Reliability of the minimum basic dataset for diagnoses of cerebrovascular disease. / Fiabilidad del conjunto mínimo básico de datos en el diagnóstico de la enfermedad cerebrovascular.

INTRODUCTION: The minimum basic dataset is the largest available hospital care administrative database that is used in clinical studies and hospital management in association with diagnosis-related groups (DRGs). In 2011, the quality of the national MBDS in hospital discharges was audited, in order to assess its reliability. This paper presents a sub-analysis of the results from that analysis which are referred to cerebrovascular disease (CVD). METHODS: Using all discharge reports from the Spanish MBDS in 2009, a representative sample was obtained by stratified sampling and 11 209 records were evaluated. Outcome indicators were obtained to measure any differences observed between the national MBDS being evaluated and the hospital's original MBDS. Analysis of codes for CVD as a primary diagnosis was performed for ICD-9-CM diagnostic categories 430 through 438. We evaluated error rates in the selection and classification of main diagnoses, as well as in DRG assignment. RESULTS: There were 397 discharges of cases of CVD which included 21 different DRGs. Diagnostic coding showed a concordance rate of 81.87%; the selection error rate was 2.26% and the classification error rate was 15.87%. The error rate in the DRG was 16.12% and associated with the greatest impact on the mortality risk level. CONCLUSIONS: While the errors we observed must be taken into account, data suggest that the quality of the MBDS for CVD is sufficient to ensure delivery of valid information. The hospital discharge registry serves as a valuable tool for use in studies of this disease.

Accessibility to primary health care centers: experience and evaluation of an appointment system program.

Appropriate access to health care is one of the components of Primary Health Care (PHC) and it can be a good quality indicator. We present in this paper the results of 1 year of follow-up of an appointment system applied in 29 PHC centers in the Balearic Islands, Spain; the program was set up by the National Institute of Health. Telephonic appointment proportion increased from the first weeks, stabilizing at about 70%. The number of calls that it is necessary to make in order to get an appointment at peak time is now 1.5 and only 1 throughout the rest of the day. To determine changes in the waiting time and visit time, and the user opinion of the system, an enquiry was made to a sample of patients 1 month before, and 1 month, 6 months and 1 year after the program started. The waiting time is now less than 15 min for most of the people interviewed, in contrast with the previous situation when the waiting time was more than 30 min. The visit time is longer now and more than two thirds of the people think that care is better or much better than prior to the start of the program. These results have been verified in the waiting room (11.2 min mean waiting time and 7.2 min mean visit time). We conclude that we have achieved the goals of the appointment system program in all the centers covered by our department.