Percepciones de gestores de salud y facilitadores de la estrategia Atención Integrada a las Enfermedades Prevalentes (AIEPI) en una zona del Noreste de Brasil y Perú / Perceptions of health managers and facilitators of the Integrated management of childhood illness (IMCI) in Northeastern Brazil and Peru / Percepções de gestores de saúde e facilitadores da estratégia Atenção Integrada às Doenças Prevalentes na Infância (AIDPI) em uma área do Nordeste do Brasil e Peru

El objetivo del estudio fue explorar las percepciones sobre la estrategia de Atención Integrada a las Enfermedades Prevalentes en la Infancia (AIEPI) de gestores de salud y facilitadores de la estrategia. Se realizó una investigación de tipo cualitativo mediante entrevistas semiestructuradas. Se llevaron a cabo 14 entrevistas entre mayo y junio del 2011, ocho en el Estado de Ceará-Brasil y seis en el Perú. En general los profesionales manifestaron una buena percepción de la estrategia AIEPI, observándose una predominancia del componente clínico, en comparación con el componente comunitario y de servicios de salud. A diferencia de Brasil, en el Perú hubo una promoción gubernamental para la adopción estrategia. En conclusión, este estudio muestra una intervención compleja de la estrategia AIEPI, con predominancia del componente clínico poniendo en evidencia las limitaciones en la integración de los componentes de la estrategia.

The objective of this study was to explore the Integrated Management of Childhood Illness (IMCI) strategy through the perceptions of the health managers and facilitators of strategy. A qualitative study was conducted using semi-structured interviews. Fourteen interviews were carried out, eight in the State of Ceará-Brazil and six in Peru, between May and June 2011. In general, participants expressed a positive perception of the IMCI strategy. Also was observed the predominance of the clinical component, compared with the community or the health services component. In Peru unlike Brazil, the government promoted the adoption of the strategy. In conclusion, this study shows a complex intervention of the IMCI strategy, with a predominance of the clinical component, evidencing the limitations in the integration of the components of the strategy.

O objetivo do estudo foi explorar as percepções da estratégia de Atenção Integrada às Doenças Prevalentes na Infância (AIDPI) de gestores de saúde e facilitadores da estratégia. A pesquisa qualitativa foi realizada por meio de entrevistas semiestruturadas. Foram realizadas 14 entrevistas, entre maio e junho de 2011, oito no Estado do Ceará-Brasil e seis no Peru. De um modo geral, os profissionais relataram uma boa percepção da estratégia AIDPI. Observou-se a predominância do componente clínico, em comparação com os serviços de componentes da comunidade e de saúde. Ao contrário do Brasil, no Peru, houve uma promoção do governo para adoção da estratégia. Em conclusão, este estudo mostra uma intervenção complexa da estratégia AIDPI, com predomínio do componente clínico, colocando em evidência as limitações na integração dos componentes da estratégia.

Modelos de ajuste de riesgo para la evaluación de la mortalidad hospitalaria / Risk-adjustment models for in-hospital mortality assessment

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Características clinicoasistenciales y factores asociados a la mortalidad intrahospitalaria por cáncer de pulmón en España / Clinical care characteristics and factors associated with in-hospital mortality for lung cancer in Spain

Background and objective: Lung cancer causes high morbimortality in Spain and is currently experiencing a significant increase in women. The aim of this study was to describe differential clinical and health care characteristics by sex, as well as factors associated with and geographic differences of in-hospital mortality. Material and method: Descriptive study of episodes registered in the National Hospital Discharge Minimum Basic Data Set for admission type and gender in 2005. Two logistic regression models by sex were built in order to explain the individual influence of variables on in-hospital mortality. Using predictive values of the models, standardized mortality rates were calculated to study the variation between Spanish regions. Results: Women presented a lower mean age, smoking habit and in-hospital mortality than men. However, women presented more adenocarcinomas, greater care in high volume centers, more surgery in readmissions and were subjected to chemotherapy more often in new admissions than men. Adenocarcinoma in men and no specific location in women were associated with higher mortality. Smoking habit and lung diagnosis procedures in men, and middle lobe location and bronchoscopy in women were associated with lower mortality. The geographical mortality pattern detected was similar in both sexes only in some regions of Spain. Conclusions: Differential clinical characteristics, health care and overall results appear to exist depending on individuals’ gender. Recognition of these differences are crucial in order to improve the effectiveness and equity of our health care system (AU)

Fundamento y objetivo: El cáncer de pulmón produce elevada morbimortalidad en España, con un notable incremento actual en las mujeres. El objetivo de este estudio es describir, en función del sexo, las características clínicas y asistenciales, así como los factores asociados y las diferencias geográficas de la mortalidad intrahospitalaria en pacientes con cáncer de pulmón. Material y método: Se estudiaron descriptivamente los episodios del conjunto mínimo básico de datos al alta hospitalaria nacional de 2005 por tipo de ingreso y sexo. Se construyeron dos modelos de regresión logística según sexo para explicar la influencia individual de las variables de interés en la mortalidad intrahospitalaria. Mediante las predicciones resultantes se obtuvieron razones de mortalidad estandarizadas para estudiar las comunidades autónomas. Resultados: Las mujeres presentan menor edad media, tabaquismo y mortalidad intrahospitalaria, y en mayor grado adenocarcinomas, atención en centros de alto volumen, cirugía en reingresos y quimioterapia en nuevos ingresos que los varones. El adenocarcinoma en varones y la localización no especificada en mujeres se asocian a mayor mortalidad. El tabaquismo y las pruebas diagnósticas pulmonares en varones, y la localización en lóbulo medio y la broncoscopia en mujeres están asociados a una menor mortalidad. El patrón geográfico de mortalidad detectado es similar en ambos sexos en algunas comunidades, pero difiere en otras. Conclusiones: Existen características diferenciales clínicas, asistenciales y de resultados en función del sexo del paciente. Su reconocimiento es crucial para conseguir mejorar la efectividad y equidad de nuestro sistema sanitario (AU)

[Clinical care characteristics and factors associated with in-hospital mortality for lung cancer in Spain]. / Características clinicoasistenciales y factores asociados a la mortalidad intrahospitalaria por cáncer de pulmón en España.

BACKGROUND AND OBJECTIVE: Lung cancer causes high morbimortality in Spain and is currently experiencing a significant increase in women. The aim of this study was to describe differential clinical and health care characteristics by sex, as well as factors associated with and geographic differences of in-hospital mortality. MATERIAL AND METHOD: Descriptive study of episodes registered in the National Hospital Discharge Minimum Basic Data Set for admission type and gender in 2005. Two logistic regression models by sex were built in order to explain the individual influence of variables on in-hospital mortality. Using predictive values of the models, standardized mortality rates were calculated to study the variation between Spanish regions. RESULTS: Women presented a lower mean age, smoking habit and in-hospital mortality than men. However, women presented more adenocarcinomas, greater care in high volume centers, more surgery in readmissions and were subjected to chemotherapy more often in new admissions than men. Adenocarcinoma in men and no specific location in women were associated with higher mortality. Smoking habit and lung diagnosis procedures in men, and middle lobe location and bronchoscopy in women were associated with lower mortality. The geographical mortality pattern detected was similar in both sexes only in some regions of Spain. CONCLUSIONS: Differential clinical characteristics, health care and overall results appear to exist depending on individuals' gender. Recognition of these differences are crucial in order to improve the effectiveness and equity of our health care system.

[Hospital management of pancreatic cancer in Spain and assessment of factors associated with in-hospital mortality]. / Manejo hospitalario del cáncer de páncreas en España y estudio de los factores asociados a la mortalidad intrahospitalaria.

BACKGROUND: Pancreatic cancer is becoming an increasingly important health problem in Spain. This study aimed to analyze the hospital management of this process and the factors associated with mortality by using an administrative data base. MATERIAL AND METHOD: We performed a descriptive study. Socio-demographic, clinical, diagnostic, and therapeutic variables of episodes registered in the national Hospital Discharge Minimum Data Set for 2004 were gathered. Comorbidity was assessed with the Charlson index. A logistic regression model was built to explain the individual influence of variables on in-hospital mortality. Mortality in the 17 autonomous regions of Spain was analyzed by using standardized mortality rates, through predicted mortality obtained from the multivariate model. RESULTS: The mean age was 68 years and men represented 56%. Readmissions accounted for 80% of the cases. The most frequent localization was in the pancreatic head and the most frequently employed procedures were computed tomography and surgery. In-hospital mortality was 25%, was higher in men, and increased with age. Mortality was higher in new admissions than in readmissions. Factors associated with higher mortality in the multivariate analysis were male sex, age, unspecified location or location in the tail, emergency admission, hospital stay, and comorbidity. Observed mortality was higher than expected in the Canary Islands and Madrid and was lower than expected in Catalonia and the Valencian Community. DISCUSSION: Future studies with more detailed information should be performed to allow the factors associated with in-hospital mortality from pancreatic cancer to be confirmed and to clarify the reasons for the geographical differences identified.

Manejo hospitalario del cáncer de páncreas en España y estudio de los factores asociados a la mortalidad intrahospitalaria / Hospital management of pancreatic cancer in Spain and assessment of factors associated with in-hospital mortality

Introducción: El cáncer de páncreas es un proceso de salud de importancia creciente en España. El objetivo de este estudio es explorar su manejo y los factores asociados a su mortalidad en el hospital mediante una base de datos administrativa. Material y método: Se realiza un estudio descriptivo con variables sociodemográficas y clínicas, y procedimientos diagnósticos y terapéuticos de episodios contenidos en el Conjunto Mínimo Básico de Datos al alta hospitalaria nacional del año 2004. La comorbilidad se valora mediante el índice de Charlson. Se construye un modelo de regresión logística para explicar la influencia individual de las variables de interés en la mortalidad intrahospitalaria. Mediante razones de mortalidad estandarizadas, a través de las predicciones de mortalidad del modelo multivariante, se estudian las 17 comunidades autónomas españolas. Resultados: La edad media es de 68 años y los varones representan el 56%. Los reingresos representan el 80%. La localización predominante es la cabeza del páncreas, y los procedimientos más empleados, la tomografía computarizada y la cirugía. La mortalidad intrahospitalaria es del 25%, superior en varones, y aumenta con la edad. La mortalidad es mayor en los nuevos ingresos que en los reingresos. Los factores asociados a mayor mortalidad en el análisis multivariante son: sexo masculino, edad, localización en la cola del páncreas o no especificada, ingreso urgente, estancia y comorbilidad. Canarias y Madrid presentan una mortalidad observada superior a la esperada; en cambio, en Cataluña y la Comunidad Valenciana sucede lo contrario. Discusión: Es necesario abordar futuros estudios con información más detallada que permitan confirmar los factores involucrados en la mortalidad intrahospitalaria del cáncer de páncreas y clarificar las razones de las diferencias geográficas encontradas

Background: Pancreatic cancer is becoming an increasingly important health problem in Spain. This study aimed to analyze the hospital management of this process and the factors associated with mortality by using an administrative data base. Material and method: We performed a descriptive study. Socio-demographic, clinical, diagnostic, and therapeutic variables of episodes registered in the national Hospital Discharge Minimum Data Set for 2004 were gathered. Comorbidity was assessed with the Charlson index. A logistic regression model was built to explain the individual influence of variables on in-hospital mortality. Mortality in the 17 autonomous regions of Spain was analyzed by using standardized mortality rates, through predicted mortality obtained from the multivariate model. Results: The mean age was 68 years and men represented 56%. Readmissions accounted for 80% of the cases. The most frequent localization was in the pancreatic head and the most frequently employed procedures were computed tomography and surgery. In-hospital mortality was 25%, was higher in men, and increased with age. Mortality was higher in new admissions than in readmissions. Factors associated with higher mortality in the multivariate analysis were male sex, age, unspecified location or location in the tail, emergency admission, hospital stay, and comorbidity. Observed mortality was higher than expected in the Canary Islands and Madrid and was lower than expected in Catalonia and the Valencian Community. Discussion: Future studies with more detailed information should be performed to allow the factors associated with in-hospital mortality from pancreatic cancer to be confirmed and to clarify the reasons for the geographical differences identified

[Analysis of in-hospital mortality from coronary artery bypass grafting surgery]. / Análisis de la mortalidad intrahospitalaria de la cirugía de revascularización coronaria.

INTRODUCTION AND OBJECTIVES: Outcomes research and monitoring are of key importance in efforts to improve health care effectiveness and quality. The aim of this study was to describe in-hospital mortality from coronary artery bypass grafting in Spain. Data in an administrative database were used to estimate the statistical performance of two risk-adjustment methods, the Charlson and Ghali indexes. PATIENTS AND METHOD: From the Spanish Hospital Minimum Basic Data Set corresponding to 1997 and 1998 all records which included a code for coronary artery bypass grafting were selected. With in-hospital mortality as the outcome variable, two risk-adjusted logistic multiple regression models were constructed. RESULTS: The database included 13,203 cases, of which 80% were men; mean age was 64.5 years. In-hospital mortality was 7.3%. The figure was significantly higher for women and increased with age. A score of one on the Charlson and Ghali indexes was associated, respectively, with a 23 and 20% increase in the risk of mortality. Probability calculated with the Hosmer-Lemeshow goodness of fit test was 0.765 and 0.965, and the C index was 0.66 and 0.67. Values of Nagelkerke's R2 were 0.051 y 0.058. CONCLUSIONS: In-hospital mortality from coronary artery bypass grafting is much higher in Spain than in other countries. The Minimum Basic Data Set, a low-cost information system that is easy to access, yields interesting and useful information to measure health care quality.

Análisis de la mortalidad intrahospitalaria de la cirugía de revascularización coronaria / Analysis of in-hospital mortality from coronary artery bypass grafting surgery

Introducción y objetivos. La investigación y monitorización de resultados constituyen un elemento fundamental para la mejora de la efectividad y calidad asistencial. El objetivo de este trabajo es describir la mortalidad intrahospitalaria en España de la cirugía de revascularización coronaria utilizando una base de datos administrativa, y estimar la capacidad predictiva de dos sistemas de ajuste de riesgo, los índices de Charlson y Ghali. Pacientes y método. Del Conjunto Mínimo Básico de Datos de los años 1997 y 1998, se han seleccionado las altas posteriores a la cirugía de revascularización coronaria. Se han obtenido dos modelos multivariantes ajustados por el riesgo con la mortalidad intrahospitalaria como variable de resultados. Resultados. La base de datos incluye 13.023 casos. El 80 por ciento son varones y la edad media es 64,5 años. La mortalidad intrahospitalaria es un 7,3 por ciento, mayor en las mujeres y aumenta con la edad. Un punto de los índices de Charlson y Ghali se asocia con un incremento del riesgo de muerte de un 23 y de un 20 por ciento. Los valores obtenidos mediante el test de Hosmer-Lemeshow fueron p = 0,765 y p = 0,965, y los valores del índice C fueron 0,66 y 0,67. Los valores de la R2 de Nagelkerke fueron 0,051 y 0,058. Conclusiones. La mortalidad intrahospitalaria de la cirugía de revascularización coronaria es más alta en España que en otros países. El Conjunto Mínimo Básico de Datos, un sistema de información de fácil accesibilidad y bajo coste, permite obtener información interesante y útil para medir la calidad asistencial (AU)