Allergy medical care network: a new model of care for specialties

In 2005 the Althaia Foundation Allergy Department performed its daily activity in the Hospital Sant Joan de Deu of Manresa. Given the increasing demand for allergy care, the department's performance was analysed and a strategic plan (SP) for 2005---2010 was designed. The main objective of the study was to assess the impact of the application of the SP on the department's operations and organisational level in terms of profitability, productivity and quality of care. MATERIAL AND METHODS: Descriptive, retrospective study which evaluated the operation of the allergy department. The baseline situation was analysed and the SP was designed. Indicators were set to perform a comparative analysis after application of the SP. RESULTS: The indicators showed an increase in medical care activity (first visits, 34%; successive visits, 29%; day hospital treatments, 51%), high rates of resolution, reduced waiting lists. Economic analysis indicated an increase in direct costs justified by increased activity and territory attended. Cost optimisation was explained by improved patient accessibility, minimised absenteeism in the workplace and improved cost per visit. CONCLUSIONS: After application of the SP a networking system was established for the allergy speciality that has expanded the territory for which it provides care, increased total activity and the ability to resolve patients, optimised human resources, improved quality of care and streamlined medical cost

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Allergy medical care network: a new model of care for specialties.

UNLABELLED: In 2005 the Althaia Foundation Allergy Department performed its daily activity in the Hospital Sant Joan de Deu of Manresa. Given the increasing demand for allergy care, the department's performance was analysed and a strategic plan (SP) for 2005-2010 was designed. The main objective of the study was to assess the impact of the application of the SP on the department's operations and organisational level in terms of profitability, productivity and quality of care. MATERIAL AND METHODS: Descriptive, retrospective study which evaluated the operation of the allergy department. The baseline situation was analysed and the SP was designed. Indicators were set to perform a comparative analysis after application of the SP. RESULTS: The indicators showed an increase in medical care activity (first visits, 34%; successive visits, 29%; day hospital treatments, 51%), high rates of resolution, reduced waiting lists. Economic analysis indicated an increase in direct costs justified by increased activity and territory attended. Cost optimisation was explained by improved patient accessibility, minimised absenteeism in the workplace and improved cost per visit. CONCLUSIONS: After application of the SP a networking system was established for the allergy speciality that has expanded the territory for which it provides care, increased total activity and the ability to resolve patients, optimised human resources, improved quality of care and streamlined medical costs.

Estudio comparativo de pacientes con agudización de EPOC tratados con moxifloxacino oral frente a otros antibióticos por vía endovenosa en una unidad de corta estancia de urgencias / COPD exacerbation treated with oral moxifloxacin versus other intravenous antibiotics at a short-stay emergency outpatient clinic: a comparative study

I ntroducción: La aparición de las nuevas fluorquinolonas pueden representar una alternativa por vía oral (vo) al tratamiento endovenoso (ev) con otros antibióticos, en los pacientes con agudización de patología respiratoria crónica que requieren ingreso hospitalario urgente. Objetivos: Comparar la eficacia del tratamiento con moxifloxacino oral frente a otros antibióticos por vía ev en paciente con agudización de patología respiratoria crónica. Material y métodos: Estudio observacional, retrospectivo, de los pacientes incluidos que ingresaron en la Unidad de Corta Estancia de Urgencias (UCEU) del Hospital Universitario de Bellvitge (HUB) entre diciembre de 2004 y marzo de 2005, distinguiendo dos grupos: grupo A tratados desde el inicio con moxifloxacino 400 mg al día por vo, grupo B tratados inicialmente con otros antibióticos por vía ev y posteriormente con el tratamiento oral equivalente (tratamiento clásico). Análisis descriptivo de la edad, género, estancia promedio, destino al alta, retorno/reingreso a los 10 días durante todo el período estudiado, así como comparación de ambos grupos según tests paramétricos (X2 o Fisher, t de Student) o no paramétricos (U de Mann Whitney). Resultados: El total de pacientes que se incluyeron en el estudio fue de 287 (120 grupo A y 167 grupo B), sin apreciarse diferencias significativas en la distribución por edad, género, severidad de la descompensación y comorbilidad. De forma estadísticamente significativa la estancia media fue de 2,51 d (DS ± 0,95) en el grupo A y de 3, 10 (DS ± 1,05) en el grupo B (p < 0,001), sin que se observaran diferencias significativas en el retorno/reingreso a urgencias/ hospital a los 10. Conclusiones: Moxifloxacino oral desde el inicio es una alternativa eficaz en el tratamiento de la agudización del paciente con patología crónica respiratoria que requiere ingreso en una UCEU (AU)

B ackground: The newer fluoroquinolones may represent an oral therapy alternative to i.v. therapy with other antibiotics in patients with exacerbations of chronic obstructive pulmonary disease (COPD) requiring urgent admission. Aims: To compare the efficacy of oral moxifloxacin therapy to that of other i.v. antibiotics in patients with acute COPD exacerbations. Material and methods: Retrospective observational study of patients admitted to the short-stay emergency outpatient clinic of the Bellvitge University Hospital between December 2004 and March 2005, with comparison of two groups. Group A received, from the beginning, moxifloxacin 400 mg/day p.o., while group B initially received other i.v. antibiotics and then the equivalent oral therapy (classical management). Descriptive analysis of age, gender, average duration of admission, destination upon discharge and return / readmission within ten days over the study period; the two groups were compared using both parametric (Fisher’s or X2 tests, Student’s t-test) or nonparametric (Mann-Whitney U-test) tests as adequate. Results: A total of 287 patients were included in the study (120 in group A and 167 in group B); there were no significant differences in the age, gender, severity of decompensation or comorbility distributions. The mean duration of admission was significantly different, 2.51 ± 0.95 days in group A and 3.10 ± 1.05 days in group B (p < 0.001); there were no significant differences in the ten-day return / readmission rates. Conclusions: Ab initio oral moxifloxacin is an effective alternative in the management of exacerbations in patients with COPD requiring admission to a short-stay emergency outpatient clinic (AU)

Evaluación de la satisfacción de los pacientes ingresados en una unidad de corta estancia de urgencias / Assessment of patient satisfaction among those admitted into a short-stay emergency unit

Objetivos: Evaluar la satisfacción de los pacientes ingresados en una unidad de corta estancia de urgencias (UCEU) mediante una encuesta autoadministrada. Métodos: Los parámetros incluidos en la encuesta fueron estancia en urgencias, personal sanitario, aspectos de hostelería e información escrita que se proporciona al ingreso. Las opciones de respuesta eran muy bien, bien, regular y mal. Además, se preguntaba a los pacientes si consideraban que se había solucionado su problema de salud actual y si volverían a ingresar en el mismo centro. Resultados: Se realizaron 954 ingresos a 854 pacientes (451 hombres y 403 mujeres) con una edad media de 71 ± 15 años y una estancia media de 3,0 ± 1,8 días. Los pacientes respondieron 283 encuestas (30% de los ingresos). La estancia en urgencias, el personal sanitario, la coordinación entre los distintos profesionales y el horario de visitas fueron evaluados como muy bien o bien por el 99% de los pacientes. En los aspectos de hostelería, peor valorados, destaca el apartado de valoración del nivel de ruido de la unidad (44% de los pacientes calificaron regular o mal). La información proporcionada al ingreso es considerada útil. Doscientos quince pacientes (76%) consideraron que se había solucionado su problema de salud y 246 (87%) volverían a ingresar en la UCEU. Conclusiones: El grado de satisfacción de los pacientes de la UCEU es muy elevado. La mayoría de los pacientes considera que se ha solucionado su problema de salud y volvería a ingresar en la UCEU (AU)

Aims: To assess patient satisfaction among those admitted into a short-stay emergency unit through a self-administered survey. Methods: The parameters included in the survey were: duration of emergency stay, quality of the emergency personnel, hostelery aspects, and written information provided on admission. The answer options were “very good”, “good”, “average” and “bad”. Patients were further questioned as to they considered that their health problem hab been solved and as to whether they would consider being again admitted into the same centre. Results: Eight hundred and fifty-four patients (451 males and 403 females) were admitted over the study period (mean age 71±15 years, mean stay 3.0±1.8 days). The patients completed 283 survey forms (30% of all admissions). The sojourn at the Emergency Ward, tha attitude of the health care personnel, the coordination among the various heath care specialists and the family visit times were rated as “very good” or “good” by 99% of the patients. The hostelery parameters, which were rated rather lower, show a clearly lower rating for the “level of noise in the Unit” (classed as “average” or “bad” by 44% of the patients). The information provided on admission was classed as “useful”. two hundred and fifteen patients (76%) considered that their problem hab been solved, and 246 (87%) would return and accept being admitted into the same short-stay emergency unit. Conclusions: The degree of satisfaction among patients at the shortstay emergency unit is quite high. Most patients consider that their health care problem has been solved and would again accept being admitted into such a unit (AU)

[Estimating the costs of health care for patients infected with the human immunodeficiency virus in a university hospital in Catalonia]. / Estimación de los costes de la asistencia sanitaria a los pacientes infectados por el virus de la inmunodeficiencia humana en un hospital universitario de Cataluña.

BACKGROUND: To estimate the use of resources and costs of health care to patients infected with the human immunodeficiency virus (HIV). METHODS: Prospective study in university hospital in Catalonia including 166 patients. AIDS was defined following 1987 criteria of the Centers for Disease Control. AIDS phase was divided into three grades according to the evolutive course: AIDS grade I, II and III. Resources/costs were calculated in function of the degree of disease, transmission mode and demographic variants. RESULTS: The mean cost per patient/year (PY) was 1,571,900 pesetas, ranging from 88,700 for the asymptomatic phase and 2,561,000 per AIDS phase. Within the AIDS phase costs ranged from 1,593,317 for AIDS grade I to 4,903,183 for grade III. This increase was due to differences in hospitalization days for PY (up to 12.4 days in pre-AIDS phases, 45.8 for AIDS phase I and 119.4 for AIDS phase III) and days in day-hospital per PY (38.1 days for AIDS grade III). Parenteral drug abusers (PDA) had a PY cost 42% lower than that corresponding to sexually infected patients. CONCLUSIONS: Health care costs per PY of HIV infected patients increase with disease progression, which relates to the increase in hospitalization days and day-hospital hospitalization that occurs in the advanced phases of the disease. Our results suggest that health care to PDA is cheaper than that for sexually infected patients.