RESUMO
OBJECTIVE: To determine whether the implementation and use of the electronic health records (EHR) modifies the quality, readability and/or the length of the discharge summaries (DS) and the average number of coded diagnosis and procedures per hospitalization episode. DESIGN: A pre-post-intervention descriptive study conducted between 2010 and 2014. SETTING: The 'Hospital Universitario 12 de Octubre' (H12O) of Madrid (Spain). A tertiary University Hospital of up to 1200 beds. INTERVENTION: Implementation and systematic use of the EHR. MAIN OUTCOME MEASURES: The quality, length and readability of the DS and the number of diagnosis and procedures codes by raw and risk-adjusted data. RESULTS: A total of 200 DS were included in the present work. After the implementation of the EHR the DS had better quality per formal requirements, although were longer and harder to read (P < 0.001). The average number of coded diagnoses and procedures was increased, 9.48 in the PRE-INT and 10.77 in the POST-INT, and the difference was statistically significant (P < 0.001) in both raw and risk-adjusted data. CONCLUSIONS: The implementation of EHR improves the formal quality of DS, although poor use of EHR functionalities might reduce its understandability. Having more clinical information immediately available due to EHR increases the number of diagnosis and procedure codes enhancing their utility for secondary uses.
Assuntos
Registros Eletrônicos de Saúde , Sumários de Alta do Paciente Hospitalar/normas , Compreensão , Diagnóstico , Técnicas e Procedimentos Diagnósticos , Hospitalização , Hospitais Universitários/organização & administração , Humanos , EspanhaRESUMO
BACKGROUND: The goal of the study was to analyze the factors associated with quality of life (QoL) in institutionalized older adults with dementia, based on self and proxy ratings, and if these characteristics differ by dementia severity. METHODS: Cross-sectional study of 525 people with dementia (PwD) and their caregivers (professional or family caregivers). Two different QoL questionnaires, leading to three measures, were used: QoL in Alzheimer's disease scale (QOL-AD), self and proxy-rated, and QoL in late-stage dementia scale (QUALID), proxy-rated. Multivariate linear regression models were tested for each QoL measure and for mild/moderate and severe stages of dementia. RESULTS: Multiple regression analyses showed a significant association between the three QoL measures and depression. Functional ability was significantly associated with QoL when assessed by proxy. Other factors such as education level, leisure activities and frequency of visits were significantly related with QOL-AD by proxy. The associated factors that differed by dementia severity were education level for moderate dementia, and frequency of visits and who answered the questionnaire (professional vs. family member) for severe dementia. CONCLUSIONS: QoL was consistently associated with depressive symptoms independently of the measures as well as functional ability and social leisure activities when the QoL questionnaire was rated by proxy. Treating depressive symptoms, increasing social activities and maintaining the functional ability may decrease the deterioration of QoL in institutionalized older adults with dementia.
Assuntos
Demência/psicologia , Depressão/diagnóstico , Qualidade de Vida , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Estudos Transversais , Família , Feminino , Humanos , Institucionalização , Atividades de Lazer , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Testes Neuropsicológicos , Procurador , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Autorrelato , Índice de Gravidade de Doença , EspanhaRESUMO
PURPOSE: This study aims to assess the change in and predictive factors of the quality of life (QoL) of institutionalized older adults with dementia over a 20-month period. METHODS: Information was used from a follow-up study conducted over an average period of 19.61 ± 1.93 months on a sample of 274 institutionalized older adults aged 60 or over, diagnosed with dementia. Two linear regression models were built to predict change in the EQ-5D index and the quality of life in Alzheimer's disease (QOL-AD) scale, taking as independent variables: sociodemographic characteristics and measures of functional ability (Barthel Index), depression in dementia (Cornell Scale), number of chronic health problems, cognitive level (MEC, the Spanish Mini-Mental State Examination) and severity of dementia (Clinical Dementia Rating) at baseline. RESULTS: The majority of the participants were women (81.75 %) with an average age of 84.70 ± 6.51 years, single (78.15 %), with severe dementia and moderate functional dependence. There was a significant decrease on the EQ-5D, EQ-VAS and QOL-AD between baseline and follow-up scores. The main predictors of QoL of the institutionalized older adults with dementia were the number of chronic problems and baseline scores of the QoL measures. CONCLUSIONS: A significant decrease in the QoL of institutionalized older adults was observed over a 20-month period. Results suggest that interventions aimed at reducing the number of chronic medical conditions may have a beneficial effect on older adults' QoL.
Assuntos
Demência/psicologia , Depressão/psicologia , Qualidade de Vida , Instituições Residenciais , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer , Doença Crônica , Estudos Transversais , Feminino , Seguimentos , Humanos , Institucionalização , Modelos Lineares , Masculino , Testes Neuropsicológicos , Espanha , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The number of aggressions towards health care professionals has risen over the past few years. There are no previous studies in primary care covering an entire region and to all professional categories. The aim of this study was to characterize aggressions in Primary Care in the Community of Madrid. METHODS: Multicenter cross-sectional study. Analysis of a Registration System that reports any type of aggression suffered by Primary Care workers, in the Community of Madrid. The study variables included sociodemographic characteristics of the aggressor and the victim, the type of aggression (verbal or physical abuse), its causes and consequences. We described median, intercuartilic range and frequencies. Logistic regression was performed calculating odds ratio and their 95% confidence intervals. RESULTS: 1,157 assaults were reported, 53.07% suffered by doctors. Physical assault occurred in 4.7% of the cases. The main reason was dissatisfaction with the care (36.1%). The non-medical staff showed less risk of being physically assaulted (OR: 0.38; CI95%: 0.17-0.86). The perpetrator profile was male (56.8%), aged between 31-40 (26.8%) years. Health care victim profile was female (84%), aged between 45-60 years. 10% of professionals reported some form of aggression, 5,9% of aggression were submitted to court. CONCLUSIONS: The risk of assault is higher in health personnel, particularly physicians. There were significant differences by gender and age, both in the profile of the aggressor and the victim.