Admisiones en los servicios de urgencias y costes económicos relacionados con procesos susceptibles de atención ambulatoria en adultos mayores que viven en centros residenciales / Emergency department admissions and economic costs burden related to ambulatory care sensitive conditions in older adults living in care homes

Objetivos Evaluar la frecuencia de las admisiones en los servicios de urgencias (ASU) por ambulatory care sensitive conditions (ACSC) y no-ACSC de personas que viven en residencias; describir y comparar sus características, y analizar los costes asociados. Método Este estudio multicéntrico, retrospectivo y observacional evaluó 2.444ASU de personas ≥65 años que viven en residencias en 5 servicios de urgencias de Cataluña por ACSC y no-ACSC, en 2017. Se recogieron variables sociodemográficas, estado funcional y cognitivo, e información sobre diagnóstico y hospitalización. Se evaluaron los costes relacionados con ACSC-ASU y se efectuó un análisis de sensibilidad utilizando diferentes supuestos de disminución de ingresos por ACSC. Resultados La media de edad de la muestra del estudio fue de 85,9 años (desviación estándar: 7,2 años). La frecuencia de ACSC-ASU y no-ACSC-ASU fue del 56,6 y el 43,4%, respectivamente. El 56,6 y el 78% presentaban dependencia severa y deterioro cognitivo, respectivamente, sin observarse diferencias entre los 2 grupos. Las 3 ACSC más frecuentes fueron caídas/traumatismos (13,8%), enfermedad pulmonar obstructiva crónica/asma (11,4%) e infección urinaria (7,4%). El coste medio por ACSC-ASU fue de 1.408,24€. Suponiendo una reducción del 60% de las ACSC-ASU, el ahorro de costes estimado sería de 1,2 millones de euros. Conclusiones Las admisiones en urgencias por ACSC procedentes de entornos residenciales suponen un impacto significativo tanto en la frecuencia como en los costes. La disminución de estas enfermedades mediante la aplicación de intervenciones específicas podría redirigir los costes evitados hacia la mejora del apoyo asistencial en los entornos residenciales (AU)

Objectives To assess the frequency of emergency department admissions (EDAs) for ambulatory care sensitive conditions (ACSC) and non-ACSC among older adults living in care homes (CH), to describe and compare their demographic and clinical characteristics, the outcomes of the hospitalization process and the associated costs. Method This multicenter, retrospective and observational study evaluated 2444 EDAs of older adults ≥65 years old living in care homes in five emergency departments in Catalonia (Spain) by ACSC and non-ACSC, in 2017. Sociodemographic variables, prior functional and cognitive status, and information on diagnosis and hospitalization were collected. Additionally, the costs related with the EDAs were calculated, as well as a sensitivity analysis using different assumptions of decreased admissions due to ACSC Results A total of 2444 ED admissions were analyzed. The patients’ mean (SD) age was 85.9 (7.2) years. The frequency of ACSC-EDA and non-ACSC-EDA was 56.6% and 43.4%, respectively. Severe dependency and cognitive impairment were present in 56.6% and 78%, respectively, with no differences between the two groups. The three most frequent ACSC were falls/trauma (13.8%), chronic obstructive pulmonary disease/asthma (11.4%) and urinary tract infection (7.4%). The average cost per ACSC-EDA was €1408.24. Assuming a 60% reduction of ACSC-EDA, the estimated cost savings would be €1.2 million. Conclusions Emergency admissions for ACSC from care homes have a significant impact on both frequency and costs. Reducing these conditions through targeted interventions could redirect the avoided costs toward improving care support in residential settings (AU)

Emergency department admissions and economic costs burden related to ambulatory care sensitive conditions in older adults living in care homes.

OBJECTIVES: To assess the frequency of emergency department admissions (EDA) for ambulatory care sensitive conditions (ACSC) and non-ACSC among older adults living in care homes (CH), to describe and compare their demographic and clinical characteristics, the outcomes of the hospitalisation process and the associated costs. METHOD: This multicenter, retrospective and observational study evaluated 2444 EDAs of older adults ≥ 65 years old living in care homes in 5 emergency departments in Catalonia (Spain) by ACSC and non-ACSC, in 2017. Sociodemographic variables, prior functional and cognitive status, and information on diagnosis and hospitalisation were collected. Additionally, the costs related with the EDAs were calculated, as well as a sensitivity analysis using different assumptions of decreased admissions due to ACSC. RESULTS: A total of 2444 ED admissions were analysed. The patients' mean (SD) age was 85.9 (7.2) years. The frequency of ACSC-EDA and non-ACSC-EDA was 56.6% and 43.4%, respectively. Severe dependency and cognitive impairment were present in 56.6% and 78%, respectively, with no differences between the two groups. The three most frequent ACSC were falls/trauma (13.8%), chronic obstructive pulmonary disease/asthma (11.4%) and urinary tract infection (7.4%). The average cost per ACSC-EDA was є1,408.24. Assuming a 60% reduction of ACSC-EDA, the estimated cost savings would be є1.2 million. CONCLUSIONS: Emergency admissions for ACSC from care homes have a significant impact on both frequency and costs. Reducing these conditions through targeted interventions could redirect the avoided costs towards improving care support in residential settings.

Appropriateness of physicians' requests of laboratory examinations in primary health care: an over- and under-ulilisation study.

The aim of this work is to study the appropriateness of the laboratory measurement for quantities that may be conditioned by the result of another quantity, estimating the proportions of inappropriate requests due to over- or under-utilisation. We refer to over-utilisation when a quantity was requested and measured when it was not needed, and we refer to under-utilisation when a quantity was not requested and not measured when it was needed. In our centre, the laboratory staff together with the primary health care physicians of the region designed a new laboratory request form. This request form incorporated an agreed requesting protocol for the most common diagnoses in primary health care. Protocols included, according to each case, one or several of 11 pairs of quantities depending on each case. Second quantity in each pair was measured or not, conditional on the result of the first quantity of the pair, the age, the sex and the diagnosis corresponding to the requested protocol. Following recommendations from scientific societies, we decided what should be the results of the first quantity in the pair so to measure the second quantity in the pair. When recommendations were not available, we reviewed the data contained in the laboratory information system, and we established as non-conditioning values, the levels of the first quantities that were associated with the results of second quantities within their reference intervals in 99.95% of cases. The study was done retrospectively using 46091 old laboratory request forms received in our laboratory over two years. Among the 46091 request forms, the first quantities included in the present forms that incorporate agreed requesting protocols were requested 66434 times. The 66434 corresponding second quantities were measured and should not have been measured in 14225 cases (21.4%) and were not measured and should have been measured in 16137 cases (24.3%). Using the request forms according to the conditioning protocols changes the number of quantities by a mean of 0.66 in every request form. This change would have increased the number of quantities measured by 0.04 quantities per form, but would also have improved the appropriate use of the laboratory.

[Factors influencing coverage, response and participation in breast cancer screening program]. / Factores condicionantes de la cobertura, la respuesta y la participación en un programa de cribado del cáncer de mama.

BACKGROUND: The objective was to analyze sociodemographic, organizational and health care-related factors associated to level of enrollment in a breast cancer screening program developed in one area of Barcelona (Spain). MATERIAL AND METHODS: Three types of indicators were used: coverage, response and participation. The influence of age, educational level, previous clinical contacts, the person who received the citation and the reason for not attending after the first citation were studied. The odds ratio (OR) was used to estimate the magnitude of the association between variables. The OR were adjusted by age and education through unconditional logistic regression. RESULTS: The rates were: coverage 79.2%, response 74.6%, and participation 61%. The response after the first citation was influenced by the recipient of the letter (p < 0.001); when it was the target-woman, the response was 75%. The response after the successive citations was 50.5% if the reason for not attending previously was circumstantial, and 11.5% when it was lack of interest. Having had previous clinical contacts in the primary care centre or in the reference hospital multiplied by 4 to 7 times the response. Coverage decreased with age, and it presented a curvilinear pattern with respect to educational level. Multivariate analyses emphasized the importance of previous clinical contacts (ORs between 3.5 and 8.1; p < 0.001). CONCLUSIONS: Previous contacts with the health system, the method of citation and the reason for not attending after the initial phase were factors clearly associated with participation in a breast cancer screening program. Research on factors influencing participation would contribute to improve the results of screening programs currently underway in Spain.

[Relation of direct hospitalization costs with length of stay]. / Relación de los costes directos de hospitalización con la duración de la estancia.

OBJECTIVE: Our main objective is to analyse to the relationship between the direct cost of a hospitalary discharge and the length of stay controlling for other care variables. METHODS: Analysis of the direct costs of pharmacy, laboratory, pathology and radiology tests of the 21,883 discharged patients in two Barcelona hospitals during 1993, in relationship to care variables contained in the basic minimum data set for discharged patient (BMDSDP). Using both hospital information systems in which are detailed the complete activity carried out and the assignment of unitary costs by means of different methods adapted to the available information, the direct cost is built up for patient and it is assembled by DRG. With the direct cost information and the care variables of the BMDSDP, a simple linear regression (least squared method) is carried out. RESULTS: The average direct cost is up to 31,533 pesetas. The regression by least squared method explains 70% of the variance (R2) and the variables with higher explanatory power are the length of stay and the relative weight of average DRG direct costs, that acts like variable of adjustment. CONCLUSIONS: The variability of the direct cost is explained principally by the length of stay. In addition, the length of stay is also very important on explaining the internal variability of DRG direct cost.