Trends and area variations in Potentially Preventable Admissions for COPD in Spain (2002-2013): a significant decline and convergence between areas.

BACKGROUND: Potentially Preventable Hospitalizations (PPH) are hospital admissions for conditions which are preventable with timely and appropriate outpatient care being Chronic Obstructive Pulmonary Disease (COPD) admissions one of the most relevant PPH. We estimate the population age-sex standardized relative risk of admission for COPD-PPH by year and area of residence in the Spanish National Health System (sNHS) during the period 2002-2013. METHODS: The study was conducted in the 203 Hospital Service Areas of the sNHS, using the 2002 to 2013 hospital admissions for a COPD-PPH condition of patients aged 20 and over. We use conventional small area variation statistics and a Bayesian hierarchical approach to model the different risk structures of dependence in both space and time. RESULTS: COPD-PPH admissions declined from 24.5 to 15.5 per 10,000 persons-year (Men: from 40.6 to 25.1; Women: from 9.1 to 6.4). The relative risk declined from 1.19 (19 % above 2002-2013 average) in 2002 to 0.77 (30 % below average) in 2013. Both the starting point and the slope were different for the different regions. Variation among admission rates between extreme areas dropped from 6.7 times higher in 2002 to 4.6 times higher in 2013. CONCLUSIONS: COPD-PPH conditions in Spain have undergone a strong decline and a reduction in geographical variation in the last 12 years, suggesting a general improvement in health policies and health care over time. Variability among areas still remains, with a substantial room for improvement.

[Incidence and cost of hospitalizations for bronchiolitis and respiratory syncytial virus infections in the autonomous community of Valencia in Spain (2001 and 2002)]. / Incidencia y costes de la hospitalización por bronquiolitis y de las infecciones por virus respiratorio sincitial en la Comunidad Valenciana. Añ 2001 y 2002.

OBJECTIVE: To assess the incidence and costs of hospitalizations for bronchiolitis and respiratory syncytial virus (RSV) infections the Autonomous Community of Valencia, Spain. METHODS: The minimum data set (MDS) of the Autonomous Community of Valencia was analyzed. Hospital discharges with the codes for bronchiolitis (with or without etiologic determination) and RSV infections occurring in 2001 and 2002 in children less than 2 years old were included. Second cases of bronchiolitis and RSV infections of possible nosocomial origin occurring during prolonged hospitalization were excluded. The average cost of hospitalization in a pediatric ward was estimated at euro 310.30 per day. To calculate the incidence, we assumed that 95 % of the hospitals reported to the MDS; the population used was that of the National Census, 2001. RESULTS: A total of 3,705 hospitalizations were obtained, of which 3,507 were coded as bronchiolitis and 42.2 % of these were RSV-positive. Virological assessment varied greatly among hospitals. Hospitalizations were most frequent between October and April, with no differences between the two years. The incidence of bronchiolitis hospitalization was 40.2 cases/1000 children < 1 year/year, with an average annual cost of 3,618 thousand Euros. CONCLUSIONS: The cost of bronchiolitis hospitalizations is high. Microbiological investigation is low in some hospitals, leading the economic impact of RSV on society to be underestimated.