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RATIONALE, AIMS AND OBJECTIVES: An integrated care program for heart failure (HF) was developed in the Basque Country in 2013. The objective of this research was to evaluate its effectiveness through the number of hospital admissions in three integrated healthcare organizations (IHOs), taking into account the longitudinal nature of the disease and the intensity of the implementation. METHODS: A retrospective observational study was carried out, based on data entered in administrative and clinical databases between 2014 and 2018 for a total population of 230 000. In addition to conventional statistical analyses, Andersen-Gill models for recurrent events were used, incorporating dynamic variables that allowed assessment of the intervention's intensity before each hospitalization. RESULTS: A total of 6768 patients were analysed. Age (hazard ratio [HR] = 1.016; 95% confidence interval [CI] 1.011-1.022), the Charlson index (HR = 1.067, 95% CI 1.047-1.087), and the number of previous hospitalizations (HR = 1.632, 95% CI 1.557-1.712) were risk factors for readmission. Differences between IHOs were also statistically significant. Greater intervention intensity was associated with a lower hospitalization rate (HR = 0.995, 95% CI 0.990-1.000). As indicated by the interaction between intervention intensity and IHO, differences between IHOs disappeared when intensity rose. No inequities in hospitalization were found as a function of deprivation index or sex. Nonetheless, inequity in the implementation of the program by sex was clear, women with HF receiving less intense intervention than men with the same level of comorbidity and age. CONCLUSIONS: The extent of program implementation measured by intervention intensity is a main driver of the effectiveness of an educational and monitoring program for HF. The evaluation of HF program effectiveness on readmissions must take into account the entire natural history of the disease. Implementation intensity explains differences between IHOs.
Subject(s)
Heart Failure , Comorbidity , Female , Heart Failure/therapy , Hospitalization , Humans , Male , Patient Readmission , Risk Factors , SpainABSTRACT
OBJECTIVE: Evaluate the process and the economic impact of an integrated palliative care program. DESIGN: Comparative cross-sectional study. LOCATION: Integrated Healthcare Organizations of Alto Deba and Goierri Alto-Urola, Basque Country. PARTICIPANTS: Patients dead due to oncologic and non-oncologic causes in 2012 (control group) and 2015 (intervention group) liable to need palliative care according to McNamara criteria. INTERVENTIONS: Identification as palliative patients in primary care, use of common clinical pathways in primary and secondary care and arrange training courses for health professionals. MAIN MEASURES: Change in the resource use profile of patients in their last 3 months. Propensity score by genetic matching method was used to avoid non-randomization bias. The groups were compared by univariate analysis and the relationships between variables were analysed by logistic regressions and generalized linear models. RESULTS: One thousand and twenty-three patients were identified in 2012 and 1,142 patients in 2015. In 2015 doubled the probability of being identify as palliative patient in deaths due to oncologic (19-33%) and non-oncologic causes (7-16%). Prescriptions of opiates rise (25-68%) and deaths in hospital remained stable. Contacts per patient with primary care and home hospitalization increased, while contacts with hospital admissions decreased. Cost per patient rise 26%. CONCLUSIONS: The integrated palliative care model increased the identification of the target population. Relationships between variables showed that the identification had a positive impact on prescription of opiates, death outside the hospital and extension to non-oncologic diseases. Although the identification decreased admissions in hospital, costs per patient had a slight increase due to home hospitalizations.
Subject(s)
Delivery of Health Care, Integrated/organization & administration , Palliative Care/organization & administration , Patient Selection , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Delivery of Health Care, Integrated/methods , Female , Health Care Costs/statistics & numerical data , Humans , Linear Models , Logistic Models , Male , Middle Aged , Needs Assessment , Outcome and Process Assessment, Health Care , Palliative Care/methods , Primary Health Care/methods , Primary Health Care/organization & administration , SpainABSTRACT
BACKGROUND: The finding of hypovitaminosis in pregnancy D has prompted the debate about its supplementation. The objective of the study was to measure the prevalence of hypovitaminosis D in mothers and newborns. METHODS: A one-year observational study was conducted including the measuring of vitamin D levels in mothers and in the umbilical cord blood of newborns. An analysis was made of the variables as regards maternal characteristics, delivery and sun exposure. RESULTS: Values lower than 20 ng/ml were found in 64.4% of 745 mothers and 41.3% of 560 newborns, and less than 30 ng/ml in 88.7% and 67.1%, respectively. Mean levels were higher in summer-autumn than in winter-spring (21.73 and 13.70 ng / ml in mothers and 29.04 and 20.49 ng/ml in cord), and higher in the umbilical cord than in the maternal plasma. Multiple pregnancies (OR: 6.29) and non-European origin (OR: 13.09) were risk factors for maternal hypovitaminosis, while maternal supplementation (OR: 0.19), physical activity (OR: 0.57), and sun exposure (OR: 0.46) had a preventive effect. CONCLUSIONS: The high rates of hypovitaminosis support the policy of giving dietary supplements to newborns. The high level of hypovitaminosis found supports the extension of screening and supplementation to all pregnant women, and not only to those with risk factors. The greater difference between mothers and newborns in seasons of low sun exposure can be interpreted as a protective effect.
Subject(s)
Dietary Supplements , Fetal Blood/metabolism , Vitamin D Deficiency/epidemiology , Vitamin D/blood , Adult , Female , Humans , Infant, Newborn , Male , Pregnancy , Prevalence , Risk Factors , Seasons , Sunlight , Vitamin D/administration & dosageABSTRACT
INTRODUCTION: An integrated health and social care program for patients with heart failure (HF) was implemented at the Friuli-Venezia Giulia deployment site as part of the SmartCare European project. The objective of this study was to validate 2 different decision modeling techniques used to perform the economic evaluation. METHODS: Data were collected during the SmartCare project which enrolled 108 patients with HF and followed for more than 6 months. The techniques used were Markov and discrete event simulation models. In both cases, a cost-effectiveness analysis and a budget impact analysis were carried out. The former was used to assign priority to the intervention and the latter to assess its sustainability. Analyses were conducted from the perspective of the Regional Health Authority. RESULTS: Results were similar with both types of model. Cost-effectiveness analysis found no significant differences in quality of life, but the intervention generated significant cost savings, becoming the dominant option. Data extrapolation showed no benefits in terms of mortality or hospital admissions, but budget impact analysis also predicted annual savings, as a significant number of in-hospital days were avoided. In budget analysis, both models predicted early, increasing and cumulative annual savings. DISCUSSION: The integrated program was dominant as it provided better outcomes and lower total costs, and thus, decision-makers should prioritize it. Besides, the work demonstrates the capacity of decision modeling to become a complementary tool in managing integrated health and social care models.
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Introducción. El carácter crónico de las enfermedades del aparato locomotor requieren una atención integrada de atención primaria y las especialidades de reumatología, traumatología y rehabilitación. El objetivo del trabajo fue evaluar la implementación de un modelo organizativo integrado de gestión de la osteoporosis, lumbalgia, enfermedades del hombro y enfermedades de la rodilla mediante el proceso de mejora continua de Deming, teniendo en cuenta las derivaciones y el consumo de recursos. Material y métodos. En la fase de planificación se utilizó un modelo de simulación para predecir la evolución del consumo de recursos en cada enfermedad del aparato locomotor y realizar un análisis del impacto presupuestario desde 2012 hasta 2020 en la comarca Goierri-Alto Urola. En la etapa de revisión se evaluó el estado del proceso en 2014 utilizando el análisis estadístico para comprobar el grado de consecución de los objetivos para cada enfermedad. Resultados. Según el modelo de simulación la población de pacientes con enfermedad osteomuscular aumentará en un 4,4% en 2020, con un incremento en costes para un sistema convencional de un 5,9%. Si la intervención integrada alcanzase sus objetivos este presupuesto se reduciría en un 8,5%. El análisis estadístico evidenció un descenso de derivaciones a traumatología y una reducción de consultas sucesivas en todas las especialidades. Discusión. La implementación del modelo integrado en las enfermedades de osteoporosis, lumbalgia, hombro y rodilla está todavía en un estadio inicial. Sin embargo, el empoderamiento de la atención primaria mejoró la derivación de pacientes y redujo ligeramente los costes (AU)
Introduction. The chronic nature of musculoskeletal diseases requires an integrated care which involves the Primary Care and the specialities of Rheumatology, Traumatology and Rehabilitation. The aim of this study was to assess the implementation of an integrated organizational model in osteoporosis, low back pain, shoulder disease and knee disease using Deming's continuous improvement process and considering referrals and resource consumption. Material and methods. A simulation model was used in the planning to predict the evolution of musculoskeletal diseases resource consumption and to carry out a Budget Impact Analysis from 2012 to 2020 in the Goierri-Alto Urola region. In the checking stage the status of the process in 2014 was evaluated using statistical analysis to check the degree of achievement of the objectives for each speciality. Results. Simulation models showed that population with musculoskeletal disease in Goierri-Alto Urola will increase a 4.4% by 2020. Because of that, the expenses for a conventional healthcare system will have increased a 5.9%. However, if the intervention reaches its objectives the budget would decrease an 8.5%. The statistical analysis evidenced a decline in referrals to Traumatology service and a reduction of successive consultations in all specialities. Discussion. The implementation of the integrated organizational model in osteoporosis, low back pain, shoulder disease and knee disease is still at an early stage. However, the empowerment of Primary Care improved patient referrals and reduced the costs (AU)
Subject(s)
Humans , Regional Health Planning/organization & administration , Rheumatic Diseases/economics , Rheumatic Diseases/epidemiology , Delivery of Health Care, Integrated/organization & administration , Delivery of Health Care, Integrated/standards , Primary Health Care , Rheumatology/economics , 28599 , Budgets/methods , Budgets/trendsABSTRACT
OBJECTIVES: To develop a framework for the management of complex health care interventions within the Deming continuous improvement cycle and to test the framework in the case of an integrated intervention for multimorbid patients in the Basque Country within the CareWell project. METHODS: Statistical analysis alone, although necessary, may not always represent the practical significance of the intervention. Thus, to ascertain the true economic impact of the intervention, the statistical results can be integrated into the budget impact analysis. The intervention of the case study consisted of a comprehensive approach that integrated new provider roles and new technological infrastructure for multimorbid patients, with the aim of reducing patient decompensations by 10% over 5 years. The study period was 2012 to 2020. RESULTS: Given the aging of the general population, the conventional scenario predicts an increase of 21% in the health care budget for care of multimorbid patients during the study period. With a successful intervention, this figure should drop to 18%. The statistical analysis, however, showed no significant differences in costs either in primary care or in hospital care between 2012 and 2014. The real costs in 2014 were by far closer to those in the conventional scenario than to the reductions expected in the objective scenario. The present implementation should be reappraised, because the present expenditure did not move closer to the objective budget. CONCLUSIONS: This work demonstrates the capacity of budget impact analysis to enhance the implementation of complex interventions. Its integration in the context of the continuous improvement cycle is transferable to other contexts in which implementation depth and time are important.
Subject(s)
Budgets/statistics & numerical data , Multiple Chronic Conditions/economics , Multiple Chronic Conditions/therapy , Primary Health Care/organization & administration , Total Quality Management/organization & administration , Cost-Benefit Analysis , Home Care Services/economics , Humans , Models, Econometric , Primary Health Care/economics , Spain , Telephone/economics , Total Quality Management/economicsABSTRACT
INTRODUCTION: The chronic nature of musculoskeletal diseases requires an integrated care which involves the Primary Care and the specialities of Rheumatology, Traumatology and Rehabilitation. The aim of this study was to assess the implementation of an integrated organizational model in osteoporosis, low back pain, shoulder disease and knee disease using Deming's continuous improvement process and considering referrals and resource consumption. MATERIAL AND METHODS: A simulation model was used in the planning to predict the evolution of musculoskeletal diseases resource consumption and to carry out a Budget Impact Analysis from 2012 to 2020 in the Goierri-Alto Urola region. In the checking stage the status of the process in 2014 was evaluated using statistical analysis to check the degree of achievement of the objectives for each speciality. RESULTS: Simulation models showed that population with musculoskeletal disease in Goierri-Alto Urola will increase a 4.4% by 2020. Because of that, the expenses for a conventional healthcare system will have increased a 5.9%. However, if the intervention reaches its objectives the budget would decrease an 8.5%. The statistical analysis evidenced a decline in referrals to Traumatology service and a reduction of successive consultations in all specialities. DISCUSSION: The implementation of the integrated organizational model in osteoporosis, low back pain, shoulder disease and knee disease is still at an early stage. However, the empowerment of Primary Care improved patient referrals and reduced the costs.
Subject(s)
Delivery of Health Care, Integrated/organization & administration , Musculoskeletal Diseases/therapy , Primary Health Care/organization & administration , Rehabilitation/organization & administration , Rheumatology/organization & administration , Traumatology/organization & administration , Budgets , Chronic Disease , Health Care Costs , Humans , Models, Theoretical , Musculoskeletal Diseases/economics , Musculoskeletal Diseases/epidemiology , Program Evaluation , Quality Improvement/organization & administration , Referral and Consultation/organization & administration , Spain/epidemiologyABSTRACT
Objective: To conduct a cost-utility analysis on an integrated healthcare model comprising an assigned internist and a hospital liaison nurse for patients with multimorbidity, compared to a conventional reactive healthcare system. Methods: A cluster randomised clinical trial was conducted. The model consisted of a reference internist and a liaison nurse, who aimed to improve coordination and communication between levels and to enhance continuity of care after hospitalisation. We recorded sociodemographic data, diagnoses and corresponding clinical categories, functional status, use of healthcare resources and quality of life. Data were collected by reviewing electronic medical records and administering questionnaires. We performed univariate and multivariate analyses both for utilities and total costs. Bootstrapping methods were applied to calculate the confidence ellipses of incremental costs and efficiency. Results: We recruited a total of 140 patients. The model assessed was not found to be efficient in general. We found an incremental cost of €1,035.90 and an incremental benefit of −0.0762 QALYs for the initiative compared to standard care after adjusting for the main variables. However, the subgroup of patients under 80 years of age with three or more clinical categories resulted in an 89% cost saving in the simulations. Conclusions: The integrated model was not suitable for all study patients. However, the subgroup analysis identified a narrow target population that should be analysed in future studies
Objetivo: Evaluar en términos de coste-utilidad un modelo de atención integrada a pacientes pluripatológicos basado en el internista de referencia y la enfermera de enlace hospitalario, comparado con un sistema asistencial convencional reactivo por episodios. Métodos: Se realizó un ensayo clínico aleatorizado por conglomerados. La intervención se basó en un internista de referencia y una enfermera de enlace hospitalario. Ambos trabajaron en la coordinación y la comunicación entre niveles y en la mejora de la continuidad de cuidados después de un ingreso. Se recogieron datos sociodemográficos y los diagnósticos con sus correspondientes categorías clínicas, así como el estado funcional, la utilización de recursos y la calidad de vida. Se utilizaron los registros electrónicos médicos existentes y cuestionarios administrados. Se realizaron análisis univariados y multivariados tanto para las utilidades como para los costes totales. Mediante bootstrapping se calcularon las elipses de confianza de los costes incrementales y la eficiencia. Resultados: Se incluyeron en el estudio 140 pacientes. En general, la intervención no resultó eficiente. El coste incremental de la intervención frente al modelo convencional fue de 1035,90 € y la efectividad incremental fue de -0,0762 años de vida ajustados por calidad, al ajustar los datos por las variables más relevantes. Sin embargo, el subgrupo de pacientes menores de 80 años con tres o más categorías clínicas ahorró costes en el 89% de las simulaciones. Conclusiones: La intervención integrada no resultó adecuada para todos los pacientes objetivo; no obstante, el análisis de subgrupos permitió identificar una población objetivo más concreta que debería ser analizada en estudios futuros
Subject(s)
Humans , Delivery of Health Care, Integrated/organization & administration , Patient Care Team/organization & administration , Models, Organizational , Comorbidity/trends , Cost-Benefit Analysis/statistics & numerical data , Practice Patterns, Physicians'/organization & administrationABSTRACT
OBJECTIVE: To conduct a cost-utility analysis on an integrated healthcare model comprising an assigned internist and a hospital liaison nurse for patients with multimorbidity, compared to a conventional reactive healthcare system. METHODS: A cluster randomised clinical trial was conducted. The model consisted of a reference internist and a liaison nurse, who aimed to improve coordination and communication between levels and to enhance continuity of care after hospitalisation. We recorded sociodemographic data, diagnoses and corresponding clinical categories, functional status, use of healthcare resources and quality of life. Data were collected by reviewing electronic medical records and administering questionnaires. We performed univariate and multivariate analyses both for utilities and total costs. Bootstrapping methods were applied to calculate the confidence ellipses of incremental costs and efficiency. RESULTS: We recruited a total of 140 patients. The model assessed was not found to be efficient in general. We found an incremental cost of 1,035.90 and an incremental benefit of -0.0762 QALYs for the initiative compared to standard care after adjusting for the main variables. However, the subgroup of patients under 80 years of age with three or more clinical categories resulted in an 89% cost saving in the simulations. CONCLUSIONS: The integrated model was not suitable for all study patients. However, the subgroup analysis identified a narrow target population that should be analysed in future studies.
Subject(s)
Delivery of Health Care, Integrated/economics , Multimorbidity , Aged , Aged, 80 and over , Analysis of Variance , Continuity of Patient Care/economics , Cost-Benefit Analysis , Female , Hospitalization , Humans , Male , Quality of Life , Quality-Adjusted Life Years , Surveys and QuestionnairesABSTRACT
Introducción. El impacto en salud del daño cerebral adquirido (DCA) se manifiesta no solo en los pacientes sino también en la pérdida de calidad de vida relacionada con la salud (CVRS) de sus cuidadores. Los objetivos de este estudio fueron medir tanto la pérdida de CVRS como la sobrecarga de los cuidadores de pacientes con DCA. Material y métodos. Se llevó a cabo un estudio retrospectivo con 76 cuidadores de pacientes con DCA. La encuesta recogió información acerca de las características sociodemográficas, la carga de los cuidados (escala de Zarit) y la CVRS (cuestionario EuroQol) de los cuidadores. Para analizar el efecto de las diferentes variables se construyeron modelos de regresión lineal múltiple y regresión logística. Resultados. Los cuidadores fueron predominantemente mujeres de más de 50 años, jubiladas o dedicadas a las tareas domésticas y que cuidaban a su marido o a uno de sus padres. Un tercio mostró un riesgo alto de claudicación. La media de la CVRS obtenida con EuroQol pasó de una cifra similar a la de la población general (0,90) en el grupo sin sobrecarga a 0,67 en el grupo con riesgo de claudicación. Los modelos de regresión explicaron mejor la sobrecarga que la pérdida de calidad de vida. Conclusiones. Los cuidadores de pacientes con daño cerebral sufren una importante pérdida de CVRS con relación a la población general. El deterioro radica en las dimensiones mentales y depende del nivel de la sobrecarga(AU)
Introduction. The health impact of acquired brain injury (ABI) is not only apparent in the patient, but also in the loss of health related quality of life (HRQol) of their carers. The objectives of this study were to measure the loss of HRQol as well as the burden of the carers of patients with ABI. Material and methods. A retrospective study was conducted with 76 carers of patients with ABI. A questionnaire was used to collect information on the sociodemographic aspects, carer burden (Zarit Scale) and the HRQol (EuroQol Questionnaire) of the carers. A multiple linear regression model was constructed to analyse the effect of the different variables. Results. The carers were predominantly women over 50years, retired or dedicated to domestic tasks and who cared for their husband or one of their parents. One third showed a high risk of claudication. The mean HRQol obtained with the EuroQol went from a similar score to that of the general population (0.9) in the group without burden, to 0.67 in the group with risk of claudication. The regression models explained the burden better than the loss in quality of life. Conclusions. Carers of patients with brain injury suffer a significant loss in HRQol compared to the general population. The deterioration arises from the mental dimensions and depends on the level of burden(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Quality of Life/psychology , Caregivers/organization & administration , Caregivers/standards , Caregivers , Brain Injuries, Traumatic/epidemiology , Brain Injuries, Traumatic/psychology , Linear Models , Caregivers/psychology , Brain Injuries, Traumatic/rehabilitation , Retrospective Studies , Surveys and Questionnaires , Logistic Models , Repertory, Barthel , Data Analysis/methodsABSTRACT
AIM: To estimate the cost-effectiveness of atorvastatin at high doses (80 mg/day) for the reduction of the risk of fatal and nonfatal stroke in patients with recent cerebrovascular accident or transient ischemic attack (TIA) and without coronary heart disease in Spain using data from the SPARCL study. PATIENTS AND METHODS: A discrete event simulation was developed to represent the natural evolution of a cohort of 1000 patients following a stroke or TIA. The risk for fatal and non fatal cardiovascular events was calculated from the clinical characteristic of patients in the SPARCL study for both treatment arms (atorvastatin 80 mg/day and placebo). Survival time, quality-adjusted-life-years (QALY), clinical events, and medical direct costs for a period of 5 years with a 3% per year discount were calculated for the two alternatives. A probabilistic sensitivity analysis was made running 1000 simulations. RESULTS: Compared to placebo, atorvastatin 80 mg/day prevented 22 strokes (14 nonfatal and 8 fatal), 22 myocardial infarctions (19 nonfatal and 3 fatal), 33 TIAs, 8 unstable angina episodes and 37 re-vascularisations per 1000 patients over 5 years. The incremental cost effectiveness ratio after 1000 simulations was 9914 euros (95% CI = 5717 to 26,082) per QALY. The acceptability curve showed 99% of the simulations falling below an acceptability threshold of 30,000 euros/QALY. CONCLUSIONS: Compared with placebo, use of high dose atorvastatin (80 mg/day) for secondary stroke prevention is not only of significant clinical benefit but can also be considered cost effective in Spain. It produces important benefits in health with an incremental cost within reasonable limits.
Subject(s)
Cost-Benefit Analysis/economics , Heptanoic Acids , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Pyrroles , Secondary Prevention , Stroke/prevention & control , Adult , Aged , Aged, 80 and over , Angina Pectoris/prevention & control , Atorvastatin , Heptanoic Acids/economics , Heptanoic Acids/therapeutic use , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/economics , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Ischemic Attack, Transient/prevention & control , Male , Middle Aged , Models, Theoretical , Myocardial Infarction/prevention & control , Placebos/therapeutic use , Pyrroles/economics , Pyrroles/therapeutic use , Risk Factors , Secondary Prevention/methods , Spain , Treatment Outcome , Young AdultABSTRACT
The economic evaluation of health technologies has become a major tool in health policy in Europe for prioritizing the allocation of health resources and the approval of new technologies. The objective of this proposal was to develop guidelines for the economic evaluation of health technologies in Spain. A group of researchers specialized in economic evaluation of health technologies developed the document reported here, following the initiative of other countries in this framework, to provide recommendations for the standardization of methodology applicable to economic evaluation of health technologies in Spain. Recommendations appear under 17 headings or sections. In each case, the recommended requirements to be satisfied by economic evaluation of health technologies are provided. Each recommendation is followed by a commentary providing justification and compares and contrasts the proposals with other available alternatives. The economic evaluation of health technologies should have a role in assessing health technologies, providing useful information for decision making regarding their adoption, and they should be transparent and based on scientific evidence.
Subject(s)
Biomedical Technology/economics , Decision Making , Guidelines as Topic , Health Expenditures/statistics & numerical data , Health Policy , Resource Allocation/economics , Biomedical Technology/statistics & numerical data , Cost-Benefit Analysis , Health Care Costs , Humans , Models, Economic , Quality-Adjusted Life Years , Resource Allocation/statistics & numerical data , Spain , Time FactorsABSTRACT
BACKGROUND: In Spain, there are substantial variations in the utilization of health resources among regions. Because the need for surgery differs in patients with appropriate surgical indication, introducing a prioritization system might be beneficial. Our objective was to assess geographical variations in the impact of applying a prioritization system in patients on the waiting list for cataract surgery in different regions of Spain by using a discrete-event simulation model. METHODS: A discrete-event simulation model to evaluate demand and waiting time for cataract surgery was constructed. The model was reproduced and validated in five regions of Spain and was fed administrative data (population census, surgery rates, waiting list information) and data from research studies (incidence of cataract). The benefit of introducing a prioritization system was contrasted with the usual first-in, first-out (FIFO) discipline. The prioritization system included clinical, functional and social criteria. Priority scores ranged between 0 and 100, with greater values indicating higher priority. The measure of results was the waiting time weighted by the priority score of each patient who had passed through the waiting list. Benefit was calculated as the difference in time weighted by priority score between operating according to waiting time or to priority. RESULTS: The mean waiting time for patients undergoing surgery according to the FIFO discipline varied from 1.97 months (95% CI 1.85; 2.09) in the Basque Country to 10.02 months (95% CI 9.91; 10.12) in the Canary Islands. When the prioritization system was applied, the mean waiting time was reduced to a minimum of 0.73 months weighted by priority score (95% CI 0.68; 0.78) in the Basque Country and a maximum of 5.63 months (95% CI 5.57; 5.69) in the Canary Islands. The waiting time weighted by priority score saved by the prioritization system varied from 1.12 months (95% CI 1.07; 1.16) in Andalusia to 2.73 months (95% CI 2.67; 2.80) in Aragon. CONCLUSION: The prioritization system reduced the impact of the variations found among the regions studied, thus improving equity. Prioritization allocates the available resources within each region more efficiently and reduces the waiting time of patients with greater need. Prioritization was more beneficial than allocating surgery by waiting time alone.