Asociación entre calidad de atención y el nivel de saturación del servicio de urgencias de un hospital de Hidalgo, México / Association between quality of care and the level of saturation of the emergency department of a hospital in Hidalgo, Mexico

La calidad de atención en los servicios médicos en México representa el reflejo de un conjunto de acciones que el sistema de salud ha encaminado para equilibrar la oferta de dichos servicios con la demanda de los usuarios y conseguir elevar su grado de satisfacción. OBJETIVO: Analizar la asociación entre calidad de atención y el nivel de saturación del servicio de urgencias de un hospital de Hidalgo, México. METODOLOGÍA: Se realizó una revisión sistemática en PubMed y SciELO - Scientific Electronic Library Online en el mes de marzo del año 2020, mediante las palabras clave: calidad de atención médica, servicios de urgencia hospitalaria, antecedentes de calidad en México, nivel de saturación de los servicios de urgencia médica, calidad en el sistema de salud mexicano. También se buscó "google académico" con los mismos términos, la búsqueda se realizó en español. RESULTADOS: La calidad técnica de la atención, valorada mediante el apego a Protocolos de atención médica y Guías de Práctica Clínica, denota áreas de oportunidad, principalmente en primer nivel de atención, tiempos de espera prolongados, días de hospitalización, los errores médicos, entre otros se perciben como asociados a la mala calidad de la atención. CONCLUSIÓN: Por los resultados detectados en las referencias consultadas, es necesario analizar los nichos del sistema que se encuentran en mayor estado de vulnerabilidad como lo es el nivel de saturación del servicio de urgencias, trabajar en los indicadores de calidad de la atención con recursos materiales y humanos, de lo contrario los resultados ante la saturación de los servicios de salud continuaran con percepción negativa, esto es, resultados no positivos

The quality of care in medical services in Mexico reflects the set of actions that the health system has aimed to balance the supply of these services with the demand of users and to increase their degree of satisfaction. AIM: To analyze the association between quality of care and the level of saturation of the emergency department of a hospital in Hidalgo, Mexico. METHODOLOGY: A systematic review was carried out in PubMed and SciELO - Scientific Electronic Library Online in March 2020, using the keywords: quality of medical care, hospital emergency services, quality history in Mexico, level of saturation of services of medical emergency, quality in the Mexican health system. We also searched for "academic google" with the same terms, the search was carried out in Spanish. RESULTS: The technical quality of care, valued through adherence to protocols of medical care and Clinical Practice Guidelines, denotes areas of opportunity, mainly in the first level of care, long waiting times, days of hospitalization, medical errors, among others. perceived as associated with poor quality of care. CONCLUSION: Due to the results detected in the references consulted, it is necessary to analyze the niches of the system that are in the highest state of vulnerability, such as the level of saturation of the emergency service, work on the quality of care indicators with material and human resources Otherwise, the results in the face of the saturation of health services will continue with a negative perception, that is, non-positive results

La buena enfermera según las personas mayores: "que sea amable, dedicada y que me explique" / The Good Nursing for Older People: "She is kind, dedicated and she explains to me"

OBJETIVO PRINCIPAL: Describir las percepciones y prácticas asociadas por las personas mayores a la buena enfermera, analizando sus expectativas y necesidades de atención en cuidados. METODOLOGÍA: Estudio cualitativo descriptivo de orientación epidemiológica sociocultural que aplica 119 entrevistas en usuarios adultos mayores de la red pública asistencial en sectores urbanos vulnerables de Chile. Se analizan dimensiones respecto de la apreciación de una buena y mala enfermera, atendiendo sus características personales, modos de relación y prácticas profesionales. La confiabilidad del estudio se fundó en la saturación empírica y la triangulación por investigador. RESULTADOS PRINCIPALES: Las personas mayores perciben que la buena enfermera es una profesional amable y con vocación. Las principales prácticas que satisfacen sus expectativas y necesidades de atención son el buen trato y la orientación terapéutica. CONCLUSIÓN PRINCIPAL: La buena enfermera es percibida como aquella que trata bien a sus pacientes, lo que destaca una dimensión predominante relacional respecto de las necesidades de atención requerida por los adultos mayores

A qualitative descriptive and analytical study, which describes perceptions and practices associated by elderly people to good nursing and analyzes their expectations and needs of care. The study is contextualized in primary care centers in vulnerable urban sectors of Talca (Maule, Chile). Perception of good and bad nurse were analysed, including individual characteristics, mode of relationship and professional practices. METHODOLOGY: The methodological strategy-oriented by Socio-Cultural Epidemiology and based on the Grounded Theory applied 119 semi-structured interviews to elderly patients in the healthcare network (2017-2018). The reliability of the study was based on empirical saturation and triangulation of results. RESULTS: Older people perceive that the good nurse is a friendly and vocational professional. They expect from their nurse a good relationship and therapeutic guidance. MAIN CONCLUSION: The good nurse is perceived as the one who treats her patients well, which highlights about the place of social dimensions in older adult's nurse care

Evaluation of discharge instructions among hospitalized Lebanese patients

BACKGROUND: Hospital readmissions are considered as the primary indicator of insufficient quality of care and are responsible of increasing annual medical costs by billions of dollars. Different factors tend to reduce readmissions, particularly instructions at discharge. OBJECTIVES: Our study objective was to evaluate discharge instructions given to hospitalized Lebanese patients and associated factors. METHODS: Two hundred patients, aged between 21 and 79 years and admitted to the emergency department, were recruited from a Lebanese university hospital. Discharge instructions were evaluated by a face-to-face interview to fill a questionnaire with the patients immediately after their final contact with the physician or nurse in charge. We mainly focused on medications instructions and created two scores related to "instructions given" and "instructions appropriate" to later conduct bivariate analysis. RESULTS: We found that discharge instructions were not completely given to all our study population. The degree of appropriateness fluctuated between 25% and 100%. The instructor in charge of giving discharge instructions had its significant influence on medication instructions given (p = 0.014). In addition, the instructor and his experience influenced the degree of "appropriate instructions". In fact, our study showed that despite being capable of giving good medication advice, nurses' instructions were significantly less effective in comparison with physicians, fellows and residents. However, nurses gave 52% of the instructions, which questions the quality of those instructions. CONCLUSIONS: In conclusion, our observational study showed that in a Lebanese university hospital, patients' understanding of discharge instructions is poor. Careful attention should be drawn to other hospitals as well and interventions should be considered to improve instructions quality and limit later complications and readmissions. The intervention of clinical pharmacists and their medication-related advice might be crucial in order to improve instructions' quality

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Content Analysis of Negative Online Reviews of Hospice Agencies in the United States.

Importance: As online reviews of health care become increasingly integral to patient decision-making, understanding their content can help health care practices identify and address patient concerns. Objective: To identify the most frequently cited complaints in negative (ie, 1-star) online reviews of hospice agencies across the United States. Design, Setting, and Participants: This qualitative study conducted a thematic analysis of online reviews of US hospice agencies posted between August 2011 and July 2019. The sample was selected from a Hospice Analytics database. For each state, 1 for-profit (n = 50) and 1 nonprofit (n = 50) hospice agency were randomly selected from the category of extra-large hospice agencies (ie, serving >200 patients/d) in the database. Data analysis was conducted from January 2019 to April 2019. Main Outcomes and Measures: Reviews were analyzed to identify the most prevalent concerns expressed by reviewers. Results: Of 100 hospice agencies in the study sample, 67 (67.0%) had 1-star reviews; 33 (49.3%) were for-profit facilities and 34 (50.7%) were nonprofit facilities. Of 137 unique reviews, 68 (49.6%) were for for-profit facilities and 69 (50.4%) were for nonprofit facilities. A total of 5 themes emerged during the coding and analytic process, as follows: discordant expectations, suboptimal communication, quality of care, misperceptions about the role of hospice, and the meaning of a good death. The first 3 themes were categorized as actionable criticisms, which are variables hospice organizations could change. The remaining 2 themes were categorized as unactionable criticisms, which are factors that would require larger systematic changes to address. For both for-profit and nonprofit hospice agencies, quality of care was the most frequently commented-on theme (117 of 212 comments [55.2%]). For-profit hospice agencies received more communication-related comments overall (34 of 130 [26.2%] vs 9 of 82 [11.0%]), while nonprofit hospice agencies received more comments about the role of hospice (23 of 33 [69.7%] vs 19 of 31 [61.3%]) and the quality of death (16 [48.5%] vs 12 [38.7%]). Conclusions and Relevance: Regarding actionable criticisms, hospice agencies could examine their current practices, given that reviewers described these issues as negatively affecting the already difficult experience of losing a loved one. The findings indicated that patients and their families, friends, and caregivers require in-depth instruction and guidance on what they can expect from hospice staff, hospice services, and the dying process. Several criticisms identified in this study may be mitigated through operationalized, explicit conversations about these topics during hospice enrollment.

Centers of excellence: Are there standards?

INTRODUCTION: Centers of Excellence (CoEs) are intended to label hospitals that have met certain quality, process, volume and infrastructure guidelines. However, there are largely no standardized metrics to designate what qualifies as a CoE, leading to entities across the healthcare spectrum creating their own designations. Empirical studies on the impact of CoEs on quality do not consistently show improved care. Given the variability in definitions and outcomes for CoEs, the study evaluated the current status of defining and using CoE designations. METHODS: We conducted semi-structured interviews with executives from 10 healthcare organizations (including hospitals, insurers, employers, and benefits managers) who have a role in determining or using CoE designations to make decisions for their organizations. The interviews were conducted in 2016 and 2017. The interviews were audio recorded, transcribed, and de-identified for thematic analysis. RESULTS: We found that there is significant variability in the process for defining CoEs. There are also many operational challenges that hinder the success of a CoE program, including how patients access care at a CoE, the right geographical distribution of CoEs in a network, and coordinating care between the CoE and local providers. CONCLUSIONS: The lack of standardization for designating CoEs not only prevents CoEs from fully achieving their intended effects of signaling "excellent" hospitals, but also causes confusion for patients, employers and payers, which dilutes the meaning of the CoE label. IMPLICATIONS: We suggest that the designation and implementation of CoEs should be standardized in healthcare.

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

Factores asociados a la satisfacción del paciente en diálisis / Factors associated with satisfaction in dialysis patients

Introducción: La satisfacción del paciente es uno de los grandes retos que persigue conseguir el sistema sanitario y que repercute de forma positiva en la esfera biopsicosocial del paciente. Constituye una prioridad de los profesionales sanitarios el velar por dicha satisfacción y ello pasa por conocer las necesidades del paciente para luego marcar objetivos que el personal debe cumplir. Objetivo: Analizar la satisfacción del paciente en diálisis a partir de la producción científica existente. Material y Método: Se ha realizado una revisión integrativa mediante una búsqueda en las bases de datos Pubmed, Cuiden, Google académico y Medes. Se incluyeron artículos científicos originales y de revisión, en inglés y español, excluyendo aquellos artículos que no presentaban resultados o que no estuviesen en texto completo. Resultados: Se revisaron 17 artículos que se ajustaron a los criterios de selección. Los principales resultados encontrados se agruparon en los siguientes aspectos: factores determinantes en el nivel de satisfacción del paciente, herramientas de valoración de la satisfacción, rol de enfermería y áreas de mejora. Conclusiones: Los factores más influyentes en la satisfacción del paciente en diálisis son, principalmente, la confianza transmitida y disposición del personal sanitario, trato personalizado, amabilidad y seguridad transmitida, la destreza para puncionar, entre otros. Respecto a los instrumentos de medida, no existe un instrumento de medida específico, para evaluar la satisfacción del paciente en diálisis. Los atributos más satisfactorios que destacan en la enfermería, son amabilidad, disposición e interés, preparación técnica profesional, trato personalizado, confianza y seguridad clínica

Aims: Patient satisfaction is one of the great challenges that the healthcare system seeks to achieve and that has a positive impact on the biopsychosocial sphere of the patient. It is a priority for healthcare professionals to ensure this satisfaction and this involves knowing the needs of the patient and then setting targets that the staff must meet. Objective: To analyse the dialysis patient satisfaction according to existing scientific production. Material and Method: An integrative review has been carried out through a search of PubMed, Cuiden, Google academic and Medes databases. Original and review articles were included, in English and Spanish, excluding those articles that did not present results or that were not in full text. Results: We reviewed 17 articles that met the selection criteria. The main results found were grouped into the following aspects: determining factors in the level of patient satisfaction, satisfaction assessment tools, nursing role and areas for improvement. Conclusions: The most influential factors in the satisfaction of dialysis patient are, mainly, the transmitted confidence and disposition of the health personnel, personalized treatment, kindness and transmitted security, the skill to puncture, among others. Regarding measurement instruments, there is no specific measurement instrument to evaluate satisfaction in dialysis patient. The most satisfactory attributes that stand out in nursing are kindness, willingness and interest, professional technical preparation, personalized treatment, confidence and clinical safety

Prácticas obstétricas desarrolladas en dos maternidades públicas para parturientas de bajo riesgo / Práticas obstétricas desenvolvidas em duas maternidades públicas para parturientes de risco habitual / Obstetric practices developed in two maternities for low risk mothers

Objetivo: Evaluar la calidad de la atención prestada a la mujeres y a su hijo durante el parto normal en las maternidades públicas de la ciudad de Natal/RN, Nordeste de Brasil. Método: Se realizó un estudio transversal, cuantitativo, en dos hospitales públicos con 314 madres asistidas en el período de abril a julio 2014. Resultados: Las diferencias entre los hospitales fueron identificadas en cuanto a la oferta de líquidos por vía oral (p=0,018), estímulo a la posición no supina (p=0,002), presencia de partograma (p=0,001), apoyo o atención por profesionales de la salud (p=0,047), infusión intravenosa (p<0,001), posición supina (p<0,001), uso de oxitocina (p<0,001), restricción de líquidos y alimentos (p=0,002), y el hecho del toque ser realizado por más de un examinador (p=0,011). La asistencia durante el proceso del parto y nacimiento mostró mejores resultados en general para la maternidad A. Conclusiones: Se hace necesario implementar mejoras y la readecuación del actual modelo obstétrico

Objetivo: Avaliou-se a qualidade da assistência prestada à mulher e ao filho durante o parto normal nas maternidades públicas municipais da cidade de Natal/RN, Nordeste do Brasil. Método: Foi realizado um estudo transversal, quantitativo, em duas maternidades públicas, com 314 puérperas atendidas no período de abril a julho de 2014. Resultados: As diferenças entre as maternidades foram identificadas quanto ao oferecimento de líquidos por via oral (p=0,018), estímulo a posições não supinas (p=0,002), existência de partograma (p=0,001), apoio ou acolhimento pelos profissionais de saúde (p=0,047), infusão intravenosa (p<0,001), posição supina (p<0,001), uso de ocitocina (p<0,001), restrição hídrica e alimentar (p=0,002), e o fato de o toque ser realizado por mais de 1 examinador (p=0,011). A assistência prestada durante o processo de parto e nascimento apresentou melhores resultados, em geral, para a maternidade A. Conclusões: Fazem-se necessárias à implementação de melhorias e readequação do modelo obstétrico vigente

Objective: Evaluate the quality of care provided to women and children during cases of natural childbirth in municipal public maternity wards of the city of Natal/RN, Brazilian Northeast. Method: A cross-sectional study, quantitative in two public hospitals with 314 puerperal women attending the period between April and July 2014. Results: The differences between the maternity wards were identified with regard to the provision of liquids orally (p=0.018), stimulus for non-supine position (p=0.002), existence of partograph (p=0.001), support or welcoming by health professionals (p=0.047) intravenous infusion (p<0.001), supine position (p<0.001), use of oxytocin (p<0.001), food and liquid restriction (p=0.002), and the fact that the touch is performed by more than one examiner (p=0.011). Assistance during the process of labor and birth showed better results in general for motherhood A. Conclusions: They become necessary to implement improvements and realignment of current obstetric model

Estratificación del riesgo en pacientes que acuden a urgencias con fallo cardiaco agudo: ¿estamos preparados? / Acute heart failure risk stratification in the emergency department: are we there yet?

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Utilidad de la escala MEESSI para la estratificación del riesgo de pacientes con insuficiencia cardiaca aguda en servicios de urgencias / The usefulness of the MEESSI score for risk stratification of patients with acute heart failure at the emergency department

Introducción y objetivos: En los servicios de urgencias hospitalarios(SUH), la escala MEESSI estratifica a los pacientes diagnosticados de insuficiencia cardiaca aguda(ICA) según su riesgo de mortalidad a 30 días. Se valida la escala de riesgo MEESSI en una nueva cohorte de pacientes para evaluar su precisión al estratificar el riesgo y compararla en diferentes entornos. Métodos: Se incluyó a los pacientes consecutivos diagnosticados de ICA en 30 SUH durante enero y febrero de 2016. Se calculó la puntuación MEESSI de cada paciente. El estadístico C midió la capacidad discriminatoria para predecir la mortalidad a 30 días del modelo MEESSI completo y los modelos secundarios. Se realizaron comparaciones entre los subgrupos de pacientes de hospitales universitarios y comunitarios, de SUH con actividad alta, media o baja y de SUH que reclutaron o que no reclutaron a pacientes de la cohorte original de derivación de la escala MEESSI. Resultados: Se analizó a 4.711 pacientes (hospitales universitarios/comunitarios: 3.811/900; SUH alta/media/baja actividad: 2.695/1.479/537; SUH participantes/no participantes en el estudio de derivación original:3.892/819). La distribución de pacientes según las categorías de riesgo de la escala MEESSI fue: 1.673 (35,5%) de bajo riesgo, 2.023 (42,9%) de riesgo intermedio, 530 (11,3%) de alto riesgo y 485 (10,3%) de muy alto riesgo, con mortalidades a 30 días del 2,0, el 7,8, el 17,9 y el 41,4% respectivamente. El estadístico C para el modelo completo fue 0,810 (IC95%, 0,790-0,830) y varió de 0,731 a 0,785 para los modelos secundarios. La capacidad discriminatoria de la escala de riesgo MEESSI fue similar entre los subgrupos de hospitales, entre SUH de distinta actividad y entre hospitales reclutadores originales y nuevos. Conclusiones: La escala MEESSI estratifica con éxito a los pacientes con ICA en los SUH según el riesgo de muerte a 30días, lo cual puede ayudar en urgencias a la toma de decisiones sobre el destino de estos pacientes

Introduction and objectives: The MEESSI scale stratifies acute heart failure (AHF) patients at the emergency department (ED) according to the 30-day mortality risk. We validated the MEESSI risk score in a new cohort of Spanish patients to assess its accuracy in stratifying patients by risk and to compare its performance in different settings. Methods: We included consecutive patients diagnosed with AHF in 30 EDs during January and February 2016. The MEESSI score was calculated for each patient. The c-statistic measured the discriminatory capacity to predict 30-day mortality of the full MEESSI model and secondary models. Further comparisons were made among subgroups of patients from university and community hospitals, EDs with high-, medium-or low-activity and EDs that recruited or not patients in the original MEESSI derivation cohort. Results: We analyzed 4711 patients (university/community hospitals: 3811/900; high-/medium-/low-activity EDs: 2695/1479/537; EDs participating/not participating in the previous MEESSI derivation study: 3892/819). The distribution of patients according to the MEESSI risk categories was: 1673 (35.5%) low risk, 2023 (42.9%) intermediate risk, 530 (11.3%) high risk and 485 (10.3%) very high risk, with 30-day mortality of 2.0%, 7.8%, 17.9%, and 41.4%, respectively. The c-statistic for the full model was 0.810 (95%CI, 0.790-0.830), ranging from 0.731 to 0.785 for the subsequent secondary models. The discriminatory capacity of the MEESSI risk score was similar among subgroups of hospital type, ED activity, and original recruiter EDs. Conclusions: The MEESSI risk score successfully stratifies AHF patients at the ED according to the 30-day mortality risk, potentially helping clinicians in the decision-making process for hospitalizing patients

Rehab MATRIX: Content Validity of a Nursing-Led Patient Assignment Algorithm.

PURPOSE: The provision of conscientious nursing care is at the forefront of health quality. Unfortunately, a lack of standardization in the assignment of patients to nurses can lead to care inequities. Rehab MATRIX is a nursing-led tool that equitably assigns patients using select acuity variables. DESIGN AND METHODS: In this initial study, we asked focus groups of 19 registered nurses and 8 patient care assistants to identify medical interventions that increase the effort of nursing care at a 24-bed inpatient rehabilitation facility (IRF). This IRF is affiliated with a comprehensive heart and vascular institute, a level I trauma center, and a The Joint Commission (TJC) Comprehensive Stroke Center. FINDINGS: Thirteen acuity variables were included in the Rehab MATRIX patient assignment grid. High-acuity patients with greater than 6 variables were color-coded "red," medium-acuity patients with 3 to 5 variables were color-coded "yellow," and low-acuity patients with less than 3 variables were color-coded "green." Each registered nurse and patient care assistant were assigned an equitable number of red-, yellow-, and green-coded patients per shift. New admissions were Rehab MATRIX color-coded during nursing report and assigned objectively. CONCLUSIONS: Nursing staff at a wide-ranging IRF created Rehab MATRIX, an equitable patient assignment tool, representative of nursing effort needed to provide quality care. CLINICAL RELEVANCE: Nursing-led patient assignment tools increase autonomy and provide the opportunity for all nursing staff to influence healthcare practice. These factors may lead to increased nursing satisfaction and decreased burnout.

Acceso a la atención sanitaria en cárceles chilenas: una mirada desde los internos / Access to healthcare in Chilean prisons: an inmates' perspective

Objetivos: analizar la percepción de acceso a las cárceles chilenas en una muestra representativa nacional de personas privadas de libertad y examinar las covariables más importantes de dicho acceso. Materiales y métodos: este estudio utiliza datos secundarios de la Primera Encuesta Nacional de Calidad de Vida Penitenciaria (2014), e indaga en torno a la percepción de los internos de ambos sexos respecto al acceso a los servicios de salud en el interior de las cárceles. Para ello, utiliza datos estadísticos descriptivos y un modelo de regresión logística ordenada. Resultados: los resultados descriptivos en el ámbito nacional muestran que el acceso a los servicios de salud en las cárceles tiende a ser "difícil" (el 44,7% de casos en esta categoría). Los resultados multivariados de la regresión logística ordenada indican que los hombres (con una razón de posibilidades u odds ratio, OR=0,43) y quienes reportaron mejor infraestructura (OR=0,70) tenían menores probabilidades de reportar un "difícil acceso a servicios de salud". Por otra parte, los internos de las cárceles concesionadas (OR=1,61) y quienes habían reportado mayores grados de maltrato (OR=1,26) se asociaron a mayores probabilidades de reportar un "difícil acceso". Discusión: el estudio sugiere que la facilidad en el acceso a la atención de salud está vinculada de forma dinámica a otros aspectos de la vida en el interior de las cárceles, como a la composición de la población penal (sexo), a los aspectos materiales de la prisión (infraestructura, tipo de cárcel) e, inclusive, a algunos aspectos relacionales (nivel de maltrato). Futuros estudios podrían expandir la discusión en torno a la temática salud y la cárcel, incorporando variables y análisis más complejos

Objectives: to analyze the perception of access to Chilean prisons in a representative national sample of persons deprived of liberty as well as to examine the most important covariates of such access. Materials and methods: this study uses secondary data from the First National Survey on the Quality of Prison Life (2014), which investigated inmates' perceptions regarding access to health services inside the prisons. To do this, it uses descriptive statistics and a logistic regression model. Results: descriptive results at the national level show that access to health services in prisons tends to be "difficult" (44.7% of cases in this category). Multivariate logistic regression results indicate that men (OR=0.43) and those who reported better infrastructure (OR=0.70) were less likely to report "difficult access to health services". On the other hand, prison inmates (OR=1.61) and those who had reported higher levels of mistreatment (OR=1.26) were associated with a higher probability of reporting "difficult access to health services". Discussion: our study suggests that access to health care is dynamically linked to other aspects of life within prisons such as the composition of the prison population (gender), some of the material aspects of prisons (infrastructure, type of facility), and even some relational aspects (level of mistreatment/abuse). Future studies could further extend the debate on healthcare in prisons, incorporating more complex both variables and analyses

Risk Adjustment for Hospital Characteristics Reduces Unexplained Hospital Variation in Pressure Injury Risk.

BACKGROUND: Research investigating risk factors for hospital-acquired pressure injury (HAPI) has primarily focused on the characteristics of patients and nursing staff. Limited data are available on the association of hospital characteristics with HAPI. OBJECTIVE: We aimed to quantify the association of hospital characteristics with HAPI and their effect on residual hospital variation in HAPI risk. METHODS: We employed a retrospective cohort study design with split validation using hierarchical survival analysis. This study extends the analysis "Hospital-Acquired Pressure Injury (HAPI): Risk Adjusted Comparisons in an Integrated Healthcare Delivery System" by Rondinelli et al. (2018) to include hospital-level factors. We analyzed 1,661 HAPI episodes among 728,266 adult hospitalization episodes across 35 California Kaiser Permanente hospitals, an integrated healthcare delivery system between January 1, 2013, and June 30, 2015. RESULTS: After adjusting for patient-level and hospital-level variables, 2 out of 12 candidate hospital variables were statistically significant predictors of HAPI. The hazard for HAPI decreased by 4.8% for every 0.1% increase in a hospital's mean mortality ([6.3%, 2.6%], p < .001), whereas every 1% increase in a hospital's proportion of patients with a history of diabetes increased HAPI hazard by 5% ([-0.04%, 10.0%], p = .072). Addition of these hierarchical variables decreased unexplained hospital variation of HAPI risk by 35%. DISCUSSION: We found hospitals with higher patient mortality had lower HAPI risk. Higher patient mortality may decrease the pool of patients who live to HAPI occurrence. Such hospitals may also provide more resources (specialty staff) to care for frail patient populations. Future research should aim to combine hospital data sets to overcome power limitations at the hospital level and should investigate additional measures of structure and process related to HAPI care.

Do the stars align? Distribution of high-quality ratings of healthcare sectors across US markets.

BACKGROUND: The US government created five-star rating systems to evaluate hospital, nursing homes, home health agency and dialysis centre quality. The degree to which quality is a property of organisations versus geographical markets is unclear. OBJECTIVES: To determine whether high-quality healthcare service sectors are clustered within US healthcare markets. DESIGN: Using data from the Centers for Medicare and Medicaid Services' Hospital, Dialysis, Nursing Home and Home Health Compare databases, we calculated the mean star ratings of four healthcare sectors in 304 US hospital referral regions (HRRs). For each sector, we ranked HRRs into terciles by mean star rating. Within each HRR, we assessed concordance of tercile rank across sectors using a multirater kappa. Using t-tests, we compared characteristics of HRRs with three to four top-ranked sectors, one to two top-ranked sectors and zero top-ranked sectors. RESULTS: Six HRRs (2.0% of HRRs) had four top-ranked healthcare sectors, 38 (12.5%) had three top-ranked health sectors, 71 (23.4%) had two top-ranked sectors, 111 (36.5%) had one top-ranked sector and 78 (25.7%) HRRs had no top-ranked sectors. A multirater kappa across all sectors showed poor to slight agreement (K=0.055). Compared with HRRs with zero top-ranked sectors, those with three to four top-ranked sectors had higher median incomes, fewer black residents, lower mortality rates and were less impoverished. Results were similar for HRRs with one to two top-ranked sectors. CONCLUSIONS: Few US healthcare markets exhibit high-quality performance across four distinct healthcare service sectors, suggesting that high-quality care in one sector may not be dependent on or improve care quality in other sectors. Policies that promote accountability for quality across sectors (eg, bundled payments and shared quality metrics) may be needed to systematically improve quality across sectors.

Patient experience and process measures of quality of care at home health agencies: Factors associated with high performance.

We examined the effects of provider characteristics on home health agency performance on patient experience of care (Home Health CAHPS) and process (OASIS) measures. Descriptive, multivariate, and factor analyses were used. While agencies score high on both domains, factor analyses showed that the underlying items represent separate constructs. Freestanding and Visiting Nurse Association agencies, higher number of home health aides per 100 episodes, and urban location were statistically significant predictors of lower performance. Lack of variation in composite measures potentially led to counterintuitive results for effects of organizational characteristics. This exploratory study showed the value of having separate quality domains.

[Variation in hospital performance according to payment sources in the states of São Paulo and do Rio Grande do Sul, Brazil]. / Variação do desempenho hospitalar segundo fontes de pagamento nos estados de São Paulo e Rio Grande do Sul, Brasil.

In Brazil, the combined presence of public and private interests in financing and provision of healthcare services stands out clearly in hospital care. Financing arrangements adopted by hospitals (the public Brazilian Unified National Health System - SUS and/or health plans and/or out-of-pocket payment) can affect quality of care. Studies have analyzed the hospital standardized mortality ratio (HSMR) in relation to quality improvements. The objective was to analyze HSMR according to source of payment for the hospitalization and the hospital's financing arrangement. The study analyzed secondary data and causes that accounted for 80% of hospital deaths. HSMR was calculated for each hospital and payment source. Hospitals with worse-than-expected performance (HSMR > 1) were mostly large public hospitals. HSMR was higher in the SUS, including between admissions in the hospital. Despite the study's limitations, the findings point to inequalities in results of care. Efforts are needed to improve the quality of hospital services, regardless of the payment sources.