Validación de un modelo para medir la calidad asistencial en los hospitales

Como consecuencia de nuestra participación en diferentes proyectos de investigación relacionados con modelos de acreditación sanitario, decidimos continuar nuestras investigaciones en esta línea, presentando una tesis cuyas hipótesis es: Es posible construir operativamente una batería de indicadores relevantes y válidos para evaluar la calidad de los servicios prestados en centros hospitalarios. El objetivo general fue el de diseñar una herramienta para la evaluación de la calidad total en los servicios hospitalarios. Se efectuó un análisis de la literatura científica y un estudio pormenorizado de experiencia de evaluación realizadas siguiendo las directrices del modelo EFQM. Una vez concluida la fase anterior, se realizó un estudio basado en técnicas de investigación cualitativa mediante la participación de diferentes profesionales, gestores y pacientes, buscando consenso sobre los indicadores más representativos de la calidad hospitalaria, tomando como base los 9 elementos del modelo EFQM. En esta fase, la muestra de participantes fue conveniente al objeto de estudio y suficiente para recoger la información necesaria. En total, para la formación de los 18 grupos participaron un total de 112 profesionales de la salud y 15 pacientes. El diseño completo del modelo propuesto para medir la calidad en los centros hospitalarios se compone de 53 indicadores que fueron pilotados en hospitales Servicio Andaluz de Salud. Para cada uno de los indicadores se calcularon los intervalos de confianza correspondientes para niveles de confianza del 95 % utilizando para ellos las formulas anteriormente descritas. El objetivo final del trabajo fue determinar diferencias por hospitales en cuanto a los indicadores de calidad que se dan en ellos y comprobar con ello la validez del modelo. Para ello hemos utilizado técnicas de análisis mutivariantes, concretamente, el Análisis de Componentes Principales (ACP). Los resultados de los indicadores de liderazgo, personas, recursos, procesos, política y estrategia, satisfacción y resultados clave ponen de manifiesto innumerables oportunidades de mejora en relación con la calidad de los servicios hospitalarios. Como conclusión general del estudio se pone de manifiesto que la estructura de nueve criterios, base del modelo original de la EFQM, es un marco de trabajo oportuno y válido para aordar estrategias de calidad en los centros sanitarios ya que sobre ellos se pueden agrupar todos los elementos relacionados con la gestión de la calidad en una organización

Proposal of a clinical care pathway for quality and safe management of headache patients: a consensus study report

Background Headache is one of the most prevalent and disabling conditions. Its optimal management requires a coordinated and comprehensive response by health systems, but there is still a wide variability that compromises the quality and safety of the care process. Purpose To establish the basis for designing a care pathway for headache patients through identifying key subpathways in the care process and setting out quality and clinical safety standards that contribute to providing comprehensive, adequate and safe healthcare. Method A qualitative research study based on the consensus conference technique. Eleven professionals from the Spanish National Health System participated, seven of them with clinical experience in headache and four specialists in healthcare management and quality. First, identification of the key subpathways in the care process for headache, barriers/limitations for optimal quality of care, and quality and safety standards applied in each subpathway. Second, two consecutive consensus rounds were carried out to assess the content of the subpathway level descriptors, until the expert agreement was reached. Third, findings were assessed by 17 external healthcare professionals to determine their understanding, adequacy and usefulness. Results Seven key subpathways were identified: (1) primary care, (2) emergency department, (3) neurology department, (4) specialised headache unit, (5) hospitalisation, (6) outpatients and (7) governance and management. Sixty-seventh barriers were identified, the most frequent being related to diagnostic errors (36,1%), resource deficiency (25%), treatment errors (19,4%), lack of health literacy (13,9%) and inadequate communications with care transitions (5,6%). Fifty-nine quality and 31 safety standards were defined. They were related to evaluation (23.3%), patient safety (21.1%), comprehensive care (12.2%), treatment (12.2%), clinical practice guidelines (7.8%), counselling (6.7%), training (4.4%) and patient satisfaction (3.3%). Conclusions This proposal incorporates a set of indicators and standards, which can be used to define a pathway for headache patients and determine the levels of quality

A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX‑EMD Study

Background The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) offers the potential to overcome the challenges associated with traditional decision-making tools. Objectives A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. Methods Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defined all of the criteria that could influence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was fitted by applying the backward elimination algorithm (relevant criteria: p value = 15 letters (p value < 0.001), effect duration per administration (p value = 0.008), retinal detachment (p value < 0.001), endophthalmitis (p value = 0.012), myocardial infarction (p value < 0.001), intravitreal hemorrhage (p value = 0.021), annual treatment cost per patient (p value = 0.001), health-related quality of life (HRQoL) (p value = 0.004), and disability level (p value = 0.021). Conclusions From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment effect duration. It should also contribute to system sustainability by being affordable, it should have a positive impact on HRQoL, and it should prevent disability

Insertion (22;9)(q11;q34q21) in a patient with chronic myeloid leukemia characterized by fluorescence in situ hybridization

An unusual cytogenetic rearrangement, described as ins(22;9)(q11;q34q21), was detected in a 49-year-old male patient diagnosed with chronic myeloid leukemia (CML). Reverse transcriptase polymerase chain reaction (RT-PCR) revealed a b3a2 fusion transcript. In order to confirm the cytogenetic findings and fully characterize the inverted insertion, we performed fluorescence in situ hybridization (FISH) assays using locus-specific and whole chromosome painting probes. Our FISH analysis showed the presence of the BCR/ABL fusion gene, verified the insertion and determined that the breakpoint on chromosome 22 where the insertion took place was located proximal to the BCR gene and distal to the TUPLE1 gene on 22q11

Effectiveness, safety/tolerability of OBV/PTV/r ± DSV in patients with HCV genotype 1 or 4 with/without HIV-1 co-infection, chronic kidney disease (CKD) stage IIIb-V and dialysis in Spanish clinical practice - Vie-KinD study

Limited data are available on the effectiveness and tolerability of direct-acting antivirals (DAAs) therapies in the real world for HCV-infected patients with comorbidities. This study aimed to describe the effectiveness of OBV/PTV/r ± DSV (3D/2D regimen) with or without ribavirin (RBV) in HCV or HCV/HIV co-infected patients with GT1/GT4 and CKD (IIIb-V stages), including those under hemodialysis and peritoneal dialysis in routine clinical practice in Spain in 2015.Non-interventional, retrospective, multicenter data collection study in 31 Spanish sites. Socio-demographic, clinical variables, study treatment characteristics, effectiveness and tolerability data were collected from medical records.Data from 135 patients with a mean age (SD) of 58.3 (11.4) years were analyzed: 92.6% GT1 (81.6% GT1b and 17.6% GT1a) and 7.4% GT4, 14 (10.4%) HIV/HCV co-infected, 19.0% with fibrosis F3 and 28.1% F4 by FibroScan®, 52.6% were previously treated with pegIFN and RBV. 11.1%, 14.8% and 74.1% of patients had CKD stage IIIb, IV and V respectively. 68.9% of patients were on hemodialysis; 8.9% on peritoneal dialysis and 38.5% had history of renal transplant. A total of 125 (96.2%) of 135 patients were treated with 3D, 10 (7.4%) with 2D and 30.4% received RBV. The overall intention-to-treat (ITT) sustained virologic response at week 12 (SVR12) was 92.6% (125/135) and the overall modified-ITT (mITT) SVR12 was 99.2% (125/126). The SVR12 rates (ITT) per sub-groups were: HCV mono-infected (91.7%), HCV/HIV co-infected (100%), GT1 (92.0%), GT4 (100%), CKD stage IIIb (86.7%), stage IV (95%) and stage V (93%). Among the 10 non-SVR there was only 1 virologic failure (0.7%); 4 patients had missing data due lost to follow up (3.0%) and 5 patients discontinued 3D/2D regimen (3.7%): 4 due to severe adverse events (including 3 deaths) and 1 patient´s decision.These results have shown that 3D/2D regimens are effective and tolerable in patients with advanced CKD including those in dialysis with GT 1 or 4 chronic HCV mono-infection and HIV/HCV coinfection in a real-life cohort. The overall SVR12 rates were 92.6% (ITT) and 99.2% (mITT) without clinically relevant changes in eGFR until 12 weeks post-treatment. These results are consistent with those reported in clinical trials

A portrait of the Trans-Neptunian Object (143707) 2003 UY117 from a stellar occultation and photometry data.

Within the Lucky Star international collaboration* on stellar occultations by TNOs and other outer solar system bodies, we predicted the occultation by the TNO (143707) 2003 UY117 of an mV ~ 14.6 mag star on 23 October 2020. Around a week before the occultation date, we updated and refined the prediction using high precision astrometry obtained using the 2 m Liverpool telescope located at El Roque de Los Muchachos Observatory on La Palma, Spain. The update resulted in a shadow path with good observability potential. We carried out a specific campaign involving 27 observing sites in the south of Spain and North of Africa to observe the occultation. We recorded 4 positive detections and several very close misses to the south of the body. With this information we determined the silhouette of 2003 UY117 at the moment of the occultation. We also obtained the geometric albedo and the size for this object. In addition to this, we carried out several photometric runs with large telescopes to determine the rotation period and rotational phase at the time of the occultation. The body presents a clear double-peaked rotational light curve consistent with a triaxial ellipsoid of considerable elongation, which means that a rotational light curve analysis is critical to correctly interpret the occultation results. The preliminary analysis indicates a larger equivalent diameter than that determined from Herschel thermal data, although consistent within the large error bars of the thermal determination. We will present the preliminary results and discuss their implications.*Lucky Star (LS) is an EU-funded research activity to obtain physical properties of distant Solar System objects using stellar occultations. LS collaboration agglomerates the efforts of the Paris, Granada, and Rio teams. https://lesia.obspm.fr/lucky-star/ Acknowledgements:JLO, PS-S, NM, MV, and RD acknowledge financial support from the State Agency for Research of the Spanish MCIU through the `Center of Excellence Severo Ochoa' award for the Instituto de Astrofísica de Andalucía (SEV-2017-0709), they also acknowledge the financial support by the Spanish grant AYA-2017-84637-R and AYARTI2018- 098657-J-I00 `LEO-SBNAF' (MCIU/AEI/FEDER, UE)

Usefulness of bone turnover markers as predictors of mortality risk, disease progression and skeletal-related events appearance in patients with prostate cancer with bone metastases following treatment with zoledronic acid: TUGAMO study

Owing to the limited validity of clinical data on the treatment of prostate cancer (PCa) and bone metastases, biochemical markers are a promising tool for predicting survival, disease progression and skeletal-related events (SREs) in these patients. The aim of this study was to evaluate the predictive capacity of biochemical markers of bone turnover for mortality risk, disease progression and SREs in patients with PCa and bone metastases undergoing treatment with zoledronic acid (ZA). Methods: This was an observational, prospective and multicenter study in which ninety-eight patients were included. Patients were treated with ZA (4mg every 4 weeks for 18 months). Data were collected at baseline and 3, 6, 9, 12, 15 and 18 months after the beginning of treatment. Serum levels of bone alkaline phosphtase (BALP), aminoterminal propeptide of procollagen type I (P1NP) and beta-isomer of carboxiterminal telopeptide of collagen I (b-CTX) were analysed at all points in the study. Data on disease progression, SREs development and survival were recorded. Results: Cox regression models with clinical data and bone markers showed that the levels of the three markers studied were predictive of survival time, with b-CTX being especially powerful, in which a lack of normalisation in visit 1 (3 months after the beginning of treatment) showed a 6.3-times more risk for death than in normalised patients. Levels of these markers were also predictive for SREs, although in this case BALP and P1NP proved to be better predictors. We did not find any relationship between bone markers and disease progression. Conclusion: In patients with PCa and bone metastases treated with ZA, b-CTX and P1NP can be considered suitable predictors for mortality risk, while BALP and P1NP are appropriate for SREs. The levels of these biomarkers 3 months after the beginning of treatment are especially importantThis study was supported by Novartis Oncology Spai

Relationship between olive oil consumption and ankle-brachial pressure index in a population at high cardiovascular risk

Background and aims: The aim of this study was to ascertain the association between the consumption of different categories of edible olive oils (virgin olive oils and olive oil) and olive pomace oil and ankle-brachial pressure index (ABI) in participants in the PREDIMED-Plus study, a trial of lifestyle modification for weight and cardiovascular event reduction in individuals with overweight/obesity harboring the metabolic syndrome. Methods: We performed a cross-sectional analysis of the PREDIMED-Plus trial. Consumption of any category of olive oil and olive pomace oil was assessed through a validated food-frequency questionnaire. Multivariable linear regression models were fitted to assess associations between olive oil consumption and ABI. Additionally, ABI ≤1 was considered as the outcome in logistic models with different categories of olive oil and olive pomace oil as exposure. Results: Among 4330 participants, the highest quintile of total olive oil consumption (sum of all categories of olive oil and olive pomace oil) was associated with higher mean values of ABI (beta coefficient: 0.014, 95% confidence interval [CI]: 0.002, 0.027) (p for trend = 0.010). Logistic models comparing the consumption of different categories of olive oils, olive pomace oil and ABI ≤1 values revealed an inverse association between virgin olive oils consumption and the likelihood of a low ABI (odds ratio [OR] 0.73, 95% CI [0.56, 0.97]), while consumption of olive pomace oil was positively associated with a low ABI (OR 1.22 95% CI [1.00, 1.48]). Conclusions: In a Mediterranean population at high cardiovascular risk, total olive oil consumption was associated with a higher mean ABI. These results suggest that olive oil consumption may be beneficial for peripheral artery disease prevention, but longitudinal studies are needed