Aportaciones e inconvenientes de la incorporación de metodología cualitativa en la evaluación de servicios sanitarios. Un caso práctico: la evaluación de una consulta de alta resolución / Advantages and disadvantages of incorporating qualitative methodology in the evaluation of health services. A practical case: evaluation of a high-resolution clinic

Objetivo. En el marco de una evaluación sobre la calidad asistencial en una Unidad de Cardiología de Alta Resolución (UCAR) realizada con técnicas cuantitativas, se analizó la utilidad de incorporar una fase cualitativa a la investigación. Material y métodos. Se realizó una investigación cuantitativa con cuestionario estructurado y selección de sujetos por muestreo aleatorio sistemático (n=320) y una investigación cualitativa mediante entrevistas semiestructuradas a pacientes seleccionados por criterios de conveniencia (n=11), observaciones en el circuito asistencial y una entrevista en grupo con los profesionales de la UCAR. Posteriormente, el equipo de investigación, multidisciplinar, analizó individualmente la información recabada en las fases cuantitativa y cualitativa, evaluando los diferentes resultados obtenidos en ambas fases y los posibles sesgos derivados del uso de métodos cualitativos. Se realizaron tres reuniones siguiendo la técnica «brainstorming», para identificar las diversas aportaciones de cada una de las metodologías empleadas, utilizando diagramas de afinidades. Resultados. La investigación cualitativa permitió profundizar en algunos aspectos concretos del servicio que habían sido recogidos en la fase cuantitativa, matizando los resultados obtenidos en la fase previa, ahondando en las razones de insatisfacción con aspectos específicos, como los tiempos de espera y las infraestructuras disponibles, e identificando cuestiones emergentes del servicio, no evaluadas anteriormente. Conclusiones. Globalmente, la fase cualitativa enriqueció de forma sustantiva los resultados de la investigación. Es adecuado y recomendable incorporar este enfoque metodológico en investigaciones encaminadas a evaluar la calidad del servicio en un determinado contexto sanitario puesto que aporta, de primera mano, la voz del cliente(AU)

Objective. We examined the usefulness of incorporating a qualitative phase in the evaluation of the quality of care in a high-resolution medical service carried out with quantitative methods. Design and methods. A quantitative research was performed using a structured questionnaire and selecting interviewees by systematic randomized sampling methods (n=320). In addition, a qualitative research was carried on through semi-structured interviews with patients selected by convenience criteria (n=11), observations in the care assistance circuit, and a group interview with health professionals working in the service. A multidisciplinary research team conducted an individual analysis of the information collected in both quantitative and qualitative phases. Subsequently, three meetings based on group brainstorming techniques were held to identify the diverse contributions of each of the methodologies employed to the research, using affinity graphs to analyse the different results obtained in both phases and evaluate possible bias arising from the use of qualitative methods. Results. Qualitative research allowed examining specific aspects of the health care service that had been collected in the quantitative phase, harmonizing the results obtained in the previous phase, giving in-depth data on the reasons for patient dissatisfaction with specific aspects, such as waiting times and available infrastructures, and identifying emerging issues of the service which had not been previously assessed. Conclusions. Overall, the qualitative phase enriched the results of the research. It is appropriate and recommendable to incorporate this methodological approach in research aimed at evaluating the quality of the service in specific health care settings, since it is provided first hand, by the voice of the customer(AU)

[Advantages and disadvantages of incorporating qualitative methodology in the evaluation of health services. A practical case: evaluation of a high-resolution clinic]. / Aportaciones e inconvenientes de la incorporación de metodología cualitativa en la evaluación de servicios sanitarios. Un caso práctico: la evaluación de una consulta de alta resolución.

OBJECTIVE: We examined the usefulness of incorporating a qualitative phase in the evaluation of the quality of care in a high-resolution medical service carried out with quantitative methods. DESIGN AND METHODS: A quantitative research was performed using a structured questionnaire and selecting interviewees by systematic randomized sampling methods (n=320). In addition, a qualitative research was carried on through semi-structured interviews with patients selected by convenience criteria (n=11), observations in the care assistance circuit, and a group interview with health professionals working in the service. A multidisciplinary research team conducted an individual analysis of the information collected in both quantitative and qualitative phases. Subsequently, three meetings based on group brainstorming techniques were held to identify the diverse contributions of each of the methodologies employed to the research, using affinity graphs to analyse the different results obtained in both phases and evaluate possible bias arising from the use of qualitative methods. RESULTS: Qualitative research allowed examining specific aspects of the health care service that had been collected in the quantitative phase, harmonizing the results obtained in the previous phase, giving in-depth data on the reasons for patient dissatisfaction with specific aspects, such as waiting times and available infrastructures, and identifying emerging issues of the service which had not been previously assessed. CONCLUSIONS: Overall, the qualitative phase enriched the results of the research. It is appropriate and recommendable to incorporate this methodological approach in research aimed at evaluating the quality of the service in specific health care settings, since it is provided first hand, by the voice of the customer.

Psychometric properties of the Spanish version of the diagnostic interview for depressive personality.

The aim of this study was to evaluate the reliability and validity of the Spanish-language version of the diagnostic interview for depressive personality (DIDP). The DIDP was administered to 328 consecutive outpatients and the test-retest and inter-rater reliability were assessed. Factor analysis was used in search of factors capable of explaining the scale and a cutoff point was established. The DIDP scales showed adequate Cronbach's α values and acceptable test-retest and inter-rater reliability coefficients. Convergent and discriminant validity were explored, the latter with respect to avoidant and borderline personality disorders. The results of the factor analysis were consistent with the four-factor structure of the DIDP scales. The receiver operating characteristic (ROC) analysis revealed the area under the curve to be 0.848. We found 30 to be a good cutoff point, with a sensitivity of 74.5% and a specificity of 78.5%. The DIDP proved to be a reliable and valid instrument for assessing depressive personality disorder, at least among our outpatients. The psychometric properties of the DIDP support its clinical usefulness in assessing depressive personality.

El programa de auditorías internas según norma UNE-EN ISO 9001 realizadas con personal propio: herramienta para la gestión del conocimiento / Une-en-ISO-9001 internal audit program performed by our own personnel: a knowledge management tool

Objetivo: A partir de la necesidad de mantener el Sistema de Gestión de Calidad según la norma UNE-EN ISO 9001:2000 de 12 servicios del Hospital General Universitario Gregorio Marañón, la realización de auditorías internas con personal propio, pareció una herramienta útil en la gestión del conocimiento y la mejora continua. El Servicio de Medicina Preventiva y Gestión de Calidad desarrolló un programa de auditorías, que viene implementándose desde los últimos 3 años. Material y métodos: Se realizó un programa de formación de auditores internos, los cuales formaron parte de la bolsa de auditores del hospital. Se consolidó como grupo a los responsables de calidad de los servicios certificados. Se desarrolló un procedimiento de programación y coordinación de auditorías. Se encuestó a los auditores y auditados sobre las dificultades en la realización de las auditorías, incluyendo un apartado para sugerencias, y se redactó para la Dirección un informe global anual con los resultados de auditorías internas y externas, y con las áreas de mejora detectadas en todo el proceso. Resultados: Se han realizado 40 auditorías internas en el Hospital General Universitario Gregorio Marañón desde el año 2007 y se cuenta con 38 personas capacitadas para su realización. El sistema de gestión de calidad ha mejorado en forma de disminución de las «No conformidades» en las auditorías externas, y todos los servicios han mantenido la certificación. Conclusiones: La percepción del personal auditor y de los servicios auditados respecto a la realización de auditorías internas con personal propio es muy positiva. Se han encontrado áreas de mejora y soluciones comunes (AU)

Introduction: The need to maintain a Quality Management System based on the UNE-EN-ISO 9001:2000 standards in 12 Departments of the "Hospital General Universitario Gregorio Marañón" (HGUGM), led us to make the decision to establish an internal audit program using our own personnel as a useful tool for knowledge management and continuous improvement. The Department of "Medicina Preventiva y Gestión de Calidad" developed an Audit Program, which has been implemented in our Hospital during the last three years. Materials and methods: We conducted a training program for internal auditors, who then became part of the hospital audit staff. Quality Managers of the accredited departments were consolidated as a group. A procedure for scheduling and coordination of audits was developed. The auditors and those audited were surveyed on the difficulties in conducting audits, including a section for suggestions, and an annual report was drafted with the results of internal and external audits, as well as the improvement areas identified in the whole process. Results: A total of 40 internal audits have been performed in HGUGM since 2007, and 38 people were trained. The Quality Management System improved in terms of the decreasing number of non-conformances (NC) in external audits, and all services have maintained the certification. Conclusions: The perception of auditors and those audited regarding the performing of internal audits by our own personnel is very positive. There were identified improvement areas and common solutions (AU)