Análisis automatizado de la calidad del conjunto mínimo de datos básicos. Implicaciones para los sistemas de ajuste de riesgos

ResumenFundamentosJunto a la edad del paciente, el diagnóstico principal, los diagnósticos secundarios (comorbilidad y complicaciones) y los procedimientos realizados son las variables críticas para el ajuste de riesgos. De ahí la importancia de su correcta incorporación al CMBD. Sin embargo, diversos trabajos, especialmente en Estados Unidos, pero también en España, han puesto en evidencia importantes problemas de calidad en estos datos, dificultades para su mejora y las limitaciones que ello conlleva para evaluar la calidad o la eficiencia de los hospitales. El objetivo de este trabajo es realizar una aproximación a la calidad de la información administrativa y clínica recogida en el CMBD del Servei Valencià de la Salut (SVS) mediante un proceso automatizado de análisis de los datos del propio CMBD, y discutir tanto sus implicaciones para la gestión, como las posibles estrategias de mejora.Material y métodoSe realizó un análisis automatizado de la calidad del CMBD 1994 del SVS (20 hospitales, 241.341 altas), utilizando indicadores de cumplimentación válida de los valores de los campos, relaciones entre campos del mismo episodio, relaciones entre variables en diferentes episodios y volumen y especificidad de la información clínica.ResultadosEl CMBD analizado contiene escasos errores en las variables administrativas, con excepción de la residencia, pero presenta importantes problemas de volumen y especificidad de la información clínica, así como una alta variabilidad en su cumplimentación y calidad en diferentes hospitales.ConclusionesLa calidad de los datos clínicos del CMBD pueden suponer sesgos en su utilización con finalidades de gestión o evaluación de la calidad, así como en los estudios epidemiológicos, de evaluación de tecnologías o utilización de servicios.SummarySettingTogether with the age of the patient, the main diagnosis, secondary diagnosis (comorbility and complications) and the procedures performed are the critical variables for risk-adjusting. Therefore, its correct incorporation to CMBD is of great importance. However, several studies, especially in the United States, but also in Spain, have made evident the existence of important problems of quality in these data, difficulties for its improvement and the limitations which this has to assess the quality or the efficiency of hospitals. The objective of this study is to approach the quality of administrative and clinical collected in the CMBD of the Valencian Health Service (VHS) using an automatized process of analysis of data from the same CMBD, and discuss the implications for its management, as well as possible improvement strategies.Material and methodAn automatized analysis of the quality of CMBD 1994 of the VHS (20 hospitals, 241,341 admissions) was performed, using indicators of valid fulfilling of field values, relationship between fields of the same episode, relationship between variables in different episodes and volume and specificity of clinical information.ResultsThe analysed CMBD contains few errors in management variables, with the exception of residence, but it shows important problems of volume and specificity of clinical information, as well as a high variability in its fulfilling and quality in different hospitals.ConclusionsThe quality of the clinical data of CMBD may be biased in its use with management aims or when assessing quality, as well as in epidemiological studies, evaluation of technology or use of services

Wake dynamics of external flow past a curved circular cylinder with the free stream aligned with the plane of curvature

Accepted versio

Spatial eigensolution analysis of discontinuous Galerkin schemes with practical insights for under-resolved computations and implicit LES

The study focusses on the dispersion and diffusion characteristics of discontinuous spectral element methods - specifically discontinuous Galerkin (DG) - via the spatial eigensolution analysis framework built around a one-dimensional linear problem, namely the linear advection equation. Dispersion and diffusion characteristics are of critical importance when dealing with under-resolved computations, as they affect both the numerical stability of the simulation and the solution accuracy. The spatial eigensolution analysis carried out in this paper complements previous analyses based on the temporal approach, which are more commonly found in the literature. While the latter assumes periodic boundary conditions, the spatial approach assumes inflow/outflow type boundary conditions and is therefore better suited for the investigation of open flows typical of aerodynamic problems, including transitional and fully turbulent flows and aeroacoustics. The influence of spurious/reflected eigenmodes is assessed with regard to the presence of upwind dissipation, naturally present in DG methods. This provides insights into the accuracy and robustness of these schemes for under-resolved computations, including under-resolved direct numerical simulation (uDNS) and implicit large-eddy simulation (iLES). The results estimated from the spatial eigensolution analysis are verified using the one-dimensional linear advection equation and successively by performing two-dimensional compressible Euler simulations that mimic (spatially developing) grid turbulence

Actividades intersectoriales en la prevención de accidentes de tráfico

ResumenSe describen las líneas de trabajo priorizadas y algunos resultados obtenidos en la implantación del programa de prevención y reducción de lesiones por accidentes de tráfico en un área de salud. A partir de 1999 el Centro de Salud Pública priorizó la identificación y búsqueda de aliados en otros sectores (Asociación de policías locales y educación), la construcción de la capacidad de trabajo conjunta y la formación de un grupo intersectorial. Se llevaron a cabo actividades docentes y jornadas. Se formó una red de personas en 17 de un total de 39 ayuntamientos que participan con actividades en el grupo intersectorial. Un total de 10 de estos ayuntamientos participaron con actividades educativas y siete, además, exigieron al cumplimiento de la legislación.El grupo intersectorial potenció la visibilidad de sus actividades a través de los medios de comunicación local. Estas actividades no están dirigidas a reducir las lesiones por tráfico, sino a crear un marco de trabajo para la movilización de los sectores implicados. Se pretende potenciar más el compromiso entre los niveles políticos, técnicos y civiles incidiendo en valores sociales de respeto para una vida más saludable.AbstractWe describe priority issues and some of the results obtained from the implementation of the «Prevention and Reduction of Traffic Accident Injuries» program in a health area. Since 1999 the public health center has made a priority of identifying and recruiting partners from other sectors (the local police association and the local education authority), increasing its capacity for working together, and setting up an intersectorial working group. Teaching activities and meetings were held. A network of people was created from 17 of a total of 39 town halls that participate in activities supported by the intersectorial group. Ten are involved in educational activities and a further seven focus on ensuring compliance with the law. The intersectorial group promoted their visibility through the local media. These activities are not aimed at reducing injuries from road traffic accidents, but rather at creating an action framework through which all the sectors involved can be mobilized. The aim is to strengthen commitment among political, technical and civil sectors by focussing on social values of respect for a healthier life

Hospitalización pediátrica evitable en la Comunidad Valenciana y Cataluña

ResumenObjetivoEstimar las tasas de hospitalización pediátrica evitable por áreas en la Comunidad Valenciana y sectores en Cataluña, y analizar su relación con el nivel socioeconómico o el desarrollo de la atención primaria.MétodoSe estudiaron las hospitalizaciones pediátricas evitables (0-14 años) a partir del Conjunto Mínimo de Datos Básicos del Alta Hospitalaria de la Comunidad Valenciana y de Cataluña (1993-1994). Las variables a estudio fueron: edad, género, nivel socioeconómico y cobertura del nuevo modelo de atención primaria. Se calcularon las tasas brutas y estandarizadas por edad y se realizó una descripción de su variación en áreas y sectores. Se analizó la relación entre las tasas y las características socioeconómicas y de la atención primaria.ResultadosLas hospitalizaciones pediátricas evitables representaron el 21% de todas las hospitalizaciones pediátricas en la Comunidad Valenciana y el 15% en Cataluña. Las tasas brutas en las áreas de la Comunidad Valenciana oscilaron entre 5,7 y 12,7 en 1993 y 6,6 y 17,8 en 1994. La razón de tasas fue de 2,2 y el coeficiente de variación de 37% en 1993 y de 2,7 y 48% respectivamente, en 1994. En los sectores de Cataluña oscilaron entre 2,7 y 24,3 en 1993 y 1,4 y 23,8 en 1994; la razón de tasas fue de 9 y el coeficiente de variación de 52% en 1993, y de 7 y 42% en 1994 respectivamente. Las diferencias encontradas fueron significativas (p < 0,005). No hubo correlación significativa entre el nivel socioeconómico y desarrollo de la atención primaria y las tasas de hospitalización pediátrica evitable por áreas o sectores.ConclusionesLas hospitalizaciones pediátricas evitables suponen una proporción importante de las hospitalizaciones pediátricas. Existe variación en las tasas de hospitalización pediátrica evitable por áreas y sectores, no asociada a los indicadores de nivel socioeconómico y atención primaria utilizados.SummaryObjectiveTo estimate the rates of avoidable pediatric hospitalization in the health areas of the Valencian Community and health sectors of Catalonia, and to analyze if they are related to socioeconomic level or development of primary care.MethodAvoilable paediatric (0-14 years old) hospitalizations were analyzed using the Minimum Basic Data Set of Hospital Discharge in two Autonomous Regions: the Valencian Community and Catalonia (1993-1994). Variables analyzed included age, gender, socioeconomic level and coverage by the new model of primary care. Crude and standardized rates for age were calculated and the variation in areas and sectors was assessed. The association between rates and socioeconomic and primary care characteristics was analyzed.ResultsAvoidable paediatric hospitalizations represent 21% of all paediatric hospitalizations in the Valencian Community and 15% in Catalonia. Crude rates for Valencian Community ranged between 5.7 and 12.7 in 1993 and 6.6 and 17.8 in 1994; extremal quotient was 2.2 and coefficient of variation 37% in 1993 and 2.7 and 48% respectively in 1994. For Catalonia they ranged between 2.7 and 24.3 in 1993 and 1.4 and 23.8 in 1994; extremal quotient was 9 and coefficient of variation 52% in 1993, and 7 and 42% in 1994 respectively. All these differences were significant (p < 0.005). There was no significant correlation between socieconomic level and development of primary health care and rates of avoidable paediatric hospitalization by health areas or sectors.ConclusionsAvoidable paediatric hospitalization represent a significant proportion of paediatric hospitalizations. There are differences in avoidable paediatric hospitalization rates by health areas and sectors, not associated with socieconomic level and primary care indicators

Structural and functional characterization of (110)-oriented epitaxial La2/3Ca1/3MnO3 electrodes and SrTiO3 tunnel barriers

La2/3Ca1/3MnO3 (LCMO) films have been deposited on (110)-oriented SrTiO3 (STO) substrates. X-ray diffraction and high-resolution electron microscopy reveal that the (110) LCMO films are epitaxial and anisotropically in-plane strained, with higher relaxation along the [1¿10] direction than along the [001] direction; x-ray absorption spectroscopy data signaled the existence of a single intermediate Mn3+/4+ 3d-state at the film surface. Their magnetic properties are compared to those of (001) LCMO films grown simultaneously on (001) STO substrates It is found that (110) LCMO films present a higher Curie temperature (TC) and a weaker decay of magnetization when approaching TC than their (001) LCMO counterparts. These improved films have been subsequently covered by nanometric STO layers. Conducting atomic-force experiments have shown that STO layers, as thin as 0.8 nm, grown on top of the (110) LCMO electrode, display good insulating properties. We will show that the electric conductance across (110) STO layers, exponentially depending on the barrier thickness, is tunnel-like. The barrier height in STO (110) is found to be similar to that of STO (001). These results show that the (110) LCMO electrodes can be better electrodes than (001) LCMO for magnetic tunnel junctions, and that (110) STO are suitable insulating barriers

Self‐assembled quantum dots of InSb grown on InP by atomic layer molecular beam epitaxy: Morphology and strain relaxation

Self-organized InSb dots grown by atomic layer molecular beam epitaxy on InP substrates have been characterized by atomic force and transmission electron microscopy. Measurement of high-energy electron diffraction during the growth indicates a Stransky–Krastanov growth mode beyond the onset of 1.4 InSb monolayer ~ML! deposition. The dots obtained after a total deposition of 5 and 7 ML of InSb present a truncated pyramidal morphology with rectangular base oriented along the ^110& directions, elongated towards the @110# direction with $111$113%/$114$111%A lateral facets in @11 ¯ 0# views, and ~001! flat top surfaces. The mismatch between the dot and the substrate has been accommodated by a network of 90° misfit dislocation at the interface. A corrugation of the InP substrate surrounding the dot has been also observedThis work has been funded by the Spanish CICYT Project MAT95-0966.Peer reviewe

Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis in Spain.

Before 1990, outbreaks of multidrug-resistanttuberculosis (MDRTB) were uncommon (1); sincethen, more than 10 outbreaks have been reported,all in hospitals and prisons in the eastern UnitedStates (2-7). Persons traditionally considered atrisk for MDRTB (foreign-born TB patients andthose inadequately treated for TB) have not beenassociated with these outbreaks. Instead, the pres-ence of patients with active TB near immunocom-promised patients in HIV-dedicated wards has ledto MDRTB-infected HIV patients whose TB casesoften go unrecognized. The patients receive inade-quate treatment in facilities without effective pro-cedures for isolating acid-fast bacilli; thesecircumstances favor nosocomial transmission.Health officials in other geographic areas whereHIV and TB are major public health threats havebeen alerted to this emerging problem, and sur-veillance systems have been designed (8).Drs. Herrera, Peiró, Castell, and Godoy have received ascholarship from the Fondo de Investigación Sanitaria delInstituto de Salud Carlos III during their 2-year epidemiologictraining period in the Field Epidemiology Training Program(Programa de Epidemiología Aplicada de Campo)