Propuestas para la incorporación del rol de enfermería en la certificación de unidades de espondiloartritis axial. Revisión bibliográfica y consenso entre expertas / Proposals for the Incorporation of the Nursing role in the Certification of Axial Spondyloarthritis Units. Literature Review and Expert Consensus

Objetivo: Analizar el papel de enfermería en el abordaje de la espondiloartritis axial (EspAax) y plantear propuestas que permitan incluir el rol de las consultas de enfermería en reumatología (CER) en la certificación de calidad de las unidades especializadas. Métodos: Revisión sistemática del rol de enfermería en los sistemas de certificación de calidad en el abordaje de la EspAax, seguida de conferencia de consenso con participación de 3enfermeras especializadas en reumatología para determinar elementos que considerar en futuras revisiones de las normas de certificación. Resultados: La revisión sistemática arrojó 5documentos relevantes. Ninguna de las publicaciones revisadas proponía estándares aplicables a la labor asistencial de enfermería en el manejo de pacientes con EspAax, aunque contemplaban actividades propias de este colectivo. Las propuestas consensuadas para incorporar el rol de las CER en las normas de certificación de las unidades monográficas de EspAax incluyeron: equipamientos y recursos básicos, organización, administración de tratamientos farmacológicos y promoción de la adherencia, programas estandarizados para EspAax, consulta telemática para control del paciente estable y promoción de la continuidad asistencial y registro de medidas de resultados informados por los pacientes. Conclusiones: La literatura sobre estándares de calidad y normas de certificación de las unidades monográficas de EspAax es escasa y apenas refleja el papel de las CER en la provisión de una atención de calidad. Las propuestas consensuadas en este trabajo incorporarían las CER en las normas de certificación de calidad. En el futuro, la mayor presencia de CER en España debiera ir acompañada de la actualización de los estándares.(AU)

Objective: To analyse the role of nursing in the approach to axial spondyloarthritis (axSpA) and to make proposals to include the role of rheumatology nursing consultations (RECs) in the quality certification of these specialized units. Methods: A systematic review of the nursing role in quality certification systems in the management of axSpA was conducted. Subsequently a consensus conference was held with the participation of 3rheumatology nurses to determine elements that should be considered in future revisions of certification standards. Results: The systematic review yielded 5papers as relevant. None of the publications reviewed explicitly proposed standards applicable to nursing care in the management of patients with axSpA, although they contemplated the activities of this professional group. The proposals agreed upon to incorporate the role of RECs in the certification standards for axSpA monographic units included the following: basic equipment and resources, organization, administration of pharmacological treatments and promotion of adherence, standardized programmes for axSpA, telematic consultation (e-consultation) for monitoring the stable patient and promoting continuity of care and registry of patient-reported outcome measures. Conclusions: The literature on quality standards and certification standards for axSpA monographic units is scarce and hardly reflects the role of RECs in providing quality care. The consensus proposals in this study would incorporate RECs into quality certification standards. In the future, the increased presence of RECs in Spain should be accompanied by a review of the indicators regarding their role.(AU)

Estándares de calidad en Atención Primaria para pacientes con espondiloartritis axial: una revisión de la literatura / Quality standards in Primary Care for patients with axial spondyloarthritis. A literature review

Introducción: la espondiloartrtis axial (Esp-Ax) es una enfermedad inflamatoria crónica del esqueleto axial. Su inicio insidioso y baja prevalencia dificultan un diagnóstico temprano. Por eso cada vez más el involucramiento de la Atención Primaria y el médico de familia gana más relevancia para una adecuada coordinación para el control de la enfermedad y la detección oportuna de comorbilidades. El objetivo de este estudio fue identificar estándares de calidad para la atención de pacientes con Esp-Ax con especial énfasis en la Atención Primaria. Métodos: se hizo una revisión de la literatura en las siguientes bases de datos: MEDLINE, EMBASE y Cochrane Library para la identificación de publicaciones y literatura gris que validen o reporten estándares de calidad para la atención de pacientes con Esp-Ax, con especial énfasis en la Atención Primaria. No se aplicaron restricciones de idioma, fecha ni de tipología de documentos para obtener una búsqueda más amplia. Resultados: fueron identificados 161 documentos, de los cuales 3 cumplieron con los criterios de inclusión. Los estándares fueron agrupados siguiendo el modelo de Donabedian, 7 estándares de estructura, 3 estándares de proceso y 10 estándares de resultado. Conclusiones. La mejora de la práctica clínica depende de la identificación de oportunidades de mejora. Los estándares de calidad persiguen este objetivo, para disminuir la variabilidad clínica, mejorar los resultados y aumentar la satisfacción de las personas con la atención prestada.(AU)

Introduction: axial spondyloarthritis is a chronic inflammatory disease of the axial skeleton. Its insidious onset and low prevalence make early diagnosis difficult. Therefore, the involvement of primary care and family physicians is becoming more relevant for adequate coordination for control of the disease and the timely detection of comorbidities. The aim of this study was to identify quality standards for the care of Sp-Ax patients with a special emphasis on primary care. Methods: a literature review was performed in the following databases: MEDLINE, EMBASE, and Cochrane Library to identify publications and grey literature that validate or report quality standards for the care of Sp-Ax patients with a special emphasis on primary care. No language, date or document type restrictions were made to obtain a broader search. Result: a total of 161 documents were identified of which three met the inclusion criteria. The standards were grouped according to the Donabedian model, seven structure standards, three process standards, and 10 outcome standards. Conclusions: improving clinical practice depends on identifying opportunities for improvement. Quality standards pursue this objective to reduce clinical variability, improve outcomes and increase people's satisfaction with the care provided.(AU)

Proposals for the incorporation of the nursing role in the certification of axial spondyloarthritis units. Literature review and expert consensus.

OBJECTIVE: To analyse the role of nursing in the approach to axial spondyloarthritis (axSpA) and to make proposals to include the role of rheumatology nursing consultations (RECs) in the quality certification of these specialized units. METHODS: A systematic review of the nursing role in quality certification systems in the management of axSpA was conducted. Subsequently a consensus conference was held with the participation of three rheumatology nurses to determine elements that should be considered in future revisions of certification standards. RESULTS: The systematic review yielded five papers as relevant. None of the publications reviewed explicitly proposed standards applicable to nursing care in the management of patients with axSpA, although they contemplated the activities of this professional group. The proposals agreed upon to incorporate the role of RECs in the certification standards for axSpA monographic units included the following: basic equipment and resources, organization, administration of pharmacological treatments and promotion of adherence, standardized programmes for axSpA, telematic consultation for monitoring the stable patient, registry of patient-reported outcome measures and e-consultation. CONCLUSIONS: The literature on quality standards and certification standards for axSpA monographic units is scarce and hardly reflects the role of RECs in providing quality care. The consensus proposals in this study would incorporate RECs into quality certification standards. In the future, the increased presence of RECs in Spain should be accompanied by a review of the indicators regarding their role.

Proposal of a clinical care pathway for quality and safe management of headache patients: a consensus study report.

BACKGROUND: Headache is one of the most prevalent and disabling conditions. Its optimal management requires a coordinated and comprehensive response by health systems, but there is still a wide variability that compromises the quality and safety of the care process. PURPOSE: To establish the basis for designing a care pathway for headache patients through identifying key subpathways in the care process and setting out quality and clinical safety standards that contribute to providing comprehensive, adequate and safe healthcare. METHOD: A qualitative research study based on the consensus conference technique. Eleven professionals from the Spanish National Health System participated, seven of them with clinical experience in headache and four specialists in healthcare management and quality. First, identification of the key subpathways in the care process for headache, barriers/limitations for optimal quality of care, and quality and safety standards applied in each subpathway. Second, two consecutive consensus rounds were carried out to assess the content of the subpathway level descriptors, until the expert agreement was reached. Third, findings were assessed by 17 external healthcare professionals to determine their understanding, adequacy and usefulness. RESULTS: Seven key subpathways were identified: (1) primary care, (2) emergency department, (3) neurology department, (4) specialised headache unit, (5) hospitalisation, (6) outpatients and (7) governance and management. Sixty-seventh barriers were identified, the most frequent being related to diagnostic errors (36,1%), resource deficiency (25%), treatment errors (19,4%), lack of health literacy (13,9%) and inadequate communications with care transitions (5,6%). Fifty-nine quality and 31 safety standards were defined. They were related to evaluation (23.3%), patient safety (21.1%), comprehensive care (12.2%), treatment (12.2%), clinical practice guidelines (7.8%), counselling (6.7%), training (4.4%) and patient satisfaction (3.3%). CONCLUSIONS: This proposal incorporates a set of indicators and standards, which can be used to define a pathway for headache patients and determine the levels of quality.

Unidades especializadas de cefalea, una alternativa viable en España / Specialised headache units, a feasible alternative in Spain

INTRODUCCIÓN: Las consultas por cefalea son el motivo más frecuente de demanda de atención de causa neurológica en la atención primaria y en los servicios de neurología. Las unidades de cefalea mejoran la calidad asistencial, reducen las listas de espera, facilitan el acceso a nuevos tratamientos de eficacia contrastada y optimizan el gasto sanitario. No obstante, la implantación de estas unidades no está extendida en España debido a la relativa importancia atribuida a la patología y a la suposición de que su coste es elevado. OBJETIVO: Definir la estructura y los requerimientos mínimos de una unidad de cefalea con la intención de contribuir a su extensión en los hospitales de España. SUJETOS Y MÉTODOS: Estudio de consenso entre profesionales tras la revisión de la bibliografía sobre la estructura, las funciones y los recursos de una unidad de cefalea para un área de 350.000 habitantes. RESULTADOS: Se tomaron como referencia ocho publicaciones para la identificación de recursos mínimos necesarios de una unidad de cefalea. El panel de expertos estuvo integrado por 12 profesionales de diferentes especialidades. El principal recurso para la implementación de estas unidades son profesionales (superiores y técnicos), lo que puede suponer un coste adicional para el primer año de alrededor de 107.287,19 euros. CONCLUSIONES: Si consideramos los costes directos e indirectos debidos a las pérdidas por productividad laboral por paciente y los comparamos con los costes estimados de implantación de estas unidades y su expectativa de resultados, todo apunta a que es necesaria la generalización de unidades de cefalea en España

INTRODUCTION: Visits due to headaches are the most frequent cause of demand for neurological treatment in primary care and neurology services. Headache units improve the quality of care, reduce waiting lists, facilitate access to new treatments of proven efficacy and optimise healthcare expenditure. However, these units have not been implemented on a widespread basis in Spain due to the relatively low importance attributed to the condition and also the assumption that such units have a high cost. AIM: To define the structure and minimum requirements of a headache unit with the intention of contributing to their expansion in hospitals in Spain. SUBJECTS AND METHODS: We conducted a consensus study among professionals after reviewing the literature on the structure, functions and resources required by a headache unit designed to serve an area with 350,000 inhabitants. RESULTS: Eight publications were taken as a reference for identifying the minimum resources needed for a headache unit. The panel of experts was made up of 12 professionals from different specialties. The main resource required to be able to implement these units is the professional staff (both supervisory and technical), which can mean an additional cost for the first year of around 107,287.19 euros. CONCLUSIONS: If we bear in mind the direct and indirect costs due to losses in labour productivity per patient and compare them with the estimated costs involved in implementing these units and their expected results, everything points to the need for headache units to become generalised in Spain

Low-value care practice in headache: a Spanish mixed methods research study.

BACKGROUND: Headache is one of the most prevalent diseases. The Global Burden of Disease Study ranks it as the seventh most common disease overall and the second largest neurological cause of disability in the world. The "Do Not Do" recommendations are a strategy for increasing the quality of care and reducing the cost of care for headache. This study aimed to identify specific low-value practices in headache care, determine their frequency, and estimate the cost overrun that they represent, in order to establish "Do not Do" recommendations specifically for headache by consensus and according to scientific evidence. METHODS: This was a mixed methods research study that combined qualitative consensus-building techniques, involving a multidisciplinary panel of experts to define the "Do Not Do" recommendations in headache care, and a retrospective observational study with review of a randomized set of patient records from the past 6 months in four hospitals, to quantify the frequency of these "Do Not Do" practices. We calculated the sum of direct costs of medical consultations, medicines, and unnecessary diagnostic tests. RESULTS: Seven "Do Not Do" recommendations were established for headache. In total, 3507 medical records were randomly reviewed. Low-value practices had a highly variable occurrence, depending on the hospital and type of headache. Overall, 34.1% of low-value practices were related to treatment, 21% were related to overuse of imaging in consultation, and 19% were related to emergency care. The estimated cost of low-value practices in the four hospitals was 203,520.47 euros per 1000 patients. CONCLUSIONS: This study identified low-value headache practices that need to be eradicated and provided data on their frequency and cost overruns.

A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX-EMD Study.

BACKGROUND: The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) offers the potential to overcome the challenges associated with traditional decision-making tools. OBJECTIVES: A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. METHODS: Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defined all of the criteria that could influence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was fitted by applying the backward elimination algorithm (relevant criteria: p value < 0.05). Finally, the results were discussed in a deliberative process (phase C). RESULTS: Thirty-one criteria were initially defined (phase A) and grouped into 5 categories: efficacy/effectiveness, safety, organizational and economic impact, patient-reported outcomes, and other therapeutic features. The DCE results (phase B) showed that 10 criteria were relevant to the decision-making process for a 50- to 65-year-old DME patient: mean change in best corrected visual acuity (p value < 0.001), percentage of patients with an improvement of ≥ 15 letters (p value < 0.001), effect duration per administration (p value = 0.008), retinal detachment (p value < 0.001), endophthalmitis (p value = 0.012), myocardial infarction (p value < 0.001), intravitreal hemorrhage (p value = 0.021), annual treatment cost per patient (p value = 0.001), health-related quality of life (HRQoL) (p value = 0.004), and disability level (p value = 0.021). CONCLUSIONS: From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment effect duration. It should also contribute to system sustainability by being affordable, it should have a positive impact on HRQoL, and it should prevent disability.

Quality assurance in specialized headache units in Spain: an observational prospective study.

OBJECTIVE: To assess the quality of the therapeutic approach in Specialized Headache Units in Spain. METHODS: An observational (prospective) study was conducted. Anonymized data of 313 consecutive patients during a defined period of time were analyzed and a comparison of performance in 13 consensual quality indicators between Specialized Headache Units and neurology consultations was calculated. Specialized Units and neurology consultations represented the type of provision that Spaniards receive in hospitals. RESULTS: The consensus benchmark standard was reached for 8/13 (61%) indicators. Specialized Headache Units performed better in the indicators, specifically in relation to accessibility, equity, safety, and patient satisfaction. Patients attended in Specialized Headache Units had more complex conditions. CONCLUSION: Although there is variability among Specialized Headache Units, the overall quality was generally better than in traditional neurology consultations in Spain.

Regresión logística y redes neuronales como herramientas para realizar un modelo Scoring / Logistic regression and neural networks as tools to perform a Scoring model / Regressão logística e redes neuronais como ferramentas para realizar Scoring

Resumen Introducción. El propósito de esta investigación es analizar el riesgo crediticio de una institución financiera no vigilada por la Superintendencia Financiera de Colombia en torno a un modelo scoring que permita determinar el incumplimiento de los clientes correspondiente a su cartera de consumo. Objetivo. Confrontar el poder de pronosticación de dos modelos scoring obtenidos a través de regresión logística y red neuronal. Materiales y métodos. Los modelos se desarrollan con base en una muestra de 43.086 obligaciones correspondiente a una cartera de consumo, utilizando las técnicas estadísticas de regresión logística y red neuronal. La primera está enmarcada en el grupo de los modelos lineales generalizados, los cuales utilizan una función logit y son útiles para modelar probabilidades referentes a un evento en función de otras variables, mientras que la segunda son modelos computacionales cuyo objetivo es resolver problemas utilizando relaciones ya estipuladas y para ello utiliza una muestra base del proceso que se ampara en el éxito del autoaprendizaje producto del entrenamiento. Resultados. Para ambos modelos se logra una precisión del 71% en la base de entrenamiento y del 72 % en la base de comprobación, sin embargo, a pesar de obtener resultados similares, la regresión logística arrojó la menor tasa de malos en la zona de aceptación. Conclusión. Las dos técnicas utilizadas son adecuadas para el estudio y predicción de la probabilidad de incumplimiento de un cliente correspondiente a una cartera de consumo, lo anterior, respaldado por el alto índice de eficacia predictiva en ambos modelos.

Abstract Introduction. The purpose of this research is to analyze the credit risk of a financial institution not supervised by the Financial Superintendence of Colombia around a scoring model that allows determining the default of clients corresponding to their consumer portfolio. Objective. Confront the forecasting power of two scoring models obtained through logistic regression and neural network. Materials and methods. The models are developed based on a sample of 43,086 obligations corresponding to a consumer portfolio, using the statistical techniques of logistic regression and neural network. The first is framed in the group of generalized linear models, which use a logit function and are useful for modeling probabilities related to an event based on other variables; while the second consists in computational models whose objective is to solve problems using relationships already stipulated, employing for this purpose a base sample of the process that is based on the success of the self-learning resulting from training. Results. For both models, an accuracy of 71 % in the training base and 72 % in the testing base is achieved. However, despite obtaining similar results, the logistic regression yielded the lowest rate of bad in the acceptance zone. Conclusion. The two techniques used are suitable for the study and prediction of the probability of default of a client corresponding to a consumer portfolio; the foregoing is supported by the high index of predictive effectiveness in both models.

Resumo Introdução. O propósito de esta pesquisa é analisar o risco creditício de uma instituição financeira não vigilada pela Superintendência Financeira da Colômbia em torno de um modelo scoring que permita determinar o incumprimento dos clientes correspondentes à sua carteira de consumidores. Objetivo. Confrontar o poder de previsão de dois modelos scoring obtidos através de regressão logística e rede neuronal. Materiais e métodos. Os modelos desenvolvam-se com base em uma amostra de 43.086 obrigações correspondentes à una carteira de consumidores, utilizando as técnicas estatísticas de regressão logística e rede neuronal. A primeira está enquadrada no grupo dos modelos lineais generalizados, os quais utilizam uma função logit e são úteis para modelar probabilidades referentes à um evento em função de outras variáveis, em quanto que, a segunda são modelos computacionais cujo objetivo é resolver problemas utilizando relações já estipuladas e para isso utiliza-se uma amostra base do processo que ampara-se no sucesso do autoaprendizagem produto do treinamento. Resultados. Para ambos os modelos se consegue uma precisão do 71% na base do treinamento e do 72% na base da comprovação, mas, não obstante isso, a pesar de obterem resultados semelhantes, a regressão logística mostrou a menor taxa ruim na zona de aceitação. Conclusão. As duas técnicas utilizadas são adequadas para o estudo e previsão da probabilidade do incumprimento de um cliente correspondente à una carteira de consumidores, o que precede, respaldado pelo alto índice de eficiência preditiva em ambos os modelos.

Cartera de servicios y cuadro básico de indicadores de calidad para las unidades de cefalea: estudio de consenso / Portfolio of services and basic table of quality indicators for Headache Units: a consensus study

Objetivo. Elaborar una propuesta de cartera de servicios para una unidad de cefalea y un conjunto básico de indicadores de calidad asistencial en cefalea. Desarrollo. Estudio que aplicó técnicas de búsqueda de consenso con participación de un total de 15 profesionales expertos en tratamiento de cefaleas (experiencia de más de 15 años) y en gestión de calidad. La descripción de los indicadores incluyó: enunciado, definición, estándar, tipo de indicador, dimensión, fuente, nivel de evidencia y aclaraciones de términos. La propuesta de cartera de servicios incluyó los siguientes ámbitos: gestión clínica, atención centrada en el paciente, implicación comunitaria, gestión del conocimiento, investigación traslacional y difusión social. La propuesta se concretó en 13 indicadores que abarcaban cinco dimensiones. Conclusiones. Esta propuesta contribuye a asegurar y evaluar el nivel de calidad de una unidad de cefaleas o de las consultas monográficas de cefaleas

Aim. To develop a proposal for a portfolio of services and a set of indicators for Headache Units. Development. Qualitative study that applied techniques of consensus with the participation of 15 professionals who are experts in the treatment of headaches (experience of 15 years) and in quality assurance. The description of the indicators included: statement, definition, standard, type of indicator, dimension, source, level of evidence, and clarification of terms. The proposal for a portfolio of services included the following areas: clinical management, patient-centered care, community involvement, knowledge management, translational research, and social dissemination. The proposal converged in 13 indicators exploring five dimensions. Conclusions. This proposal contributes to ensure and assess the level of quality of a Headache Unit or outpatient clinic

Indicadores de calidad en el tratamiento de pacientes con depresión, trastorno bipolar o esquizofrenia. Estudio de consenso / Quality indicators in the treatment of patients with depression, bipolar disorder or schizophrenia. Consensus study

Objetivo. Identificar, para el conjunto de la red asistencial en salud mental en España, un conjunto de indicadores para monitorizar la calidad asistencial en esquizofrenia, depresión mayor y trastorno bipolar. Material y método. Estudio basado en el consenso de especialistas en psiquiatría (6 en comité de dirección y un panel de 43 psiquiatras de la sanidad pública). Tras revisar la literatura se elaboró una propuesta inicial de 44 indicadores para depresión mayor, 42 para esquizofrenia y 58 para trastorno bipolar que, mediante estudio Delphi, fue analizada por los expertos. La valoración de estos indicadores en sucesivas rondas permitió descartar aquellos con menor grado de consenso. Se consideraron factibilidad, sensibilidad y relevancia clínica. El estudio fue realizado entre los meses de julio de 2015 y marzo de 2016. Resultados. Se definieron por consenso 70 indicadores: 17 indicadores específicos de depresión mayor, 16 de esquizofrenia, 17 de trastorno bipolar y 20 comunes a las tres patologías. Entre estos indicadores se incluyeron medidas relativas a adecuación de los ingresos, seguridad del paciente, reagudización, contención mecánica, conducta suicida, programas psicoeducativos, adherencia terapéutica, mortalidad y salud física. Conclusiones. Este conjunto de indicadores permite monitorizar la calidad en el tratamiento de pacientes con esquizofrenia, depresión o trastorno bipolar. Cada dispositivo asistencial puede, a partir de esta propuesta, elaborar un cuadro de mando integral ajustado a sus prioridades y objetivos asistenciales

Objective. To define a set of indicators for mental health care, monitoring quality assurance in schizophrenia, depression and bipolar disorders in Spain. Material and method. Qualitative research. Consensus-based study involving 6 psychiatrists on the steering committee and a panel of 43 psychiatrists working in several health services in Spain. An initial proposal of 44 indicators for depression, 42 for schizophrenia and 58 for bipolar disorder was elaborated after reviewing the literature. This proposal was analysed by experts using the Delphi technique. The valuation of these indicators in successive rounds allowed those with less degree of consensus to be discarded. Feasibility, sensitivity and clinical relevance were considered. The study was carried out between July 2015 and March 2016. Results. Seventy indicators were defined by consensus: 17 for major depression, 16 for schizophrenia, 17 for bipolar disorder and 20 common to all three pathologies. These indicators included measures related to adequacy, patient safety, exacerbation, mechanical restraint, suicidal behaviour, psychoeducation, adherence, mortality and physical health. Conclusions. This set of indicators allows quality monitoring in the treatment of patients with schizophrenia, depression or bipolar disorder. Mental health care authorities and professionals can use this proposal for developing a balanced scorecard adjusted to their priorities and welfare objectives

Quality indicators in the treatment of patients with depression, bipolar disorder or schizophrenia. Consensus study. / Indicadores de calidad en el tratamiento de pacientes con depresión, trastorno bipolar o esquizofrenia. Estudio de consenso.

OBJECTIVE: To define a set of indicators for mental health care, monitoring quality assurance in schizophrenia, depression and bipolar disorders in Spain. MATERIAL AND METHOD: Qualitative research. Consensus-based study involving 6 psychiatrists on the steering committee and a panel of 43 psychiatrists working in several health services in Spain. An initial proposal of 44 indicators for depression, 42 for schizophrenia and 58 for bipolar disorder was elaborated after reviewing the literature. This proposal was analysed by experts using the Delphi technique. The valuation of these indicators in successive rounds allowed those with less degree of consensus to be discarded. Feasibility, sensitivity and clinical relevance were considered. The study was carried out between July 2015 and March 2016. RESULTS: Seventy indicators were defined by consensus: 17 for major depression, 16 for schizophrenia, 17 for bipolar disorder and 20 common to all three pathologies. These indicators included measures related to adequacy, patient safety, exacerbation, mechanical restraint, suicidal behaviour, psychoeducation, adherence, mortality and physical health. CONCLUSIONS: This set of indicators allows quality monitoring in the treatment of patients with schizophrenia, depression or bipolar disorder. Mental health care authorities and professionals can use this proposal for developing a balanced scorecard adjusted to their priorities and welfare objectives.

Quality Indicators to Assure and Improve Cancer Care in Spain Using the Delphi Technique.

BACKGROUND: The quality of cancer care has become a priority for health care systems. The goal of this research was to develop a set of evidence-based quality indicators (QIs) for organization, palliative care, and colorectal, breast, and lung cancers for introducing a system of benchmarking in Spain. METHODS: A comprehensive evidence-based literature search was performed to identify potential QIs. An expert panel (the health care quality promotion group) of 9 oncologists identified indicators and evaluated them. A Delphi process involving 58 physicians was used to rank QIs by clinical relevance (validity). The expert panel then evaluated the selected indicators in terms of the feasibility of measuring them in Spanish hospitals, their usefulness for comparisons, their degree of clinical relevance, and their sensitivity to the impact of health care improvements. RESULTS: From the literature review, 99 potential QIs were identified. The Delphi process shortened the list to 72 QIs. A final set of 57 QIs was established by the health care quality promotion group: 12 related to organizational issues, 11 to colorectal cancer, 11 to breast cancer, 12 to lung cancer, and 11 to palliative care. This final set included structure (n=2), process (n=36), and outcome (n=19) indicators. CONCLUSIONS: A set of QIs has been developed using a validated Delphi method, meaning that we can be confident of their validity, feasibility, sensitivity, and acceptability. These QIs are to serve as the basis of a strategy for benchmarking across oncology services in Spanish hospitals and should enable us to assure and improve the quality of cancer care.

El punto de vista de los pacientes sobre la seguridad clínica de los hospitales: Validación del Cuestionario de Percepción de Seguridad / Hospital clinical safety from the patient's point of view: Validation of a safety perception questionnaire

Background: Approximately 10 percent of hospitalized patients suffer an adverse event during their hospital stay. An important proportion of subjects also feel that they have a high risk of suffering such an event during an eventual hospitalization. Aim: To determine the perception on clinical safety among patients discharged from a hospital. Material and methods: A questionnaire about hospital safety was mailed to 1300 patients discharged from a hospital. The questionnaire was analyzed using construct validity predictive validity and Cronbach Alpha for internal consistency Results: The questionnaire was answered by 384 patients, yielding a response rate of 29 percent. Of these, 77 incomplete answers were discarded. Thirty-one subjects (10 percent) reported a possible adverse event. In 19 cases (5.8 percent), it was due to medication errors and in 19 (6.1 percent), to surgical procedures. In seven cases (2.3 percent), both errors coincided (2.3 percent). According to the predictive validity of the questionnaire, if a patient reports an adverse event, the confidence in the hospital and in the professionals is reduced (p <0.001), communication with the physician is considered inappropriate (p =0.0001) and risk perception increases (p =0.003). Unsatisfied patients are those that believe that they have higher risks of suffering a medical error (p =0.005). Conclusions: Risk perception for adverse events increases after having suffered such an event. Patient satisfaction minimizes the effects of adverse events on their confidence and attitude.

[Hospital clinical safety from the patient's point of view: validation of a safety perception questionnaire]. / El punto de vista de los pacientes sobre la seguridad clínica de los hospitales: Validación del Cuestionario de Percepción de Seguridad.

BACKGROUND: Approximately 10% of hospitalized patients suffer an adverse event during their hospital stay. An important proportion of subjects also feel that they have a high risk of suffering such an event during an eventual hospitalization. AIM: To determine the perception on clinical safety among patients discharged from a hospital. MATERIAL AND METHODS: A questionnaire about hospital safety was mailed to 1300 patients discharged from a hospital. The questionnaire was analyzed using construct validity predictive validity and Cronbach Alpha for internal consistency. RESULTS: The questionnaire was answered by 384 patients, yielding a response rate of 29%. Of these, 77 incomplete answers were discarded. Thirty-one subjects (10%) reported a possible adverse event. In 19 cases (5.8%), it was due to medication errors and in 19 (6.1%), to surgical procedures. In seven cases (2.3%), both errors coincided (2.3%). According to the predictive validity of the questionnaire, if a patient reports an adverse event, the confidence in the hospital and in the professionals is reduced (p <0.001), communication with the physician is considered inappropriate (p =0.0001) and risk perception increases (p =0.003). Unsatisfied patients are those that believe that they have higher risks of suffering a medical error (p =0.005). CONCLUSIONS: Risk perception for adverse events increases after having suffered such an event. Patient satisfaction minimizes the effects of adverse events on their confidence and attitude.

La indización en Index Medicus/Medline: un reto posible / Inclusion in Index Medicus/Medline: a seasible goal

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Un modelo de gestión de la calidad total para la enfermería hospitalaria / A model of total quality management for the hospital nursing

Introducción: El modelo Europeo para la Gestión de la calidad Total (EFQM) se sintetiza de la siguiente manera: La satisfacción de los clientes y empleados, se consiguen mediante un liderazgo que impulse la política y estrategia de la organización a través de una adecuada utilización de los recursos con una perfecta gestión de los procesos más importantes de la organización con objeto de conseguir unos resultados excelentes. Existen algunas experiencias aisladas en Europa y algunos proyectos en marcha en España que intenta adaptar el modelo EFQM para instituciones sanitarias. Este modelo, al igual que puede ser aplicable al contexto general de las actividades que se llevan a cabo en un hospital, también sería posible circunscribirlo al área de los cuidados de enfermería. Es precisamente ésta aplicación la que hemos llevado a cabo. Objetivo: Evaluar mediante un modelo de excelencia de gestión de calidad total la enfermería hospitalaria. Material y Métodos: Se presenta un estudio basando en técnicas de investigación cualitativas (brainstorming, Técnica de grupo nominal-TGN), en el que diferentes enfermeros expertos (clínicos, gestores y docentes) y pacientes lograron consenso sobre los aspectos, contenidos, instrumentos y métodos, que basados en los criterios del modelo EFQM, sirvan para medir la calidad de los cuidados de enfermería en los hospitales. Completado el modelo, que consta de más de 500 áreas o criterios de evaluación, se aplicó en el área materno infantil de 3 hospitales del Servicio Andaluz de Salud. Resultados: Se contrastan los resultados obtenidos en los tres centros y las dificultades que ha presentado su aplicación. De los resultados se desprende que en todos los criterios y en todos los hospitales existen innumerables aéreas que mejorar y que las puntuaciones obtenidas (373,4, 174,3 y 193,1 sobre 1.000) distan mucho de las obtenidas por organizaciones excelentes. Conclusión: El modelo nos muestra una herramienta útil y exhaustiva, que puede ser utilizada para la detección y priorización de oportunidades de mejora, sobre las cuales podemos intervenir para alcanzar mejoras en las distintas áreas abordadas (AU)

Adaptación de un Modelo de Gestión de Calidad Total al sector sanitario / An adaptation of a Total Quality Management Model to the health care sector

Introducción: la implantación de técnicas de gestión de calidad total en el sector sanitario es reciente, este artículo describe el proceso de adaptación del modelo EFQM de excelencia a nuestro medio. Material y método: el proceso de adaptación se realizó mediante técnicas cualitativas y han participado en su elaboración expertos de diferentes Servicios Regionales de Salud y del Insalud. Resultados: en la adaptación se ha modificado mínimamente el modelo en el nivel de criterios, aunque en el nivel de subcriterios se ha simplicado para facilitar su aplicación en nuestro medio, y se han incluido las diferentes áreas a analizar en cada uno de los subcriterios para facilitar el proceso de evaluación (AU)