Factores determinantes y coste económico del absentismo de pacientes en consultas externas de la Agencia Sanitaria Costa del Sol / Determinants and economic cost of patient absenteeism in outpatient departments of the Costa del Sol Health Agency

Fundamento: Identificar los factores de la persona, el proceso y el contexto que influyen en el cumplimiento de las citas de consultas externas en la Agencia Sanitaria Costa del Sol, describiendo el perfil del paciente que no acude a su cita, los motivos del absentismo y realizando una estimación del coste económico. Método: Estudio observacional, multicéntrico de casos y controles, mediante encuesta a pacientes citados en consultas ambulatorias durante 2013 y 2014 y análisis de costes por consultas. Resultados: Participaron en el estudio 882 pacientes (294 casos y 588 controles). El olvido (29,6%; n=87) y el fallo en la comunicación (16%; n=47), fueron los principales motivos manifestados por los pacientes absentistas. Una menor demora en la cita y la edad avanzada se asociaban significativamente con menos ausencias, al igual que haber frecuentado más las consultas en el último año. El coste económico fue superior a 3 millones de euros para una tasa de inasistencia del 13,8%. Conclusiones: Los pacientes jóvenes que no frecuentan habitualmente las consultas constituyen el grupo de mayor riesgo de ausencia a las citas programadas en nuestra área sanitaria. Los principales motivos del absentismo son evitables y podrían beneficiarse de intervenciones como la mejora de los procedimientos de comunicación o sistemas de recordatorio de citas (AU)

Background: To identify factors related to the people, the process and the context that determine patient compliance with their appointments in the ambulatory outpatient services in the Costa del Sol Health Care Agency; and to obtain the profile of patients who fail to keep their appointments, the reasons for this failure and an estimation of its economic cost. Methods: Observational multicenter case-control study, through a survey carried out on patients with an appointment in the ambulatory outpatient services during 2013 and 2014, and analysis of the cost per appointment. Results: In total, 882 patients participated in the study (294 cases and 588 controls). The main reasons for missing an appointment were forgetting about it (29, 6%; n=87), and failure in communication (16%; n=47). A shorter time period before the appointment and older age were significantly associated with fewer absences, as well as the fact of having attended more consultations in the past year. The economic cost was more than 3 million euros for a non-attendance rate of 13.8%. Conclusions: Young patients who usually do not visit outpatient clinics are at greatest risk of absence from scheduled appointments in our health area. The main reasons for absenteeism are preventable and interventions such as improved communication procedures or appointment reminder systems could be beneficial (AU)

Evaluating a scalable model for implementing electronic health records in resource-limited settings.

Current models for implementing electronic health records (EHRs) in resource-limited settings may not be scalable because they fail to address human-resource and cost constraints. This paper describes an implementation model which relies on shared responsibility between local sites and an external three-pronged support infrastructure consisting of: (1) a national technical expertise center, (2) an implementer's community, and (3) a developer's community. This model was used to implement an open-source EHR in three Ugandan HIV-clinics. Pre-post time-motion study at one site revealed that Primary Care Providers spent a third less time in direct and indirect care of patients (p<0.001) and 40% more time on personal activities (p=0.09) after EHRs implementation. Time spent by previously enrolled patients with non-clinician staff fell by half (p=0.004) and with pharmacy by 63% (p<0.001). Surveyed providers were highly satisfied with the EHRs and its support infrastructure. This model offers a viable approach for broadly implementing EHRs in resource-limited settings.

Making the electronic medical record work for the orthopedic surgeon.

This article explores the current reasons why orthopedic surgeons might consider the adoption of an electronic medical record system in their practices today. The costs and benefits as well as the barriers to implementation are discussed.

Tipping point. The arrival of connected health.

After decades of experimentation and demonstration, Connected Health is poised to arrive. Several powerful factors have become more pronounced and their convergence more potent. Clearly there are issues and barriers that still need to be resolved. Healthcare providers are often hesitant to integrate Connected Health into their care practices. Reimbursement is still limited and uneven and under-powered. The value of several applications, such as the Personal Health Record, is unclear. Privacy concerns persist. However, given its utility and the factors at work, Connected Health will become an integral and significant component of healthcare.

Adoption of health information technology in community health centers: results of a national survey.

To the extent that health information technology (IT) improves health care quality, differential adoption among providers that serve vulnerable populations may exacerbate health disparities. This first national survey of federally funded community health centers (CHCs) shows that although 26 percent reported some electronic health record (EHR) capacity and 13 percent have the minimal set of EHR functionalities, CHCs serving the most poor and uninsured patients were less likely to have a functional EHR. CHCs cited lack of capital as the top barrier to adoption. Ensuring comparable health IT capacity among providers that disproportionately serve disadvantaged patients will have increasing relevance for disparities; thus, monitoring adoption among such providers should be a priority.

Stark redo. Hospitals hesitate to help digitize doctors' offices until the 'relaxed' rules are further clarified.

Observers expected hospitals to leap at the chance to help wire physicians' offices after the government relaxed its rules in August. So what's holding them up?

Nuevas formas de gestión en un Servicio de Cirugía General comarcal / New forms of management in a regional General Surgery Unit

El objetivo principal de este trabajo es demostrar una mejora en la asistencia sanitaria con el nuevo modelo de Unidad de Gestión Clínica (UGC) en comparación con el tradicional, a través de variables económicas, asistenciales y de calidad/ eficiencia. Entre los resultados destaca que han disminuido los ingresos totales en un 4,2% a expensas de los programados (-10,3%), así como las estancias totales (-7,8%), produciéndose un ahorro en estancias por la Cirugía Mayor Ambulatoria (CMA) del 331,1%. Ha aumentado el total de intervenciones en un 10,7%, debido fundamentalmente a la CMA (341%). Se ha conseguido un ahorro en gasto por CMA de 387,5%. El índice de intervenciones suspendidas descendió (-27,8%), así como el de infecciones nosocomiales (-8,3%). También descendió el número de pacientes en lista de espera (-30,9%), y la media de días de lista espera (-22,4%). La satisfacción global del usurario experimentó un aumento del 9,3%. Como conclusión se establece que desde la constitución de la UGC se han mejorado la casi totalidad de los parámetros asistenciales, económico y de calidad, en relación al modelo previo con el que se compara (AU)

The main objective of this article is to demonstrate an improvement in health care with the new model of the Clinical Management Unit (UGC) in comparison with the traditional one, using financial, nursing and quality/efficiency variables. Finally, it is also mentioned that since setting up the Clinical Management Unit, almost all the nursing, financial and quality parameters have improved in relation to the previous model it is compared with (AU)