[The quality of care in shoulder pain. A medical audit]. / La calidad de la atención al hombro doloroso. Audit clínico.

BACKGROUND: To evaluate the quality of hospital ambulatory care in non-surgical painful shoulder by auditing medical records using quality indicators. MATERIAL AND METHODS: We reviewed 245 medical records of non-surgical patients assisted for pain shoulder in 1999-2000 in two public hospitals. Quality of care indicators for antecedents, physic exploration, diagnosis and treatment were developed based in systematic reviews of clinical trials, guidelines and expert criteria. Medical records review was carried out by two rehabilitative doctors. Fulfilling of quality criteria and differences between hospitals was analyzed. RESULTS: 76.3% of the medical records did not fulfill > or = 4 of 10 quality criteria for antecedents, 61.6% did not fulfill > or = 3 of 10 criteria for physical exploration, and 7.7% did not have any diagnosis registered. 96.9% of the 98 patients with impingement syndrome did not complete the criteria of anti-inflammatory treatment or infiltration in the pre-established time, and up to 15.3% had not been proposed physiotherapy or programmed exercise in the 4 weeks after the diagnosis; 95.8% of the 24 patients with rotators cuff tears were not proposed for early surgical evaluation, and 86.7% of the 15 cases of adhesive capsulitis did not receive instructions to carry out programmed exercise in the proposed times. CONCLUSIONS: The audit revealed significant deficiencies in adherence to quality indicators in non-surgical pain shoulder. Part of these problems can be due to low medical records quality.

A epidemiologia: desenvolvimentos, usos e aplicações / The epidemiology: development, uses and applications

A epidemiologia é o ramo da saúde publica que tem como propósito descrever e explicar a dinâmica da saúde populacional e identificar os elementos que a compõem, a fim de intervir no curso do seu desenvolvimento natural. Algo que já comentei de passagem e que neste aspecto é fundamental, é que os estudos epidemiológicos são de base populacional, razão pela qual suas conclusões e inferências só são aplicáveis em termos populacionais, nunca individuais. É um erro de interpretação que se comete com demasiada freqüência.

The epidemiology is a field of public health that describes and explains the dynamic of populational health as well as identifies the elements that make it in order to interfere in its natural development. Something fundamental, I have already mentioned, is that the epidemiological studies have popular basis, which is why its conclusions and interferences are applicable only in popular terms, never individually. This interpretation mistake occurs quite often.

A epidemiologia: desenvolvimentos, usos e aplicações / The epidemiology: development, uses and applications

A epidemiologia é o ramo da saúde publica que tem como propósito descrever e explicar a dinâmica da saúde populacional e identificar os elementos que a compõem, a fim de intervir no curso do seu desenvolvimento natural. Algo que já comentei de passagem e que neste aspecto é fundamental, é que os estudos epidemiológicos são de base populacional, razão pela qual suas conclusões e inferências só são aplicáveis em termos populacionais, nunca individuais. É um erro de interpretação que se comete com demasiada freqüência.

The epidemiology is a field of public health that describes and explains the dynamic of populational health as well as identifies the elements that make it in order to interfere in its natural development. Something fundamental, I have already mentioned, is that the epidemiological studies have popular basis, which is why its conclusions and interferences are applicable only in popular terms, never individually. This interpretation mistake occurs quite often.

La calidad de la atención al hombro doloroso. Audit clínico / The quality of care in pain shoulder. A medical audit

Fundamento: Valorar la calidad de la atención al hombro doloroso no quirúrgico en la consulta externa hospitalaria mediante la revisión de historias clínicas (HC) y su contraste con indicadores de calidad. Material y métodos: Revisión retrospectiva de 245 HC de pacientes no quirúrgicos atendidos por hombro doloroso entre 1999-2000 en dos hospitales públicos. Se establecieron indicadores de calidad de la anamnesis, exploración física, diagnóstico y tratamiento, basados en revisiones sistemáticas de ensayos clínicos, guías de práctica y revisión por expertos. La revisión de HC se realizó por dos médicos rehabilitadores y se analizó la cumplimentación de los criterios de calidad y las diferencias entre hospitales. Resultados: Un 76,3% de las HC no recogía >= 4 de los 10 criterios de calidad de la anamnesis, un 61,6% no incluía >= 3 de los 10 criterios de calidad de la exploración física y un 7,7% no tenía el diagnóstico anotado. El 96,9% de los 98 pacientes con síndrome subacromial no cumplía el criterio de tratamiento antiinflamatorio o infiltración en los tiempos preestablecidos, y a un 15,3% no se le había propuesto fisioterapia o ejercicio programado en las 4 semanas tras el diagnóstico; al 95,8% de los 24 pacientes con rotura del manguito de rotadores no se le propuso evaluación temprana para posible cirugía, y el 86,7% de los 15 casos de capsulitis adhesiva no recibió instrucciones para realizar ejercicio programado en los tiempos propuestos. Conclusiones: Hay importantes insuficiencias en la calidad de la atención al hombro doloroso o en su registro en la HC

Background: To evaluate the quality of hospital ambulatory care in non-surgical painful shoulder by auditing medical records using quality indicators. Material and methods: We reviewed 245 medical records of non-surgical patients assisted for pain shoulder in 1999-2000 in two public hospitals. Quality of care indicators for antecedents, physic exploration, diagnosis and treatment were developed based in systematic reviews of clinical trials, guidelines and expert criteria. Medical records review was carried out by two rehabilitative doctors. Fulfilling of quality criteria and differences between hospitals was analyzed. Results: 76.3% of the medical records did not fulfill >= 4 of 10 quality criteria for antecedents, 61.6% did not fulfill >= 3 of 10 criteria for physical exploration, and 7.7% did not have any diagnosis registered. 96.9% of the 98 patients with impingement syndrome did not complete the criteria of anti-inflammatory treatment or infiltration in the pre-established time, and up to 15.3% had not been proposed physiotherapy or programmed exercise in the 4 weeks after the diagnosis; 95.8% of the 24 patients with rotators cuff tears were not proposed for early surgical evaluation, and 86.7% of the 15 cases of adhesive capsulitis did not receive instructions to carry out programmed exercise in the proposed times. Conclusions: The audit revealed significant deficiencies in adherence to quality indicators in non-surgical pain shoulder. Part of these problems can be due to low medical records quality