Lessons learnt from the development of the Patient Safety Incidents Reporting an Learning System for the Spanish National Health System: SiNASP / Lecciones aprendidas del desarrollo del Sistema de Notificación y Aprendizaje para la Seguridad del Paciente para el Sistema Nacional de Salud: SiNASP

Objective. To describe the development process and characteristics of a patient safety incidents reporting system to be implemented in the Spanish National Health System, based on the context and the needs of the different stakeholders. Design. Literature review and analysis of most relevant reporting systems, identification of more than 100 stakeholder's (patients, professionals, regional governments representatives) expectations and requirements, analysis of the legal context, consensus of taxonomy, development of the software and pilot test. Results. Patient Safety Events Reporting and Learning system (Sistema de Notificación y Aprendizajepara la Seguridad del Paciente, SiNASP) is a generic reporting system for all types of incidents related to patient safety, voluntary, confidential, non punitive, anonymous or nominative with anonimization, system oriented, with local analysis of cases and based on the WHO International Classification for Patient Safety. The electronic program has an on-line form for reporting, a software to manage the incidents and improvement plans, and a scoreboard with process indicators to monitor the system. Conclusions. The reporting system has been designed to respond to the needs and expectations identified by the stakeholders, taking into account the lessons learned from the previous notification systems, the characteristics of the National Health System and the existing legal context. The development process presented and the characteristics of the system provide a comprehensive framework that can be used for future deployments of similar patient safety systems (AU)

Objetivo. Describir el proceso de desarrollo y las características del sistema de notificación de incidentes de seguridad del paciente para el Sistema Nacional de Salud, basado en el contexto y en las necesidades de los distintos implicados. Diseño. Revisión bibliográfica y análisis de los sistemas de notificación más relevantes, identificación de las necesidades y expectativas de más de 100 implicados (pacientes, profesionales, representantes de las Comunidades Autónomas), análisis del contexto legal, conseso de la taxonomía del SiNASP, desarrollo del programa informático y prueba piloto. Resultados. SiNASP es un sistema de notificación genérico para todo tipo de incidentes relacionados con la seguridad del paciente, voluntario, confidencial, no punitivo, anónimo o nominativo con deidentificación, con orientación sistémica, con análisis local de casos y basado en la Clasificación Internacional de Seguridad del Paciente de la OMS. La aplicación informática tiene un cuestionario para la notificación a través de internet, un software para gestionar los incidentes y los planes de mejora y un cuadro de mando de indicadores para monitorizar el sistema. Conclusiones. El sistema de notificación se ha diseñado para dar respuesta a las necesidad y expectativas de los implicados, teniendo en cuenta las lecciones aprendidas de los sistemas de identificación previos, las características del Sistema Nacional de Salud y el contexto legal. El proceso de desarrollo descrito y las características del sistema proporcionan un marco que puede servir de base para el desarrollo de otros sistemas de seguridad del paciente (AU)

Lessons learnt from the development of the Patient Safety Incidents Reporting an Learning System for the Spanish National Health System: SiNASP.

OBJECTIVE: To describe the development process and characteristics of a patient safety incidents reporting system to be implemented in the Spanish National Health System, based on the context and the needs of the different stakeholders. DESIGN: Literature review and analysis of most relevant reporting systems, identification of more than 100 stakeholder's (patients, professionals, regional governments representatives) expectations and requirements, analysis of the legal context, consensus of taxonomy, development of the software and pilot test. RESULTS: Patient Safety Events Reporting and Learning system (Sistema de Notificación y Aprendizajepara la Seguridad del Paciente, SiNASP) is a generic reporting system for all types of incidents related to patient safety, voluntary, confidential, non punitive, anonymous or nominative with anonimization, system oriented, with local analysis of cases and based on the WHO International Classification for Patient Safety. The electronic program has an on-line form for reporting, a software to manage the incidents and improvement plans, and a scoreboard with process indicators to monitor the system. CONCLUSIONS: The reporting system has been designed to respond to the needs and expectations identified by the stakeholders, taking into account the lessons learned from the previous notification systems, the characteristics of the National Health System and the existing legal context. The development process presented and the characteristics of the system provide a comprehensive framework that can be used for future deployments of similar patient safety systems.

[Measurement in public health: what pulmonary tuberculosis management has taught us]. / Evaluación en salud pública: lecciones aprendidas de la gestión de la tuberculosis pulmonar.

Pulmonary tuberculosis rates are increasing worldwide, including in Spain. One of the main challenges when treating this disease is achieving treatment completion, since studies have shown that approximately 30-35% of all patients do not take their medications as intended. The present article explores a continuum of evaluation strategies and performance measures for assessing the effectiveness of community-based programs designed to enhance treatment completion in patients with active pulmonary tuberculosis. Four traditional evaluation strategies (case studies, retrospective and case-control studies, forecasting/modeling, and cost effectiveness analysis) and 2 emerging and promising approaches (quality of life assessment and indicators of the continuum of care) are presented. Several of the evaluation strategies reviewed indicate that treatment programs using directly observed therapy (DOT) that are comprehensive, community-based and patient-centered achieve the highest treatment completion rates. Combinations of these strategies are recommended to create a body of evidence capturing the impact and nuances of community-based public health interventions in improving health outcomes, in this case for patients with pulmonary tuberculosis.

Evaluación en salud pública: lecciones aprendidas de la gestión de la tuberculosis pulmonar / Measurement in Public Health: what pulmonary tuberculosis management has taught us

Las tasas de tuberculosis pulmonar están aumentando entodo el mundo, incluida España. Uno de los retos principales al tratar esta enfermedad es conseguir un buen cumplimiento terapéutico, puesto que alrededor de un 30-35% de los pacientes no sigue la pauta de medicación prescrita. Este artículo revisa un conjunto de estrategias de evaluación y medidas de la práctica para valorar la efectividad de los programas comunitarios orientados a reforzar el cumplimiento terapéutico de los pacientes con tuberculosis pulmonar activa. Se revisan 4 estrategias de evaluación tradicionales (estudio de un caso, estudio retrospectivo y de casos controles,predicción/pronóstico y análisis de coste-efectividad) y 2 enfoques de evaluación emergentes y prometedores (evaluación de calidad de vida e indicadores de continuidad de la asistencia).Varias de las estrategias de evaluación revisadas indican que los programas de tratamiento mediante la terapia de observación directa (directly observed therapy [DOT]), amplios, comunitarios y centrados en el paciente, alcanzan los índices más altos de cumplimiento terapéutico. Se recomienda la utilización conjunta de varias de estas estrategias de evaluación para crear un cuerpo de evidencia que refleje el impacto delos programas de intervención comunitaria en la mejorade los resultados de salud, en este caso concreto para los pacientes con tuberculosis pulmonar

Pulmonary tuberculosis rates are increasing worldwide, including in Spain. One of the main challenges when treating this disease is achieving treatment completion, since studies have shown that approximately 30-35% of all patients do not take their medications as intended.The present article explores a continuum of evaluation strategies and performance measures for assessing the effectiveness of community-based programs designed to enhance treatment completion in patients with active pulmonary tuberculosis. Four traditional evaluation strategies (case studies, retrospective and case-control studies, forecasting/modeling, and cost effectiveness analysis) and 2 emerging and promising approaches (quality of life assessment and indicators ofthe continuum of care) are presented.Several of the evaluation strategies reviewed indicate that treatment programs using directly observed therapy (DOT) that are comprehensive, community-based and patient-centered achieve the highest treatment completion rates. Combinations of these strategies are recommended to create a body of evidencecapturing the impact and nuances of community-basedpublic health interventions in improving health outcomes, in this case for patients with pulmonary tuberculosis (AU)