Maturity Assessment model for Patient Blood Management to assist hospitals in improving patients' safety and outcomes. The MAPBM project.

BACKGROUND: Patient blood management (PBM) is an evidence-based care bundle with proven ability to improve patients' outcomes by managing and preserving the patient's own blood. Since 2010, the World Health Organisation has urged member states to implement PBM. However, there has been limited progress in developing PBM programmes in hospitals due to the implicit challenges of implementing them. To address these challenges, we developed a Maturity Assessment Model (MAPBM) to assist healthcare organisations to measure, benchmark, assess in PBM, and communicate the results of their PBM programmes. We describe the MAPBM model, its benchmarking programme, and the feasibility of implementing it nationwide in Spain. MATERIALS AND METHODS: The MAPBM considers the three dimensions of a transformation effort (structure, process and outcomes) and grades these within a maturity scale matrix. Each dimension includes the various drivers of a PBM programme, and their corresponding measures and key performance indicators. The structure measures are qualitative, and obtained using a survey and structured self-assessment checklist. The key performance indicators for process and outcomes are quantitative, and based on clinical data from the hospitals' electronic medical records. Key performance indicators for process address major clinical recommendations in each PBM pillar, and are applied to six common procedures characterised by significant blood loss. RESULTS: In its first 5 years, the MAPBM was deployed in 59 hospitals and used to analyse 181,826 hospital episodes, which proves the feasibility of implementing a sustainable model to measure and compare PBM clinical practice and outcomes across hospitals in Spain. CONCLUSION: The MAPBM initiative aims to become a useful tool for healthcare organisations to implement PBM programmes and improve patients' safety and outcomes.

[Surgical patients hospital home care program: two years evaluation]. / Programa de hospitalización domiciliara de pacientes quirúrgicos: evaluación de los dos años de funcionamiento.

OBJECTIVE: To evaluate the results after two years of the implementation of surgical patients' hospital home care program in Consort. Hospitalari de Vic. METHOD: Longitudinal study conducted between January 2011 and December 2012 on patients enrolled in hospital home care program patients. Sociodemographic, clinical, financial, management and patients experience variables were analysed. Data were obtained from hospital home care program records and Hospital Information Systems in addition to telephone surveys. We performed a univariate descriptive analysis using the statistical package SPSS Statistics 19. RESULTS. 691 patients were assessed, and 80.75% were included in hospital home care program. The average hospital length of stay was 5.01 days, with a 3.05% of readmission rate. A higher number of male patients were treated; patients under general surgery, orthopaedics and urology specialties were the more prevalence in the program. 82% of patients were assigned to the care plan "surgical patient", and the most recorded potential complications were pain (539) and infection (436). The mean overall satisfaction score with care was 8.67 +/- 1.37 out of 10. CONCLUSIONS: The results objectively reflect the impact of hospital home care program in our context. Moreover, it highlights the importance of the advanced nursing role.

Programa de hospitalización domiciliaria de pacientes quirúrgicos. Evaluación de los dos años de funcionamiento / Surgical patients hospital home care program: two years evaluation

Objetivo. Evaluar los resultados obtenidos con la implantación del programa de Hospitalización Domiciliaria Quirúrgica (HDQ) en el Consorci Hospitalari de Vic durante un periodo de dos años. Método. Estudio longitudinal realizado entre enero de 2011 y diciembre de 2012, sobre los pacientes incluidos en el programa de HDQ. Se estudiaron variables sociodemográficas, clínicas, económicas, de gestión y de percepción del usuario. Los datos se obtuvieron de los registros del programa HDQ, de la Unidad de Planificación y de los sistemas de información, y mediante encuestas telefónicas. Se realizó un análisis descriptivo univariado con el paquete estadístico IBM SPSS Statistics 19. Resultados. Se valoraron 691 pacientes. El 80.75 % se incluyó en el programa HDQ, su estancia media global fue de 5.01 días y la tasa de reingreso del 3.05 %. Destacó un mayor número de pacientes tratados de sexo masculino; las especialidades que aportaron más pacientes al programa fueron cirugía general, traumatología y urología. Se asignó el plan de cuidados del «paciente quirúrgico intervenido» al 82 % de los pacientes, y las complicaciones potenciales enfermeras más registradas fueron el dolor (539) y la infección (436). La puntuación media de satisfacción global sobre la atención recibida y el funcionamiento de HDQ fue de 8.67 ± 1.37 sobre 10. Conclusiones. Los resultados objetivan el impacto de la HDQ en nuestro ámbito y ponen de manifiesto la relevancia del rol de la atención enfermera especializada en el domicilio (AU)

Objective. To evaluate the results after two years of the implementation of surgical patients’ hospital home care program in Consorci Hospitalari de Vic. Method. Longitudinal study conducted between January 2011 and December 2012 on patients enrolled in hospital home care program patients. Sociodemographic, clinical, financial, management and patients experience variables were analysed. Data were obtained from hospital home care program records and Hospital Information Systems in addition to telephone surveys. We performed a univariate descriptive analysis using the statistical package SPSS Statistics 19. Results. 691 patients were assessed, and 80.75 % were included in hospital home care program. The average hospital length of stay was 5.01 days, with a 3.05 % of readmission rate. A higher number of male patients were treated; patients under general surgery, orthopaedics and urology specialties were the more prevalence in the program. 82 % of patients were assigned to the care plan «surgical patient», and the most recorded potential complications were pain (539) and infection (436). The mean overall satisfaction score with care was 8.67 ± 1.37 out of 10. Conclusions. The results objectively reflect the impact of hospital home care program in our context. Moreover, it highlights the importance of the advanced nursing role (AU)

Pacientes quirúrgicos e intervenciones enfermeras estandarizadas. Estudio descriptivo sobre resultados / Descriptive study of the results of nursing interventions applied to surgical patients

Objetivos: conocer la evolución de los resultados de salud de los pacientes quirúrgicos durante su estancia hospitalaria, evaluando criterios de resultado NOC al ingreso y alta. Método: estudio prospectivo observacional realizado en las plantas de hospitalización quirúrgica del Hospital General de Vic, con pacientes que precisaron una intervención quirúrgica de cualquier especialidad, a partir de 18 añ;os, con niveles de riesgo anestésico I, II o III. Las variables principales de resultado fueron indicadores asociados a cada NOC de un plan de cuidados estandarizado, basado en el concepto «paciente tipo». Resultados: participaron 460 pacientes, de ellos 69(15%) fueron intervenidos de operaciones del sistema musculoesquelético y 391(85%) de operaciones del aparato digestivo, urinario y órganos genitales masculinos y femeninos, de operaciones de la piel, tegumentos y/o sistema endocrino. Las puntuaciones NOC al alta de todos los pacientes se mantuvieron o mejoraron, nunca empeoraron y en todos los pacientes el número de caídas y de infecciones recurrentes fue una constante. Prácticamente ningún enfermo se cayó, ni se infectó. Conclusiones: la mayoría de los pacientes quirúrgicos en el momento de recibir el alta hospitalaria mejoran o mantienen sus condiciones de ingreso y los que empeoran nunca lo hacen sustancialmente(AU)

Objectives: Knowing the evolution of health outcomes of surgical patients during their hospital stay, evaluating NOC outcome criteria at admission and discharge. Material and methods: Prospective observational study conducted in the surgical hospital wards of the Hospital General de Vic, with patients who required surgical intervention of any specialty, of 18 or more years old and anesthetic risk levels I, II or III. The main outcome variables were indicators associates with each NOC of a standard of care based on the "patient type" concept. Results: Four hundred and six patients participated. Of these, 69 (15%) were operated of the musculoskeletal system and 391 (85%) were operated on the digestive or urinary systems, male/female genitalia, skin, integuments, and endocrine system. NOC scores high of all patients were maintained or improved, never worse and in all patients the number of falls and recurrent infections was constant, virtually no patient fell or became infected. Conclusions: The majority of surgical patients at the time of hospital discharge improves or maintain their conditions of admission and patients who never worse substantially(AU)

[Descriptive study of the results of nursing interventions applied to surgical patients]. / Pacientes quirúrgicos e intervenciones enfermeras estandarizadas. Estudio descriptivo sobre resultados.

OBJECTIVES: Knowing the evolution of health outcomes of surgical patients during their hospital stay, evaluating NOC outcome criteria at admission and discharge. MATERIAL AND METHODS: Prospective observational study conducted in the surgical hospital wards of the Hospital General de Vic, with patients who required surgical intervention of any specialty, of 18 or more years old and anesthetic risk levels I, II or III. The main outcome variables were indicators associates with each NOC of a standard of care based on the "patient type" concept. RESULTS: Four hundred and six patients participated. Of these, 69 (15%) were operated of the musculoskeletal system and 391 (85%) were operated on the digestive or urinary systems, male/ female genitalia, skin, integuments, and endocrine system. NOC scores high of all patients were maintained or improved, never worse and in all patients the number of falls and recurrent infections was constant, virtually no patient fell or became infected. CONCLUSIONS: The majority of surgical patients at the time of hospital discharge improves or maintain their conditions of admission and patients who never worse substantially.

Is there an association between the quality of hospitals' research and their quality of care?

OBJECTIVE: It is often claimed that hospitals that are leaders in biomedical research provide higher health care quality, or vice versa. Although several studies have shown a relationship between teaching status and quality of care, none has analysed the association between research output and hospital outcomes. Our aim was to determine whether there is a relationship between bibliometric measures of research output in acute hospitals and hospital mortality for two common cardiac conditions. METHODS: A cross-sectional analysis of secondary data of in-hospital risk-adjusted mortality for congestive heart failure and acute myocardial infarction (2002-2004) and several bibliometric measures of publications (1996-2004) in cardiovascular disease. The setting was 50 acute Spanish public hospitals, voluntarily participating in an external quality initiative, with more than 30 medical cases of congestive heart failure and acute myocardial infarction per year, and more than five citable papers in the field of heart disease. Spearman's rho non-parametric correlation coefficient was used to assess association. RESULTS: There was a low-to-moderate negative correlation between the risk-adjusted mortality ratio and the weighted citations ratio: -0.43 (95% CI -0.17 to -0.63) for congestive heart failure and -0.37 (-0.10 to -0.59) for acute myocardial infarction. Teaching status and the technological level of the hospital had a stronger correlation with hospital mortality. CONCLUSIONS: Measures of research output could be considered for incorporation into comparisons of the quality of hospitals. A weighted citations ratio is the most suitable measure of research output, but more research is needed on the interplay between research and practice as complementary ways of developing medical knowledge.

Concepto «paciente tipo»: utilidad para el cuidado de los pacientes quirúrgicos / The concept of “patient type”: utility for the care of surgical patients

Objetivo. Identificar y describir las necesidades y las características de los pacientes intervenidos de patología quirúrgica y describir un modelo de «paciente tipo» quirúrgico. Método. Se realizó un estudio transversal para describir un paciente tipo quirúrgico, formado por una o más tipologías con características y/o necesidades similares. La población de estudio fueron los pacientes ingresados en las plantas de hospitalización quirúrgicas de un hospital general, en un período de 10 meses. Se recogieron variables sociodemográficas, clínicas, grado de autonomía y necesidades según V. Henderson mediante una entrevista llevada a cabo durante el postoperatorio. Se realizaron análisis univariante, descriptivo estratificado y de correspondencias múltiples. Resultados. Participaron 270 pacientes de mediana o de baja complejidad, de diferentes especialidades quirúrgicas. Durante el proceso quirúrgico (preoperatorio y postoperatorio) casi la mitad de los pacientes se hipotensaban, la frecuencia cardíaca no sufría cambios significativos y no variaba el riesgo de sufrir úlceras por presión según la escala de Norton. Un primer análisis estadístico clasificó a los pacientes quirúrgicos en 5 grupos y mostró la relación existente entre el grado de autonomía mediante el índice de Barthel, y el número de problemas personales de los pacientes según el modelo de Henderson. Posteriormente, el análisis de conglomerados clasificó a los pacientes quirúrgicos en 4 clases o tipos que explicaban el 70% de la varianza total. Conclusiones. Se ha identificado mediante el modelo de Henderson un «paciente tipo» formado por 4 clases. Se plantea su uso para facilitar el cuidado de los pacientes de mediana o de baja complejidad quirúrgica de diferentes especialidades(AU)

Objective. To describe a model of surgical “patient type” by identifying the needs and characteristics of surgical patients. Method. We performed a cross-sectional study of surgical patients with one or more diseases and similar needs and/or characteristics admitted to the surgical wards of a general hospital over a 10-month period. The variables analyzed were sociodemographic and clinical data, degree of autonomy, and Virginia Henderson′s needs, which were identified through an interview performed in the postoperative period. Univariate analysis, stratified descriptive statistics and multiple correspondence analysis were performed. Results. A total of 270 medium- or low-complexity patients from different surgical specialities took part in the analysis. During the surgical process (pre- and post-operative), almost a half of the patients suffered from hypotension, heart rate showed no significant changes and the risk of developing a pressure ulcer was unmodified according to Norton's scale. The first statistical analysis classified the surgical patients into five groups and showed the relationship between the degree of autonomy (measured through Barthel's index) and the number of personal problems (assessed according to the Henderson model). A subsequent statistical analysis classified the patients into four groups or types, explaining 70% of the total variance. Conclusions. Through the use of Virginia Henderson's model, a surgical patient type composed of four different groups was identified. The results of this study may be useful in the care of low- and medium-complexity patients in distinct surgical specialities(AU)

[The concept of "patient type": utility for the care of surgical patients]. / Concepto <>: utilidad para el cuidado de los pacientes quirúrgicos.

OBJECTIVE: To describe a model of surgical "patient type" by identifying the needs and characteristics of surgical patients. METHOD: We performed a cross-sectional study of surgical patients with one or more diseases and similar needs and/or characteristics admitted to the surgical wards of a general hospital over a 10-month period. The variables analyzed were sociodemographic and clinical data, degree of autonomy, and Virginia Henderson's needs, which were identified through an interview performed in the postoperative period. Univariate analysis, stratified descriptive statistics and multiple correspondence analysis were performed. RESULTS: A total of 270 medium- or low-complexity patients from different surgical specialties took part in the analysis. During the surgical process (pre- and post-operative), almost a half of the patients suffered from hypotension, heart rate showed no significant changes and the risk of developing a pressure ulcer was unmodified according to Norton's scale. The first statistical analysis classified the surgical patients into five groups and showed the relationship between the degree of autonomy (measured through Barthel's index) and the number of personal problems (assessed according to the Henderson model). A subsequent statistical analysis classified the patients into four groups or types, explaining 70% of the total variance. CONCLUSIONS: Through the use of Virginia Henderson's model, a surgical patient type composed of four different groups was identified. The results of this study may be useful in the care of low- and medium-complexity patients in distinct surgical specialties.

Utilización de servicios de salud y flujos asistenciales / Health services provision and geographic accessibility

Este estudio describe la oferta de servicios de salud de Cataluña como parte del análisis de la situación del Mapa Sanitario, fijando un punto de partida para el proceso de adaptación de los servicios a las necesidades de la población. Incluye también un análisis de la accesibilidad geográfica a los centros sanitarios del sistema público de salud mediante la utilización de un sistema de información geográfica (SIG), con variables de georreferenciación y cálculos de distancia y tiempo de desplazamiento, y se exponen sus principales resultados, de los cuales se constata, por un lado, la adecuación de la red asistencial catalana a la distribución de la población, con una elevada proximidad geográfica de los servicios a la población y un alto grado de capilaridad, principalmente en la atención primaria. Por otro lado, se pone de manifiesto la importancia que pueden adquirir las herramientas y procedimientos SIG en la planificación sanitaria

This article analyses the use of healthcare services in Catalonia with reference to their variability and cross-territory healthcare flows. The coefficients of variation show a lower degree of territorial dispersion in acute-care and primary-care hospitalisation, and a greater degree in social-healthcare. In the territorial analysis of the penetration indices, five large attraction poles are salient. There is no significant association among healthcare flows between the specialised healthcare given in acute healthcare hospitals, mental healthcare and social-healthcare,whereas a strong association was observed between the set of services associated to the acute-care hospital structure (hospitalisation, outpatient service and emergency care) and also among the social healthcareinternment services (medium and long-term stays). This would seem to suggest that the association between flows refers to services that are habitually rendered from one single healthcare mechanism, and not so much to a pattern of cross-territory relations

[Use of health services and healthcare flows]. / Utilización de servicios de salud y flujos asistenciales.

This article analyses the use of healthcare services in Catalonia with reference to their variability and cross-territory healthcare flows. The coefficients of variation show a lower degree of territorial dispersion in acute-care and primary-care hospitalisation, and a greater degree in social-healthcare. In the territorial analysis of the penetration indices, five large attraction poles are salient. There is no significant association among healthcare flows between the specialised healthcare given in acute healthcare hospitals, mental healthcare and social-healthcare, whereas a strong association was observed between the set of services associated to the acute-care hospital structure (hospitalisation, outpatient service and emergency care) and also among the social healthcare internment services (medium and long-term stays). This would seem to suggest that the association between flows refers to services that are habitually rendered from one single healthcare mechanism, and not so much to a pattern of cross-territory relations.