Malignant asbestos-related disease in a population exposed to asbestos.

OBJECTIVES: The first asbestos fiber cement plant in Spain operated in Cerdanyola, in the Barcelona metropolitan area, between 1907 and 1997. We describe clinical and epidemiological characteristics of patients diagnosed with the malignant asbestos-related disease (ARD) in the area of the plant between 2007 and 2016. METHODS: A prospective, descriptive study was undertaken in the 12 municipalities of the county of Barcelona most proximate to the plant. We describe malignant ARD cases by time of diagnosis, source of exposure, periods of exposure and latency, and distribution by sex. Cumulative incidence and age-standardized incidence rates (ASIR) are calculated. RESULTS: Of 477 patients diagnosed with ARD between 2007 and 2016, 128 (26%) presented with asbestos-associated malignancy. Pleural mesothelioma was noted in 105 patients (82.0%) with a linear trend Z-score of -0.2 (NS) in men and 2.7 (P < .01) in women. The highest ASIRs for malignant ARD (6.1/100 000 residents/year; 95% confidence interval [CI], 2.2-13.3) and pleural mesothelioma (4.8/100 000 residents/year; 95% CI, 1.5-11.6) occurred in municipalities closest to the focal point of contamination. The origin of malignant ARD was nonoccupational in 32.2% of men and 81.6% of women (P < .001). CONCLUSIONS: More than 20 years after the closure of the fiber cement plant, the grave consequences of exposure to asbestos remain. The detection of cases of pleural mesothelioma in men seems to have plateaued whereas in women an ascending trend continues, which principally has its origin in nonoccupational exposures.

Risk Factors of Mortality from All Asbestos-Related Diseases: A Competing Risk Analysis.

BACKGROUND: The mortality from all malignant and nonmalignant asbestos-related diseases remains unknown. The authors assessed the incidence and risk factors for all asbestos-related deaths. METHODS: The sample included 544 patients from an asbestos-exposed community in the area of Barcelona (Spain), between Jan 1, 1970, and Dec 31, 2006. Competing risk regression through a subdistribution hazard analysis was used to estimate risk factors for the outcomes. RESULTS: Asbestos-related deaths were observed in 167 (30.7%) patients and 57.5% of these deaths were caused by some type of mesothelioma. The incidence rate after diagnosis was 3,600 per 100,000 person-years. In 7.5% of patients death was non-asbestos-related, while pleural and peritoneal mesothelioma were identified in 87 (16.0%) and 18 (3.3%) patients, respectively. CONCLUSIONS: Age, sex, household exposure, cumulative nonmalignant asbestos-related disease, and single malignant pathology were identified as risk factors for asbestos-related death. These findings suggest the need to develop a preventive approach to the community and to improve the clinical follow-up process of these patients.

Pleural mesothelioma in relation to meteorological conditions and residential distance from an industrial source of asbestos.

OBJECTIVES: Few studies have focused on pleural mesothelioma and environmental exposure in individuals residing around an industrial source of asbestos. The aim of this study is to determine whether residential distance and wind conditions are related to the risk of developing pleural mesothelioma. METHODS: In this retrospective cohort study carried out in an area of Barcelona province (Catalonia, Spain), 24 environmental pleural mesothelioma cases were diagnosed between 2000 and 2009. We calculated the age-standardised incidence rate ratios of developing this disease in the population studied, taking into account the residential distance from the plant. For cases living within a 500-m radius of the plant, the geographical location in relation to the factory was also assessed. RESULTS: The incidence rate of environmental pleural mesothelioma was higher in the population living within 500 m of the plant than in those living in a radius of 500-2000 m and much higher than those living at 2000-10 000 m. The highest incidence rate ratio for pleural mesothelioma (161.9) was found in the southeast quadrant of the 500-m area, coinciding with the predominant wind direction. CONCLUSIONS: Residential distance from an industrial source of asbestos and local wind conditions have a considerable impact on the risk of developing environmental pleural mesothelioma.

Prospective study of asbestos-related diseases incidence cases in primary health care in an area of Barcelona province.

BACKGROUND: Asbestos related diseases include a number of conditions due to inhalation of asbestos fibres at work, at home or in the environment, such as pleural mesothelioma, asbestosis and calcified pleural plaques. Few epidemiological studies have established the incidence of asbestos related diseases in our area. The present proposal is based on a retrospective study externally funded in 2005 that is currently taking place in the same area and largely carried out by the same research team.The aim of the study is to achieve a comprehensive and coordinated detection of all new cases of Asbestos Related Diseases presenting to primary care practitioners. METHODS/DESIGN: This is a multicentre, multidisciplinary and pluri-institutional prospective study.Setting12 municipalities in the Barcelona province within the catchment area of the health facilities that participate in the study.SampleThis is a population based study, of all patients presenting with diseases caused by asbestos in the study area.MeasurementsA clinical and epidemiological questionnaire will be filled in by the trained researchers after interviewing the patients and examining their clinical reports. DISCUSSION: Data on the incidence of the different Asbestos Related Diseases in this area will be obtained and the most plausible exposure source and space-time-patient profile will be described. The study will also improve the standardization of patient management, the coordination between health care institutions and the development of preventive activities related with asbestos exposure and disease.

Enfermedad por amianto en una población próxima a una fábrica de fibrocemento / Asbestos-Related Diseases in a Population Neara Fibrous Cement Factory

Introducción: En 1907 se instaló en Cerdanyola (Barcelona) la primera fabrica de fibrocemento de España, que actuó como foco contaminante hasta su cierre en 1997. El objetivo del estudio ha sido conocer las características clinico epidemiológicas de la población afectada por enfermedades relacionadas con el amianto (ERA) que había trabajado o/y vivía en el entorno de esta fábrica. Material y métodos: Se trata de un estudio retrospectivo que reúne la información disponible de los pacientes afectados de ERA que residían en el momento del diagnóstico en la zona cercana a la factoría de fibrocemento. La información se obtuvo a partir de la documentación médica de los centros de atención primaria de las 12 poblaciones circundantes y del único hospital de referencia de la zona, para los casos diagnosticados entre el 1 de enero de 1970 y el 31 de diciembre de 2006. Resultados: En los 559 pacientes diagnosticados se identificaron 1.107 casos de ERA. La incidencia anual media entre 2000 y 2006 fue de 9,5 pacientes por 100.000 habitantes para toda la zona, y de 35,5 para la más próxima a la fábrica. La prevalencia de pacientes con ERA a fecha de 31 de diciembre de 2006 fue de 91 por 100.000 personas en toda la zona y de 353,4 en la más próxima a la fábrica. De los 1.107 casos, el 86,5%correspondía a enfermedad benigna y el 8,4%a mesotelioma pleural. Conclusiones: En lazona estudiada, la fábrica supuso un factor de riesgo importante de ERA para sus trabajadores y la población cercana. La detección de casos mostró una tendencia ascendente. La incidencia de ERA fue muy elevada (AU)

Background and Objective: The first fibrous cement factory in Spain was setup in Cerdanyola, Barcelona, in 1907 and was a source of pollution there untilit was closed in 1997. The aim of this study was to determine the clinical and epidemiologic characteristics of the population with by asbestos-related diseases who had worked in the factory and/or lived in the vicinity. Material and Methods: We retrospectively collected information available on patients with asbestos-related diseases who at the time of diagnosis had resided in the are an ear the fibrous cement factory. Information was obtained from the medical records of the primary care centers of the 12 surrounding towns and the sole referral hospital in the area for cases diagnosed between January 1, 1970 and December 31, 2006. Results: In the 559 patients diagnosed, 1107 cases of asbestos-related diseases were identified. Between 2000 and 2006, the average annual incidence was 9.5 cases per 100000 inhabitants for the entire study area and 35.5 cases per 100000 for the area nearest the factory. The prevalence of asbestos-related diseases as of December 31, 2006 was 91 cases per 100000 inhabitants in the entire study area and 353.4 cases per 100000 in the area nearest the factory. Of the 1107 asbestos-related disease cases identified, 86.5% were benignand 8.4%pleural mesothelioma. Conclusions: The factory introduced an important area-wide risk factor for asbestos-related diseases for both workers and for the nearby population. The number of cases of asbestos-related diseases detected annually showed an up ward trend. The incidence was extremely high in the period studied (AU)

[Asbestos-related diseases in a population near a fibrous cement factory]. / Enfermedad por amianto en una población próxima a una fábrica de fibrocemento.

BACKGROUND AND OBJECTIVE: The first fibrous cement factory in Spain was set up in Cerdanyola, Barcelona, in 1907 and was a source of pollution there until it was closed in 1997. The aim of this study was to determine the clinical and epidemiologic characteristics of the population with by asbestos-related diseases who had worked in the factory and/or lived in the vicinity. MATERIAL AND METHODS: We retrospectively collected information available on patients with asbestos-related diseases who at the time of diagnosis had resided in the area near the fibrous cement factory. Information was obtained from the medical records of the primary care centers of the 12 surrounding towns and the sole referral hospital in the area for cases diagnosed between January 1, 1970 and December 31, 2006. RESULTS: In the 559 patients diagnosed, 1107 cases of asbestos-related diseases were identified. Between 2000 and 2006, the average annual incidence was 9.5 cases per 100,000 inhabitants for the entire study area and 35.5 cases per 100,000 for the area nearest the factory. The prevalence of asbestos-related diseases as of December 31, 2006 was 91 cases per 100,000 inhabitants in the entire study area and 353.4 cases per 100,000 in the area nearest the factory. Of the 1107 asbestos-related disease cases identified, 86.5% were benign and 8.4% pleural mesothelioma. CONCLUSIONS: The factory introduced an important area-wide risk factor for asbestos-related diseases for both workers and for the nearby population. The number of cases of asbestos-related diseases detected annually showed an upward trend. The incidence was extremely high in the period studied.

[Patterns of health services use and costs in patients with mental disorders in primary care]. / Costes y patrón de uso de servicios en pacientes que demandan atención por problemas mentales en asistencia primaria.

OBJECTIVES: To determine the pattern of services use and costs of patients requiring care for mental disorders (MD) in primary care in the context of routine clinical practice. METHODS: We performed a retrospective study of patients older than 15 consulting primary care at least once for MD, attended by 5 primary care teams in 2004. A comparative group was formed with the remaining outpatients without MD. The main measurements were age, gender, case-mix/comorbidity and health resource utilization and corresponding outpatient costs (drugs, diagnostic tests and visits). Multiple logistic regression analysis and ANCOVA models were applied. RESULTS: A total of 64,072 patients were assessed, of which 11,128 had some type of MD (17.4%; 95% CI, 16.7-18.1). Patients consulting for MD had a greater number of health problems (6.7 vs. 4.7; p < 0.0001) and higher resource consumption, mainly all-type medical visits/patient/year (10.7 vs. 7.2; p < 0.0001). The mean annual cost per patient was higher for patients with MD (851.5 vs. 519.2 euros; p < 0.0001), and this difference remained significant after adjusting by age, sex and comorbidities, with a differential cost of euros 72.7 (95% CI, 59.2-85.9). All components of outpatient management costs were significantly higher in the MD group. CONCLUSIONS: Outpatients seeking care for some type of MD had a high number of comorbidities and showed greater annual cost per patient in the primary care setting.

Costes y patrón de uso de servicios en pacientes que demandan atención por problemas mentales en asistencia primaria / Patterns of health services use and costs in patients with mental disorders in primary care

Objetivos: Determinar el patrón de uso de servicios y costes en pacientes que demandan atención por problemas mentales (PM) en asistencia primaria en situación de práctica clínica habitual. Métodos: Estudio retrospectivo. Se incluyeron pacientes mayores de 15 años, con al menos una demanda de atención por PM, atendidos por 5 equipos de atención primaria durante el año 2004. Se formó un grupo comparativo con el resto de pacientes sin PM. Las variables fueron: edad, sexo, casuística/comorbilidad, utilización de recursos sanitarios y costes ambulatorios correspondientes (medicamentos, procedimientos diagnósticos y visitas). Se empleó el análisis de regresión logística múltiple y modelos de ANCOVA. Resultados: Se incluyeron 64.072 pacientes, de los cuales 11.128 presentaron algún PM (17,4%; intervalo de confianza [IC] del 95%, 16,7-18,1). Los pacientes que demandaron atención por PM presentaron un mayor número de problemas de salud (6,7 frente a 4,7; p < 0,0001) y de utilización de recursos sanitarios, particularmente visitas médicas/paciente/año (10,7 frente a 7,2; p < 0,0001). El coste medio anual en pacientes con PM fue significativamente superior (851,5 frente a 519,2 euros; p < 0,0001) y se mantuvo después de corregir por edad, sexo y comorbilidades, con un coste diferencial de 72,7 euros (IC del 95%, 59,2-85,9). Todos los componentes del coste por paciente fueron mayores en el grupo de pacientes con PM. Conclusiones: Los pacientes que han demandado atención por algún PM presentan un elevado número de comorbilidades y un mayor coste anual por paciente en el ámbito de la atención primaria

Objectives: To determine the pattern of services use and costs of patients requiring care for mental disorders (MD) in primary care in the context of routine clinical practice. Methods: We performed a retrospective study of patients older than 15 consulting primary care at least once for MD, attended by 5 primary care teams in 2004. A comparative group was formed with the remaining outpatients without MD. The main measurements were age, gender, case-mix/comorbidity and health resource utilization and corresponding outpatient costs (drugs, diagnostic tests and visits). Multiple logistic regression analysis and ANCOVA models were applied. Results: A total of 64,072 patients were assessed, of which 11,128 had some type of MD (17.4%; 95% CI, 16.7-18.1). Patients consulting for MD had a greater number of health problems (6.7 vs. 4.7; p < 0.0001) and higher resource consumption, mainly all-type medical visits/patient/year (10.7 vs. 7.2; p < 0.0001). The mean annual cost per patient was higher for patients with MD (851.5 vs. 519.2 euros; p < 0.0001), and this difference remained significant after adjusting by age, sex and comorbidities, with a differential cost of euros 72.7 (95% CI, 59.2-85.9). All components of outpatient management costs were significantly higher in the MD group. Conclusions: Outpatients seeking care for some type of MD had a high number of comorbidities and showed greater annual cost per patient in the primary care setting

Adjusted Clinical Groups use as a measure of the referrals efficiency from primary care to specialized in Spain.

BACKGROUND: To determine the referral rate (RR) per centre, its main causes and the adjusted efficiency indexes, through the retrospective implementation of the Adjusted Clinical Groups (ACG) in a Spanish primary care setting. METHODS: Design descriptive-retrospective study. Attended patients by five primary care teams (PCT) during the year 2004 were included. General parameters, age, gender, dependent (visits and episodes), and comorbidity of each patient relative to each ACG are used as measures. The RR was defined as the quotient between the number of referrals and the visits made. Efficiency Index (EI) was established dividing the observed by the expected referrals obtained by indirect standardization. Statistical significance P<0.05. RESULTS: Studied patients 81,335 (use: 76.9%), 5.0+/-3.6 episodes and 7.9+/-7.8 visits/patient/year. Percentage of visits with a referral, adjusted for morbidity burden, was 7.5% (CI: 7.3-7.7); age: 48.3+/-22.7 years (women: 55.9%), P=0.000. The average of referrals was of 59.6 per 100 attended patients/year (P=0.000). Visits and episodes explain 34.1-68.1%, respectively (P=0.000), the explanatory power of the classification's variability was of 23.6% (P=0.0001). EI per centre were: 0.95 (CI: 0.82-1.08); 0.78 (CI: 0.63-0.93); 0.88 (CI: 0.73-1.03); 1.15 (CI: 1.03-1.27) and 1.08 (CI: 0.95-1.21), P=0.034 (family practice); and 0.83 (CI: 0.70-0.96); 0.83 (CI: 0.68-0.98); 0.84 (CI: 0.70-0.98); 1.24 (CI: 1.12-1.36) and 1.16 (CI: 1.03-1.29), P=0.041 (paediatrics), respectively. CONCLUSIONS: Adjusted morbidity by ACG explains an important part of the referrals variability. The study results must be interpreted cautiously even after adjustment by age, gender and morbidity. Should the results be confirmed, it would allow an improvement in the measurement of referrals for clinical management in the PCT.

[Comparative study at 4 health centres of efficiency, measured on the basis of ambulatory care groups]. / Estudio comparativo de la eficiencia, medida a partir de los Ambulatory Care Groups, entre 4 centros de salud.

OBJECTIVE: To measure efficiency in the use of resources for the care lists of four primary care centres (PCC), by using ambulatory care Groups (ACGs). DESIGN: Retrospective, observational study. SETTING: Four PC teams. PARTICIPANTS: All patients attended during 2003. MEASUREMENTS: Dependent variables (costs per patient, between medical lists [family medicine, paediatrics] and PCCs) and case load variables. The model of costs for each patient was set by differentiating the semi-fixed and variable costs. The efficiency index (EI) was set as the quotient between the observed real cost and the expected cost on the basis of ACG distribution, by indirect standardization. The study population was 62,311 patients seen, with an average of 4.8+/-3.2 episodes/patient/year. MAIN RESULTS: The total health care cost reached 24,135,236.62 euro, of which 65.2% was for prescription, 28.9% for semi-fixed costs, and 2.9% for cost of specialist referrals. The average total cost per patient/year was 387.34 euro+/-145.87 euro (average relative weight). The EI for each centre was: 0.93 (95% CI, 0.85-1.01), 0.97 (95% CI, 0.89-1.05), 1.04 (95% CI, 0.96-1.12), and 1.05 (95% CI, 0.97-1.13), P < .0001. In addition, differences between the medical lists (rank, 0.63-1.56) and between the paediatrics lists (rank, 0.73-1.26) were found (P = .005). CONCLUSIONS: The ACGs enabled us to estimate the efficiency of our PCCs and care lists. Efficiency cannot be isolated from other dimensions of the quality of health care delivery. Study of the EI improved our understanding of the profile of professionals and health centres.

Estudio comparativo de la eficiencia, medida a partir de los Ambulatory Care Groups, entre 4 centros de salud / Comparative study at 4 health centres of efficiency, measured on the basis of ambulatory care groups

Objetivo. Medir la eficiencia en el uso de recursos entre los cupos asistenciales de 4 centros de atención primaria de salud (APS), a partir de la utilización de los Ambulatory Care Groups (ACG). Diseño. Estudio observacional retrospectivo. Emplazamiento. Cuatro equipos de atención primaria. Participantes. Todos los pacientes atendidos durante el año 2003. Mediciones. Variables dependientes (costes por paciente, entre cupos médicos [medicina de familia, pediatría] y centros asistenciales) y de casuística. El modelo de costes para cada paciente se estableció diferenciando los costes semifijos y los variables. El índice de eficiencia (IE) se estableció entre el cociente entre el coste real observado y el coste esperado en función de la distribución ACG, por estandarización indirecta. Resultados principales. La población de estudio fue de 62.311 pacientes atendidos, con una media de 4,8 ± 3,2 episodios/paciente/año. El coste total de la atención sanitaria ascendió a 24.135.236,62 €, de los cuales el 65,2% correspondió a la prescripción de farmacia, el 28,9% a los costes semifijos y el 2,9% al coste de las derivaciones a especialistas. El promedio de coste total por paciente/año fue de 387,34 ± 145,87 € (peso relativo medio). El IE por centro fue de 0,93 (intervalo de confianza [IC] del 95% 0,85-1,01), 0,97 (IC del 95% del 95% 0,89-1,05), 1,04 (IC del 95% 0,96-1,12) y 1,05 (IC del 95%, 0,97-1,13), respectivamente (p < 0,0001). Además, se observan diferencias entre los cupos médicos (rango, 0,63-1,56) y entre los cupos pediátricos (rango, 0,73-1,26) (p = 0,005). Conclusiones. Los ACG permiten realizar una aproximación a la medida de la eficiencia de centros y cupos asistenciales de APS de nuestro entorno. La eficiencia no puede ser considerada de manera aislada de otras dimensiones de la calidad asistencial. El estudio del IE permite profundizar en el conocimiento del perfil de los profesionales y de los centros de salud

Objective. To measure efficiency in the use of resources for the care lists of four primary care centres (PCC), by using ambulatory care Groups (ACGs). Design. Retrospective, observational study. Setting. Four PC teams. Participants. All patients attended during 2003. Measurements. Dependent variables (costs per patient, between medical lists [family medicine, paediatrics] and PCCs) and case load variables. The model of costs for each patient was set by differentiating the semi-fixed and variable costs. The efficiency index (EI) was set as the quotient between the observed real cost and the expected cost on the basis of ACG distribution, by indirect standardization. The study population was 62 311 patients seen, with an average of 4.8±3.2 episodes/patient/year. Main results. The total health care cost reached €24 135 236.62, of which 65.2% was for prescription, 28.9% for semi-fixed costs, and 2.9% for cost of specialist referrals. The average total cost per patient/year was €387.34±€145.87 (average relative weight). The EI for each centre was: 0.93 (95% CI, 0.85-1.01), 0.97 (95% CI, 0.89-1.05), 1.04 (95% CI, 0.96-1.12), and 1.05 (95% CI, 0.97-1.13), P<.0001. In addition, differences between the medical lists (rank, 0.63-1.56) and between the paediatrics lists (rank, 0.73-1.26) were found (P=.005). Conclusions. The ACGs enabled us to estimate the efficiency of our PCCs and care lists. Efficiency cannot be isolated from other dimensions of the quality of health care delivery. Study of the EI improved our understanding of the profile of professionals and health centres

[Measurement of relative cost weights as an effect of the retrospective application of adjusted clinical groups in primary care]. / Medida de los pesos relativos del coste de la asistencia como efecto de la aplicación retrospectiva de los adjusted clinical groups en atención primaria.

OBJECTIVE: The objective of the study is to obtain the cost's relative average weights of the assistance with the retrospective application of the Adjusted Clinical Groups (ACG's) in four teams of Primary Care with an attended population in the habitual clinical practice situation. METHODS: Descriptive study of retrospective character. It was included in the study all attended patients by four teams of Primary Care during year 2003. The main measures were: universal variables (age and gender), dependents (visits and costs) and casuistic and co morbidity. The model of cost per each patient was established differencing the fix costs and the variable ones. Was effected a multiple lineal regression analysis for the prediction of models. The relative cost of each ACG was obtained dividing the average cost of each category among the average cost of each population of reference. RESULTS: The total number of the studied patients was 62,311 (intensity of use: 76.7%), with an average 4.8 +/- 3.2 episodes and 7.8 +/- 7.5 visits/patient/year. The distribution of costs was 24,135,236.41 euro, 28.9% for fix. The total unitary cost per visit/year was 49.62 +/- 24.71 euro and the average of the total cost per patient/year 387.34 +/- 145.87 euro (relative weights of reference). The explicative power of the classification of ACG was 50.1% in visits and 54.9% for total costs. CONCLUSIONS: The ACG are an acceptable system of classification of patients in situation of habitual clinic practice. In case results were confirmed will make possible an improvement in the practice application of ACG as a possible tool for the clinical management in Primary Care centers.

[Prospects of adjusted clinical groups (ACG's) in capitated payment risk adjustment]. / Posibilidades de los grupos clínicos ajustados (ajusted clinical groups-ACGS) en el ajuste de riesgos de pago capitativo.

BACKGROUND: Most patient classification systems have been designed in the United States for the purpose of availing of a tool providing a means of gauging the use of resources. This study was aimed at calculating the mean relative weights (MRW's) for the cost of care at several primary care health facilities as compared to those in the U.S. by using the Adjusted Clinical Groups (ACG's) as a possible capitated payment risk adjustment. METHODS: Descriptive study. All of the clinical records generated by four primary care facilities throughout 2003 were included. The main measurements were: age and gender, resources (visits and costs) and casuistics. The cost model was determined for each individual patient by differentiating the fixed and variable costs. A regression analysis was made for model adjustment purposes. The relative cost of each ACG was calculated by dividing the mean cost of each category by the mean cost of the population as a whole. RESULTS: A total of 62,311 records were studied, revealing an average of 4.8 +/- 3.2 diagnoses and 7.8 +/- 7.5 visits/patient/year. The total expense was 24.1 million euros, the fixed and semi-fixed costs totaling 28.9% and the variable costs 71.1%. The mean total cost/patient/year was 387.34 +/- 145.87? (reference). The adjusted explicative power of the cost of care between the two classifications (U.S. classification vs. the one studied) was 64.3%; p = 0.000). CONCLUSIONS: The generalization of the results must be carefully construed. ACG's show themselves to be a suitable tool, and the mean U.S. RW's could be used for adjusting capitated payment risk adjustments in view of the difficulty of availing of full, consistent databases in our environment. Further research would be required to back up the consistency of the results.

Medida de los pesos relativos del coste de la asistencia como efecto de la aplicación retrospectiva de los adjusted clinical groups en atención primaria / Measurement of relative cost weights as an effect of the retrospective application of adjusted clinical groups in primary care

Objetivo: El objeto del estudio es obtener los pesos relativos medios de los costes de la asistencia con la aplicación retrospectiva de los adjusted clinical groups (ACG) en población atendida por equipos de atención primaria en situación de práctica clínica habitual. Métodos: Estudio descriptivo de carácter retrospectivo. Fueron incluidos en el estudio todos los pacientes atendidos por 4 equipos de atención primaria durante el año 2003. Las principales mediciones fueron: variables universales (edad y sexo), dependientes (visitas y costes) y de casuística o comorbilidad. El modelo de costes para cada paciente se estableció diferenciando los costes fijos y los variables. Se efectuó un análisis de regresión lineal múltiple para la predicción de los modelos. El coste relativo de cada ACG se obtuvo dividiendo el coste medio de cada categoría entre el coste medio de toda la población de referencia. Resultados: El número total de pacientes estudiados fue de 62.311 (intensidad de uso del 76,7%), con una media de 4,8 ± 3,2 episodios y 7,8 ± 7,5 visitas/paciente/año. La distribución de los costes fue de 24.135.236,41 €, el 28,9% fijos. El coste unitario total por visita/año fue de 49,62 ± 24,71 € y el promedio paciente/año de 387,34 ± 145,87 € (pesos relativos de referencia). El poder explicativo de la clasificación ACG fue del 50,1% en las visitas y del 54,9% para los costes totales. Conclusiones: Los ACG se muestran como un aceptable sistema de clasificación de pacientes en situación de práctica clínica habitual. De confirmarse los resultados posibilitarían una mejora en la aplicación práctica de los ACG como una posible herramienta para la gestión clínica en los centros de atención primaria

Objective: The objective of the study is to obtain the cost's relative average weights of the assistance with the retrospective application of the Adjusted Clinical Groups (ACG's) in four teams of Primary Care with an attended population in the habitual clinical practice situation. Methods: Descriptive study of retrospective character. It was included in the study all attended patients by four teams of Primary Care during year 2003. The main measures were: universal variables (age and gender), dependents (visits and costs) and casuistic and co morbidity. The model of cost per each patient was established differencing the fix costs and the variable ones. Was effected a multiple lineal regression analysis for the prediction of models. The relative cost of each ACG was obtained dividing the average cost of each category among the average cost of each population of reference. Results: The total number of the studied patients was 62,311 (intensity of use: 76.7%), with an average 4.8 ± 3.2 episodes and 7.8 ± 7.5 visits/patient/year. The distribution of costs was 24,135,236.41 €, 28.9% for fix. The total unitary cost per visit/year was 49.62 ± 24.71 € and the average of the total cost per patient/year 387.34 ± 145.87 € (relative weights of reference). The explicative power of the classification of ACG was 50.1% in visits and 54.9% for total costs. Conclusions: The ACG are an acceptable system of classification of patients in situation of habitual clinic practice. In case results were confirmed will make possible an improvement in the practice application of ACG as a possible tool for the clinical management in Primary Care centers

Posibilidades de los grupos clínicos ajustados (ajusted clinical groups-acgs) en el ajuste de riesgos de pago capitativo / Prospects of adjusted clinical groups (ACG´s) in capitated payment risk adjustment

Fundamento: La mayoría de los sistemas de clasificación depacientes han sido diseñados en Estados Unidos con la finalidad dedisponer de una herramienta que facilite una medida en la utilizaciónde los recursos. El objeto del estudio fue obtener los pesos relativos(PR) medios del coste de la asistencia en varios equipos de atenciónprimaria de salud, en comparación con los americanos, mediante laaplicación de los Grupos Clínicos Ajustados (ACGs), como un posibleajuste de riesgos de pago capitativo.Métodos: Estudio descriptivo. Se incluyeron todas las historiasclínicas generadas por cuatro equipos de atención primaria durante elaño 2003. Las principales mediciones fueron: edad y sexo, recursos(visitas y costes) y casuística. El modelo de costes para cada pacientese estableció diferenciando los costes fijos y variables. Se efectuóun análisis de regresión para la corrección del modelo. El coste relativode cada ACG se obtuvo dividiendo el coste medio de cada categoríaentre el coste medio de toda la población de referencia.Resultados: El número total de historias estudiadas fue de62.311, con una media de 4,8±3,2 diagnósticos y 7,8±7,5visitas/paciente/año. El gasto total fue de 24,1 millones de euros, loscostes fijos o semifijos representan el 28,9% y los variables el71,1%. El promedio de coste total por paciente/año fue de387,34±145,87? (referencia). El poder explicativo corregido delcoste de la asistencia entre las dos clasificaciones (estadounidenserespecto a la estudiada) fue del 64,3%; p=0,000).Conclusiones: La generalización de los resultados debe de interpretarsecon prudencia. Los ACGs se muestran como un instrumentoadecuado y podrían utilizarse los PR medios estadounidenses parael ajuste del riesgo en el pago capitativo, ante la dificultad de tenerbases de datos amplias y consistentes en nuestro medio. Sería necesarioesperar nuevas investigaciones que refuercen la consistencia delos resultados

Background: Most patient classification systems have beendesigned in the United States for the purpose of availing of a toolproviding a means of gauging the use of resources. This study wasaimed at calculating the mean relative weights (MRW´s) for thecost of care at several primary care health facilities as compared tothose in the U.S. by using the Adjusted Clinical Groups (ACG´s) asa possible capitated payment risk adjustment.Methods: Descriptive study. All of the clinical records generatedby four primary care facilities throughout 2003 were included.The main measurements were: age and gender, resources (visits andcosts) and casuistics. The cost model was determined for each individualpatient by differentiating the fixed and variable costs. Aregression analysis was made for model adjustment purposes. Therelative cost of each ACG was calculated by dividing the mean costof each category by the mean cost of the population as a whole.Results: A total of 62,311 records were studied, revealing anaverage of 4.8±3.2 diagnoses and 7.8±7.5 visits/patient/year. Thetotal expense was 24.1 million euros, the fixed and semi-fixed coststotaling 28.9% and the variable costs 71.1%. The mean totalcost/patient/year was 387.34±145.87? (reference). The adjustedexplicative power of the cost of care between the two classifications(U.S. classification vs. the one studied) was 64.3%; p=0,000).Conclusions: The generalization of the results must be carefullyconstrued. ACG´s show themselves to be a suitable tool, and themean U.S. RW´s could be used for adjusting capitated payment riskadjustments in view of the difficulty of availing of full, consistentdatabases in our environment. Further research would be required toback up the consistency of the results