE and in the incidence of uterine rupture, obstetric hemorrhage and severe hypertension. The use of the Plataforma QualiParto (in Portuguese) (qualiparto.ccs.ufrn.br) by the services contributed to the quality control activity, being positively evaluated in terms of content, functioning, utility and satisfaction. This study signals problems in adherence to GP and AE avoidable in Brazilian and Mexican maternity hospitals. Monitoring indicators on this topic is an essential activity for quality management, and the QualiParto software described and tested can assist in the control of these measures. The multifaceted intervention based on the checklist was effective in improving GP and AE in Brazilian maternity hospitals with different profiles. Although the adoption of this technology appears to be promising in inducing evidence-based practices, partial adherence to its use possibly limited its benefits (AU).


Subject(s)
Humans , Female , Quality of Health Care , Maternal-Child Health Services , Checklist , Patient Safety , Chi-Square Distribution , Indicators of Health Services/statistics & numerical data
3.
Farm. hosp ; 43(3): 94-100, mayo-jun. 2019. tab
Article in Spanish | IBECS | ID: ibc-183011

ABSTRACT

Objetivo: Identificar unos indicadores del uso hospitalario de antimicrobianos a partir del análisis comparativo de los datos de consumo entre hospitales del mismo nivel por medio del juicio colectivo de un grupo de expertos. Método: Un comité formado por miembros de la Sociedad Española de Farmacia Hospitalaria y de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica preparó una propuesta de indicadores que fue sometida a consenso por un panel de 21 expertos en enfermedades infecciosas, microbiología y terapéutica antimicrobiana mediante un método Delphi modificado. El panel se sometió a dos rondas de puntuaciones por correo electrónico. Los participantes puntuaron de 1 (completamente en desacuerdo) a 9 (completamente de acuerdo) la relevancia de cada indicador en cuatro dimensiones: evidencia científica, eficacia y seguridad, repercusión ecológica y coste. Las puntuaciones fueron procesadas según el método UCLA-RAND. Un indicador fue juzgado como relevante si al menos una dimensión distinta al coste obtenía una mediana de puntuación igual o superior a 7 sin haber desacuerdo entre el panel. Resultados: El comité planteó una propuesta inicial de 14 indicadores. Tras la primera ronda de puntuaciones del panel, un indicador fue desestimado y dos fueron modificados para el paso a la segunda ronda. finalmente, 13 indicadores fueron considerados relevantes. Conclusiones: El establecimiento de indicadores del uso hospitalario de antimicrobianos basados en el consumo puede permitir a los programas de optimización de antimicrobianos detectar cuáles son los problemas potenciales de uso de los antimicrobianos, y ayudar a orientar sus esfuerzos para emprender acciones de mejora, así como para valorar el impacto de las medidas efectuadas


Objective: To identify indicators of hospital use of antimicrobials from the benchmark analysis of consumption data between hospitals at the same level through the collective judgement of a group of experts. Method: A committee formed by members of the Spanish Societies of Hospital Pharmacy and Infectious Diseases and Clinical Microbiology prepared a proposal of indicators which was submitted to consensus by a panel of 21 experts on infectious diseases, microbiology and antimicrobial therapy, through a modified Delphi method. The panel underwent two rounds of scores by e-mail. Participants assigned a score from 1 (completely disagree) to 9 (completely agree) to the relevance of each indicator in four dimensions: scientific evidence, efficacy and safety, ecological impact and cost. Scores were processed according to the RAND-UCLA method. An indicator was considered to be relevant if at least one dimension other than cost obtained a median score equal to or higher than 7 without disagreement among the panel. Results: The committee submitted an initial proposal of 14 indicators. After the first round of panel scores, one indicator was ruled out and two were modified for moving on to the second round. finally, 13 indicators were considered relevant. Conclusions: Determining indicators of the hospital use of antimicrobial agents based on consumption can allow the antimicrobial stewardship programs to detect any potential problems with the use of antimicrobial agents, and to help guide their efforts in order to implement actions of improvement, as well as to assess the impact of the measures implemented


Subject(s)
Humans , Anti-Bacterial Agents/therapeutic use , Drug Prescriptions/statistics & numerical data , Pharmacy Service, Hospital , Anti-Bacterial Agents/administration & dosage , Societies, Medical/standards , Societies, Pharmaceutical/standards , Communicable Diseases/drug therapy , Delphi Technique , Indicators of Health Services/statistics & numerical data
4.
Actas dermo-sifiliogr. (Ed. impr.) ; 109(9): 807-812, nov. 2018. tab
Article in Spanish | IBECS | ID: ibc-175743

ABSTRACT

INTRODUCCIÓN Y OBJETIVOS: Recientemente se han consensuado unos indicadores de calidad de la atención del cáncer de piel no melanoma y melanoma promovidos por la Fundación Piel Sana AEDV. El objetivo de este estudio es conocer la adherencia a estos criterios de calidad asistencial. MATERIAL Y MÉTODOS: En noviembre de 2016 se realizó una encuesta anónima que constaba de 32 preguntas, dirigida a los responsables de los servicios de dermatología y venereología españoles incluidos en la base de datos de la AEDV. Las preguntas de la encuesta hacían referencia a los diferentes indicadores consensuados previamente. RESULTADOS: Fueron respondidas 104 de las 150 encuestas enviadas (69,3% de porcentaje de respuesta). El menor porcentaje conseguido de respuesta a una pregunta fue del 56% (n=84). Más del 85% de los encuestados contestaron a 29 (91%) o más preguntas. Los indicadores con mayor implantación fueron la disponibilidad de TAC o RMN para el estudio de carcinoma espinocelular (98%), seguidos de la existencia de un modelo estandarizado para la realización del informe anatomopatológico de melanoma (90%). Los indicadores con menor implantación se relacionaron con el acceso a electroquimioterapia (25%) y el acceso a otras terapias invasivas para el melanoma locorregionalmente avanzado (20%). CONCLUSIONES: Se ha encontrado variabilidad en la adherencia de estos criterios en los diferentes centros. Con los datos obtenidos se pueden identificar posibilidades de mejora en los centros. Futuras investigaciones deberían centrarse en la medición de indicadores de proceso y resultado


INTRODUCTION AND OBJECTIVES: A series of quality indicators for melanoma and nonmelanoma skin cancer were recently approved within a project promoted by the Healthy Skin Foundation of the Spanish AEDV. The aim of this study was to evaluate adherence to these indicators. MATERIAL AND METHODS: In November 2016, an anonymous questionnaire consisting of 32 items was sent to the heads of Spanish dermatology and venereology departments listed in the AEDV's database. The questions referred to the above-mentioned quality of care indicators. RESULTS: The questionnaire was completed by 104 of the 150 people contacted (response rate, 69.3%). The lowest response rate for any given question was 56% (84 respondents). Over 85% of respondents answered 29 questions or more (91%). The most widely used indicators were those related to the use of computed tomography or magnetic resonance imaging for squamous cell carcinoma (98%), followed by the availability of a standardized melanoma pathology report (90%). The least widely used indicators were related to availability of electrochemotherapy (25%) and other invasive therapies for locoregionally advanced melanoma (20%). CONCLUSIONS: Adherence to quality of cancer care criteria at the different hospitals evaluated varied. Our findings could be useful for identifying areas for improvement at different hospitals. Future studies should focus on measuring both process and outcome indicators


Subject(s)
Humans , Patient Care/statistics & numerical data , Skin Neoplasms/epidemiology , 17140 , Indicators of Health Services/statistics & numerical data , Quality of Health Care/statistics & numerical data , Dermatology/statistics & numerical data , Surveys and Questionnaires
5.
Aten. prim. (Barc., Ed. impr.) ; 50(1): 23-34, ene. 2018. tab, graf
Article in Spanish | IBECS | ID: ibc-172628

ABSTRACT

Objetivos: Los objetivos de este trabajo son analizar cómo influye el hecho de que en el hogar haya una persona dependiente en el estado de salud de las personas con quien convive y en los estilos de vida; compararlo con otras situaciones que impliquen dedicación de tiempo y energía, y analizar diferencias de género y edad en cada etapa el ciclo vital. Diseño: Estudio descriptivo transversal analizando datos secundarios. Emplazamiento: El método de recogida de información es el de entrevista personal asistida por ordenador en las viviendas seleccionadas, realizada por el Ministerio de Sanidad, Servicios Sociales e Igualdad. Participantes: Un total de 19.351 individuos mayores de 25 años que realizaron la Encuesta Nacional de Salud 2011-2012 (ENSE 2011/2012). Mediciones principales: Estudio llevado a cabo con datos sobre la sociedad española procedentes de la ENSE 2011/12. Como marco empírico, seleccionamos el modelo Logit, reportando los datos en odds ratio. Las estimaciones se repiten de manera independiente por submuestras de edad y género. Resultados: La salud de las personas que conviven con una persona dependiente es peor que la de aquellas personas que no conviven (hasta 5 veces más riesgo de tener problemas de salud), especialmente si se es mujer, de edad avanzada, con un nivel educativo bajo o no trabaja. También ser cuidador reduce la probabilidad de mantener unos hábitos saludables como son el realizar ejercicio, el descanso o una dieta equilibrada. Conclusiones: Por lo general, convivir con una persona dependiente reduce la probabilidad de mantener estilos de vida saludables y deteriora la salud. Encontramos importantes diferencias de género y edad (AU)


Objetives: The purpose of this work is to analyse the effects on informal caregiver‘s health and lifestyle when living with a dependent person at home. A comparison will be made between this situation and other situations involving commitment of time and energy, taking into account gender and age differences in each stage of the life cycle. Design: Cross-sectional study analysing secondary data. Setting: The method used for collecting information is the computer assisted personal interview carried out in selected homes by the Ministry of Health, Social Services and Equality. Participants: The study included 19,351 participants aged over 25 years who completed the 2011-2012 Spanish National Health Survey. Main measurements: This research is based on demographic information obtained from a Spanish National Health Survey (2011/12). Using an empirical framework, the Logit model was select and the data reported as odds ratio. The estimations were repeated independently by sub-groups of age and gender. Results: The study showed that the health of people who share their lives with a dependent person is worse than those who do not have any dependent person at home (they are 5 times at higher risk of developing health problems). The study found that being a woman, advance age, low educational level and does not work, also has an influence. Being a caregiver reduces the likelihood of maintaining a healthy lifestyle through physical exercise, relaxation, or eating a balanced diet. Conclusions: Living with a dependent person reduces the likelihood of maintaining healthy lifestyles and worsens the state of health of family members. Significant differences in gender and age were found (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Frail Elderly/statistics & numerical data , Family Health/statistics & numerical data , Health Status , Health Surveys/statistics & numerical data , Health Behavior , Life Style , Cross-Sectional Studies/methods , Indicators of Health Services/statistics & numerical data , Health Status Indicators
6.
Med. intensiva (Madr., Ed. impr.) ; 41(9): 523-531, dic. 2017. graf, tab
Article in Spanish | IBECS | ID: ibc-169223

ABSTRACT

Introducción: En los servicios de Medicina Intensiva (SMI) se realizan múltiples intervenciones a los pacientes críticos. Nuestros objetivos son conocer la presencia en la práctica diaria de los SMI de elementos relacionados con los 6 indicadores de calidad en Bioética de la Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias y la participación de sus miembros en los comités de ética asistencial. Material y métodos: Estudio observacional multicéntrico mediante encuesta que estudia aspectos descriptivos de los SMI, plantea 25 cuestiones relacionadas con los indicadores de calidad bioéticos y describe la participación de miembros del SMI en los comités de ética asistencial. Los SMI se clasifican por tamaño (mayor/menor de 10 camas) y tipo de hospital (público/privado-concertado, docente/no docente). Resultados: En las 68 encuestas analizadas encontramos: información familiar diaria (97%), efectuada en sala de información (82%); protocolos de cuidados al final de vida (44%); formulario de limitación de tratamiento de soporte vital (48,43%); protocolo de contención (40%). El cumplimiento del proceso de consentimiento informado es: traqueostomía (92%), intervención vascular (76%), depuración extrarrenal (25%). La presencia actual de miembros del SMI en el Comité de Ética es frecuente (69%). Conclusiones: La información a familiares es adecuada, aunque hay SMI sin sala de información. El cumplimiento del proceso de consentimiento informado de varios procedimientos es insuficiente. La participación de miembros del SMI en los comités de ética asistencial es frecuente. Los resultados evidencian margen de mejora en la calidad bioética de los SMI (AU)


Introduction: Multiple interventions are performed in critical patients admitted to Intensive Care Units (ICUs). This study explores the presence in the daily practice of ICUs of elements related to the 6 bioethics quality indicators of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units, and the participation of their members in the hospital ethics committees. Materials and methods: A multicenter observational study was carried out, using a survey exploring descriptive aspects of the ICUs, with 25 questions related to bioethics quality indicators, and assessing the participation of ICU members in the hospital ethics committees. The ICUs were classified by size (larger or smaller than 10 beds) and type of hospital (public/private-public concerted center, with/without teaching). Results: The 68 analyzed surveys revealed: daily informing of the family (97%), carried out in the information room (82%); end-of-life care protocols (44%); life support limitation form (48.43%); and physical containment protocol (40%). Compliance with the informed consent process referred to different procedures is: tracheostomy (92%), vascular procedures (76%), and extrarenal clearance (25%). The presence of ICU members in the hospital ethics committee is currently frequent (69%). Conclusions: Information supplied to relatives is adequate, although there are ICUs without an information room. Compliance with the informed consent requirements of various procedures is insufficient. The participation of ICU members in the hospital ethics committees is frequent. The results obtained suggest a chance for improvement in the bioethical quality of the ICU (AU)


Subject(s)
Humans , Critical Care/statistics & numerical data , Indicators of Health Services/statistics & numerical data , Indicators of Quality of Life , Bioethics , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Informed Consent/ethics , Informed Consent/statistics & numerical data
7.
Gac. sanit. (Barc., Ed. impr.) ; 31(3): 194-203, mayo-jun. 2017. graf, tab
Article in Spanish | IBECS | ID: ibc-162083

ABSTRACT

Objetivo: Proporcionar indicadores para evaluar, en España y en sus comunidades autónomas, el impacto sobre la salud, sus determinantes sociales y las desigualdades en salud del contexto social y de la crisis económica más reciente. Métodos: Basándonos en el marco conceptual de los determinantes de las desigualdades sociales en salud en España, identificamos indicadores secuencialmente a partir de documentos clave, Web of Science y organismos con estadísticas oficiales. La información recopilada dio lugar a un directorio amplio de indicadores que fue revisado por un panel de expertos. Posteriormente seleccionamos un conjunto de esos indicadores según un criterio geográfico y otro temporal: disponibilidad de datos según comunidades autónomas y al menos desde 2006 hasta 2012. Resultados: Identificamos 203 indicadores contextuales sobre determinantes sociales de la salud y seleccionamos 96 (47%) según los criterios anteriores. De los indicadores identificados, el 16% no cumplieron el criterio geográfico y el 35% no cumplieron el criterio temporal. Se excluyó al menos un 80% de los indicadores relacionados con la dependencia y los servicios de salud. Los indicadores finalmente seleccionados cubrieron todas las áreas de los determinantes sociales de la salud. El 62% de estos no estuvieron disponibles en Internet. Alrededor del 40% de los indicadores se extrajeron de fuentes relacionadas con el Instituto Nacional de Estadística. Conclusiones: Proporcionamos un amplio directorio de indicadores contextuales sobre determinantes sociales de la salud y una base de datos que facilitarán la evaluación, en España y sus comunidades autónomas, del impacto de la crisis económica sobre la salud y las desigualdades en salud (AU)


Objective: To provide indicators to assess the impact on health, its social determinants and health inequalities from a social context and the recent economic recession in Spain and its autonomous regions. Methods: Based on the Spanish conceptual framework for determinants of social inequalities in health, we identified indicators sequentially from key documents, Web of Science, and organizations with official statistics. The information collected resulted in a large directory of indicators which was reviewed by an expert panel. We then selected a set of these indicators according to geographical (availability of data according to autonomous regions) and temporal (from at least 2006 to 2012) criteria. Results: We identified 203 contextual indicators related to social determinants of health and selected 96 (47%) based on the above criteria; 16% of the identified indicators did not satisfy the geographical criteria and 35% did not satisfy the temporal criteria. At least 80% of the indicators related to dependence and healthcare services were excluded. The final selection of indicators covered all areas for social determinants of health, and 62% of these were not available on the Internet. Around 40% of the indicators were extracted from sources related to the Spanish Statistics Institute. Conclusions: We have provided an extensive directory of contextual indicators on social determinants of health and a database to facilitate assessment of the impact of the economic recession on health and health inequalities in Spain and its autonomous regions (AU)


Subject(s)
Humans , Economic Recession/trends , 50230 , Resource Allocation/trends , Social Determinants of Health/trends , Health Status Disparities , Health Services Accessibility/trends , Indicators of Health Services/statistics & numerical data , Health Impact Assessment
9.
Rev. neurol. (Ed. impr.) ; 62(4): 157-164, 16 feb., 2016. graf, tab
Article in Spanish | IBECS | ID: ibc-148778

ABSTRACT

Introducción. El ictus es una entidad grave, pero potencialmente reversible. La reducción del tiempo de atención en el momento agudo es fundamental para limitar la morbimortalidad. La evaluación de las actuaciones en la atención al ictus es esencial, porque permite identificar oportunidades de mejora. Objetivo. Conocer y analizar los factores condicionantes de la demora en los tiempos de atención intrahospitalaria para la posterior implementación de un ciclo de mejora. Pacientes y métodos. Estudio retrospectivo de pacientes con ictus isquémico agudo tratados con trombólisis intravenosa (TLIV) y/o trombectomía intraarterial mecánica (TIAM) en un hospital terciario entre 2009-2014. Se analizaron los tiempos intrahospitalarios, los indicadores de calidad y sus factores condicionantes. Resultados. Un total de 337 pacientes fueron tratados con TLIV (66,2%) y/o TIAM (54,1%). Tiempos medios de actuación (intervalo de confianza al 95%): puerta-TLIV, 75,88 min (71,67-80,16 min); puerta-TC, 43,27 min (40,17-46,37 min); TC-TLIV, 38,01 min (34,08-41,93 min); TLIV-TIAM, 127,44 min (108,7-146,18 min); puerta-TIAM, 155,22 min (140,03-170,4 min). El 36,6% fue tratado en menos de 60 min, la neuroimagen se realizó en menos de 25 min en un 19,9% y el tiempo TLIVTIAM fue menor de 90 min en un 28,8%. La edad, el tiempo inicio-puerta, la procedencia de otro hospital y el período de aprendizaje se identificaron como factores condicionantes. Conclusiones. El conocimiento de la situación actual de los tiempos e indicadores intrahospitalarios y sus factores condicionantes son el punto de partida y proporcionan la motivación necesaria para impulsar una iniciativa para la mejora de la calidad asistencial en el paciente con ictus agudo (AU)


Introduction. Stroke is a serious but potentially reversible entity. Reducing the time of care in the acute phase is essential to limit morbidity and mortality. The evaluation of the performances in stroke care is essential because it allows identify opportunities for improvement. Aim. To understand and analyze the determinants of the delay in the time of hospital care for the subsequent implementation of a cycle of improvement. Patients and methods. Retrospective study of patients with acute ischemic stroke treated with intravenous thrombolysis (IVT) and/or intra-arterial mechanical thrombectomy (IAMT) in a tertiary hospital between 2009-2014. In-hospital times, quality indicators and associated factors were analyzed. Results. 337 patients with acute ischemic stroke were treated with IVT (66.2%) and/or IAMT (54.1%). In-hospital times (95% confidence interval): door-to-needle time, 75.88 min (71.67-80.16 min); door-to-imaging, 43.27 min (40.17-46.37 min), imaging-to-needle, 38.01 min (34.08-41.93 min); IVT-IAMT time, 127.44 min (108.7-146.18 min); door-to-groin puncture, 155.22 min (140.03-170.40 min). 36.6% treated in less than 60 min, neuroimaging in less than 25 min in a 19.9% and IVT-IAMT time in less than 90 minutes in 28.8%. Age, onset-to-door time, non-ambulance transport and the learning period were identified as determinants. Conclusions. Knowledge of the current situation of the times and quality indicators and their determinants are essential to provide the motivation to start an initiative to improve the quality of care in patients with acute stroke (AU)


Subject(s)
Humans , Male , Female , Stroke/epidemiology , Stroke/rehabilitation , Length of Stay/statistics & numerical data , Length of Stay/trends , Thrombolytic Therapy/methods , Thrombectomy/methods , Thrombectomy , Indicators of Health Services/organization & administration , Indicators of Health Services/standards , Indicators of Health Services/statistics & numerical data , Indicators of Quality of Life , Indicators of Morbidity and Mortality , Time Factors , Confidence Intervals
10.
Med. clín (Ed. impr.) ; 145(4): 141-146, ago. 2015. tab, graf
Article in Spanish | IBECS | ID: ibc-139603

ABSTRACT

Fundamento y objetivo: El Programa de Detección Precoz del Cáncer de Colon y Recto de Barcelona se puso en marcha en diciembre de 2009 y cuenta con las oficinas de farmacia para la distribución y recogida del test de cribado. En este artículo se describen los principales indicadores de la primera ronda del Programa (2010-2011) según los propuestos por la Unión Europea. Material y métodos: El Programa de Detección Precoz del Cáncer de Colon y Recto de Barcelona se dirige a varones y mujeres de 50 a 69 años residentes en las áreas de referencia del Hospital Clínic y del Hospital del Mar, tiene periodicidad bienal, y utiliza el test inmunológico de detección de sangre oculta en heces y posterior confirmación diagnóstica mediante colonoscopia. Resultados: La población diana fue de 197.795 personas. La tasa de participación fue del 43,6%, siendo mayor en mujeres y en mayores de 59 años. Un 2,1% de la población invitada declaró un cribado externo al Programa. La tasa de positividad fue del 6,2%, mayor en varones y con amplia variabilidad entre áreas básicas de salud. Las tasas de detección de adenoma de bajo y alto riesgo, y de cáncer invasivo fueron, respectivamente, del 9,1‰, del 21,7‰, y del 3,1‰. El 48,2% de los tumores fueron estadio i. Conclusiones: Los resultados obtenidos se consideran satisfactorios y acordes con los de otros programas y estándares europeos, aunque se han identificado aspectos de mejora. La elevada participación puede atribuirse, al menos parcialmente, al test empleado y a la implicación de la red de oficinas de farmacia comunitaria (AU)


Background and objective: The Colorectal Cancer Screening Program of Barcelona was implemented in December 2009 and involves pharmacies for the distribution and collection of screening tests. The aim of this article is to describe the main indicators of the first round of the Program (2010-2011), based on the ones suggested by the European Union. Material and methods: The target population of the Colorectal Cancer Screening Program of Barcelona includes men and women aged 50-69 years who live in the catchment areas of Hospital Clínic and Hospital del Mar. Screening consists of biennial immunochemical fecal occult blood testing, with colonoscopy as confirmatory procedure. Results: Target population comprised 197,795 persons. Participation rate was 43.6%, was higher among women and among those aged 60 and older. 2.1% of the eligible population stated to have been already screened for colorectal cancer. Overall positivity rate was 6.2%, higher among men and with a broad variability among health care areas. The detection rates of low- and high-risk adenoma, and of invasive cancer were 9.1 ‰, 21.7 ‰ and 3.1 ‰, respectively. 48.2% of tumors were stage i. Conclusions: These results are considered satisfactory and consistent with those obtained in other programs and with European standards. Nevertheless, some areas for improvement have been identified. The high participation rate can be attributed, at least in part, to the type of test and to the involvement of community pharmacies (AU)


Subject(s)
Female , Humans , Male , Middle Aged , Early Detection of Cancer/methods , Early Detection of Cancer/statistics & numerical data , Colonic Neoplasms/epidemiology , Occult Blood , Colonic Neoplasms/prevention & control , Rectal Neoplasms/epidemiology , Community Pharmacy Services/organization & administration , Adenoma/epidemiology , Early Detection of Cancer/trends , Early Detection of Cancer , Spain/epidemiology , Colonoscopy/methods , Risk Assessment/organization & administration , Risk Factors , Mass Screening/prevention & control , Indicators of Health Services/statistics & numerical data , Indicators of Morbidity and Mortality , Health Status Indicators
11.
Trauma (Majadahonda) ; 25(1): 46-53, ene.-mar. 2014. tab
Article in Spanish | IBECS | ID: ibc-122357

ABSTRACT

Objetivo: Diseño y validación de un mapa de riesgos de la atención urgente (MR) aplicable para todos los servicios de urgencias (SU) hospitalarios españoles. Material y métodos: Diseño de un MR utilizando la metodología del Análisis Modal de Fallos y Efectos (AMFE). El trabajo constó de cuatro fases: diseño, consenso (rondas de consultores mediante técnica Delphi), validación y diseño definitivo. Resultados: El MR definitivo recogió, tras su validación, 13 procesos, 118 subprocesos, 271 fallos posibles y 1.368 riesgos. Atendiendo a las puntuaciones de mediana del índice de probabilidad de riesgos (IPR), se elaboraron dos versiones reducidas: MR Recomendado, con los riesgos por encima de la mediana global de cada proceso, formado por 13 procesos, 108 subprocesos, 217 fallos posibles y 748 riesgos; y MR Imprescindible (con los riesgos >280 puntos de IPR), formado por 10 procesos, 54 subprocesos, 79 fallos posibles y 180 riesgos. Conclusión: El MR obtenido es una herramienta proactiva homogénea y validada, que analiza todos los procesos asistenciales urgentes y que permite la gestión de riesgos en cualquier SU (AU)


Objective: To design and validate an emergency care risk map (RM) which can be used in all the Spanish emergency departments (ED). Material and methods: To design a RM using the Failures Modes and Effects Analysis method (FMEA). The study has four phases: Design, consensus (using Delphi technique), validation and final design. Results: The final RM collected, after validation, a total of 13 processes, 118 subprocesses, 271 possible failures and 1,368 risks. Based on median scores risk odds ratio (IPR), we obtained two smaller versions: Recommended MR, with the risks above the overall median for each process, consists of 13 processes, 108 subprocesses, 217 possible failures and 748 risks; and Essential RM (with the risk >280 points IPR), consisting of a total of 10 processes, 54 subprocesses, 79 and 180 potential risks. Conclusion: The RM obtained is a proactive, homogeneous and validated tool, which analyzes all the emergency cares processes, and which allows risk management in every ED (AU)


Subject(s)
Humans , Male , Female , Risk Map , Patient Safety/statistics & numerical data , Patient Safety/standards , Emergency Medical Services/organization & administration , Emergency Medical Services/statistics & numerical data , Emergency Medical Services/standards , Emergency Medicine/methods , Emergency Medicine/statistics & numerical data , Risk Factors , Indicators of Health Services/organization & administration , Indicators of Health Services/statistics & numerical data , Health Status Indicators
13.
Epidemiol. serv. saúde ; 22(2): 325-334, 2013. tab, graf
Article in Portuguese | LILACS | ID: lil-682077

ABSTRACT

Objetivo: descrever os indicadores de atenção básica e indicadores de atenção especializada de saúde bucal em municípios do Estado do Pará, Brasil. Métodos: foi realizado estudo ecológico com dados do Sistema de Informações Ambulatoriais do Sistema Único de Saúde (SIA/SUS), sobre o período de 2001-2010 para os indicadores de atenção básica e o período de 2008-2010 para os indicadores de atenção secundária. Resultados: no período 2001-2010, houve aumento da cobertura de primeira Consulta Odontológica Programática (de 7,8 por cento para 14,6 por cento), do número de procedimentos restauradores e periodontais básicos, assim como especializados; observou-se redução na razão entre o número de exodontia de dentes permanentes e procedimentos odontológicos individuais, de 22,2 por cento para 17,5 por cento, embora o número de procedimentos anuais tenha-se mantido estável ao longo do período. Conclusão: houve elevação do número de procedimentos; entretanto, o número de procedimentos per capita demonstra a baixa cobertura populacional, denotando dificuldades de acesso aos procedimentos odontológicos, principalmente os especializados.


Objective: to describe the indicators of primary care and specialized oral health care in municipalities in Pará state. Methods: An ecological study using Unified Health System Outpatient Information System data between 2001-2010 for primary care indicators and between 2008-2010 for secondary care indicators. Residents in the places studied were the reference population. Results: first Programmatic Dental Consultation coverage of basic and specialized restoration and periodontal procedures increased from 7.8 per cent to 14.6 per cent between 2001-2010. A reduction was observed in the proportion of tooth extractions and individual dental procedures from 22.23 per cent to 17.52 per cent, although the annual number of procedures remained stable over the period. Conclusion: the number of procedures increased. However, the number of procedures per capita shows low population coverage, denoting difficulties in accessing dental procedures, especially specialized ones.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Ecological Studies , Health Policy , Indicators of Health Services/statistics & numerical data , Oral Health , Time Series Studies
14.
Psicothema (Oviedo) ; 24(1): 133-141, ene.-mar. 2012. tab, ilus
Article in Spanish | IBECS | ID: ibc-93970

ABSTRACT

La evaluación de la precisión en la clasificación binaria debe contemplar dos indicadores no independientes: verdaderos positivos y falsos positivos. Se han propuesto varios índices. Estos han sido estimados en algunos tests para la detección temprana o cribaje. Resumimos y revisamos los principales métodos propuestos para realizar meta-análisis que evalúan la precisión de este tipo de instrumentos. Se aplican a los resultados de 14 estudios que informan de estimaciones de la precisión del test AUDIT. La agregación directa no permite el uso de los procedimientos meta-analíticos; la estimación separada de la sensibilidad y la especificidad no reconoce que no son independientes; el método de la curva ROC-resumen trata la precisión y el umbral como factores fijos y tiene limitaciones para manejar el papel potencial de las covariables. Los modelos Normal Bivariado y Jerárquico de la curva ROC Resumen son estadísticamente rigurosos y son capaces de incorporar las covariables adecuadamente. Ambos métodos permitieron analizar la asociación entre el género de la muestra y el comportamiento del AUDIT (AU)


The assessment of accuracy in binary classification tools must take into account two non-independent rates: true positives and false positives. A variety of indices have been proposed. They have been estimated for tests employed for early detection or screening purposes. We summarize and review the main methods proposed for performing a meta-analysis that assesses the accuracy of this type of tools. They are applied to the results from 14 studies that report estimates of the accuracy of the AUDIT. The method of direct aggregation does not allow the use of meta-analytic procedures; the separate estimation of sensitivity and specificity does not acknowledge that they are not independent; the SROC method treats accuracy and threshold as fixed effects and has limitations to deal with the potential role of covariates. The Normal Bivariate (NB) model and the Hierarchical Summary ROC (HSROC) model are statistically rigorous and can deal with the covariates properly. They allowed analyzing the association between the gender composition of the sample and the way the test AUDIT behaves in the example (AU)


Subject(s)
Humans , Male , Female , Meta-Analysis as Topic , Indicators of Health Services/methods , Indicators of Health Services/statistics & numerical data , Sensitivity and Specificity , ROC Curve , Commission on Professional and Hospital Activities , Models, Theoretical/methods
15.
Psicothema (Oviedo) ; 23(4): 527-536, oct.-dic. 2011. tab
Article in Spanish | IBECS | ID: ibc-91406

ABSTRACT

La creación del Espacio Europeo de Educación Superior ha traído consigo la relevancia de la evaluación de la calidad científica. Por ello, se observa un creciente interés por la elaboración de rankings de universidades, tanto nacionales como internacionales. Para seguir con la línea comenzada hace dos años, el objetivo de esta investigación es actualizar el ranking de productividad en investigación de las universidades públicas españolas con los datos del año 2010. Se sigue la misma metodología que con los datos de 2008 y 2009, aunque este año se incluyen medidas de producción total. Se evalúan los mismos indicadores de investigación que en 2009: artículos en revistas indexadas en el JCR, tramos de investigación, proyectos I+D, tesis doctorales, becas FPU, doctorados con Mención de Calidad y patentes. A partir de los resultados obtenidos, se observa que las universidades con una mayor producción en investigación fueron la Complutense de Madrid, Barcelona y Granada. Las más productivas fueron la Universidad Pompeu Fabra, la Pablo de Olavide y la Autónoma de Barcelona (AU)


The creation of the European Higher Education Area has brought the relevance of the scientific quality assessment in higher education. The result of this interest is a growing interest in the development of rankings of universities, both nationally and internationally. To continue the line started two years ago, the goal of this research is to update the ranking of research productivity in Spanish public universities with the data of 2010. We follow the same methodology to data from 2008 and 2009; although this year it includes measures of total production. The same indicators to evaluate research in 2009: journals articles indexed in the JCR, research periods, research + development projects, doctoral dissertations, grants for training university teachers, Doctoral Programs with Quality Mention and patents. From the results obtained show that universities with higher production were Complutense de Madrid, Barcelona and Granada. The most productive were the Pompeu Fabra University, the Pablo de Olavide, and the Autónoma de Barcelona (AU)


Subject(s)
Humans , 35174 , Research/organization & administration , Research/statistics & numerical data , Universities/organization & administration , Universities/statistics & numerical data , 50088 , Scientific Publication Indicators , Indicators of Health Services/organization & administration , Indicators of Health Services/statistics & numerical data
16.
Rev. esp. salud pública ; 84(6): 575-770, nov.-dic. 2010. tab
Article in Spanish | IBECS | ID: ibc-83021

ABSTRACT

Fundamento: Por su elevada incidencia y mortalidad el cáncer colorrectal (CCR) se considera un importante problema de Salud Pública. Los programas de cribado están adquiriendo cada vez mayor relevancia en su abordaje dada la importancia del diagnóstico precoz en la disminución de la mortalidad por esta causa. El objetivo de este trabajo es presentar el desarrollo y resultados del programa de cribado poblacional de CCR en Cantabria. Métodos: Estudio descriptivo del programa de cribado de carácter bienal diseñado para la población de 55 a 69 años a partir de la base de datos de la Tarjeta Sanitaria (92.605 personas). La determinación de sangre oculta en heces (SOH) por método inmunoquímico cualitativo es la prueba de cribado, empleándose la colonoscopia óptica como confirmación. La población recibe una carta de invitación, debiéndose citar en su Centro de Salud si aceptan participar. Tras aplicar los criterios de exclusión, las personas con resultado positivo en el test son citadas para colonoscopia. Aquellos en los que se detecta un carcinoma invasivo son remitidos directamente al Servicio de digestivo. Resultados: En el periodo de estudio estaban cubiertas por el programa 35.005 personas (37,8 % de la población diana). De las invitadas (7.406) participaron 2.384 (32,1%). Fueron detectados un carcinoma «in situ», 2 invasivos y 43 adenomas de alto riesgo. Conclusión: Por su integración en Atención Primaria, ausencia de aparataje, fácil uso y rápida realización, el test de detección de SOH inmunoquímico cualitativo facilita la extensión del cribado, con resultados similares a los de los test inmunoquímicos cuantitativos(AU)


Background: The colorectal cancer (CCR) is a Public Health problem because of its high incidence and mortality. Screening programs are important for early detection of CCR. An early detection of this illness could decrease its mortality. The objectives of our study are to present the colorectal cancer screening program in Cantabria and its main results. Methods: Descriptive study of a two-year screening program for population in the 55 – 69 years age range, according to the Cantabria Health Service data base (92,605 people). The screening test used a qualitative immunochemical method in search of faecal occulted blood (FOB), complemented by optical colonoscopy confirmation. Eligible people were invited to participate in the screening program by means of personal letter and, in case of acceptance, they were dated in their primary Health Center. After application of exclusion criteria, selected people with a positive result test were submitted to optical colonoscopy. Those in which an invasive cancer was detected were directly addressed to the Digestive Service. Results: The program was offered to 35,005 (37.8 %) of the eligible population of Cantabria at the end of study period. 2,384 persons participated (32.1%). The main colonoscopy findings were 1 «in situ» cancer, 2 invasive cancer and 43 high-risk adenomas. Conclusion: Due to its integration into primary care, lack of apparatus, ease use and fast implementation, qualitative immunochemical test FOBT facilitates the extension of screening, with similar results to those of quantitative immunochemical test(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Early Diagnosis , Colorectal Surgery/statistics & numerical data , Colorectal Neoplasms/epidemiology , Mass Screening/statistics & numerical data , Colonoscopy/statistics & numerical data , Indicators of Health Services/statistics & numerical data , Public Health/statistics & numerical data , Primary Health Care/statistics & numerical data , Predictive Value of Tests
20.
Rio de Janeiro; IBGE; 2009. 102 p. tab, graf.(Contas nacionais, 29).
Monography in Portuguese | LILACS | ID: lil-540672

ABSTRACT

Nesta publicação, há dados sobre produção, consumo e comércio exterior de bens e serviços relacionados à saúde e informações sobre trabalho e renda nas atividades que geram esses produtos. Esses dados permitem traçar um panorama dos recursos e usos da saúde e de sua evolução ao longo do período 2005-2007. Eles detalham a participação de cada atividade relacionada à saúde, na economia, e permitem acompanhar anualmente sua evolução.


Subject(s)
Humans , Indicators of Health Services/economics , Indicators of Health Services/statistics & numerical data , Health Services/economics , Health Services/statistics & numerical data , Brazil , Exportation of Products , Health Care Economics and Organizations/statistics & numerical data , Importation of Products , Health Resources/statistics & numerical data
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