Calidad percibida del cuidado hospitalario

ResumenFundamentoSERVQUAL ha sido introducido en el sector sanitario como alternativa a las encuestas de satisfacción del paciente. SERVQUAL es uno de los cuestionarios más utilizados para medir la calidad percibida por los clientes de empresas de servicios dentro del denominado paradigma de la desconfirmación (diferencia entre expectativa y percepción del servicio). Pese a su pretendida utilidad no se ha estudiado la estructura, validez y fiabilidad de este cuestionario en el medio hospitalario de nuestro país.MétodosEste trabajo se diseñó con tres objetivos: 1) analizar la estructura factorial del SERVQUAL; 2) determinar la capacidad predictiva de las diferentes puntuaciones que de él pueden obtenerse (escala de percepciones, de expectativas, y diferencia entre expectativas y percepciones); 3) validar una versión del SERVQUAL adaptada al medio hospita lario (a la que denominamos SERVQHOS). Se diseñó un estudio descriptivo basado en encuestas con análisis multi-variante de los datos. Se entrevistó a 826 sujetos que habían sido atendidos en los hospitales de Alicante, Elche y Elda de la provincia de Alicante.ResultadosLa estructura factorial en cinco dimensiones del SERVQUAL no pudo ser confirmada. La escala de percepciones reunió mayor capacidad predictiva que la derivada de la puntuación de la diferencia entre expectativas y percepciones. Se identificaron cuatro factores en SERVQHOS (56% de varianza explicada). Alfa de Cronbach de 0,87, coeficiente Spearman-Brown 0,77. La escala de percepciones SERVQHOS mostró una mayor capacidad predictiva que las puntuaciones derivadas de la diferencia entre expectativas y percepciones con respecto a los criterios «satisfacción del paciente» (55% de varianza explicada) y «¿es recomendable el hospital?» (76,36% de clasificaciones correctas con respecto a los niveles de respuesta del criterio).ConclusionesEl empleo de SERVQUAL requiere de un proceso de validación previo. En este sentido, SERVQHOS ha demostrado índices psicométricos adecuados, si bien algunos de los problemas metodológicos atribuidos a las mediciones basadas en SERVQUAL han quedado patentes, la principal que el valor predictivo de la escala de percepciones de la experiencia del servicio fue superior al de la magnitud de la diferencia entre expectativas y percepciones.SummaryIntroductionSERVQUAL has been introduced in the healthcare sector as an alternative to the patient satisfaction measures. SERVQUAL is one of the most used questionnaires to measure the customers’ perceived quality. It is based on the disconfirmation paradigm (expectations-minus-perceptions). However, the structure, validity and reliability of this questionnaire have not been assessed in the Spanish hospital context.MethodsThree main targets defined in this study: 1) analyze the SERVQUAL's factorial solution, 2) determine which of its scales (perceptions, expectations, and expectations-minus-perceptions) has higher predictive efficiency, and 3) develop a new version for hospital setting (which was called SERVQHOS). A descriptive study based on surveys with multivariate analysis of data was conducted. Eight-hundred-twenty-six subjects were interviewed. All were attended in the Alicante's, Elche's, or Elda's hospital.ResultsA five-factor solution of the SERVQUAL was not corroborated. The perceptions scale obtained a higher predictive efficiency than expectations and expectations-minus-perceptions scales. Four factors were identified using SERVQHOS (56% explained variance). Perceptions-SERVQHOS gathered a greater predictive capacity that the scores derived from the difference among expectations and perceptions. This result was obtained in both criteria: patient satisfaction (55% explained variance) and whether the respondents would recommend the hospital (76,36% right classifications with respect to response levels of the criterion).ConclusionsBefore using SERVQUAL is highly recommended to realize a validation procedure of this questionnaire. SERVQHOS has shown adequate reliability and validity. However, there were some methodological problems using it. The most important inconvenience was that perceptions' scores showed greater predictive capacity than expectations-minus-perceptions

The development of the DISCO-RC for measuring children's discomfort during research procedures

Background: There is a need for data on children's self-reported discomfort in clinical research, helping ethics committees to make their evaluation of discomfort described in study protocols evidence-based. Since there is no appropriate instrument to measure children's discomfort during medical research procedures, we aimed to develop a generic, short and child-friendly instrument: the DISCO-RC questionnaire (DISCOmfort in Research with Children). Methods: This article describes the six steps of the development of the DISCO-RC. First, we updated a literature search on children's self-reported discomfort in clinical research to get insight in what words are used to measure discomfort (step 1). Subsequently, we interviewed 46 children (6-18years) participating in research to get insight into important forms of discomfort for children (step 2), and asked them about their preferred response option for measuring discomfort (step 3). Next, we consulted nine paediatric research professionals from various backgrounds for input on the content and feasibility of the DISCO-RC (step 4). Based on the previous steps, we developed a draft version of the DISCO-RC, which we discussed with the professionals. The DISCO-RC was then pretested in 25 children to ensure face-validity from the child's perspective and feasibility (step 5). Finally, validity, reliability and internal consistency were tested (step 6). Results: The search-update revealed several words used for measuring discomfort in research (e.g. 'worries', 'unpleasantness'). The interviews gave insight into important forms of discomfort for children in research (e.g. 'pain', 'boredom'). Children preferred a 5-point Likert scale as response option for the DISCO-RC. The experts recommended a short, digital instrument involving different forms of discomfort, and measuring discomfort of individual research procedures. Pretesting of the DISCO-RC resulted in a few layout changes, and feedback from the children confirmed the feasibility of the DISCO-RC. Convergent validity and test-retest reliability were acceptable. Internal consistency based on item-rest correlations and Cronbach's alpha were low, as expected. Conclusions: The DISCO-RC is a generic, practical and psychometrically sound instrument for measuring children's discomfort during research procedures. It contributes to make the evaluation of discomfort in paediatric research evidence-based. Therefore, we recommend including the DISCO-RC as standard component of paediatric research studies

Avoidable Adverse Events Related to Ignoring the Do-Not-Do Recommendations: A Retrospective Cohort Study Conducted in the Spanish Primary Care Setting

Objective This study aimed to measure the frequency and severity of avoidable adverse events (AAEs) related to ignoring do-not-do recommendations (DNDs) in primary care. Methods A retrospective cohort study analyzing the frequency and severity of AAEs related to ignoring DNDs (7 from family medicine and 3 from pediatrics) was conducted in Spain. Data were randomly extracted from computerized electronic medical records by a total of 20 general practitioners and 5 pediatricians acting as reviewers; data between February 2018 and September 2019 were analyzed. Results A total of 2557 records of adult and pediatric patients were reviewed. There were 1859 (72.7%) of 2557 (95% confidence interval [CI], 71.0%-74.4%) DNDs actions in 1307 patients (1507 were performed by general practitioners and 352 by pediatricians). Do-not-do recommendations were ignored more often in female patients (P < 0.0001). Sixty-nine AAEs were linked to ignoring DNDs (69/1307 [5.3%]; 95% CI, 4.1%-6.5%). Of those, 54 (5.1%) of 1062 were in adult patients (95% CI, 3.8%-6.4%) and 15 (6.1%) of 245 in pediatric patients (95% CI, 3.1%-9.1%). In adult patients, the majority of AAEs (51/901 [5.7%]; 95% CI, 4.2%-7.2%) occurred in patients 65 years or older. Most AAEs were characterized by temporary minor harm both in adult patients (28/54 [51.9%]; 95% CI, 38.5%-65.2%) and pediatric patients (15/15 [100%]). Conclusions These findings provide a new perspective about the consequences of low-value practices for the patients and the health care systems. Ignoring DNDs could place patients at risk, and their safety might be unnecessarily compromised

Preventing and addressing the stress reactions of health care workers caring for patients with COVID-19: Development of a digital platform (Be + against COVID)

Background: COVID-19 became a major public health concern in March 2020. Due to the high rate of hospitalizations for COVID-19 in a short time, health care workers and other involved staff are subjected to a large workload and high emotional distress. Objective: The objective of this study is to develop a digital tool to provide support resources that might prevent and consider acute stress reactions in health care workers and other support staff due to the COVID-19 pandemic. Methods: The contents of the digital platform were created through an evidence-based review and consensus conference. The website was built using the Google Blogger tool. The Android version of the app was developed in the Java and XML languages using Android Studio version 3.6, and the iOS version was developed in the Swift language using Xcode version 11.5. The app was evaluated externally by the Andalusian Agency for Healthcare Quality. Results: We detected the needs and pressing situations of frontline health care workers, and then, we proposed a serial of recommendations and support resources to address them. These resources were redesigned using the feedback received. A website in three different languages (Spanish, English, and Portuguese) and a mobile app were developed with these contents, and the AppSaludable Quality Seal was granted to the app. A specific self-report scale to measure acute stress and additional tools were included to support the health care workforce. This instrument has been used in several Latin American countries and has been adapted considering cultural differences. The resources section of the website was the most visited with 18, 516 out of 68, 913 (26.9%) visits, and the “Self-Report Acute Stress Scale” was the most visited resource with 6468 out of 18, 516 (34.9%) visits. Conclusions: The Be + against COVID platform (website and app) was developed and launched to offer a pool of recommendations and support resources, which were specifically designed to protect the psychological well-being and the work morale of health care workers. This is an original initiative different from the usual psychological assistance hotlines

SOBRINA Spanish study-analysing the frequency, cost and adverse events associated with overuse in primary care: protocol for a retrospective cohort study

Introduction Several institutions and quality national agencies have fostered the creation of recommendations on what not to do to reduce overuse in clinical practice. In primary care, their impact has hardly been studied. The frequency of adverse events (AEs) associated with doing what must not be done has not been analysed, either. The aim of this study is to measure the frequency of overuse and AEs associated with doing what must not be done (commission errors) in primary care and their cost. Methods and analysis A coordinated, multicentric, national project. A retrospective cohort study using computerised databases of primary care medical records from national agencies and regional health services will be conducted to analyse the frequency of the overuse due to ignore the do-not-do recommendations, and immediately afterwards, depending on their frequency, a representative random sample of medical records will be reviewed with algorithms (triggers) that determine the frequency of AEs associated with these recommendations. Cost will determine by summation of the direct costs due to the consultation, pharmacy, laboratory and imaging activities according to the cases. Ethics and dissemination The study protocol has been approved by the Ethics Committee of Primary Care Research of the Valencian Community. We aim to disseminate the findings through international peerreviewed journals and on the website (http://www. nohacer. es/). Outcomes will be used to incorporate algorithms into the electronic history to assist in making clinical decisions

Si ocurrió un evento adverso piense en decir “lo siento”

Fundamento. La información al paciente víctima de un evento adverso (EA) presenta ciertas particularidades en función del marco legal del país en el que se produzca, especialmente en lo referido al ofrecimiento de una disculpa. En el presente trabajo se pretende establecer los límites y las condiciones que debemos considerar a la hora de trasladar una disculpa al paciente que ha sufrido un EA. Método. Conferencia de consenso entre 26 profesionales de distintas comunidades autónomas, instituciones y perfiles profesionales con experiencia acreditada en la gestión de sistemas de Seguridad del Paciente y Derecho Penal de diferentes ámbitos laborales (sanidad, aseguradoras, inspección, académico). Resultados. El paciente, tras un EA además de ser informado, debiera recibir una disculpa expresada en términos neutros (manifestación empática y de pesar por lo sucedido), sin que el informante se identifique a sí mismo como responsable del daño, culpabilice a terceros, ni ofrezca una compensación en nombre de la compañía aseguradora. El profesional que se siente más directamente involucrado en el incidente es normalmente el menos indicado para informar y disculparse. El informante debe ajustarse al tipo y gravedad del EA. La normativa y condiciones del seguro de responsabilidad aconsejan no ofrecer información concreta sobre la magnitud de la compensación. Conclusiones. La disculpa debe medirse en función del marco normativo que rige en cada país. En nuestro caso procede una respuesta de empatía hacia el paciente, manifestando pesar por lo sucedido (decir lo siento) que puede facilitar la relación con el paciente, reducir su desconfianza y el número de litigios. Background. Disclosing information to a patient who is a victim of an adverse event (AE) presents some particularities depending on the legal framework in the country where the AE occurred. The aim of this study is to identify the limits and conditions when apologizing to a patient who has suffered an AE. Methods. A consensus conference involving 26 professionals from different autonomous communities, institutions, and profiles (health, insurance, inspection, academic) with accredited experience in patient safety management systems and criminal law. Results. Open disclosure should include an apology expressed in neutral terms (showing empathy and regret for what has happened) without the informant being identified as responsible for the damage, blaming third parties, or offering compensation on behalf of the insurance company. The professional who feels most directly involved in the incident is usually the least likely to report it and apologise. The informant profile must conform to the type and severity of the AE. The rules and conditions of liability insurance advise against providing specific information on the amount of compensation. Conclusions. The apology should be offered in terms of the regulatory framework in force in each country. In Spain, an appropriate response of empathy for the patient is warranted, expressing regret for what happened (apologising), which can facilitate the relationship with the patient, mitigate their mistrust, and reduce the number of disputes

Colossal dielectric constants in transition-metal oxides

Many transition-metal oxides show very large ("colossal") magnitudes of the dielectric constant and thus have immense potential for applications in modern microelectronics and for the development of new capacitance-based energy-storage devices. In the present work, we thoroughly discuss the mechanisms that can lead to colossal values of the dielectric constant, especially emphasising effects generated by external and internal interfaces, including electronic phase separation. In addition, we provide a detailed overview and discussion of the dielectric properties of CaCu3Ti4O12 and related systems, which is today's most investigated material with colossal dielectric constant. Also a variety of further transition-metal oxides with large dielectric constants are treated in detail, among them the system La2-xSrxNiO4 where electronic phase separation may play a role in the generation of a colossal dielectric constant.Comment: 31 pages, 18 figures, submitted to Eur. Phys. J. for publication in the Special Topics volume "Cooperative Phenomena in Solids: Metal-Insulator Transitions and Ordering of Microscopic Degrees of Freedom

Critical exponents and equation of state of the three-dimensional Heisenberg universality class

We improve the theoretical estimates of the critical exponents for the three-dimensional Heisenberg universality class. We find gamma=1.3960(9), nu=0.7112(5), eta=0.0375(5), alpha=-0.1336(15), beta=0.3689(3), and delta=4.783(3). We consider an improved lattice phi^4 Hamiltonian with suppressed leading scaling corrections. Our results are obtained by combining Monte Carlo simulations based on finite-size scaling methods and high-temperature expansions. The critical exponents are computed from high-temperature expansions specialized to the phi^4 improved model. By the same technique we determine the coefficients of the small-magnetization expansion of the equation of state. This expansion is extended analytically by means of approximate parametric representations, obtaining the equation of state in the whole critical region. We also determine a number of universal amplitude ratios.Comment: 40 pages, final version. In publication in Phys. Rev.