Catalan experience of deadoption of low-value practices in primary care

Pràctica basada en l'evidència; Millora de la qualitat assistencial; Ciència de la implementacióEvidencia basada en la práctica; Mejora de la calidad de la asistencia sanitaria; Ciencia de la implementaciónEvidence-based practice; Healthcare quality improvement; Implementation scienceReducing ineffective practices is one way to ensure highquality and efficient healthcare for the population. For this reason, several initiatives have been implemented worldwide to reduce low-value care. This article describes the experience of the Essencial project, a multifaceted deadoption strategy implemented in the Catalan primary care system. Lessons learnt from this project include the importance of considering the local context in deadoption strategies, providing adequate training and communication material to patients and clinicians and supporting the key role of clinical champions. Given the knowledge gaps regarding the conditions for successful deadoption strategies, the Catalan experience could provide enlightenment on how to implement, evaluate and sustain a large-scale collaborative deadoption strategy in primary healthcare

Anàlisi de les defuncions observades i esperades durant l'epidèmia de COVID-19 a Catalunya

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Defuncions; Mortalitat; Desigualtats en salutCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Defunciones; Mortalidad; Desigualdades en saludCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Deaths; Mortality; Health inequalitiesAquest informe té com a objectiu descriure les defuncions enregistrades per COVID-19 durant l’epidèmia, així com comparar les defuncions observades amb les defuncions esperades per estimar l’excés de defuncions relacionat amb la COVID-19 a Catalunya

Short term culture with the caspases inhibitor z-VAD fmk reduces beta cell apoptosis in transplanted islets and improves the metabolic outcome of the graft

In the initial days after transplantation islets are particularly vulnerable and show increased apoptosis and necrosis. We have studied the effects of caspase inhibition on this early beta cell death in syngeneically transplanted islets. Streptozotocin-diabetic C57BL/6 mice were transplanted with 150 syngeneic islets, an insufficient mass to restore normoglycemia, preincubated with or without the pan-caspase inhibitor z-VAD. fmk 2 h before transplantation. Beta cell apoptosis was increased in control islets on day 3 after transplantation (0.28 ± 0.02%) compared with freshly isolated islets (0.08 ± 0.02%, p< 0.001), and was partially reduced in transplanted islets preincubated with z-VAD.fmk 200 μM (0.14 ± 0.02%, p = 0.003) or with z-VAD.fmk 500 μM (0.17 ± 0.01%, p = 0.012), but not with a lower z-VAD.fmk (100 μM) concentration. Diabetic mice transplanted with islets preincubated with z-VAD.fmk 500 μM showed an improved metabolic evolution compared with control and z-VAD.fmk 200 μM groups. The z-VAD.fmk 500 μM group showed an overall lower blood glucose after transplantation (p = 0.02), and at the end of the study blood glucose values were reduced compared with transplantation day (15.7 ± 3.6 vs. 32.5 ± 0.5 mmol/L, p = 0.001). In contrast, blood glucose was not significantly changed in control and z-VAD.fmk 200 μM groups. Four weeks after transplantation beta cell mass was higher in z-VAD.fmk 500 μM group (0.15 ± 0.02 mg) than in the control group (0.10 ± 0.02 mg) (p = 0.043). In summary, the treatment of freshly isolated islets with the caspase inhibitor z-VAD.fmk reduced the subsequent apoptosis of the islets once they were transplanted and improved the outcome of the graft

Avaluació de l’hospitalització a domicili: anàlisi de la situació a Catalunya en el període 2010-2014

Hospitalització a domicili; Anàlisi; EstadístiquesHospitalización a domicilio; Análisis; EstadísticasHospitalization at home; Analysis; StatisticsL’hospitalització a domicili és un recurs assistencial sanitari avançat que té com a objectiu atendre el pacient en el seu propi domicili proporcionant-li processos diagnòstics i terapèutics de complexitat i intensitat comparables als que es realitzen en règim d’internament en hospitalització convencional. Entre les seves finalitats organitzatives hi trobem estalviar estades hospitalàries i alliberar recursos per a destinar-los a altres actuacions especialitzades. Hi ha diverses modalitats d’hospitalització a domicili: la modalitat d’alta precoç o early discharge, que permet avançar l’alta de pacients ingressats en plantes d’hospitalització, i la de substitució o evitació de l’ingrés o admission avoidance, on l’hospitalització a domicili ofereix una alternativa vàlida a l’ingrés en planta de molts pacients que acudeixen al servei d’urgències hospitalàries o que són derivats des de l’atenció primària, sense el pas previ d’ingrés en un hospital d’aguts amb internament convencional. L'objectiu és Objectiu és descriure les característiques i l’evolució de les unitats d’hospitalització a domicili dels hospitals del Sistema Sanitari Integral d’Utilització Pública de Catalunya (SISCAT). Aquest és un dels objectius específics del projecte avaluador de l’hospitalització a domicili: l’anàlisi de la situació de l’hospitalització a domicili a Catalunya (2010-2014).La hospitalización a domicilio es un recurso asistencial sanitario avanzado que tiene como objetivo atender al paciente en su propio domicilio proporcionándole procesos diagnósticos y terapéuticos de complejidad e intensidad comparables a los que se realizan en régimen de internamiento en hospitalización convencional. Entre sus finalidades organizativas encontramos ahorrar estancias hospitalarias y liberar recursos para destinarlos a otras actuaciones especializadas. Existen varias modalidades de hospitalización a domicilio: la modalidad de alta precoz o early discharge, que permite avanzar el alta de pacientes ingresados ​​en plantas de hospitalización, y la de sustitución o evitación del ingreso o admisión avoidance, donde la hospitalización a domicilio ofrece una alternativa válida al ingreso en planta de muchos pacientes que acuden al servicio de urgencias hospitalarias o que son derivados desde la atención primaria, sin el paso previo de ingreso en un hospital de agudos con internamiento convencional. El objetivo es Objetivo es describir las características y la evolución de las unidades de hospitalización a domicilio de los hospitales del Sistema Sanitario Integral de Utilización Pública de Cataluña (SISCAT). Este es uno de los objetivos específicos del proyecto evaluador de la hospitalización a domicilio: el análisis de la situación de la hospitalización a domicilio en Cataluña (2010 a 2014).Home-based hospitalization is an advanced health care resource whose goal is to assist the patient in his or her own home by providing diagnostic and therapeutic processes of complexity and intensity comparable to those that are carried out in the internal hospitalization system in conventional hospitalization. Among its organizational goals, we can save on hospital stays and free resources to be used for other specialized activities. There are several types of home-based hospitalization: the high precocious or early discharge modality, which allows to advance the discharge of patients admitted to hospitalization plants, and the replacement or avoidance of admission or admission avoidance, where home-based hospitalization offers a valid alternative to the admission to the plant of many patients who attend the hospital emergency services or that are derived from primary care, without the previous step of admission to a hospital of acute with internally conventional The objective is Objective to describe the characteristics and evolution of the home-based hospitalization units of the hospitals of the Comprehensive Health System for Public Use of Catalonia (SISCAT). This is one of the specific objectives of the home remedies assessment project: the analysis of the situation of hospitalization at home in Catalonia (2010-2014)

Differences in results and related factors between hospital-at-home modalities in Catalonia: a cross-sectional study

Average stay; Cross-sectional study; Hospital-at-home; MortalityEstancia media; Estudio transversal; Hospital en casa; MortalidadEstada mitjana; Estudi transversal; Hospital a casa; MortalitatHospital-at-home (HaH) is a healthcare modality that provides active treatment by healthcare staff in the patient's home for a condition that would otherwise require hospitalization. The aims were to describe the characteristics of different types of hospital-at-home (HaH), assess their results, and examine which factors could be related to these results. A cross-sectional study based on data from all 2014 HaH contacts from Catalonia was designed. The following HaH modalities were considered-admission avoidance (n = 7,214; 75.1%) and early assisted discharge (n = 2,387; 24.9%). The main outcome indicators were readmission, mortality, and length of stay (days). Multivariable models were fitted to assess the association between explanatory factors and outcomes. Hospital admission avoidance is a scheme in which, instead of being admitted to acute care hospitals, patients are directly treated in their own homes. Early assisted discharge is a scheme in which hospital in-care patients continue their treatment at home. In the hospital avoidance modality, there were 8.3% readmissions, 0.9% mortality, and a mean length of stay (SD) of 9.6 (10.6) days. In the early assisted discharge modality, these figures were 7.9%, 0.5%, and 9.8 (11.1), respectively. In both modalities, readmission and mean length of stay were related to comorbidity and type of hospital, and mortality with age. The results of HaH in Catalonia are similar to those observed in other contexts. The factors related to these results identified might help to improve the effectiveness and efficiency of the different HaH modalities

A deprivation index to reform the financing model of primary care in Catalonia (Spain)

Índice de privación; Desigualdades en salud; Datos administrativos; Financiación de la atención primariaÍndex de privació; Desigualtats en salut; Dades administratives; Finançament de l'atenció primàriaDeprivation index; Health inequalities; Administrative data; Primary care financingObjetivo Construir un índice de privación para la asignación del presupuesto de los equipos de atención primaria de Cataluña, válido tanto para entornos urbanos como rurales y actualizable con más frecuencia que los índices construidos con las variables censales. Método A partir de la revisión de los índices de privación más comunes se seleccionaron las variables existentes de fuentes que permiten una actualización frecuente y que son representativas del ámbito territorial de las áreas básicas de salud. Se calcularon las correlaciones entre las variables escogidas y las variables de utilización de atención sanitaria y morbilidad. Se aplicó el análisis de componentes principales. Finalmente, se calcularon las correlaciones entre el índice construido y el índice MEDEA, y con variables de utilización de recursos y morbilidad para diferentes tramos de dispersión poblacional. Resultados Las variables de renta, ocupación y nivel de estudios son las que tienen más correlación con la utilización de atención sanitaria y la morbilidad. El índice socioeconómico compuesto (ISC) tiene un rango de −0,01 a 5,68, una media de 2,60 y una desviación estándar de 0,91. La correlación entre el ISC y el MEDEA es de 0,89. El ISC se correlaciona con la utilización de atención sanitaria tanto en los entornos urbanos como en los rurales, aunque en estos últimos la asociación es menor. Conclusiones El ISC se ha construido con datos que permiten una actualización frecuente, y se ha integrado en el modelo de asignación de recursos de la atención primaria a partir de 2017.Objective To build a deprivation index for the assignation of the budgets of the primary healthcare teams in Catalonia (Spain) valid for both urban and rural environments and updatable with greater frequency than indices built from census variables. Method Starting from a review of the most common deprivation indices, variables were selected from sources that allow frequent updating and are representative at the territorial level of primary care. The correlations were calculated between the chosen variables and variables of need for healthcare and morbidity. principal components analysis was applied. Finally, the correlations of the index built with the MEDEA index and with variables of use of healthcare resources and morbidity was calculated stratifying by geographical dispersion. Results The variables of income, occupation and education are the ones with the highest correlation with the need for healthcare and morbidity. The composed socioeconomic index (CSI) ranges from −.01 to 5.68, with an average value of 2.60 and a standard deviation of .91. The correlation between the CSI and the MEDEA index is .89. The CSI correlates with use for healthcare in both urban and rural environments, although in rural environments the association is lower. Conclusions The CSI was built with data that allow frequent updating and was integrated in the model for allocating resources to primary healthcare starting in 2017

A deprivation index to reform the financing model of primary care in Catalonia (Spain)

Índice de privación; Desigualdades en salud; Datos administrativos; Financiación de la atención primariaÍndex de privació; Desigualtats en salut; Dades administratives; Finançament de l'atenció primàriaDeprivation index; Health inequalities; Administrative data; Primary care financingObjetivo Construir un índice de privación para la asignación del presupuesto de los equipos de atención primaria de Cataluña, válido tanto para entornos urbanos como rurales y actualizable con más frecuencia que los índices construidos con las variables censales. Método A partir de la revisión de los índices de privación más comunes se seleccionaron las variables existentes de fuentes que permiten una actualización frecuente y que son representativas del ámbito territorial de las áreas básicas de salud. Se calcularon las correlaciones entre las variables escogidas y las variables de utilización de atención sanitaria y morbilidad. Se aplicó el análisis de componentes principales. Finalmente, se calcularon las correlaciones entre el índice construido y el índice MEDEA, y con variables de utilización de recursos y morbilidad para diferentes tramos de dispersión poblacional. Resultados Las variables de renta, ocupación y nivel de estudios son las que tienen más correlación con la utilización de atención sanitaria y la morbilidad. El índice socioeconómico compuesto (ISC) tiene un rango de −0,01 a 5,68, una media de 2,60 y una desviación estándar de 0,91. La correlación entre el ISC y el MEDEA es de 0,89. El ISC se correlaciona con la utilización de atención sanitaria tanto en los entornos urbanos como en los rurales, aunque en estos últimos la asociación es menor. Conclusiones El ISC se ha construido con datos que permiten una actualización frecuente, y se ha integrado en el modelo de asignación de recursos de la atención primaria a partir de 2017.Objective To build a deprivation index for the assignation of the budgets of the primary healthcare teams in Catalonia (Spain) valid for both urban and rural environments and updatable with greater frequency than indices built from census variables. Method Starting from a review of the most common deprivation indices, variables were selected from sources that allow frequent updating and are representative at the territorial level of primary care. The correlations were calculated between the chosen variables and variables of need for healthcare and morbidity. principal components analysis was applied. Finally, the correlations of the index built with the MEDEA index and with variables of use of healthcare resources and morbidity was calculated stratifying by geographical dispersion. Results The variables of income, occupation and education are the ones with the highest correlation with the need for healthcare and morbidity. The composed socioeconomic index (CSI) ranges from −.01 to 5.68, with an average value of 2.60 and a standard deviation of .91. The correlation between the CSI and the MEDEA index is .89. The CSI correlates with use for healthcare in both urban and rural environments, although in rural environments the association is lower. Conclusions The CSI was built with data that allow frequent updating and was integrated in the model for allocating resources to primary healthcare starting in 2017

Anàlisi de les defuncions observades i esperades durant l'epidèmia de COVID-19 a Catalunya

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Defuncions; Mortalitat; Desigualtats en salutCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Defunciones; Mortalidad; Desigualdades en saludCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Deaths; Mortality; Health inequalitiesAquest informe té com a objectiu descriure les defuncions enregistrades per COVID-19 durant l’epidèmia, així com comparar les defuncions observades amb les defuncions esperades per estimar l’excés de defuncions relacionat amb la COVID-19 a Catalunya

Socioeconomic inequalities in health and the use of healthcare services in Catalonia : Analysis of the individual data of 7.5 million residents

The aim of this study is to analyse the health status, the use of public healthcare services and the consumption of prescription drugs in the population of Catalonia, taking into consideration the socioeconomic level of individuals and paying special attention to vulnerable groups. Cross-sectional study of the entire population resident in Catalonia in 2015 (7.5 million people) using administrative records. Twenty indicators are analysed related to health, the use of healthcare services and consumption of prescription drugs. Rates, frequencies and averages are obtained for the different variables stratified by age groups (under 15 years, 15-64 years and 65 years or older), gender and socioeconomic status (calculated on the basis of pharmacy copayment levels and Social Security benefits received). A socioeconomic gradient was observed in all the indicators analysed, in both sexes and in all age groups. Morbidity, use of mental healthcare centres, hospitalisation rates and probability of drug consumption among children is 3-7 times higher for those with low socioeconomic level respect to those with a higher one. In children and adults, the steepest gradient was found in the use of mental health services. Moreover, there are gender inequalities. There are significant socioeconomic inequalities in health status and in the use of healthcare services in the population of Catalonia. To respond to this situation, new policies on health and other areas, such as education and employment, are required, especially those that have an impact on early years

Linear correlation between beta cell mass and body wight throughout the lifespan in Lewis rats: role of beta cell hyperplasia and hypertrophy

We determined the beta-cell replicative rate, beta-cell apoptosis, cross-sectional beta-cell area, and pancreatic beta-cell mass throughout the entire postweaning lifespan (months 1, 3, 7, 10, 15, and 20) of Lewis rats. Beta-cell replication was progressively reduced in the initial months of life but remained stable after month 7 (month 1, 0.99 +/- 0.10%; month 3, 0.24 +/- 0.04%; month 7, 0.12 +/- 0.02%; month 10, 0.14 +/- 0.02%; month 15, 0.10 +/- 0.03%; month 20, 0.13 +/- 0.03%; analysis of variance [ANOVA], P < 0.001). Beta-cell apoptosis was low and did not change significantly from month 1 to 20 of life. Cross-sectional area of individual beta-cells increased progressively in the initial months, remained stable from month 7 to 15, and increased again on month 20. The estimated number of beta-cells per pancreas, calculated as the ratio of total beta-cell mass to individual beta-cell mass, tripled from month 1 to 7 but did not change significantly thereafter. Beta-cell mass increased approximately 8 times from month 1 to 20 (month 1, 2.04 +/- 0.28 mg; month 20, 15.5 +/- 2.32 mg; ANOVA, P < 0.001) and showed a strong and significant linear correlation with body weight (r = 0.98, P < 0.001). In summary, we have shown that beta-cell replication was maintained throughout the lifespan in normal rats, clearly establishing that the beta-cell birth rate does not fall to 0, even in very old rats. Beta-cell mass increased throughout the lifespan, closely matching the increment in total body weight at any time point. This increment was selective for beta-cells, since the growth of the endocrine non-beta-cell mass was limited to the initial months of life. Both beta-cell hypertrophy and hyperplasia contributed to increased beta-cell mass in young animals, but only beta-cell hypertrophy was responsible for the increased beta-cell mass found in old animals. This study provides a global perspective for understanding the dynamics of beta-cell mass in young, adult, and aged animals