[Implementation of the "Best Practice Spotlight Organization" Program at the Virgen de las Nieves University Hospital.] / Implantación del programa "Centros Comprometidos con la Excelencia en Cuidados" en el Hospital Universitario Virgen de las Nieves. Rev Esp Salud Pública.

The objective of this work was to describe the implantation project presented by the Virgen de las Nieves University Hospital (Granada, Spain) to be selected as a candidate for "Best Practice Spotlight Organization"® (in Spain CCEC®) program in the cohort (2015-2017) to implement three guidelines for Nurses Association of Canada Ontario (RNAO) clinical practice of care. The methodology used was the model called "knowledge for action" and the actions developed for each of the phases of the action cycle for applying knowledge to practice were described: 1) identification of the problem, 2) adaptation to the local context, 3) evaluation of facilitators and barriers, 4) adaptation and implementation of interventions, 5) monitoring and evaluation of results and 6) sustainability. This work adds to the set of studies that address the improvement and maintenance of evidence-based practice programs in nursing, and in health services in general. It shows the application of a framework for the implementation of clinical practice guidelines for care in a specific health environment for its replication in other different health settings. It has been shown that it is essential to dedicate efforts to planning the implementation of this type of programs, taking into account the context in which they are developed, the specific characteristics of the population being served, identifying the different barriers and facilitators that may affect during the course of the program. process and defining actions to make the changes in practice sustainable.

El objetivo de este trabajo fue describir el proyecto de implantación presentado por el Hospital Universitario Virgen de las Nieves (Granada, España) para ser seleccionado candidato del programa "Centros Comprometidos con la Excelencia en Cuidados" (CCEC)® en la cohorte (2015-2017) para implantar tres guías de práctica clínica de cuidados de la Asociación de Enfermeras de Ontario de Canadá (RNAO). La metodología utilizada fue el modelo denominado "conocimiento para la acción" y se describieron las actuaciones desarrollas para cada una de las fases de las que consta el ciclo de acción para la aplicación de conocimientos a la práctica: 1) identificación del problema, 2) adaptación al contexto local, 3) evaluación de los facilitadores y barreras, 4) adaptación e implantación de las intervenciones, 5) monitorización y evaluación de resultados y 6) sostenibilidad. Este trabajo se suma al conjunto de estudios que abordan la mejora y el mantenimiento de programas de prácticas basadas en la evidencia en enfermería, y en los servicios de salud en general. Muestra la aplicación de un marco de implantación de guías de práctica clínica de cuidados en un entorno sanitario específico para su replicación en otros escenarios de salud diferentes. Se ha demostrado que resulta esencial dedicar esfuerzos en planificar la implantación de este tipo de programas atendiendo al contexto en el que se desarrollan, a las características específicas de la población a la que se atiende, identificando las diferentes barreras y facilitadores que pueden afectar durante el proceso y definiendo acciones para hacer sostenible los cambios en la práctica.

Gestión de casos: adaptación para pacientes pluripatológicos y cuidadores en Colombia / Case management: adaptation for patients with comorbidity and caregivers in Colombia / Gestão de casos: adaptação de pacientes multimorbidos e cuidadores na Colômbia

Objetivo: Identificar puntos de consenso de tomadores de decisiones, profesionales, y usuar-ios, frente a aspectos fundamentales que debe contener un Modelo de Gestión de Casos en el contexto colombiano, para atender a personas en situación de pluripatología y sus cuidadores familiares. Método: Estudio descriptivo. Método de consenso entre expertos y muestreo por conveniencia. Se realizó la técnica Delphi de tiempo real en dos rondas. El análisis incluyó promedios aritméticos para determinar las propuestas más importantes y gobernables. Re-sultados: Participaron 25 expertos en la primera ronda y 23 en la segunda. Se obtuvo mayor consenso en: mayor disponibilidad de recursos económicos para garantizar infraestructura y recursos humanos suficientes; cualificación de recurso humano; potenciar la figura de la enfermera gestora de casos; implementación de rutas de atención integrales; sistemas de in-formación que faciliten el tránsito y conexión de los usuarios; planes de alta vinculación de actores sociales para fomentar la autogestión. Conclusión: La adaptación del Modelo de GC en el sistema de aseguramiento colombiano, permitió identificar factores sustanciales para implementarlo en los niveles macro, meso y micro del sistema de salud, reconocido por los actores como altamente fragmentado.

Objective: Identify the points of consensus of decision makers, professionals, and users, re-garding the fundamental aspects a Case Management Model should have in the Colombian context, to care for people with comorbidity and their family caregivers. Method: Descriptive study. Consensus decision-making among experts and convenience sampling. The Delphi method was applied in real time for two rounds. The analysis included arithmetic means to determine the most important and manageable proposals. Results: 25 experts participated in the first round and 23 in the second round. A greater consensus was obtained in: avail-ability of economic resources to guarantee sufficient infrastructure and human resources; qualification of human resources; potentiate the figure of the nurse in case management; implementation of comprehensive health care pathways; information systems that facilitates the transition and connection of the users; plans for high engagement of social actors to promote self-management. Conclusion: The adaptation of the Case Management Model in the Colombian insurance system, allowed the identification of substantial factors to implement it in the macro, meso and micro levels of the health care system, recognized by the actors as highly fragmented.

Objetivo: identificar os pontos em comum de tomadores de decisões, profissionais e usuários, perante aspectos fundamentais a considerar-se no Modelo de Gestão de Casos (MGC) no contexto colombiano, para atender as pessoas em situação de múltiplas patologias e os seus cuidadores familiares. Materiais e métodos: estudo descritivo. Método de consenso entre ex-pertos e amostragem por conveniência. Realizou0-se a técnica Delphi de tempo real em duas chances. A análise incluiu medias aritméticas para determinar as propostas mais importantes e governáveis. Resultados: participaram 25 expertos na primeira virada e 23 na segunda. Obteve-se maior consenso em: maior disponibilidade de recursos financeiros para garantir a infraestrutura e recursos humanos suficientes; qualificação do recurso humano; potenciar a figura da enfermeira gestora de casos; implementação de rotas de atendimento integrais; sistemas de informação que facilitem a transição e conexão entre os usuários; planos de alta vinculação de atores sociais para o fomento da autogestão. Conclusão: a adaptação do MGC no sistema de saúde colombiano, permitiu identificar fatores substanciais para implementá-lo nos níveis macro, intermediários e micro do sistema de saúde, reconhecido pelos atores como altamente fragmentado.

Design of a case management model for people with chronic disease (Heart Failure and COPD). Phase I: modeling and identification of the main components of the intervention through their actors: patients and professionals (DELTA-icE-PRO Study).

BACKGROUND: Chronic diseases account for nearly 60% of deaths around the world. The extent of this silent epidemic has not met determined responses in governments, policies or professionals in order to transform old Health Care Systems, configured for acute diseases. There is a large list of research about alternative models for people with chronic conditions, many of them with an advanced practice nurse as a key provider, as case management. But some methodological concerns raise, above all, the design of the intervention (intensity, frequency, components, etc). OBJECTIVES: General: To develop the first and second phases (theorization and modeling) for designing a multifaceted case-management intervention in people with chronic conditions (COPD and heart failure) and their caregivers. SPECIFIC AIMS: 1) To identify key events in people living with chronic disease and their relation with the Health Care System, from their point of view. 2) To know the coping mechanisms developed by patients and their caregivers along the story with the disease. 3) To know the information processing and its utilization in their interactions with health care providers. 4) To detect potential unmet needs and the ways deployed by patients and their caregivers to resolve them. 5) To obtain a description from patients and caregivers, about their itineraries along the Health Care System, in terms of continuity, accessibility and comprehensiveness of care. 6) To build up a list of promising case-management interventions in patients with Heart Failure and COPD with this information in order to frame it into theoretical models for its reproducibility and conceptualization. 7) To undergo this list to expert judgment to assess its feasibility and pertinence in the Andalusian Health Care. DESIGN: Qualitative research with two phases: For the first five objectives, a qualitative technique with biographic stories will be developed and, for the remaining objectives, an expert consensus through Delphi technique, on the possible interventions yielded from the first phase. The study will be developed in the provinces of Almería, Málaga and Granada in the Southern Spain, from patients included in the Andalusian Health Care Service database with the diagnosis of COPD or Heart Failure, with the collaboration of case manager nurses and general practitioners for the assessment of their suitability to inclusion criteria. Patients and caregivers will be interviewed in their homes or their Health Centers, with their family or their case manager nurse as mediator. DISCUSSION: First of a series of studies intended to design a case-management service for people with heart failure and COPD, in the Andalusian Health Care System, where case management has been implemented since 2002. Accordingly with the steps of a theoretical model for complex interventions, in this study, theorization and intervention modeling phases will be developed.

[Evidence Based Public Health: resources on effectiveness of community interventions]. / Salud pública basada en la evidencia: recursos sobre la efectividad de intervenciones en la comunidad.

The evaluation of interventions in Public Health is a key element through the process of developing health policies, but it is not free of controversy. For doing this purpose it is essential the use of research outcomes, although there are sticking points related to the traditional approach of Evidence Based Medicine, dominated by the randomized clinical trial as the gold standard. Not always it is possible to develop randomized and controlled studies in Public Health (sometimes due to ethical limitations, or because of the technical impossibility for performing the trial or because conceptual incompatibility) and the interventions are mostly multifaceted, therefore, the interpretation of the results is a complex task. In other hand, the usual criteria for research appraisal underestimates systematically the observational studies which, frequently, are the indicated in Public Health scenarios. Nevertheless, a great advance has been implemented with the generation of strategies as TREND (Transparent Reporting of Evaluations with Non randomized Designs), as well as other instruments like STROBE (STrenghtening the Reporting of OBservational studies in Epidemiology) or MOOSE (Meta-analysis Of Observational Studies in Epidemiology). But regardless of the existence of more or less consolidated critical appraisal tools, we all need a solvent and rigorous way of knowing the outcomes of Public Health interventions. This would make more dynamic the review, design or planning phases, and it would contribute to facilitate the decision-making process when a well grounded knowledge be available. In this paper all the methodological process about searching evidence in Public Health interventions is reviewed, as well as the main sources providing this information, in order to facilitate this task to the Public health professionals.