Improving low-value clinical practices in Murcia: a healthcare management area in Spain.

The 'do not do' (DND) movement looks for improving patient safety and reducing health spending by decreasing the prevalence of unnecessary clinical practices through building and launching 'do not do' recommendations, although the impact is generally low. The objective of this study is to improve the quality of care and safety of patients assigned to a health management area by reducing the prevalence of DND practices. Quasi-experimental before and after study carried out in a Spanish health management area of 264 579 inhabitants, 14 primary care teams, and a 920-bed third level reference hospital. The study included the measurement of a set of 25 valid and reliable indicators on DND prevalence from different clinical areas previously designed, considering acceptable prevalence values of less than 5%. For those indicators that exceeded this value, a bunch of interventions was implemented: (i) inclusion in the annual objectives of the clinical units involved; (ii) discussion of results in a general clinical session; (iii) educational outreach visits to the clinical units involved; and (iv) detailed feedback reports. A second evaluation was subsequently carried out. In the first evaluation, 12 DNDs (48%) showed prevalence values below 5%. In the second evaluation, nine DND of the remaining 13 (75%) improved results, reaching five of them (42%) prevalence values below 5%. Thus, a total of 17 of the 25 DNDs initially evaluated (68%) achieved this goal. Reducing the prevalence of low-value clinical practices in a healthcare organization makes it necessary to turn them into easily measurable indicators and carry out multicomponent interventions. Among these, it seems essential that the professionals involved are informed and that training activities are carried out on-site. Improvement cycles are emerging as a useful tool to do this.

[Evaluation of the telematic consultation in endocrine surgery during confinement due to COVID-19]. / Evaluación de la consulta telemática en cirugía endocrina durante el confinamiento por COVID-19.

BACKGROUND: The coronavirus disease pandemic of 2019 (COVID-19) made necessary to remodel the hospital's clinical consultations. OBJECTIVE: To evaluate the telematic consultation in endocrine surgery, as well as to select the group of patients susceptible to perform a telematic consultation in the future according to this assessment. METHODS: The study population were patients who had a clinical consultation by telephone. The evaluation was made with the Net Promoter Score (NPS). STATISTICAL ANALYSIS: SPSS v.28, X2 test and a multivariate analysis. RESULTS: 55 patients were analyzed. The NPS was +16, 24 promoters (43.6%) and 15 detractors (27.2%). There were differences between those whose main reason for consultation was malignant pathology (OR 4.5; p = 0.033). The NPS between malignant vs. non-malignant pathology was -13 vs. +38 (p > 0.001). The evaluation of the telematic consultations for the future was: telephone (83% very well), video call (58%), videoconference (19%). CONCLUSIONS: The evaluation of the telephone consultation has been good, finding a better assessment among patients with non-malignant pathology. Its future implementation could be necessary, being the telephone the preferred way.

Impact of the COVID-19 Pandemic on the Hospital: Inpatient's Perceived Quality in Spain.

Although the Coronavirus disease 2019 (COVID-19) pandemic has generated a large amount of studies, the patient-perceived quality of care (PQ) in this context is still not well known, so more studies intending to focus on this issue are strongly needed. This study assesses changes on PQ in patients hospitalized in Spain during the first month of the COVID-19 pandemic and investigates differences between those admitted for this cause and the rest a descriptive study using the "Net Promoters Score" and the hospital regular monitoring plan. Due to this point of view, ethical approval is not applicable. Four PQ dimensions (nurse, physician, and nurse assistant actions [NA], and discharge information [DI]) were measured in all COVID patients (57) and in a sample of non-COVID patients (60) discharged at home during the first month of the pandemic, and also compared with another sample (384) from an immediately previous period. The COVID patients scored worse (8.2) than non-COVID ones (9.0; P < .0001), especially in NA and DI, and were more likely to be detractors (odds ratio [OR]: 3.05, P < .0001) and less to be promoters (OR: 0.64, P < .05). Global and DI net promoters score values before the pandemic were higher than afterward. In conclusion, the COVID-19 pandemic negatively and significantly influenced the health care quality as perceived by inpatients, both in COVID and in non-COVID ones, but more intensely in the former. As a health care organization, this knowledge meant an opportunity from improvement and to be better qualified to face the pandemic.

Indicadores de calidad en gastroscopia. Procedimiento de la gastroscopia / Quality indicators in gastroscopy. Gastroscopy procedure

Enmarcado dentro del proyecto "Indicadores de calidad en endoscopia digestiva", liderado por la Sociedad Española de Patología Digestiva (SEPD), el objetivo de esta investigación es proponer los procedimientos e indicadores de estructura, proceso y resultado necesarios para aplicar y evaluar la calidad en la gastroscopia. Primero, se ha diseñado un diagrama con los pasos a seguir durante el procedimiento de gastroscopia. En segundo lugar, un grupo de expertos en calidad asistencial y/o endoscopia han realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en los procedimientos endoscópicos, incluidas las gastroscopias. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y el análisis de la literatura seleccionada. Se ha identificado para gastroscopias un total de nueve indicadores de procesos (uno de preprocedimiento y ocho de procedimiento). La calidad de la evidencia se ha analizado aplicando la escala de clasificación utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation)

Within the project "Quality indicators in digestive endoscopy", pioneered by the Spanish Society for Digestive Diseases (SEPD), the objective of this research is to suggest the structure, process, and results procedures and indicators necessary to implement and assess quality in the gastroscopy setting. First, a chart was designed with the steps to be followed during a gastroscopy procedure. Secondly, a team of experts in care quality and/or endoscopy performed a qualitative review of the literature searching for quality indicators for endoscopic procedures, including gastroscopies. Finally, using a paired analysis approach, a selection of the literature obtained was undertaken. For gastroscopy, a total of nine process indicators were identified (one preprocedure, eight intraprocedure). Evidence quality was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification scale

Quality indicators in gastroscopy. Gastroscopy procedure.

Within the project "Quality indicators in digestive endoscopy", pioneered by the Spanish Society for Digestive Diseases (SEPD), the objective of this research is to suggest the structure, process, and results procedures and indicators necessary to implement and assess quality in the gastroscopy setting. First, a chart was designed with the steps to be followed during a gastroscopy procedure. Secondly, a team of experts in care quality and/or endoscopy performed a qualitative review of the literature searching for quality indicators for endoscopic procedures, including gastroscopies. Finally, using a paired analysis approach, a selection of the literature obtained was undertaken. For gastroscopy, a total of nine process indicators were identified (one preprocedure, eight intraprocedure). Evidence quality was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification scale.

Indicadores de calidad en colangiopancreatografía retrógrada endoscópica. Procedimiento de la colangiopancreatografía retrógrada endoscópica / Quality indicators for endoscopic retrograde cholangiopancreatography. The procedure of endoscopic retrograde cholangiopancreatography

El objetivo del proyecto en el que se inscribe este trabajo es proponer procedimientos e indicadores de calidad y seguridad útiles para facilitar la mejora de la calidad en unidades de endoscopia digestiva. En este tercer resultado se proponen procedimientos e indicadores de la colangiopancreatografía retrógrada endoscópica (CPRE). Primero, se ha diseñado un diagrama de los pasos previos y consecutivos a la realización de la CPRE. Un grupo de expertos en calidad asistencial y/o endoscopia, bajo el amparo de la Sociedad Española de Patología Digestiva (SEPD), ha realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en la CPRE. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y análisis de la literatura seleccionada. Se han identificado un total de seis indicadores específicos, independientemente de los ya descritos comunes, todos de proceso (dos de preprocedimiento y cuatro de procedimiento). Se ha analizado la calidad de la evidencia de cada uno de ellos aplicando la clasificación utilizada en Grading of Recommendations Assessment, Development and Evaluation) GRADE

The goal of the project encompassing the present paper is to propose useful quality procedures and indicators in order to improve quality in digestive endoscopy units. In this third part outcome procedures and indicators are suggested for endoscopic retrograde cholangiopancreatography (ERCP). First, a diagram of pre- and post-ERCP steps was developed. A group of experts in healthcare quality and/or endoscopy, under the shelter of the Spanish Society of Digestive Diseases (Sociedad Española de Patología Digestiva - SEPD), carried out a qualitative review of the literature regarding quality indicators for ERCP. Then, a paired analysis was used for the selection of identified references. A total of six specific indicators, apart from the common indicators already described, were identified, all of them process indicators (two pre-procedure and four post-procedure). Evidence quality was analyzed for each indicator using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification

Quality indicators for endoscopic retrograde cholangiopancreatography. The procedure of endoscopic retrograde cholangiopancreatography.

The goal of the project encompassing the present paper is to propose useful quality procedures and indicators in order to improve quality in digestive endoscopy units. In this third part outcome procedures and indicators are suggested for endoscopic retrograde cholangiopancreatography (ERCP). First, a diagram of pre- and post-ERCP steps was developed. A group of experts in healthcare quality and/or endoscopy, under the shelter of the Spanish Society of Digestive Diseases (Sociedad Española de Patología Digestiva - SEPD), carried out a qualitative review of the literature regarding quality indicators for ERCP. Then, a paired analysis was used for the selection of identified references. A total of six specific indicators, apart from the common indicators already described, were identified, all of them process indicators (two pre-procedure and four post-procedure). Evidence quality was analyzed for each indicator using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification.

Indicadores de calidad en colonoscopia. Procedimiento de la colonoscopia / Quality indicators in colonoscopy. The colonoscopy procedure

El objetivo del proyecto en el que se inscribe este trabajo es proponer procedimientos e indicadores de calidad y seguridad útiles para facilitar la mejora de la calidad en unidades de Endoscopia Digestiva. En este segundo resultado se proponen procedimientos e indicadores de la colonoscopia. Primero, se ha diseñado un diagrama de los pasos previos y consecutivos a la realización de la colonoscopia. Un grupo de expertos en calidad asistencial y/o endoscopia, bajo el amparo de la Sociedad Española de Patología Digestiva (SEPD), han realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en la colonoscopia. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y análisis de la literatura seleccionada. Se han identificado un total de 13 indicadores específicos, independientemente de los ya descritos comunes, de los cuales diez son de proceso (uno de preprocedimiento, siete de procedimiento y dos de posprocedimiento) y tres, de resultado. Se ha analizado la calidad de la evidencia de cada uno de ellos aplicando la clasificación utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation)

The aim of the project this paper is part of was to propose quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. In this second issue, procedures and indicators are suggested regarding colonoscopy. First, a diagram charting the previous and subsequent steps of colonoscopy was designed. A group of experts in health care quality and/or endoscopy, under the auspices of the Sociedad Española de Patología Digestiva (SEPD), performed a qualitative review of the literature regarding colonoscopy-related quality indicators. Subsequently, using a paired-analysis method, the aforementioned literature was selected and analyzed. A total of 13 specific indicators were found aside of the common markers elsewhere described, ten of which are process-related (one pre-procedure, seven procedure, and two post-procedure markers) while the remaining three are outcome-related. Quality of evidence was assessed for each one of them using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) classification

Indicadores de calidad en endoscopia digestiva: introducción a los indicadores comunes de estructura, proceso y resultado / Quality indicators in digestive endoscopy: introduction to structure, process, and outcome common indicators

El objetivo general del proyecto en el que se inscribe este trabajo es proponer procedimientos e indicadores de calidad y seguridad útiles para facilitar la mejora de la calidad en unidades de Endoscopia Digestiva. En este primer resultado se proponen procedimientos e indicadores comunes a las pruebas de endoscopia digestiva. Primero, se ha diseñado un diagrama de los pasos previos y consecutivos a la realización de la endoscopia digestiva. Un grupo de expertos en calidad asistencial y/o endoscopia, bajo el amparo de la Sociedad Española de Patología Digestiva, han realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en los procedimientos endoscópicos. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y análisis de la literatura seleccionada. Se ha identificado un total de 20 indicadores, de los cuales siete son de estructura; once, de proceso (cinco de preprocedimiento, tres de procedimiento y tres de posprocedimiento); y dos, de resultado. Se ha analizado la calidad de la evidencia de cada uno de ellos aplicando la clasificación utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation) (AU)

The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification (AU)

Quality indicators in digestive endoscopy: introduction to structure, process, and outcome common indicators.

The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification.

Escala de peligro para interacción grave: una herramienta para la priorización de estrategias de mejora en la seguridad de la prescripción en medicina de familia / A hazard scale for severe interactions: a tool for establishing prioritising strategies to improve the safety of the prescription in family medicine

Objetivo: Localizar de forma efectiva los medicamentos más implicados en interacciones graves,como base para diseñar actividades de mejora en la seguridad de los pacientes en AtenciónPrimaria.Diseño: Estudio transversal de las prescripciones realizadas en OMI-AP, la historia clínica electrónicade Atención Primaria.Emplazamiento: Áreas I, VI, VII y IX de Murcia (723.664 habitantes).Participantes: 362.271 pacientes que disponen de OMI-AP, son mayores de 14 años y estánadscritos a un médico que usa OMI-AP habitualmente.Mediciones principales: Analizamos los fármacos que cada paciente pudiera estar tomando enbusca de interacciones graves. Construimos una escala de peligro para interacción grave (e-PIG)calculando: 1) la probabilidad de que un paciente no seleccionado este tomando un fármacodeterminado, y 2) la probabilidad de que un medicamento produzca una interacción grave. Conello estimamos el riesgo de producir interacción grave para cada medicamento, que se traducea una escala logarítmica de 5 puntos.Resultados: Hallamos 83.138 pacientes (22,9%) en riesgo (toman 2 o más fármacos). Identificamos466.940 prescripciones provenientes de 939 fármacos y 5.597 interacciones graves(prevalencia 5,8%). En ellas hay implicados 167 fármacos, de los que e-PIG identifica 5 (3%)con valor extremo: omeprazol, diazepam, acenocumarol, ibuprofeno y calcio.Conclusiones: e-PIG es una expresión logarítmica del riesgo de que prescribir un determinadomedicamento produzca una interacción grave en un escenario de lugar y tiempo determinados.Su monitorización puede convertirse en un elemento de priorización que facilite el diseño deestrategias de mejora de la seguridad del uso de medicamentos(AU)

Objective: To effectively locate the drugs most implicated in severe interactions as a basis ofdesigning actions to improve patient safety in Primary Care.Design: Cross-sectional study of prescriptions using the Primary Care computerised medicalrecords database (OMI-PC).Setting: Murcia (Spain) Health Areas I, VI, VII and IX (723,664 inhabitants).Participants: There are 362,271 patients over 14 years-old available in the OMI-PC and areassigned to a doctor who uses the OMI-PC regularly.Main measurements: We analysed the drugs that each patient could be taking, looking forsevere interactions. We constructed a severe interaction hazard scale (e-PIG) calculating [1]the probability that a non-selected patient may be taking a particular drug and [2] the probabilitythat a drug may produce a severe interaction. With this, we estimated the risk ofproducing a severe interaction for each drug, which was converted into a 5 point logarithmicscale.Results: We found 83,138 patients (22.9%) at risk (they took 2 or more drugs). We identified466,940 prescriptions providing 939 drugs and 5,597 severe interactions (prevalence 5.8%).In these, 167 drugs were involved, of which e-PIG identified 5 (3%) with an extreme value:omeprazole, diazepam, acenocoumarol, ibuprofen and calcium.Conclusions: e-PIG is a logarithmic expression of the risk that prescribing a particular drug mayproduce a severe interaction in a determined setting and time. Its monitoring could become aprioritisation element that may assist the design of strategies for improving the safety of theuse of drugs(AU)

A randomized trial of the effectiveness and efficiency of interventions to reduce potential drug interactions in primary care.

The authors tested the effectiveness and estimated the cost of several interventions aimed at reducing drug interactions in primary care by designing a 15-month cluster-controlled trial. The trial involved 265 family physicians and their patients who were randomized into 4 groups: control, report (received feedback reports), session (group sessions), and face-to-face (personal interviews). The outcome was the mean of relevant interactions detected on electronic medical records. Cost-effectiveness was defined as the incremental cost to reduce drug interactions by 1%. The authors detected a baseline mean of 6.7 interactions per 100 patients, which was reduced to 5.3 interactions after follow-up. No improvement was seen in the report group when compared with the control group, whereas progressive improvement in the other groups was noted (P < .001). Incremental cost was higher in the face-to-face group (69.4€ vs 50.7€); cost-effectiveness results were slightly better in the session group (4.2€ vs 4.5€).

[A hazard scale for severe interactions: a tool for establishing prioritising strategies to improve the safety of the prescription in family medicine]. / Escala de peligro para interacción grave: una herramienta para la priorización de estrategias de mejora en la seguridad de la prescripción en medicina de familia.

OBJECTIVE: To effectively locate the drugs most implicated in severe interactions as a basis of designing actions to improve patient safety in Primary Care. DESIGN: Cross-sectional study of prescriptions using the Primary Care computerised medical records database (OMI-PC). SETTING: Murcia (Spain) Health Areas I, VI, VII and IX (723,664 inhabitants). PARTICIPANTS: There are 362,271 patients over 14 years-old available in the OMI-PC and are assigned to a doctor who uses the OMI-PC regularly. MAIN MEASUREMENTS: We analysed the drugs that each patient could be taking, looking for severe interactions. We constructed a severe interaction hazard scale (e-PIG) calculating [1] the probability that a non-selected patient may be taking a particular drug and [2] the probability that a drug may produce a severe interaction. With this, we estimated the risk of producing a severe interaction for each drug, which was converted into a 5 point logarithmic scale. RESULTS: We found 83,138 patients (22.9%) at risk (they took 2 or more drugs). We identified 466,940 prescriptions providing 939 drugs and 5,597 severe interactions (prevalence 5.8%). In these, 167 drugs were involved, of which e-PIG identified 5 (3%) with an extreme value: omeprazole, diazepam, acenocoumarol, ibuprofen and calcium. CONCLUSIONS: e-PIG is a logarithmic expression of the risk that prescribing a particular drug may produce a severe interaction in a determined setting and time. Its monitoring could become a prioritisation element that may assist the design of strategies for improving the safety of the use of drugs.

Prevalence and typology of potential drug interactions occurring in primary care patients.

PURPOSE: To investigate the prevalence and types of potential drug interactions in primary care patients to detect risky prescriptions as an essential condition to design intervention policies leading to an improvement in patient safety. METHODS: Cross-sectional descriptive study. SETTING: Two areas in Spain comprising 715,661 inhabitants. PATIENTS: 430,525 subjects with electronic medical records and assigned to a family doctor regularly updating them. RESULTS: On a random day, 29.4% of the population was taking medication. Of these, 73.9% were at risk of suffering interactions, and these were found in 20.6% of them. The amount of interactions was higher among people with chronic conditions, the elderly, females and polymedicated patients. From the total of interactions, 55.1% belonged to the highest clinical relevance 'A' level, and 28.3% should have been avoided. The active ingredients primarily involved were hydrochlorothiazide and ibuprofen and, when focusing on those that should be avoided, omeprazole and acenocoumarol. The most frequent 'A' interaction that should be avoided was between non-conjugated excreted benzodiazepines and proton-pump inhibitors, followed by some NSAIDs and diuretics. CONCLUSIONS: 1 in 20 Spanish citizens is currently undergoing a potential drug interaction, including a high rate of clinically relevant ones that should be avoided. These results confirm the existence of a serious safety issue that should be approached and where all parties involved (physicians, health services, medical societies and patients) must do our bit to improve. Health services should foster the implementation of prescription alert systems linked with electronic medical records including clinical data.

Evolución de la producción científica en calidad. Análisis y mejora del proceso de evaluación en el XXIV Congreso de la Sociedad Española de Calidad Asistencial / Progress of scientific production in quality care. Analysis and improvement in the evaluation process, the XXIV Congress of the Spanish Quality Care Society

Objetivo: Analizar el proceso de evaluación de comunicaciones presentadas al Congreso de SECA celebrado en 2006 para contribuir a su mejora continua y presentar sus resultados científicos. Material y métodos: Diseño: estudio descriptivo. Evaluación de las comunicaciones por 11 parejas de evaluadores mediante criterios explícitos puntuables y cuestionario estructurado. Población: todas las comunicaciones recibidas. Proceso: selección de comunicaciones según decisión concordante de las parejas de evaluadores. Las discrepancias fueron reevaluadas por una terna de evaluadores. Para la adjudicación de premios todos los evaluadores reevaluaron las comunicaciones propuestas que no mostrasen discrepancias de puntuación mayores de 25 puntos. La presentación de las comunicaciones seleccionadas fue revisada por un jurado seleccionado al efecto que contaba con una guía de evaluación expresamente diseñada. La satisfacción de los congresistas fue evaluada mediante cuestionario anónimo. Resultados: Se recibieron 849 comunicaciones. Cada evaluador evaluó una media de 79 (puntuación media, 56 puntos). Fueron aceptadas 762 (89,7%), el 56,8% en formato póster. En números absolutos, el mayor número de comunicaciones procedió de Madrid (133) y Cataluña (124). Ajustado por millón de habitantes, destacan Cantabria y Murcia. Conclusiones: La evaluación de comunicaciones es un proceso metodológicamente complejo y, a pesar de las medidas correctoras introducidas en los últimos años, continúa siendo mejorable, condicionado por la necesidad de limitar la extensión de las comunicaciones a evaluar y de compatibilizar con la gestión de tiempos en la organización del Congreso. Las aportaciones científicas al Congreso mantienen la tendencia ascendente; su sede representa una oportunidad territorial para impulsar trabajos de calidad

Objective: To analyze the process of evaluating abstracts in the 2006 National Quality in Healthcare Conference in order to contribute to its continuous improvement, and to present its main scientific results. Material and methods: Design: descriptive study. 11 pairs of reviewers using explicit criteria evaluated abstracts. Population: all the abstracts received. Process: abstracts were accepted/rejected according to reviewers' concordant decisions. Disagreements were re-evaluated by 3 reviewers. Accepted abstracts were organized and distributed in the Conference according to the following criteria: total amount, available room and time, number of reviewers. The abstracts nominated for awards and which did not have discrepancies higher than 25 points were re-evaluated by all the reviewers. Their presentations in the Conference were also reviewed by a panel of judges created for this purpose, according to an evaluation guide. Results: 849 communications were received. Each reviewer evaluated a mean of 79 communications, obtaining an average score of 56 points. 762 communications were accepted (89.7%), 56.8% of them as a poster. Madrid (133) and Catalonia (124) had the highest amount of presentations in the Conference, but Cantabria and Murcia obtained the highest rates per million inhabitants. Conclusions: Despite the recently introduced changes, evaluating abstracts is a complex methodological process that still can be improved. It is conditioned by the need for limiting the extension of oral presentations and Conference time management. The scientific contribution to the Conference keeps rising. Its venue represents a geographic opportunity to encourage quality works

[Not Available]. / Evolución de la producción científica en calidad. Análisis y mejora del proceso de evaluación en el XXIV Congreso de la Sociedad Española de Calidad Asistencial.

OBJECTIVE: To analyze the process of evaluating abstracts in the 2006 National Quality in Healthcare Conference in order to contribute to its continuous improvement, and to present its main scientific results. DESIGN: descriptive study. 11 pairs of reviewers using explicit criteria evaluated abstracts. POPULATION: all the abstracts received. PROCESS: abstracts were accepted/rejected according to reviewers' concordant decisions. Disagreements were re-evaluated by 3 reviewers. Accepted abstracts were organized and distributed in the Conference according to the following criteria: total amount, available room and time, number of reviewers. The abstracts nominated for awards and which did not have discrepancies higher than 25 points were re-evaluated by all the reviewers. Their presentations in the Conference were also reviewed by a panel of judges created for this purpose, according to an evaluation guide. RESULTS: 849 communications were received. Each reviewer evaluated a mean of 79 communications, obtaining an average score of 56 points. 762 communications were accepted (89.7%), 56.8% of them as a poster. Madrid (133) and Catalonia (124) had the highest amount of presentations in the Conference, but Cantabria and Murcia obtained the highest rates per million inhabitants. CONCLUSIONS: Despite the recently introduced changes, evaluating abstracts is a complex methodological process that still can be improved. It is conditioned by the need for limiting the extension of oral presentations and Conference time management. The scientific contribution to the Conference keeps rising. Its venue represents a geographic opportunity to encourage quality works.