Mapping analysis to predict EQ-5D-5 L utility values based on the Oxford Hip Score (OHS) and Oxford Knee Score (OKS) questionnaires in the Spanish population suffering from lower limb osteoarthritis.

BACKGROUND: The EQ-5D-5 L is a quality-of-life questionnaire based on individuals' preferences that is widely employed for cost-effectiveness analysis. Given the current demand for mapping algorithms to directly assign "utilities", this study aimed to generate different mapping models for predicting EQ-5D-5 L utility values based on scores of the Oxford Hip Score (OHS) and Oxford Knee Score (OKS) questionnaires provided by patients suffering from hip and knee osteoarthritis (OA), respectively, and to assess the predictive capability of these functions. METHODS: This was a prospective, observational study. Following the criteria of the American Rheumatism Association, 361 patients with hip OA and 397 with knee OA from three regions in Spain were included. Health-related quality of life (HRQoL) was assessed through the EQ-5D-5 L general questionnaire and the OHS and OKS specifically for lower limb OA. Based on the scores on the OHS and OKS questionnaires, EQ-5D-5 L utilities were estimated using 4 models: ordinary least squares (OLS), Tobit, generalized linear model (GLM), and beta regression (Breg). The models were validated on the same patients after 6 months: the mean absolute error (MAE) and mean squared error (MSE) with their 95% confidence intervals (CI), mean values of standard errors (SE), intraclass correlation coefficients (ICC), and Bland-Altman plots were obtained. RESULTS: The lowest MAEs were obtained using GLM and Breg models, with values of 0.1103 (0.0993-0.1214) and 0.1229 (0.1102-0.1335) for hip OA, and values of 0.1127 (0.1014-0.1239) and 0.1141 (0.1031-0.1251) for knee OA. MSE values were also lower using GLM and Breg. ICCs between predicted and observed values were around or over the 0.8 cut-off point. Bland-Altman plots showed an acceptable correlation, but precision was lower for subjects with worse HRQoL, which was also evident when comparing MAEs of the bottom and top halves of the utilities scale. Predictive equations for utilities based on OHS/OKS scores were proposed. CONCLUSIONS: The OHS and OKS scores allow for estimating EQ-5D-5 L utility indexes for patients with hip and knee OA, respectively, with adequate validity and precision. GLM and Breg produce the best predictions. The predictive power of proposed equations is more consistent for subjects in better health condition.

Evaluación y mejora de la comprensión de los documentos de consentimiento informado / Evaluation and improvement of the comprehension of informed consent documents

INTRODUCCIÓN: Contar con documentos de consentimiento informado (DCI) de calidad implica que la información pueda ser comprendida y asimilada por el paciente. El propósito de este estudio es evaluar y mejorar la facilidad de comprensión de los DCI presentados para su acreditación en un hospital de tercer nivel. MÉTODOS: Estudio de evaluación y mejora de la calidad de 132 DCI provenientes de 2 servicios de un hospital público de tercer nivel, estructurado en 3 fases: evaluación inicial, intervención y reevaluación. Se utilizaron 2 criterios: extensión (deseable inferior a 490 palabras) e índice de legibilidad INFLESZ (adecuado si >55 puntos), tanto del DCI completo como de cada uno de sus apartados. Los contenidos propuestos por los servicios fueron adaptados por una persona entrenada no sanitaria, cuyas dudas sobre términos médicos fueron resueltas por los autores. Para comparar los resultados entre evaluaciones se calcularon mejoras relativas en extensión e INFLESZ, y su significación estadística. RESULTADOS: Antes de la intervención, el 78,8% de los DCI eran de extensión deseable (IC 95%: 86,5-71,1) con un INFLESZ medio de 44,1 puntos (3,8% > 55 puntos) (IC 95%: 6,0-1,6). Tras ella, el INFLESZ fue de 61,9 puntos (mejora relativa 40,3%, p < 0,001), con el 100% > 55. Los DCI resultantes dedican una mayor extensión a describir la naturaleza del procedimiento (p < 0,0001) y menor a consecuencias, riesgos (p < 0,0001) y alternativas (p < 0,05). CONCLUSIONES: Introducir dinámicas de mejora en el diseño de DCI es posible y necesario, ya que produce DCI de mayor calidad y más fáciles de comprender por los pacientes

INTRODUCTION: The information contained in a good informed consent form (ICF) must be understood by the patients. The aim of this study is to assess and improve the readability of the ICF submitted for accreditation in a tertiary hospital. METHODS: Study of assessment and improvement of the quality of 132 ICF from 2 departments of a public tertiary hospital, divided into 3 phases: Initial assessment, intervention and reassessment. Both length and readability are assessed. Length is measured in words (adequate to 470, excessive over 940), and readability in INFLESZ points (suitable if over 55). The ICF contents initially proposed by departments were adapted by non-health-related trained persons, whose doubts about medical terms were resolved by the authors. To compare results between evaluations, relative improvement (in both length and INFLESZ) and statistical significances were calculated. RESULTS: Baseline data: 78.8% of the ICFs showed a desired length (CI95% 86,5-71,1) and a mean of 44.1 INFLESZ points (3.8% >55 points, CI95% 6,0-1,6). After the intervention, INFLESZ raised to 61.9 points (improvement 40.3%, P<.001), all ICF showing >55 points. The resulting ICFs had a longer description of the nature of the procedure (P<.0001) and a shorter description of their consequences, risks (P <.0001) and alternatives (P <.05). CONCLUSIONS: The introduction of improvement dynamics in the design of ICFs is possible and necessary because it produces more effective and easily readable ICFs

[Identification of the factors conditioning times and indicators of quality in the intrahospital care of acute stroke]. / Identificación de los factores condicionantes de tiempos e indicadores de calidad en la atención intrahospitalaria al ictus agudo.

INTRODUCTION: Stroke is a serious but potentially reversible entity. Reducing the time of care in the acute phase is essential to limit morbidity and mortality. The evaluation of the performances in stroke care is essential because it allows identify opportunities for improvement. AIM: To understand and analyze the determinants of the delay in the time of hospital care for the subsequent implementation of a cycle of improvement. PATIENTS AND METHODS: Retrospective study of patients with acute ischemic stroke treated with intravenous thrombolysis (IVT) and/or intra-arterial mechanical thrombectomy (IAMT) in a tertiary hospital between 2009-2014. In-hospital times, quality indicators and associated factors were analyzed. RESULTS: 337 patients with acute ischemic stroke were treated with IVT (66.2%) and/or IAMT (54.1%). In-hospital times (95% confidence interval): door-to-needle time, 75.88 min (71.67-80.16 min); door-to-imaging, 43.27 min (40.17-46.37 min), imaging-to-needle, 38.01 min (34.08-41.93 min); IVT-IAMT time, 127.44 min (108.7-146.18 min); door-to-groin puncture, 155.22 min (140.03-170.40 min). 36.6% treated in less than 60 min, neuroimaging in less than 25 min in 19.9% and IVT-IAMT time in less than 90 minutes in 28.8%. Age, onset-to-door time, non-ambulance transport and the learning period were identified as determinants. CONCLUSIONS: Knowledge of the current situation of the times and quality indicators and their determinants are essential to provide the motivation to start an initiative to improve the quality of care in patients with acute stroke.

TITLE: Identificacion de los factores condicionantes de tiempos e indicadores de calidad en la atencion intrahospitalaria al ictus agudo.Introduccion. El ictus es una entidad grave, pero potencialmente reversible. La reduccion del tiempo de atencion en el momento agudo es fundamental para limitar la morbimortalidad. La evaluacion de las actuaciones en la atencion al ictus es esencial, porque permite identificar oportunidades de mejora. Objetivo. Conocer y analizar los factores condicionantes de la demora en los tiempos de atencion intrahospitalaria para la posterior implementacion de un ciclo de mejora. Pacientes y metodos. Estudio retrospectivo de pacientes con ictus isquemico agudo tratados con trombolisis intravenosa (TLIV) y/o trombectomia intraarterial mecanica (TIAM) en un hospital terciario entre 2009-2014. Se analizaron los tiempos intrahospitalarios, los indicadores de calidad y sus factores condicionantes. Resultados. Un total de 337 pacientes fueron tratados con TLIV (66,2%) y/o TIAM (54,1%). Tiempos medios de actuacion (intervalo de confianza al 95%): puerta-TLIV, 75,88 min (71,67-80,16 min); puerta-TC, 43,27 min (40,17-46,37 min); TC-TLIV, 38,01 min (34,08-41,93 min); TLIV-TIAM, 127,44 min (108,7-146,18 min); puerta-TIAM, 155,22 min (140,03-170,4 min). El 36,6% fue tratado en menos de 60 min, la neuroimagen se realizo en menos de 25 min en un 19,9% y el tiempo TLIV-TIAM fue menor de 90 min en un 28,8%. La edad, el tiempo inicio-puerta, la procedencia de otro hospital y el periodo de aprendizaje se identificaron como factores condicionantes. Conclusiones. El conocimiento de la situacion actual de los tiempos e indicadores intrahospitalarios y sus factores condicionantes son el punto de partida y proporcionan la motivacion necesaria para impulsar una iniciativa para la mejora de la calidad asistencial en el paciente con ictus agudo.

[Evaluation and improvement of the comprehension of informed consent documents]. / Evaluación y mejora de la comprensión de los documentos de consentimiento informado.

INTRODUCTION: The information contained in a good informed consent form (ICF) must be understood by the patients. The aim of this study is to assess and improve the readability of the ICF submitted for accreditation in a tertiary hospital. METHODS: Study of assessment and improvement of the quality of 132 ICF from 2 departments of a public tertiary hospital, divided into 3 phases: Initial assessment, intervention and reassessment. Both length and readability are assessed. Length is measured in words (adequate to 470, excessive over 940), and readability in INFLESZ points (suitable if over 55). The ICF contents initially proposed by departments were adapted by non-health-related trained persons, whose doubts about medical terms were resolved by the authors. To compare results between evaluations, relative improvement (in both length and INFLESZ) and statistical significances were calculated. BASELINE DATA: 78.8% of the ICFs showed a desired length (CI95% 86,5-71,1) and a mean of 44.1 INFLESZ points (3.8% >55 points, CI95% 6,0-1,6). After the intervention, INFLESZ raised to 61.9 points (improvement 40.3%, P<.001), all ICF showing >55 points. The resulting ICFs had a longer description of the nature of the procedure (P<.0001) and a shorter description of their consequences, risks (P <.0001) and alternatives (P <.05). CONCLUSIONS: The introduction of improvement dynamics in the design of ICFs is possible and necessary because it produces more effective and easily readable ICFs.

Identificación de los factores condicionantes de tiempos e indicadores de calidad en la atención intrahospitalaria al ictus agudo / Identification of the factors conditioning times and indicators of quality in the intrahospital care of acute stroke

Introducción. El ictus es una entidad grave, pero potencialmente reversible. La reducción del tiempo de atención en el momento agudo es fundamental para limitar la morbimortalidad. La evaluación de las actuaciones en la atención al ictus es esencial, porque permite identificar oportunidades de mejora. Objetivo. Conocer y analizar los factores condicionantes de la demora en los tiempos de atención intrahospitalaria para la posterior implementación de un ciclo de mejora. Pacientes y métodos. Estudio retrospectivo de pacientes con ictus isquémico agudo tratados con trombólisis intravenosa (TLIV) y/o trombectomía intraarterial mecánica (TIAM) en un hospital terciario entre 2009-2014. Se analizaron los tiempos intrahospitalarios, los indicadores de calidad y sus factores condicionantes. Resultados. Un total de 337 pacientes fueron tratados con TLIV (66,2%) y/o TIAM (54,1%). Tiempos medios de actuación (intervalo de confianza al 95%): puerta-TLIV, 75,88 min (71,67-80,16 min); puerta-TC, 43,27 min (40,17-46,37 min); TC-TLIV, 38,01 min (34,08-41,93 min); TLIV-TIAM, 127,44 min (108,7-146,18 min); puerta-TIAM, 155,22 min (140,03-170,4 min). El 36,6% fue tratado en menos de 60 min, la neuroimagen se realizó en menos de 25 min en un 19,9% y el tiempo TLIVTIAM fue menor de 90 min en un 28,8%. La edad, el tiempo inicio-puerta, la procedencia de otro hospital y el período de aprendizaje se identificaron como factores condicionantes. Conclusiones. El conocimiento de la situación actual de los tiempos e indicadores intrahospitalarios y sus factores condicionantes son el punto de partida y proporcionan la motivación necesaria para impulsar una iniciativa para la mejora de la calidad asistencial en el paciente con ictus agudo (AU)

Introduction. Stroke is a serious but potentially reversible entity. Reducing the time of care in the acute phase is essential to limit morbidity and mortality. The evaluation of the performances in stroke care is essential because it allows identify opportunities for improvement. Aim. To understand and analyze the determinants of the delay in the time of hospital care for the subsequent implementation of a cycle of improvement. Patients and methods. Retrospective study of patients with acute ischemic stroke treated with intravenous thrombolysis (IVT) and/or intra-arterial mechanical thrombectomy (IAMT) in a tertiary hospital between 2009-2014. In-hospital times, quality indicators and associated factors were analyzed. Results. 337 patients with acute ischemic stroke were treated with IVT (66.2%) and/or IAMT (54.1%). In-hospital times (95% confidence interval): door-to-needle time, 75.88 min (71.67-80.16 min); door-to-imaging, 43.27 min (40.17-46.37 min), imaging-to-needle, 38.01 min (34.08-41.93 min); IVT-IAMT time, 127.44 min (108.7-146.18 min); door-to-groin puncture, 155.22 min (140.03-170.40 min). 36.6% treated in less than 60 min, neuroimaging in less than 25 min in a 19.9% and IVT-IAMT time in less than 90 minutes in 28.8%. Age, onset-to-door time, non-ambulance transport and the learning period were identified as determinants. Conclusions. Knowledge of the current situation of the times and quality indicators and their determinants are essential to provide the motivation to start an initiative to improve the quality of care in patients with acute stroke (AU)

[Quality of life related to health as a factor explaining the use of family medical consultation: a study on the behavioral model]. / La calidad de vida relacionada con la salud como factor explicativo de la utilización de la consulta de medicina de familia: un estudio bajo el modelo conductual.

BACKGROUND: Health services utilization has been studied under several conceptual models. This study is aimed to assess the influence of Health Related Quality of Life (HRQL) on the variability of the primary care consultation utilization under the <> METHODS: A cross-sectional study. Interviews were conducted with 451 subjects at six health centers in the Community of Madrid. Environmental and individual characteristics (predisposing, enabling and need factors) and HRQL (EuroQol-5D) were collected. Annual visits were retrieved from the computerized clinical history. RESULTS: Median utilization was 13 visits/year (interquartile range 7-20). HRQL explained 5,2% of utilization variability, living in high-income areas an additional 2.4%, age a 7.4%, incomes a 1.0% and <> (chronic illnesses or a hospital admission in the last year) explained an additional 4.1% of the variability. Each increase of the tercile in the perception of HRQL was associated with a decrease of 13,8% of the number of visits/year. Living in high-income areas, and each increase of 1000 in the incomes decreased the percentage of annual visits 17.5 % and 9.5% respectively. Age is associated with an increase of 8.0% of annual visits per decade. Suffering from chronic illnesses or a hospital admission in the last year increased the average number of visits/year to 51.9 and 26.5%. CONCLUSIONS: HRQL is independently associated with the variability of the demand for the family physician after adjusting by << health need>> factors as the <> proposes.