[Variations in the use of hospital resources in treating patients with chronic obstructive pulmonary disease]. / Variabilidaad en la utilización de recursos hospitalarios en pacientes con enfermedad pulmonar obstructiva crónica (EPOC),

AIM: To analyze factors associated with the length of stay and pharmaceuticals expense for patients admitted with chronic obstructive pulmonary disease (COPD) and to evaluate whether treatment by different physicians means greater or less use of hospital resources. METHODS: We retrospectively studied a cohort of 1033 COPD patients admitted to the Hospital de Mataró, Catalonia, Spain, during the years 1996 through 1998 in order to analyze factors associated with length of stay and pharmaceuticals use. We used the Minimum Basic Data Set, laboratory databases, and pharmacy single-dose database. We also analyzed the differences among patients treated by different physicians and developed multiple linear regression models to evaluate differences in treatment between one physician and another. RESULTS: The length of stay increased with patient age, the number of times admitted, the presence of atrial fibrillation or respiratory insufficiency, ventilatory alterations, chronicity, a forced expiratory volume in 1 second less than 50% of predicted, and treatment by certain physicians. Medication costs showed a similar pattern. Although the characteristics of patients treated by different physicians were quite homogeneous, the median length of stay varied from 9 to 11 days depending on the physician, while the median cost for medication varied from;43.62 to;54.39 (from $41.07 to $51.21). After removing the effects of several covariables by multiple regression analysis, an effect of physician persisted. CONCLUSIONS: Significant differences in length of hospital stay and consumption of pharmaceuticals are related to attending physician and continue to have an important effect after controlling for the differences in the severity of patient status.

[Senior citizen health conditions and hospitalization on geriatric, general and surgical floors, a population study conducted in Toledo]. / Estado de salud de las personas ancianas y hospitalización en servicios geriátricos, médicos y quirúrgicos. Estudio poblacional en Toledo.

BACKGROUND: The health condition and some clinical aspects configure a group of senior citizens in need of further care who could benefit from specialized geriatric care, although no consensus exists as to how to identify these patients. The aim of this study is to describe the profile of those patients over 64 years of age who are hospitalized in a geriatric unit and to compare this profile to the senior citizens hospitalized in general medical and surgical units. METHOD: A cohort representative of the population over age 64 in the Judicial District of Toledo (n = 3214) was studied over an eighteen-month period for the purpose of identifying the income and length of stays at the public hospitals in the health care district in question. The health condition-related variables were gathered by means of personal interviews, and the income and the different aspects thereof by way of hospital admissions department data. RESULTS: A total of 410 individuals were admitted (12.8%), 168 patients (30.7%) in geriatrics, 204 (37.3%) in medical units and 174 (32.0%) in surgical units. In geriatrics, the average age was significantly higher (age 77.4), there being no differences in the average length of stay (12.8 days; CI 95%) 10.6-14.0), 44 patients (8.1%) having died, 26 (59.1%) hospitalized in geriatrics. More females, younger patients having minor vision and hearing impairments were admitted to the surgical units. In geriatrics, as compared to the medical units, more patients over 80 years of age, living in senior citizen living facilities, having no spouse, moderate-to-severe functional dependence, impaired cognitive function, depression, poor quality of life and scanty social resources. CONCLUSIONS: No differences were found to exist between the health conditions of those over age 64 who were hospitalized in non-surgical and surgical units. In geriatrics, as compared to the other groups of units, the patients were older, in worse condition, had a higher death rate and similar average length of stay.

[Declaring conflict of interest in scientific publications. Time for the spotlights and stenographers in the backroom of research financed by the industry?]. / La declaración del conflicto de intereses en las publicaciones científicas. Tiempo para las luces y los taquígrafos en la trastienda de la investigación financiada por la industria?

The term conflict of interests is applied to those situations in which the research validity and integrity may be influenced by a secondary interest, typically an economic benefit, but also an ideological, personal or professional interest. In this work we describe some ways of conflict of interests--particularly those related with the publication of clinical and epidemiological research supported by the industry--and the regulation of this problem from medical journals, including references to the situation in Spain. The conflict of interest is not synonymous of scientific fraud neither malpraxis in research, but in the medical literature there exists enough evidence to consider it as an important source of biases. The usual form of facing the conflict of interests is to make it public, so that readers can judge its importance. The editorial policies of the Spanish journals are, in general, far from giving importance to this problem, an aspect which could favor an attitude of the investigators, to maintain funding or to obtain new contracts, unnecessarily subordinated to the interests of the companies.

[The quality assessment from the minimum basic hospital discharge data set]. / Evaluación de calidad a partir del conjunto mínimo de datos básicos al alta hospitalaria.

INTRODUCTION: Risk adjustment is essential before comparing patient outcomes across hospitals. With this aim several risk adjustment systems have been developed, including the well-known diagnosis related groups. MATERIAL AND METHODS: Narrative review on risk assessment framework from administrative databases, including data quality and system pitfalls. RESULTS: The risk adjustment systems developed for cost-control aims to group different patient typologies in relation to the predicted use of resources with the aim to develop incentives to cost-reduction; the systems developed for measuring effectiveness have the objective to assess the health care quality. Both systems are useful for clinical, management and health public uses, but they have several pitfalls and their results should be interpreted cautiously. CONCLUSIONS: Managers and physicians should consider the risk adjustment systems as a valuable resource for decision-making and reducing uncertainty, but not as the scientific referee of hospital quality or hospital efficiency.

[Chronic comorbidity and homogeneity in diagnostic related groups]. / Comorbilidad crónica y homogeneidad de los grupos de diagnósticos relacionados.

OBJECTIVE: [corrected] One of the ways to compare the efficiency of different hospitals and services is to evaluate Diagnostic Related Groups (DRGs), with the hypothesis that patients in the same RDG will present homogeneous behavior with respect to length of stay. The object of this study was to evaluate in the context os the National Health System the internal variability of specific DRGs in terms of the patients' comorbidity. METHODS: On the basis of various comorbidity scores measured with the Charlson index (ChI), we analyzed length of stay, inhospital mortality and emergency readmissions at 30 and 365 days in 106.673 hospitalizations (excluding subjects younger than 17 years of age, and obstetrics and psychiatric patients) in 12 hospitals, and in 17 DRGs selected on the basis of their greater frequency and comorbidity. RESULTS: In the aggregated analysis, length of stay (from 8.5 days in patients with no comorbidity to 17.0 days in patients with scores higher than 4) and inhospital mortality rates (from 3.7% in patients with no comorbidity to 17.6% in patients with highest score) increased significantly with each level of the Charlson index. The readmission rate at 30 days rose from 4.7% to 10.9% also in step with increases in comorbidity scores. Readmissions at one year varied from 14.8% in patients with scores of 0 to 35.2% in patients with scores of 3-4, and dropped to 27.9% in patients with scores higher than 4. When analysing different DRGs, 8 of the 17 groups studied showed a significantly higher length of stay with increased comorbidity scores. Some DRGs also showed intra-group variability with respect to mortality and readmission, particularly at 365 days. CONCLUSIONS: Some DRGs show significant internal variability in terms of comorbidity that may be generating a false worse evaluation of the efficiency of hospitals that treat patients with higher comorbidity.