Predictors of mortality among elderly dependent home care patients.

BACKGROUND: The purpose of this study is to identify which variables--among those commonly available and used in the primary care setting--best predict mortality in a cohort of elderly dependent patients living at home (EDPLH) that were included in a home care program provided by Primary Care Teams (PCT). Additionally, we explored the risk of death among a sub-group of these patients that were admitted to hospital the year before they entered the home care program. METHODS: A one-year longitudinal cohort study of a sample of EDPLH patients included in a home care programme provided by 72 PCTs. Variables collected from each individual patient included health and social status, carer's characteristics, carer's burden of care, health and social services received. RESULTS: 1,001 patients completed the study (91.5%), 226 were admitted to hospital the year before inclusion. 290 (28.9%) died during the one-year follow-up period. In the logistic regression analysis women show a lower risk of death [OR= 0.67 (0.50-0.91)]. The risk of death increases with comorbidity [Charlson index OR= 1.14 (1,06-1.23)], the number of previous hospital admissions [OR= 1,16 (1.03-1.33)], and with the degree of pressure ulcers [ulcers degree 1-2 OR = 2.94 (1.92-4.52); ulcers degree 3-4 OR = 4.45 (1.90-10.92)]. The logistic predictive model of mortality for patients previously admitted to hospital identified male sex, comorbidity, degree of pressure ulcers, and having received home care rehabilitation as independent variables that predict death. CONCLUSIONS: Comorbidity, hospital admissions and pressure ulcers predict mortality in the following year in EDPLH patients. The subgroup of patients that entered home care programs with a previous record of hospital admission and a high score in our predictive model might be considered as candidates for palliative care.

[Assessment of clinical practice in patients with infectious meningitis]. / Evaluación de la práctica clínica en pacientes diagnosticados de meningitis infecciosa.

OBJECTIVES: Medical practice assessments for a specific patient population can be useful for improving health care quality and decreasing the variations in clinical practice. Our aim was to assess compliance with clinical practice guidelines established for patients with meningitis using previously formulated indicators. METHODS: The indicators of quality were based on clinical practice guidelines and selected through consensus meetings. A data protocol was designed and applied retrospectively to the medical records of all patients with a diagnosis of meningitis between 1987 and 2004 in a 280-bed general hospital. RESULTS: A total of 99 episodes were included. Information on pre-treatment was recorded in 94%, duration of symptoms in 65%, funduscopic examination in 21%, and cerebrospinal fluid (CSF) pressure in 5% of patients. Biochemical and microbiological CSF study was adequate (93%-99%), but blood culture (73%) was not. Cranial CT scan was adequate in 52% of patients, since in many cases it was performed without an indication for this study. Treatment was given according to the local protocol in 53.6% of patients with suspected bacterial meningitis and 79.5% of those with suspected viral meningitis. Three patients died due to meningitis. CONCLUSIONS: The use of funduscopic examination was poor, whereas the use of cranial CT scanning was excessive. Treatment of bacterial meningitis adhered to the established local antibiotic protocol in half the patients. This type of auditing is useful for determining compliance with guidelines and designing strategies to improve health care quality.