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

A set of quality and safety indicators for hospitals of the «Agencia Valenciana de Salud»

Objetivos: Elaborar un conjunto de indicadores de calidad y seguridad en el contexto de los hospitales de la Agencia Valenciana de Salud. Material y métodos: Se utilizó la técnica Metaplan® para identificar propuestas sobre sostenibilidad y enfermería. Se empleó el catálogo de la Sociedad Espanola ˜ de Calidad Asistencial como punto de partida para los indicadores clínicos. Utilizando la Técnica Delphi 207 profesionales fueron invitados a participar en el proceso para identificar los indicadores más fiables y factibles. Finalmente, la propuesta resultante fue validada por los directivos de 12 hospitales, teniendo en cuenta la variabilidad, objetividad, factibilidad, fiabilidad y sensibilidad de los indicadores. Resultados: La tasa de participación osciló entre el 66,67 y 80,71%. De los 159 indicadores de la propuesta inicial se priorizaron y seleccionaron 68 (21 económicos o de gestión, 22 de cuidados de enfermería y 25 clínicos). De ellos 3 eran comunes a las 3 categorías y 2 no cumplían los criterios específicos de la fase de validación, por lo que el conjunto final consta de 63 indicadores. Conclusiones: Se ha elaborado un conjunto de indicadores de calidad y seguridad. El sistema de información actual permite su monitorización.Objectives: To prepare a set of quality and safety indicators for Hospitals of the «Agencia Valenciana de Salud». Material and methods: The qualitative technique Metaplan® was applied in order to gather proposals on sustainability and nursing. The catalogue of the «Spanish Society of Quality in Healthcare» was adopted as a starting point for clinical indicators. Using the Delphi technique, 207 professionals were invited to participate in the selecting the most reliable and feasible indicators. Lastly, the resulting proposal was validated with the managers of 12 hospitals, taking into account the variability, objectivity, feasibility, reliability and sensitivity, of the indicators. Results: Participation rates varied between 66.67% and 80.71%. Of the 159 initial indicators, 68 were prioritized and selected (21 economic or management indicators, 22 nursing indicators, and 25 clinical or hospital indicators). Three of them were common to all three categories and two did not match the specified criteria during the validation phase, thus obtaining a final catalogue of 63 indicators. Conclusions: A set of quality and safety indicators for Hospitals was prepared. They are currently being monitored using the hospital information systems.Medicin

Evaluación de la satisfacción de los pacientes crónicos con los dispositivos de telemedicina y con el resultado de la atención recibida. Programa ValCrònic

Objetivo: Evaluar la satisfacción de los pacientes con el programa ValCrònic, los dispositivos de telemedicina y con el resultado de la atención recibida tras 2 años de seguimiento. Diseño: Estudio observacional descriptivo basado en encuestas telefónicas. Emplazamiento: Comunidad Valenciana. Participantes: En total participaron 410 pacientes que presentaban una o varias de las siguientes patologías: hipertensión, insuficiencia cardíaca, diabetes o enfermedad pulmonar obstructiva crónica. Se incluyó a 585 pacientes, de los cuales 104 abandonaron el programa (18 por fallecimiento) y 71 rehusaron participar. Métodos: Se diseñó y validó una escala específica. Se consideraron los efectos techo y suelo. Se analizó la consistencia interna mediante alfa de Cronbach. Para comprobar la validez de constructo se empleó un análisis exploratorio de componentes principales con criterio de autovaloración igual a 1. Se aplicó el procedimiento de rotación Varimax. Se consideraron como pérdidas aceptables de información cargas factoriales ≥ 0,55. La escala se conformó con 7 preguntas cerradas y 1 abierta. Resultados: Respondieron un total de 322 pacientes (tasa de respuesta del 78,5%). 118 (36.6%) fueron mujeres. En 48 (14,9%) casos respondió un cuidador. El valor del alfa de Cronbach fue de 0,7. ValCrònic supuso para 278 (86,3%) pacientes una ayuda para conocer mejor su enfermedad, 270 (83,9%) afirmaron hacer un uso más seguro de la medicación gracias a ValCrònic y 283 (87,9%) dijeron conocer ahora mejor su enfermedad. Para 288 (89,4%) los dispositivos fueron fáciles de manejar en casa. Solo en 12 (3,7%) casos el paciente consideró que los dispositivos de telemedicina suponían una carga de trabajo difícil de conciliar en su día a día. Conclusiones: ValCrònic ha contribuido a la activación de los pacientes para autocuidado

Estimation of the overuse of preoperative chest X-rays according to "Choosing wisely", "No hacer", and "Essencial" initiatives: are they equally applicable and comparable?

Background: Overuse reduces the efficiency of healthcare systems and compromises patient safety. Different institutions have issued recommendations on the indication of preoperative chest X-rays, but the degree of compliance with these recommendations is unknown. This study investigates the frequency and characteristics of the inappropriateness of this practice. Methods: This is a descriptive observational study with analytical components, performed in a tertiary hospital in the Community of Madrid (Spain) between July 2018 and June 2019. The inappropriateness of preoperative chest X-ray tests was analyzed according to “Choosing Wisely”, “No Hacer” and “Essencial” initiatives and the cost associated with this practice was estimated in Relative Value and Monetary Units. Results: A total of 3449 preoperative chest X-ray tests were performed during the period of study. In total, 5.4% of them were unjustified according to the “No Hacer” recommendation and 73.3% according to “Choosing Wisely” and “Essencial” criteria, which would be equivalent to 5.6% and 11.8% of the interventions in which this test was unnecessary, respectively. One or more preoperative chest X-ray(s) were indicated in more than 20% of the interventions in which another chest X-ray had already been performed in the previous 3 months. A higher inappropriateness score was also recorded for interventions with an American Society of Anesthesiologists (ASA) grade ≥ III (16.5%). The Anesthesiology service obtained a lower inappropriateness score than other Petitioning Surgical Services (57.5% according to “Choosing Wisely” and “Essencial”; 4.1% according to “No Hacer”). Inappropriate indication of chest X-rays represents an annual cost of EUR 52,122.69 (170.1 Relative Value Units) according to “No Hacer” and EUR 3895.29 (2276.1 Relative Value Units) according to “Choosing Wisely” or “Essencial” criteria. Conclusions: There was wide variability between the recommendations that directly affected the degree of inappropriateness found, with the main reasons for inappropriateness being duplication of preoperative chest X-rays and the lack of consideration of the particularities of thoracic interventions. This inappropriateness implies a significant expense according to the applicable recommendations and therefore a high opportunity cost

Low-Value Clinical Practices: Knowledge and Beliefs of Spanish Surgeons and Anesthetists

OBJECTIVES: To know the frequency and causes of low value surgical practices, according to the opinion of surgeons and anesthetists, and to determine their degree of knowledge about the Spanish "Choosing wisely" initiative. METHODS: Cross-sectional observational study, based on a self-administered online questionnaire through an opportunistic sample of 370 surgeons and anesthetists from three Spanish regions, contacted through Scientific Societies. The survey took part between July and December 2017. RESULTS: A patient profile requesting unnecessary practices was identified (female, 51-65 years old and unaffiliated disease). The frequency of requests was weekly or daily for 50.0% of the professionals, of whom 15.1% acknowledged succumbing to these pressures. To dissuade the patient, clinical reasons (47%) were considered the most effective. To increase control and safety in the case was the main reason to indicate them. The greatest responsibility for overuse was attributed to physicians, defensive medicine and mass media. Assessing professionals' knowledge on unnecessary practices, an average of 5 correct answers out of 7 was obtained. Some 64.1% of the respondents were unaware of the Spanish "Choosing wisely" initiative. CONCLUSIONS: Low value surgical practices are perceived as a frequent problem, which requires an approach entailing intervention with patients and the media as well as profession

Resultados en el tratamiento del ictus en hospitales con y sin Unidad de Ictus.

Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department