Trends and area variations in Potentially Preventable Admissions for COPD in Spain (2002-2013): A significant decline and convergence between areas

Background: Potentially Preventable Hospitalizations (PPH) are hospital admissions for conditions which are preventable with timely and appropriate outpatient care being Chronic Obstructive Pulmonary Disease (COPD) admissions one of the most relevant PPH. We estimate the population age-sex standardized relative risk of admission for COPD-PPH by year and area of residence in the Spanish National Health System (sNHS) during the period 2002–2013. Methods: The study was conducted in the 203 Hospital Service Areas of the sNHS, using the 2002 to 2013 hospital admissions for a COPD-PPH condition of patients aged 20 and over. We use conventional small area variation statistics and a Bayesian hierarchical approach to model the different risk structures of dependence in both space and time. Results: COPD-PPH admissions declined from 24.5 to 15.5 per 10, 000 persons-year (Men: from 40.6 to 25.1; Women: from 9.1 to 6.4). The relative risk declined from 1.19 (19 % above 2002–2013 average) in 2002 to 0.77 (30 % below average) in 2013. Both the starting point and the slope were different for the different regions. Variation among admission rates between extreme areas dropped from 6.7 times higher in 2002 to 4.6 times higher in 2013. Conclusions: COPD-PPH conditions in Spain have undergone a strong decline and a reduction in geographical variation in the last 12 years, suggesting a general improvement in health policies and health care over time. Variability among areas still remains, with a substantial room for improvement

Shared component modelling as an alternative to assess geographical variations in medical practice: gender inequalities in hospital admissions for chronic diseases

<p>Abstract</p> <p>Background</p> <p>Small area analysis is the most prevalent methodological approach in the study of unwarranted and systematic variation in medical practice at geographical level. Several of its limitations drive researchers to use disease mapping methods -deemed as a valuable alternative. This work aims at exploring these techniques using - as a case of study- the gender differences in rates of hospitalization in elderly patients with chronic diseases.</p> <p>Methods</p> <p>Design and study setting: An empirical study of 538,358 hospitalizations affecting individuals aged over 75, who were admitted due to a chronic condition in 2006, were used to compare Small Area Analysis (SAVA), the Besag-York-Mollie (BYM) modelling and the Shared Component Modelling (SCM). Main endpoint: Gender spatial variation was measured, as follows: SAVA estimated gender-specific utilization ratio; BYM estimated the fraction of variance attributable to spatial correlation in each gender; and, SCM estimated the fraction of variance shared by the two genders, and those specific for each one.</p> <p>Results</p> <p>Hospitalization rates due to chronic diseases in the elderly were higher in men (median per area 21.4 per 100 inhabitants, interquartile range: 17.6 to 25.0) than in women (median per area 13.7 per 100, interquartile range: 10.8 to 16.6). Whereas Utilization Ratios showed a similar geographical pattern of variation in both genders, BYM found a high fraction of variation attributable to spatial correlation in both men (71%, CI95%: 50 to 94) and women (62%, CI95%: 45 to 77). In turn, SCM showed that the geographical admission pattern was mainly shared, with just 6% (CI95%: 4 to 8) of variation specific to the women component.</p> <p>Conclusions</p> <p>Whereas SAVA and BYM focused on the magnitude of variation and on allocating where variability cannot be due to chance, SCM signalled discrepant areas where latent factors would differently affect men and women.</p

Las estadísticas de causa médica de muerte: coordenadas históricas, herramientas actuales

El trabajo nos acerca a la producción de estadísticas de causas medicas de muerte y su problemática en el siglo XIX, con la aparición de la moderna estadística.-- Un paso importante en la consolidación de aquellas fue la adopción de una clasificación internacional de enfermedades, y posteriormente un primer consenso en las estrategias de recogida (certificado medico internacional) y tratamiento de la información (normas de codificación).-- Superada esa fase de consolidación, la atención se ha dirigido hacia nuevos retos: maximizar la información analiza (estudios de causas múltiples), mejorar la calidad de la cumplimentación medica y eliminar la variabilidad atribuible al proceso de codificación

Indicadores de sucesos adversos hospitalarios (mortalidad, complicaciones, reingresos) a partir del conjunto mínimo de datos hospitalario

Fondo de Investigación Sanitaria FIS 96/103

Las estadísticas de causa médica de muerte: coordenadas históricas, herramientas actuales

El trabajo nos acerca a la producción de estadísticas de causas medicas de muerte y su problemática en el siglo XIX, con la aparición de la moderna estadística.-- Un paso importante en la consolidación de aquellas fue la adopción de una clasificación internacional de enfermedades, y posteriormente un primer consenso en las estrategias de recogida (certificado medico internacional) y tratamiento de la información (normas de codificación).-- Superada esa fase de consolidación, la atención se ha dirigido hacia nuevos retos: maximizar la información analiza (estudios de causas múltiples), mejorar la calidad de la cumplimentación medica y eliminar la variabilidad atribuible al proceso de codificación

Variation in Antiosteoporotic Drug Prescribing and Spending Across Spain. A Population-Based Ecological Cross-Sectional Study

Introduction: Evidence has shown that utilization of antiosteoporotic medications does not correspond with risk, and studies on other therapies have shown that adequacy of pharmaceutical prescribing might vary between regions. Nevertheless, very few studies have addressed the variability in osteoporotic drug consumption. We aimed to describe variations in pharmaceutical utilization and spending on osteoporotic drugs between Health Areas (HA) in Spain.Methods: Population-based cross-sectional ecological study of expenditure and utilization of the five therapeutic groups marketed for osteoporosis treatment in Spain in 2009. Small area variation analysis (SAVA) methods were used. The units of analysis were the 168 HA of 13 Spanish regions, including 7.2 million women aged 50 years and older. The main outcomes were the defined daily dose (DDD) per 1000 inhabitants and day (DDD/1000/Day) dispensed according to the pharmaceutical claims reimbursed, and the expenditure on antiosteoporotics at retail price per woman ≥50 years old and per year.Results: The average osteoporosis drug consumption was 116.8 DDD/1000W/Day, ranging from 78.5 to 158.7 DDD/1000W/Day between the HAs in the 5th and 95th percentiles. Seventy-five percent of the antiosteoporotics consumed was bisphosphonates, followed by raloxifene, strontium ranelate, calcitonins, and parathyroid hormones including teriparatide. Regarding variability by therapeutic groups, biphosphonates showed the lowest variation, while calcitonins and parathyroid hormones showed the highest variation. The annual expenditure on antiosteoporotics was €426.5 million, translating into an expenditure of €59.2 for each woman ≥50 years old and varying between €38.1 and €83.3 between HAs in the 5th and 95th percentiles. Biphosphonates, despite accounting for 79% of utilization, only represented 63% of total expenditure, while parathyroid hormones with only 1.6% of utilization accounted for 15% of the pharmaceutical spending.Conclusion: This study highlights a marked geographical variation in the prescription of antiosteoporotics, being more pronounced in the case of costly drugs such as parathyroid hormones. The differences in rates of prescribing explained almost all of the variance in drug spending, suggesting that the difference in prescription volume between territories, and not the price of the drugs, is the main source of variation in this setting. Data on geographical variation of prescription can help guide policy proposals for targeting areas with inadequate antiosteoporotic drug use

Porcentaje de cesáreas en mujeres de bajo riesgo: un indicador útil para comparar hospitales que atienden partos con riesgos diferentes

Background: the C-section rate has been criticized as a performance indicator for not considering that different hospitals manage deliveries with diverse risks. In this work we explore the characteristics of a new indicator restricted to low C-section risk deliveries. Methods: retrospective cohort of all births (n=214,611) in all public hospitals during 2005-2010 in the Valencia Region, Spain (source: minimum basic dataset). A low-risk subpopulation consisting of women under-35, no history of c-section, between 37 and 41 gestational weeks, and with a single fetus, with cephalic presentation and normal weight (2500-3999 g) was constructed. We analyzed variability in the new indicator, its correlation with the crude indicator and, using multilevel logistic regression models, the presence of residual risks. Results: a total of 117 589 births (58.4% of the whole deliveries) were identified as low C-section risk. The c-section rate in these women was 11.9% (24.4% for all deliveries) ranging between hospitals from 7.0% to 28.9%. The c-section rate in low-risk and total deliveries correlated strongly (r=0.88). The remaining risks in the population of low risk did not alter the hospital effect on the c-section rate. Conclusion: the percentage of C-section in low risk women include a high volume of deliveries, correlated with the crude indicator and residual risks are not differentially influenced by hospitals, being a useful indicator for monitoring the quality of obstetric care in the National Health System.Fundamentos: el uso del "porcentaje de cesáreas" como indicador de calidad ha sido criticado por no considerar que los hospitales atienden partos con riesgos diferentes que podrían justificar su variabilidad. El objetivo de este trabajo es explorar las características de un indicador restringido al porcentaje de cesáreas en partos de bajo riesgo. Métodos: cohorte retrospectiva de todos los partos atendidos en hospitales públicos de la Comunidad Valenciana durante el periodo 2005-2010 (n=214.611; fuente: Conjunto mínimo de datos básicos), en la que se identificaron los partos de bajo riesgo (edad menor 35 años, sin antecedentes de cesárea, duración de lasgestación entre 37-41 semanas, y feto único, presentación cefálica y normopeso. Se analizó la variabilidad en el indicador, su correlación con el indicador bruto y, mediante modelos de regresión logística multinivel, la presencia de riesgos remanentes. Resultados: un total de 117.589 (58,4% del total) partos fueron identificados como de bajo riesgo. El porcentaje de cesáreas en este subgrupo fue del 11,9% (24,4% para el total) con un rango entre hospitales del 7,0% al 28,9%. El porcentaje de cesáreas en bajo riesgo y total se correlacionaron fuertemente (r=0,88). El ajuste de los riesgos remanentes en la población de bajo riesgo no alteró el efecto hospital sobre el porcentaje de cesáreas. Conclusiones: el porcentaje de cesáreas en partos de bajo riesgo incluye un alto volumen de partos, correlaciona con el indicador bruto y los riesgos remanentes no están influidos diferencialmente por los hospitales, siendo útil para monitorizar la calidad de la atención obstétrica en el Sistema Nacional de Salud

Sesgos territoriales en la mortalidad hospitalaria estimada por la Encuesta de Morbilidad Hospitalaria de 2004

Fundamentos. La Encuesta de Morbilidad Hospitalaria (EMH) incorpora actualmente el 85% de los hospitales y el 90% de las altas, y es la única fuente de ámbito estatal que permite profundizar, con información sobre diagnóstico, edad o género, en el estudio del hospital como lugar de fallecimiento. El objetivo de este trabajo es analizar la posible presencia de sesgos territoriales en la mortalidad hospitalaria recogida en la EMH respecto al universo muestral que supone la Estadística de Establecimientos Sanitarios con Régimen de Internado (EESCRI). Métodos. Se contrastó, para cada provincia y en 2004, las estimaciones de altas, fallecidos y porcentaje de mortalidad de la EMH con los datos de la EESCRI (universo muestral), ajustando un modelo de regresión lineal para el número de fallecimientos y un segundo modelo para el porcentaje de mortalidad intrahospitalaria. Resultados. La EMH infraestimó el volumen de altas (- 8,6%) y fallecimientos (-11,4%), pero no el porcentaje de mortalidad hospitalaria (3,55% vs. 3,45%). A pesar de la excelente correlación en el número de fallecimientos (0,99), la cifra de muertes de la EMH es inferior a la de la EESCRI en la gran mayoría de las provincias y en 13 la discrepancia supera el 20%. El porcentaje de mortalidad hospitalaria mostró diferencias superiores al 20% en 9 provincias. Conclusión. En 2004, la EMH infraestima el número de altas y de fallecimientos hospitalarios pero, salvo en 9 provincias, no hay evidencia de sesgos en el porcentaje de mortalidad respecto al total de altas hospitalarias