Transparencia en los resultados de la sanidad pública: el ejemplo de la central de resultados del sistema sanitario catalán

La mejora de la calidad y la transparencia del gobierno sanitario tiene un impacto en la salud de la población a través de las políticas, de la gestión de las organizaciones y de la práctica clínica. Además, la comparación entre centros sanitarios y la retroalimentación de los resultados de forma transparente a los profesionales y a la ciudadanía contribuye directamente a la mejora en los resultados. La Central de Resultados del sistema sanitario catalán mide y difunde los resultados alcanzados en el ámbito de la asistencia sanitaria por los diferentes proveedores a fin de facilitar una toma de decisiones corresponsable al servicio de la calidad de la atención sanitaria prestada a la población de Cataluña. Esta es una iniciativa pionera en el Estado español, y está alineada con los países más avanzados en políticas de transparencia y rendición de cuentasImproving the quality and transparency of the healthcare government has an impact on the health of the population through policies, management of organizations, and clinical practice. Moreover, the comparison between healthcare centres and the transparent feedback of results to professionals and to the citizens contributes directly to improved results. The Results Centre of the Catalan healthcare system measures and disseminates the results achieved by the different healthcare centres in order to facilitate a co-responsible decision making process, at the service of the quality of healthcare provided to the population of Catalonia. This is a pioneering initiative in Spain, and is aligned with the most advanced countries in policies of transparency and accountabilit

Measuring health inequalities : a systematic review of widely used indicators and topics

Altres ajuts: Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) I CIBER de Epidemiología y Salud Pública (CIBERESP)Background: According to many conceptual frameworks, the first step in the monitoring cycle of health inequalities is the selection of relevant topics and indicators. However, some difficulties may arise during this selection process due to a high variety of contextual factors that may influence this step. In order to help accomplish this task successfully, a comprehensive review of the most common topics and indicators for measuring and monitoring health inequalities in countries/regions with similar socioeconomic and political status as Catalonia was performed. Methods: We describe the processes and criteria used for selecting health indicators from reports, studies, and databases focusing on health inequalities. We also describe how they were grouped into well-known health topics. The topics were filtered and ranked by the number of indicators they accounted for. Results: We found 691 indicators used in the study of health inequalities. The indicators were grouped into 120 topics, 34 of which were selected for having five indicators or more. Most commonly found topics in the list include "Life expectancy", "Infant mortality", "Obesity and overweight (BMI)", "Mortality rate", "Regular smokers/tobacco consumption", "Self-perceived health", "Unemployment", "Mental well-being", "Cardiovascular disease/hypertension", "Socioeconomic status (SES)/material deprivation". Conclusions: A wide variety of indicators and topics for the study of health inequalities exist across different countries and organisations, although there are some clear commonalities. Reviewing the use of health indicators is a key step to know the current state of the study of health inequalities and may show how to lead the way in understanding how to overcome them

Salut i pobresa infantil: què ens diuen les dades?

Salut dels infants; Crisi econòmica; Indicadors de salutSalud de los niños; Crisis económica; Indicadores de saludChild health; Economic crisis; Health indicatorsAnàlisi de les desigualtats en salut de la població infantil segons el seu nivell socioeconòmic a conseqüència de la situació de crisi econòmica viscuda els darrers anys. Es presenten un conjunt d'indicadors estadístics de l'any 2015.Análisis de las desigualdades en salud de la población infantil según su nivel socioeconómico como consecuencia de la situación de crisis económica vivida en los últimos años. Se presentan un conjunto de indicadores estadísticos del año 2015.Analysis of health inequalities in the child population according to their socioeconomic level as a result of the economic crisis experienced in the last years. It offers a set of statistical indicators for the year 2015

The impact of an easy access drug supply management policy law on the consumption and abuse of opioids in Catalonia : A population-based study

Background: Over the last two decades, the rise in opioid prescription has worsened health outcomes worldwide, increasing both levels of abuse and mortality rates. In order to reduce the scale of this public health problem, new policies have been implemented in many countries. In 2012, Spain adopted new legislation on opioid prescription (the ROE law), which meant that practitioners no longer needed to obtain extra authorisation in order to prescribe strong opioids. The objective of the paper is to assess the impact of this law on opioid use and abuse in Catalonia, Spain. Methods: We established two measures of the use of strong and weak opioids: DDDs, and abuse. We used benzodiazepines and antidepressants as controls, and adjusted for age, sex, drug co-payment level, death or near death, cancer diagnosis, morbidity group, and type of prescription. The data were obtained from administrative and dispensing drug databases in a population of 7.5 million inhabitants. We estimated two-way fixed effects using difference in difference models. Results: The ROE law impacted reducing the monthly use of strong opioids by 0.903 DDDs, representing a 3.15% decrease in the mean monthly use of strong opioids. However, abuse rose 1.86 times compared with the average pre-ROE value, which represents an increase of 11,190 months of opioid abuse (i.e., an 11.33% of all monthly opioids use). Conclusion: The abolition of the duplicate prescription programme for strong opioids led to a reduction in the average monthly use of strong opioids, but an increase in abuse

Living longer in declining health: factors driving healthcare costs among older people

Background Developed countries are facing challenges in caring for people who are living longer but with a greater morbidity burden. Such people are likely to be regular users of healthcare. Objectives Our analytical aim is to identify factors that explain healthcare costs among: (1) people over 55 years old; (2) the top 5% and 1% high-cost users among this population; (3) those that transition into the top 5% and 1% from one year to the next; (4) those that appear in the top 5% and 1% over multiple years; and (5) those that remain in the top 5% and 1% over consecutive years. Methods The data covered 2011 to 2017 and comprised 1,485,170 observations for a random sample of 224,249 people aged over 55 years in the Catalan region of Spain. We analysed each person's annual healthcare costs across all public healthcare settings related to their age, gender, socio-economic status (SES), whether or not and when they died, and morbidity status, through Adjusted Morbidity Groups. Results After controlling for morbidity status, the oldest people did not have the highest costs and were less likely to be among the most costly patients. There was also only a modest impact on costs associated with SES and with dying. Healthcare costs were substantially higher for those with a neoplasm or four or more long term conditions (LTCs), costs rising with the complexity of their conditions. These morbidity indicators were also the most important factors associated with being and remaining in the top 5% or top 1% of costs. Conclusion Our results suggest that age and proximity to death are poor predictors of higher costs. Rather, healthcare costs are explained mainly by morbidity status, particularly whether someone has neoplasms or multiple LTCs. Morbidity measures should be included in future studies of healthcare costs

Do governments care about socioeconomic inequalities in health? Narrative review of reports of EU-15 countries

Altres ajuts: Fundació "La Caixa"Socioeconomic inequalities in health have been an issue in all European countries since the publication of the "Black Report" in the United Kingdom in 1980. However, data show that nowadays there are important socioeconomic health inequalities within EU countries. The purpose of this paper is to review EU-15 government reports that address socioeconomic inequalities in health. We reviewed 101 reports. The pioneer countries in analyzing this topic have a Beveridge-type health system, and they are the leaders over time. The top socioeconomic indicators used are education level, social class, deprivation level of the area, and nationality. Given the current COVID-19 pandemic situation and its economic consequences, EU governments need to continue monitoring the existing inequalities in health and to act transversely in all public policies

Socioeconomic inequalities in 29 childhood diseases: evidence from a 1,500,000 children population retrospective study

Desigualtats socioeconòmiques; Infància; SalutDesigualdades socioeconómicas; Infancia; SaludSocioeconomic inequalities; Childhood; HealthL'objectiu d’aquest estudi ha estat triple: 1) calcular la desigualtat socioeconòmica per a una àmplia gama de malalties en tota una població infantil, 2) determinar les diferències de gènere en les desigualtats en cada malaltia i 3) estimar la càrrega de patologia atribuïble a l’NSE mitjançant mesures de desigualtat i impacte en el camp de l’epidemiologia

Comorbidity patterns and socioeconomic inequalities in children under 15 with medical complexity : A population-based study

Children with medical complexity (CMC) denotes the profile of a child with diverse acute and chronic conditions, making intensive use of the healthcare services and with special health and social needs. Previous studies show that CMC are also affected by the socioeconomic position (SEP) of their family. The aim of this study is to describe the pathologic patterns of CMC and their socioeconomic inequalities in order to better manage their needs, plan healthcare services accordingly, and improve the care models in place. Cross-sectional study with latent class analysis (LCA) of the CMC population under the age of 15 in Catalonia in 2016, using administrative data. LCA was used to define multimorbidity classes based on the presence/absence of 57 conditions. All individuals were assigned to a best-fit class. Each comorbidity class was described and its association with SEP tested. The Adjusted Morbidity Groups classification system (Catalan acronym GMA) was used to identify the CMC. The main outcome measures were SEP, GMA score, sex, and age distribution, in both populations (CMC and non-CMC) and in each of the classes identified. 71% of the CMC population had at least one parent with no employment or an annual income of less than €18,000. Four comorbidity classes were identified in the CMC: oncology (36.0%), neurodevelopment (13.7%), congenital and perinatal (19.8%), and respiratory (30.5%). SEP associations were: oncology OR 1.9 in boys and 2.0 in girls; neurodevelopment OR 2.3 in boys and 1.8 in girls; congenital and perinatal OR 1.7 in boys and 2.1 in girls; and respiratory OR 2.0 in boys and 2.0 in girls. Our findings show the existence of four different patterns of comorbidities in CMC and a significantly high proportion of lower SEP children in all classes. These results could benefit CMC management by creating more efficient multidisciplinary medical teams according to each comorbidity class and a holistic perspective taking into account its socioeconomic vulnerability

La salut de la població de Catalunya en el context europeu: actualització 2016

Esperança de vida; Bona salut; Estadístiques de salutLife expectancy; Good health; Health StatisticsEsperanza de vida; Buena salud; Estadísticas de saludAquest document és una actualització d’un monogràfic de Central de Resultats publicat fa dos anys. El seu objectiu és oferir una comparació actualitzada dels aspectes més rellevants de la salut i el sistema sanitari de Catalunya amb un grup de països de la Unió Europea amb característiques geogràfiques, socials, culturals, econòmiques i d’estructura del sistema sanitari similars.This document is an update of the Central de Resultats monograph published two years ago. It aims to provide an updated comparison of the most important aspects of health and health system in Catalonia with a group of countries of the European Union with similar geographical, social, cultural, economic features and similar health system structure.Este documento es una actualización de un monográfico de Central de Resultats publicado dos años antes. Su objetivo es ofrecer una comparación actualizada de los aspectos más relevantes de la salud y el sistema sanitario de Cataluña con un grupo de países de la Unión Europea con características geográficas, sociales, culturales, económicas y de estructura del sistema sanitario similares

Do hospitals have a higher mortality rate on weekend admissions? An observational study to analyse weekend effect on urgent admissions to hospitals in Catalonia

Background 'Weekend effect' is a term used to describe the increased mortality associated with weekend emergency admissions to hospital, in contrast with admission on weekdays. The objective of the present study is to determine whether the weekend effect is present in hospitals in Catalonia. Methods We analysed all urgent admissions in Catalonia in 2018, for a group of pathologies. Two groups were defined (those admitted on a weekday and those admitted on a weekend). We obtained mortality at 3, 7, 15 and 30 days, and applied a proportions test to both groups. Additionally, we used Cox's regression for mortality at 30 days, using the admission on a weekend as the exposition, adjusting by socioeconomic and clinical variables. We used the hospital discharge database and the Central Registry of the Insured Population. Results 72 427 admissions for the selected pathologies during 2018 were found. No statistically significant differences in mortality at 30 days (p=0.524) or at 15 days (p=0.119) according to the day of admission were observed. However, significant differences were found in mortality at 7 days (p=0.025) and at 3 days (p=0.002). The hazard rate associated with the weekend was 1.13 (95% CI: 1.04 to 1.23). By contrast, the adjusted HR of the weekend interaction with time was 0.99 (95% CI: 0.99 to 1.00). Conclusions There is a weekend effect, but it is not constant in time. This could suggest the existence of dysfunctions in the quality of care during the weekend