Innovación en los sistemas de información y nuevas tecnologías para transformar la gestión sanitaria

[spa] INTRODUCCIÓN: La gestión sanitaria es una disciplina que debe avanzar para ofrecer una atención sanitaria de calidad que permita mejorar la salud de la población de forma sostenible para el sistema sanitario. Los sistemas de información y las nuevas tecnologías pueden ayudar a transformar la gestión sanitaria desde el nivel macro, con la mejora en los sistemas de financiación, hasta el nivel micro con la gestión adecuada de cada paciente. HIPÓTESIS: La transformación en la gestión sanitaria puede ser potenciada mediante la innovación de los sistemas de información salud y las nuevas tecnologías de la información y la comunicación. OBJETIVO: Explorar y generar evidencia sobre cómo los sistemas de información en salud y las nuevas tecnologías de la información y la comunicación pueden potenciar la transformación gestión sanitaria

Análisis de la calidad de derivaciones urgentes desde Atención Primaria al Hospital

Derivació urgent, Atenció Primària, Atenció EspecialitzadaDerivación urgente, Atención Primaria, Atención EspecializadaUrgent derivation, Primary Care, Specialized CareSe evalua la calidad, adecuación y concordancia diagnóstica de las derivaciones a urgencias desde atención primaria (AP) al hospital y el grado de mención de la valoración recibida en AP en los informes de alta del hospital. Se debe concienciar a los profesionales de la importancia del informe de derivación como instrumento de comunicación entre niveles asistenciales. Es necesario disponer de parámetros de calidad establecidos y estandarizados que nos permitan hacer comparaciones y facilitar el enfoque de acciones de mejora.S'avalua la qualitat, adequació i concordança diagnòstica de les derivacions a urgències des d'atenció primària (AP) a l'hospital i el grau de menció de la valoració rebuda en AP en els informes d'alta de l'hospital. S'ha de conscienciar als professionals de la importància de l'informe de derivació com a instrument de comunicació entre nivells assistencials. Cal disposar de paràmetres de qualitat establerts i estandarditzats que ens permetin fer comparacions i facilitar l'enfocament d'accions de millora.The quality, adequacy and diagnostic agreement of the referrals to the emergency department from primary care (PC) to the hospital and the degree of mention of the assessment received in PC in hospital discharge reports are evaluated. Professionals must be made aware of the importance of the referral report as an instrument of communication between levels of care. It is necessary to have established and standardized quality parameters that allow us to make comparisons and facilitate the focus of improvement action

The Roadmap for Implementing Value-Based Healthcare in European University Hospitals—Consensus Report and Recommendations

Expert recommendation; Patient-reported outcomes; Quality in healthcareRecomendación experta; Resultados informados por el paciente; Calidad en la asistencia sanitariaRecomanació experta; Resultats informats pel pacient; Qualitat en l'assistència sanitàriaObjectives Value-based healthcare (VBHC) aims at improving patient outcomes while optimizing the use of hospitals’ resources among medical personnel, administrations, and support services through an evidence-based, collaborative approach. In this article, we present a blueprint for the implementation of VBHC in hospitals, based on our experience as members of the European University Hospital Alliance. Methods The European University Hospital Alliance is a consortium of 9 large hospitals in Europe and aims at increasing the quality and efficiency of care to ultimately drive better outcomes for patients. Results The blueprint describes how to prepare hospitals for VBHC implementation; analyzes gaps, barriers, and facilitators; and explores the most effective ways to turn patient pathways into a process that results in high-value care. Using a patient-centric approach, we identified 4 core minimum components that must be established as cornerstones and 7 organizational enablers to waive the barriers to implementation and ensure sustainability. Conclusion The blueprint guides through pathway implementation and establishment of key performance indicators in 6 phases, which hospitals can tailor to their current status on their way to implement VBHC

Performance of comprehensive risk adjustment for the prediction of in-hospital events using administrative healthcare data: The queralt indices

Background: Accurate risk adjustment is crucial for healthcare management and benchmarking. Purpose: We aimed to compare the performance of classic comorbidity functions (Charlson's and Elixhauser's), of the All Patients Refined Diagnosis Related Groups (APR-DRG), and of the Queralt Indices, a family of novel, comprehensive comorbidity indices for the prediction of key clinical outcomes in hospitalized patients. Material and Methods: We conducted an observational, retrospective cohort study using administrative healthcare data from 156,459 hospital discharges in Catalonia (Spain) during 2018. Study outcomes were in-hospital death, long hospital stay, and intensive care unit (ICU) stay. We evaluated the performance of the following indices: Charlson's and Elixhauser's functions, Queralt's Index for secondary hospital discharge diagnoses (Queralt DxS), the overall Queralt's Index, which includes pre-existing comorbidities, in-hospital complications, and principal discharge diagnosis (Queralt Dx), and the APR-DRG. Discriminative ability was evaluated using the area under the curve (AUC), and measures of goodness of fit were also computed. Subgroup analyses were conducted by principal discharge diagnosis, by age, and type of admission. Results: Queralt DxS provided relevant risk adjustment information in a larger number of patients compared to Charlson's and Elixhauser's functions, and outperformed both for the prediction of the 3 study outcomes. Queralt Dx also outperformed Charlson's and Elixhauser's indices, and yielded superior predictive ability and goodness of fit compared to APR-DRG (AUC for in-hospital death 0.95 for Queralt Dx, 0.77- 0.93 for all other indices; for ICU stay 0.84 for Queralt Dx, 0.73- 0.83 for all other indices). The performance of Queralt DxS was at least as good as that of the APR-DRG in most principal discharge diagnosis subgroups. Conclusion: Our findings suggest that risk adjustment should go beyond pre-existing comorbidities and include principal discharge diagnoses and in-hospital complications. Validation of comprehensive risk adjustment tools such as the Queralt indices in other settings is needed

Added value of patient-reported outcome measures (PROMs) after an acute stroke and early predictors of 90 days PROMs

Outcomes; Stroke; Value based health careResultats; Ictus; Atenció de la salut basada en valorsResultados; Ictus; Atención de la salud basado en valoresIntroduction Value-based health care represents a patient-centered approach by valuing Patient-Reported Outcome Measures (PROMs). Our aim was to describe the additional value of PROMs after an acute stroke over conventional outcome measures and to identify early predictors of poor PROMs. Methods Acute stroke patients discharged from a tertiary care hospital followed by a web/phone-based PROMs collection program in the post hospitalization phase. Main PROMs involve anxiety and depression (HADS) (each defined by HADS ≥ 10) and global physical (PHY-) and mental (M-) health (PROMIS-10). PROMIS cut-off raw values of normality were: PHY-PROMIS ≥ 13 and M-PROMIS ≥ 11. An overall health status (OHS) from 0 to 100 was also determined. PROMs related to the different modified Rankin Scale (mRS) grades were defined. Early predictors of PROMs were evaluated. Results We included 1321 stroke patients, mean age 75 (± 8.6) and 55.7% male; 77.7% returned home. Despite a favorable mRS at 3 months (< 3), a relevant rate of patients considered without symptoms or with mild disability showed unfavorable results in the measured PROMs (8% unfavorable OHS, 15% HAD-depression, 12.1% HAD-anxiety, 28.7% unfavorable M-PROMIS and 33.1% unfavorable PHY-PROMIS results). Along follow-up, only PHY-PROMIS and OHS showed significant improvement (p < 0.01 and 0.03, respectively). The multivariate analysis including discharge variables showed that female sex, higher discharge mRS and discharge to socio-rehabilitation-center (SRC) were independent predictors of unfavorable results in PROMs (p < 0.01). When adding 7 days PROMs results, they emerged as the strongest predictors of 3 months PROMs. Conclusions A high proportion of stroke patients show unfavorable results in PROMs at 3 months, even those with favorable mRS, and most results obtained by PROMs during follow-up continued to indicate alterations. Female sex, mRS and discharge to SRC predicted unfavorable results in PROMs, but the strongest predictors of 3 months PROMs were the results of the 7 days PROMs

Reactogenicity to the mRNA-1273 Booster According to Previous mRNA COVID-19 Vaccination

COVID-19-vaccination; Adverse reactions; Booster doseVacunación de COVID-19; Reacciones adversas; Dosis de refuerzoVacunació de COVID-19; Reaccions adverses; Dosi de reforçThe objective of this study was to assess the local and systemic adverse reactions after the administration of a COVID-19 mRNA-1273 booster between December 2021 and February 2022 by comparing the type of mRNA vaccine used as primary series (mRNA-1273 or BNT162b2) and homologous versus heterologous booster in health care workers (HCW). A cross-sectional study was performed in HCW at a tertiary hospital in Barcelona, Spain. A total of 17% of booster recipients responded to the questionnaire. The frequency of reactogenicity after the mRNA-1273 booster (88.5%) was similar to the mRNA-1273 primary doses (85.8%), and higher than the BNT162b2 primary doses (71.1%). The reactogenicity was similar after receiving a heterologous booster compared to a homologous booster (88.0% vs. 90.2%, p = 0.3), and no statistically significant differences were identified in any local or systemic reactions. A higher frequency of medical leave was identified in the homologous booster dose group vs. the heterologous booster dose group (AOR 1.45; 95% CI: 1.00–2.07; p = 0.045). Our findings could be helpful in improving vaccine confidence toward heterologous combinations in the general population and in health care workers

Análisis de la calidad de derivaciones urgentes desde Atención Primaria al Hospital

Derivació urgent, Atenció Primària, Atenció EspecialitzadaDerivación urgente, Atención Primaria, Atención EspecializadaUrgent derivation, Primary Care, Specialized CareSe evalua la calidad, adecuación y concordancia diagnóstica de las derivaciones a urgencias desde atención primaria (AP) al hospital y el grado de mención de la valoración recibida en AP en los informes de alta del hospital. Se debe concienciar a los profesionales de la importancia del informe de derivación como instrumento de comunicación entre niveles asistenciales. Es necesario disponer de parámetros de calidad establecidos y estandarizados que nos permitan hacer comparaciones y facilitar el enfoque de acciones de mejora.S'avalua la qualitat, adequació i concordança diagnòstica de les derivacions a urgències des d'atenció primària (AP) a l'hospital i el grau de menció de la valoració rebuda en AP en els informes d'alta de l'hospital. S'ha de conscienciar als professionals de la importància de l'informe de derivació com a instrument de comunicació entre nivells assistencials. Cal disposar de paràmetres de qualitat establerts i estandarditzats que ens permetin fer comparacions i facilitar l'enfocament d'accions de millora.The quality, adequacy and diagnostic agreement of the referrals to the emergency department from primary care (PC) to the hospital and the degree of mention of the assessment received in PC in hospital discharge reports are evaluated. Professionals must be made aware of the importance of the referral report as an instrument of communication between levels of care. It is necessary to have established and standardized quality parameters that allow us to make comparisons and facilitate the focus of improvement action

Multimorbidity Patterns in Elderly Primary Health Care Patients in a South Mediterranean European Region: A Cluster Analysis.

The purpose of this study was to identify clusters of diagnoses in elderly patients with multimorbidity, attended in primary care.Cross-sectional study.251 primary care centres in Catalonia, Spain.Individuals older than 64 years registered with participating practices.Multimorbidity, defined as the coexistence of 2 or more ICD-10 disease categories in the electronic health record. Using hierarchical cluster analysis, multimorbidity clusters were identified by sex and age group (65-79 and ≥80 years).322,328 patients with multimorbidity were included in the analysis (mean age, 75.4 years [Standard deviation, SD: 7.4], 57.4% women; mean of 7.9 diagnoses [SD: 3.9]). For both men and women, the first cluster in both age groups included the same two diagnoses: Hypertensive diseases and Metabolic disorders. The second cluster contained three diagnoses of the musculoskeletal system in the 65- to 79-year-old group, and five diseases coincided in the ≥80 age group: varicose veins of the lower limbs, senile cataract, dorsalgia, functional intestinal disorders and shoulder lesions. The greatest overlap (54.5%) between the three most common diagnoses was observed in women aged 65-79 years.This cluster analysis of elderly primary care patients with multimorbidity, revealed a single cluster of circulatory-metabolic diseases that were the most prevalent in both age groups and sex, and a cluster of second-most prevalent diagnoses that included musculoskeletal diseases. Clusters unknown to date have been identified. The clusters identified should be considered when developing clinical guidance for this population

Traducción y adaptación transcultural al español, catalán y gallego de la escala Hopkins Symptom Checklist-25 para la detección de depresión en Atención Primaria

Altres ajuts: Este trabajo recibió financiación de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) al resultar ganador de una ayuda para la realización de tesis doctorales Isabel Fernández 2019. Este proyecto ha recibido una beca de la Fundación Instituto Universitario de Investigación en Atención Primaria de Salud Jordi Gol i Gurina (IDIAP Jordi Gol 7Z19/019) para la capacitación en investigación y realización del doctorado en Atención Primaria y otra beca de la cátedra de la Universidad Autónoma de Barcelona-Novartis de investigación en Medicina Familiar y Comunitaria, ambas en la convocatoria 2019. Estas ayudas han sido otorgadas a la autora M. Rodríguez-Barragán.Describir el proceso de traducción y adaptación transcultural de la escala Hopkins Symptom Checklist-25 (HSCL-25) al español, catalán y gallego. Traducción, adaptación transcultural y análisis de la comprensibilidad mediante entrevistas cognitivas. Unidades de Investigación de Atención Primaria de Barcelona y Vigo. Médicos de familia y pacientes de Atención Primaria. Siguiendo las guías de la International Society for Pharmacoeconomics and Outcomes Research (ISPOR), se realizaron: 1) traducción directa; 2) estudio piloto basado en metodología Delphi con médicos de familia; 3) retrotraducción; 4) análisis de equivalencias; 5) análisis de comprensibilidad de las versiones obtenidas en español, catalán y gallego mediante entrevista cognitiva en una muestra de pacientes, y 6) armonización transcultural. En el estudio Delphi participaron 73 médicos de familia. El consenso se estableció en la primera ronda para la traducción española y catalana, y en la segunda ronda para la gallega. Las retrotraducciones fueron similares en los 3 idiomas. Todas las versiones fueron equivalentes entre ellas y respecto a la versión original inglesa. En la entrevista cognitiva participaron 10 pacientes por cada idioma, sin que se modificara la redacción de los ítems. Las traducciones de la escala HSCL-25 en español, catalán y gallego son equivalentes semántica y conceptualmente a la versión original. Las traducciones son comprensibles y bien aceptadas por los pacientes

Local and Systemic Adverse Reactions to mRNA COVID-19 Vaccines Comparing Two Vaccine Types and Occurrence of Previous COVID-19 Infection

The aim of this study was to assess adverse reactions to COVID-19 vaccines, comparing the BNT162b2 or the mRNA-1273 COVID-19 vaccines and the presence and seriousness of a previous COVID-19 infection. We conducted a cross-sectional online survey of vaccinated healthcare workers at a tertiary hospital in Barcelona (Spain). Thirty-eight percent of vaccine recipients responded to the questionnaire. We compared the prevalence of adverse reactions by vaccine type and history of COVID-19 infections. A total of 2373 respondents had received the BNT162b2 vaccine, and 506 the mRNA-1273 vaccine. The prevalence of at least one adverse reaction with doses 1 and 2 was 41% and 70%, respectively, in the BNT162b2 group, and 60% and 92% in the mRNA-1273 group (p &lt; 0.001). The BNT162b2 group reported less prevalence of all adverse reactions. Need for medical leave was significantly more frequent among the mRNA-1273 group (12% versus 4.6% p &lt; 0.001). Interestingly, respondents with a history of allergies or chronic illnesses did not report more adverse reactions. The frequency of adverse reactions with dose 2 was 96% (95% CI 88&ndash;100%) for those with a history of COVID-19 related hospitalization, and 86% (95% CI 83&ndash;89%) for those with mild or moderate symptomatic COVID-19, significantly higher than for participants with no history of COVID-19 infections (67%, 95% CI 65&ndash;69%). Our results could help inform vaccine recipients of the probability of their having adverse reactions to COVID-19 vaccines