[Patient safety training for ward clerks of an Occupational Mutual Insurance Company collaborating with the Social Security, immediate impact and after six months]. / Formación en seguridad del paciente para el personal administrativo de una Mutua Colaboradora con la Seguridad Social, impacto inmediato y a los seis meses.

INTRODUCTION: Ward Clerks are an essential part of the healthcare team, as they provide administrative and organizational support in healthcare institutions. The aim of this study is to determine the training impact of a basic one-hour online course on patient safety for this staff. METHOD: A quasi-experimental before/after study carried out on a population of 170 administrative staff working in the centers of an Occupational Mutual Insurance Company (MC Mutual) who took the patient safety course. A convenience sample of 22 administrative professionals, who agreed to participate, was chosen from this population, which made it possible to reconstruct their knowledge before and after the course, by examination and interview, immediately after the course and at 6 months. RESULTS: Of the 170 professionals participating in the course, 167 (98.2%) completed the initial test and the post-test, with mean scores increasing from 5.7 (P1) to 7.3 (P2) (p<0.05). A total of 22 out of a sample of 42 (52.4%) agreed to participate in the interviews and all three interviews were achieved by 21 (E1), 22 (E2) and 19 (E3) professionals, whose mean scores increased from 5.9 (E1) to 7.2 (E2) and 7.5 (E3) (p<0.05). CONCLUSIONS: The results suggest that the training course was effective. The evaluation by interview 6 months after the course indicates a likely medium to long term effect. The involvement of administrative professionals in the the Company´s patients care is key. Evaluating the impact of an intervention is essential to inform its effectiveness and guide its planning.

Introducción: El personal administrativo es un colectivo esencial. El objetivo de este estudio es analizar el impacto formativo de un curso online básico sobre seguridad del paciente para administrativos.  Método: Estudio cuasi experimental antes/después en una población de 170 administrativos/as que prestaban sus servicios en los centros de la Mutua Colaboradora con la Seguridad Social MC Mutual y que realizaron un curso de seguridad del paciente. Se evaluaron los conocimientos adquiridos mediante una prueba al inicio (P1) y al final del curso (P2). Además, se eligió una muestra de conveniencia de 42 administrativos/as para evaluar sus conocimientos mediante entrevista, previos (E1) y posteriores (E2) al curso, y a los 6 meses (E3). Resultados: De los 170 administrativos/as participantes en el curso, 167 (98,2%) completaron la prueba al inicio y final, con puntuaciones medias que incrementaron de 5,7 (P1) a 7,3 (P2) (p<0,05). Aceptaron participar en las entrevistas 22 administrativos/as de una muestra de 42 (52,4%), y se consiguieron las tres entrevistas de 21 (E1), 22 (E2) y 19 (E3) administrativos/as, cuyas puntuaciones medias incrementaron desde 5,9 (E1) a 7,2 (E2) y 7,5 (E3) (p<0,05).  Conclusiones: Los resultados sugieren que el curso de formación fue efectivo. La evaluación mediante la entrevista a los seis meses del curso indica un probable efecto a medio-largo plazo. La implicación de los/as profesionales administrativos/as en la atención a los usuarios de la Mutua es clave. La evaluación del impacto de una intervención es esencial para informar sobre su efectividad y orientar su planificación.

Formación en seguridad del paciente para el personal administrativo de una Mutua Colaboradora con la Seguridad Social, impacto inmediato y a los seis meses / Training in patient safety for the administrative staff of a Mutual Collaborator with Social Security, immediate impact and after six months

Introducción: El personal administrativo es un colectivo esencial. El objetivo de este estudio es analizar el impacto formativo de un curso online básico sobre seguridad del paciente para administrativos. Método: Estudio cuasi experimental antes/después en una población de 170 administrativos/as que prestaban sus servicios en los centros de la Mutua Colaboradora con la Seguridad Social MC Mutual y que realizaron un curso de seguridad del paciente. Se evaluaron los conocimientos adquiridos mediante una prueba al inicio (P1) y al final del curso (P2). Además, se eligió una muestra de conveniencia de 42 administrativos/as para evaluar sus conocimientos mediante entrevista, previos (E1) y posteriores (E2) al curso, y a los 6 meses (E3).Resultados: De los 170 administrativos/as participantes en el curso, 167 (98,2%) completaron la prueba al inicio y final, con puntuaciones medias que incrementaron de 5,7 (P1) a 7,3 (P2) (p<0,05). Aceptaron participar en las entrevistas 22 administrativos/as de una muestra de 42 (52,4%), y se consiguieron las tres entrevistas de 21 (E1), 22 (E2) y 19 (E3) administrativos/as, cuyas puntuaciones medias incrementaron desde 5,9 (E1) a 7,2 (E2) y 7,5 (E3) (p<0,05). Conclusiones: Los resultados sugieren que el curso de formación fue efectivo. La evaluación mediante la entrevista a los seis meses del curso indica un probable efecto a medio-largo plazo. La implicación de los/as profesionales administrativos/as en la atención a los usuarios de la Mutua es clave. La evaluación del impacto de una intervención es esencial para informar sobre su efectividad y orientar su planificación.(AU)

Introduction: Clerical staff are an essential part of the healthcare team, as they provide administrative and organizational support to healthcare institutions. The aim of this study is to determine the impact of a basic one-hour online training course on patient safety for these staff.Method: A quasi-experimental pre/post study carried out in a population of 170 administra-tive staff working in the centers of an Occupational Mutual Insurance Company (MC Mutu-al) who completed the patient safety training. A convenience sample of 22 administrative professionals, who agreed to participate, was chosen from this population, which made it possible to test their knowledge before and after the course, by examination (P1, P2) and interview, immediately after the course and at 6 months (E1, E2, E3).Results: Of the 170 professionals participating in the course, 167 (98.2%) completed the initial test and the post-test, with mean scores increasing from 5.7 (P1) to 7.3 (P2) (p<0.05). A total of 22 out of a sample of 42 (52.4%) agreed to participate in the interviews and all three interviews were completed by 21 (E1), 22 (E2) and 19 (E3) professionals, whose mean scores increased from 5.9 (E1) to 7.2 (E2) and 7.5 (E3) (p<0.05) Conclusions: The results suggest that the training course was effective. The evaluation by interview 6 months after the course indicates a likely medium to long term effect. The involvement of administrative professionals in the company ́s patient care is key. Evaluating the impact of an intervention is essential to inform its effectiveness and guide its plannin.(AU)

Adverse events in the global healthcare practice of an Occupational Mutual Insurance Company in Spain.

BACKGROUND: Patient safety is currently a main issue in healthcare practice. Adverse events (AEs) management is a key instrument for the application of strategies to prevent harm to patients. OBJECTIVE: To analyze the type, severity and preventability, according to validated scales, of AEs occurring annually in the healthcare practice of an Occupational Mutual Insurance Company in order to implement action plans to improve patient safety. METHODS: We analyzed the reported AEs in an Incident Reporting System and AEs detected in the Audit program of clinical records as a result of treating injured or ill workers in our 88 ambulatory care centers. RESULTS: We detected 28 AEs in the clinical records (CR), representing 0.05 AE/CR, with maximum values in the COM sample (26 AEs, 0.11) and much lower in INT (1 AEs, 0.02) and MIN (1 AE, 0.02). The most frequent AE type was procedure-related, followed by infection and care. AEs of severity level D (11 cases) and E (9 cases) predominated, while level F was also detected (6 cases). Intermediate values in preventability (3 and 4) predominated, 61.5% were preventable. With the Incident Reporting System, 27 AEs were identified, predominated by procedural type. Most reported AE severities was in levels E (10 cases) and C (8 cases), 89% were preventable. CONCLUSION: Our company detects AEs via the Incident Reporting System and annual Audit program of clinical records, both of which are complementary, and may result in the implementation of more effective Patient Safety measures.

Differences in Perception of Healthcare Management between Patients and Professionals.

Patient perception and the organizational and safety culture of health professionals are an indirect indicator of the quality of care. Both patient and health professional perceptions were evaluated, and their degree of coincidence was measured in the context of a mutual insurance company (MC Mutual). This study was based on the secondary analysis of routine data available in databases of patients' perceptions and professionals' evaluations of the quality of care provided by MC Mutual during the period 2017-2019, prior to the COVID-19 pandemic. Eight dimensions were considered: the results of care, coordination of professionals, trust-based care, clinical and administrative information, facilities and technical means, confidence in diagnosis, and confidence in treatment. The patients and professionals agreed on the dimension of confidence in treatment (good), and the dimensions of coordination and confidence in diagnosis (poor). They diverged on confidence in treatment, which was rated worse by patients than by professionals, and on results, information and infrastructure, which were rated worse by professionals only. This implies that care managers have to reinforce the training and supervision activities of the positive coincident aspects (therapy) for their maintenance, as well as the negative coincident ones (coordination and diagnostic) for the improvement of both perceptions. Reviewing patient and professional surveys is very useful for the supervision of health quality in the context of an occupational mutual insurance company.

Measuring the Impact of Future Outbreaks? A Secondary Analysis of Routinely Available Data in Spain.

Background: As of 7 January 2022, it is estimated that 5.5 million people worldwide have died from COVID-19. Although the full impact of SARS-CoV-2 (COVID-19) on healthcare systems worldwide is still unknown, we must consider the socio-economic impact. For instance, it has resulted in an 11% decrease in the GDP (Gross Domestic Product) in the European Union. We aim to provide valuable information for policymakers by analysing widely available epidemiological and socioeconomic indicators using Spanish data. Methods: Secondary analysis of routinely available data from various official data sources covering the period from 1 March 2020 to 31 March 2021. To measure the impact of COVID-19 in the population, a set of epidemiological and socioeconomic indicators were used. The interrelationships between these socioeconomic and epidemiological indicators were analysed using Pearson's correlation. Their behaviour was grouped according to their greater capacity to measure the impact of the pandemic and was compared to identify those that are more appropriate to monitor future health crises (primary outcome) using multivariate analysis of canonical correlation for estimating the correlation between indicators using different units of analysis. Results: Data from different time points were analysed. The excess of mortality was negatively correlated with the number of new companies created during the pandemic. The increase in COVID-19 cases was associated with the rise of unemployed workers. Neither GDP nor per capita debt was related to any epidemiological indicators considered in the annual analysis. The canonical models of socioeconomic and epidemiological indicators of each of the time periods analysed were statistically significant (0.80-0.91 p < 0.05). Conclusions: In conclusion, during the COVID-19 pandemic in Spain, excess mortality, incidence, lethality, and unemployment constituted the best group of indicators to measure the impact of the pandemic. These indicators, widely available, could provide valuable information to policymakers and higher management in future outbreaks.

Factors affecting the non-urgent consultations in the emergency department of a tertiary hospital in the Philippines: A cross-sectional study.

OBJECTIVES: The non-standard emergency medicine services and the limited utilisation of primary care providers in the Philippines may contribute towards the ED being a preferred area for patients with non-urgent conditions. Our study aims to determine the factors associated with non-urgent consultations in the ED of a tertiary hospital in the Philippines. METHODS: From 7 January to 15 February 2020, we surveyed non-urgent ED patients (n = 757) presenting to a tertiary hospital in the Philippines. We evaluated the data using descriptive statistics, while chi-squared and multivariate analyses versus urgent ED patients (n = 281) were used to show the association of factors. RESULTS: Our recruited non-urgent patients were mostly 21-40 years old (n = 576 [76%]), single (n = 437 [58%]), with full-time employment (n = 654 [86%]), have Health Maintenance Organization coverage (n = 684 [90%]), self-referred (n = 498 [66%]), and have private means of getting to ED (n = 414 [55%]). They had moderate scores of social support-seeking behaviours (mean 3.92/5; 95% confidence interval [CI] 3.88-3.96), health literacy (mean 3.58/5; 95% CI 3.56-3.61), self-efficacy (mean 3.09/5; 95% CI 3.56-3.61), whereas their ED access score (mean 4.10/5; 95% CI 4.06-4.14) was high. They had moderate self-assessed severity (mean 3.75/6; 95% CI 3.70-3.80), urgency (mean 3.83/6; 95% CI 3.78-3.88), and anxiety (mean 3.88/6; 95% CI 3.83-3.93) scores and high ED satisfaction rating (mean 4.73/6; 95% CI 4.69-4.77). They mostly had digestive (n = 203 [26.8%]) and infection-related (n = 172 [22.7%]) chief complaints and final diagnoses (n = 198 [26.2%] and n = 145 [19.2%], respectively), without previous consultations (n = 577 [76%]), and eventually discharged (n = 755 [99%]). Our urgent patients had similar characteristics, but with higher assessed patient severity, urgency, anxiety and satisfaction with ED services (P < 0.001). CONCLUSION: Non-urgent consultations in ED are attributed to multiple factors encompassing socio-demographic, socio-economic and psychosocial dimensions. These factors must be considered in improving the current healthcare management system for the appropriate utilisation of ED in the Philippines.

Risk Management in the Ambulatory Care Process in a Mutual Benefit Association Covering Work-Related Accidents and Diseases: Applying Modified Failure Mode and Effect Analysis (FMEA) Methodology.

AIM: To assess the impact of different forms of use of failure mode and effect analysis methodology for risk prioritization in the ambulatory care process in a mutual benefit association covering work-related accidents and diseases. METHODS: The study is based on a previously drafted and individually prioritized risk map by a multidisciplinary team made up of patient safety committee members from health care centers and clinics in a mutual benefit association covering work-related accidents and diseases. The professionals mainly carry out their work in the field of management (individual manager group (IMG)). A group formed by clinicians subsequently completed 2 prioritizations: one based on the individual opinions of each of the members (individual clinical group (ICG)) and another in a consensual way (consensual clinical group (CCG)) as recommended by failure mode and effect analysis methodology. The risk prioritization was compared in the 3 groups (IMG, ICG, and CCG). RESULTS: The risk prioritization by the IMG defines 7 extreme risks (risk prioritization ≥ 275). When the clinical group prioritizes them in an individual way (ICG), there is no extreme risk, whereas when it does so in a consensual way (CCG), there are 21 extreme risks. With respect to the coincidences of existing causes between the 3 groups, it is noted that the "risk of falls" is rated by both the clinical and the manager group but prioritized differently. On the other hand, the ICG and CCG coincide in that pressure on health care services can contribute to carrying out incomplete anamnesis. They also both consider that internal and external waiting lists and holiday periods can cause a delay in the starting of rehabilitation. The IMG and the CCG show similarity in the risk assessment of overprescribing medication and that multiple computer sessions are initiated. Finally, the IMG and the ICG coincide in the "lack of delivery of the medication leaflet". CONCLUSIONS: The point of view of the clinicians is important in the risk prioritization of the ambulatory health care process. The difference in the risk prioritization between the clinical group at individual level and after consensus is remarkable.

Patient Safety Culture in Mutual Insurance Companies in Spain.

OBJECTIVES: The aim of the study was to assess the safety culture in a mutual insurance sector, searching for improvement opportunities. This sector offers health insurance for work-related injuries and occupational illnesses and represents an annual volume of patients corresponding to approximately 10% of the working population in Europe. METHODS: A cross-sectional study was conducted to assess the safety culture in the mutual insurance sector in Spain. All physicians, nurses, and physiotherapists (N = 816) working in the organization in hospitals, outpatient clinics, and managerial settings were invited to reply to an online survey. RESULTS: A total of 499 professionals completed the questionnaire (response rate, 61%). Two dimensions were assessed: attitudinal (5 items) and instrumental (5 items). There were no differences between professional profiles or centers in the attitudinal (7.8; standard deviation, 1.3; 95% confidence interval, 7.6-7.9) or instrumental (8.5; standard deviation, 1.0; 95% confidence interval, 8.5-8.6) factors. The lowest level of implementation (<9 points) was related to the following: open disclosure after an adverse event (73%), having a quality and safety plan (75%), prioritizing the improvement of patient care (75%), and involving patients when making decisions on potential treatments (63%). Managers showed lower scores than the rest of professionals' groups (P < 0.05). CONCLUSIONS: This intent is to introduce a patient safety culture assessment in the mutual insurance companies. These results may encourage the implementation of quality and safety plans in this sector by paying more attention to attitudinal aspects.

Quality Assurance and Patient Safety Measures: A Comparative Longitudinal Analysis.

OBJECTIVE: To analyze whether the results on quality assurance and safety culture in a healthcare organization are related to and affected by the actions implemented. SETTING: Health Insurance of Work-related Accidents and Occupational Diseases. METHODS: The study was conducted as a longitudinal observational study that analyzed the relationship of the Safety Culture and Quality Assurance measurements. Participants who were involved came from small centers with less than eight workers (N = 52), big centers (eight and more workers) (N = 707), and those centers with quality coordinators (N = 91). Data were collected during the years 2015 and 2016. RESULTS: A total of 595 healthcare professionals responded in 2015 and 491 in 2016. The scores showed a positive progression both in Quality Assurance (T-test = 3.5, p = 0.001) and in Safety Culture (T-test = 5.6, p < 0.0001). Hence, the gradient of improvement in quality (average 5.5%) was greater compared to that of the safety culture (2.1%). CONCLUSIONS: The assessments of the quality assurance goals were consistent with the safety culture assessment. Hence, the results on Safety Culture were observed to be more stable over time.

Influence of Social Determinants, Lifestyle, Emotional Well-Being and the Use of Unconventional Therapies in Breast Cancer Progression in a Cohort of Women in Barcelona: Protocol for the DAMA Cohort.

BACKGROUND: Breast cancer continues to be the most commonly diagnosed cancer in women. Breast cancer survivors face numerous problems, especially after completing the first year of intense treatment. We present the protocol for an ongoing study to analyze the impact of a series of factors on breast cancer survival related to lifestyle, emotional well-being, and use of complementary and alternative medicine (CAM). OBJECTIVE: We aim to analyze the influence of social determinants, lifestyle changes, emotional well-being, and use of CAM in the progression of breast cancer in women diagnosed with breast cancer between 2003 and 2013 in Barcelona, Spain. METHODS: We will perform a mixed cohort study (prospective and retrospective) of women diagnosed with breast cancer, created using a convenience sample in which we study the evolution of the disease (relapse, death, or remaining disease-free). Once identified, we sent the women information about the study and an informed consent form that they are required to sign in order to participate; a total of 2235 women were recruited. We obtained the following information from all participants: sociodemographic profile via a phone interview, and a self-administered survey of information about the study's objectives (lifestyles, emotional well-being, health care services, and the use of CAM). Lastly, we examined clinical records to obtain data on the tumor at the time of diagnosis, the treatment received, the occurrence of relapses (if any), and the tumor typology. We present data on the women's social profile based on descriptive data obtained from the telephone interview (welcome survey). RESULTS: Based on the welcome survey, which was completed by 2712 women, 14.42% (391/2712) of respondents were <50 years of age, 45.50% (1234/2712) were between 50 and 65 years of age, and 40.08% (1087/2712) were >65 years of age. A total of 43.69% (1185/2712) belonged to the highest social classes (I and II), 31.27% (848/2712) to the middle class (III), and 23.49% (637/2712) to the working classes (IV and V). Approximately 22.71% (616/2712) lived alone, 38.31% (1039/2712) lived with one person, and 38.97% (1057/2712) lived with two or more people. CONCLUSIONS: We obtained information from a large cohort of women, but this study has limitations related to the convenience sampling strategy, one of which is reduced representativeness. Conversely, being a self-administered survey, the study introduces biases, especially from respondents that answered on paper. However, the information that the study provides will serve as the basis for designing future interventions aimed at improving the knowledge gaps indicated for women with breast cancer.

Assessment of the magnitude of geographical variations in the duration of non-work-related sickness absence by individual and contextual factors / Evaluación de la magnitud de la variabilidad geográfica en la duración de la incapacidad temporal por contingencia común por factores individuales y contextuales

Objective: To examine variation in the duration of non-work-related sickness absence (NWRSA) across geographical areas and the degree to which this variation can be explained by individual and/or contextual factors. Methods: All first NWRSA episodes ending in 2007 and 2010 were analyzed. Individual (diagnosis, age, sex) and contextual factors (healthcare resources, socioeconomic factors) were analyzed to assess how much of the geographical variation was explained by these factors. Median NWRSA durations in quartiles were mapped by counties in Catalonia. Multilevel Cox proportional hazard regression models with episodes nested within counties were fitted to quantify the magnitude of this variation. The proportional change in variance (PCV), median hazard ratios (MHR) and interquartile hazard ratios (IHR) were calculated. Results: We found a geographical pattern in the duration of NWRSA, with longer duration in north western Catalonia. There was a small, but statistically significant, geographical variation in the duration of NWRSA, which mostly decreased after adjustment for individual factors in both women (PCV=34.98%, MHR=1.09, IHR=1.13 in 2007; PCV=34.68%, MHR=1.11, IHR=1.28 in 2010) and men (PCV=39.88%, MHR=1.10, IHR=1.27 in 2007; PCV=45.93%, MHR=1.10, IHR=1.25 in 2010); only in the case of women in 2010 was there a reduction in county-level variance due to contextual covariates (PCV=16.18%, MHR=1.12, IHR=1.32). Conclusions: County-level variation in the duration of NWRSA was small and was explained more by individual than by contextual variables. Knowledge of geographic differences in NWRSA duration is needed to plan specific programs and interventions to minimize these differences (AU)

Objetivo: Examinar la variabilidad de la duración la incapacidad temporal por contingencia común (ITcc) entre áreas geográficas y el grado en que factores individuales y/o contextuales la explican. Métodos: Se analizaron los primeros episodios de ITcc finalizados en 2007 y 2010. Se evaluó la variabilidad geográfica explicada por factores individuales (diagnóstico, edad, sexo) y contextuales (recursos sanitarios, socioeconómicos). Se representó gráficamente la duración mediana por comarcas de Cataluña. Se cuantificó la variabilidad geográfica de la duración de la ITcc entre comarcas ajustando modelos de regresión multinivel de riesgos proporcionales, con episodios anidados en comarcas. Se calculó el porcentaje de cambio de la varianza (PCV), el razón de riesgo mediano (RRM) y razón de riesgo intercuartílico (RRI). Resultados: Se encontró un patrón geográfico en la duración de la ITcc, con mayor duración en el noroeste de Cataluña. La variabilidad geográfica de la duración de la ITcc fue, aunque no elevada, estadísticamente significativa, y disminuyó después de ajustar por factores de nivel individual en mujeres (PCV=34.98%, RRM =1.09, RRI =1.13 en 2007; PCV=34.68%, RRM =1.11, RRI =1.28 en 2010) y hombres (PCV=39.88%, RRM =1.10, RRI =1.27 en 2007; PCV=45.93%, RRM =1.10, RRI =1.25 en 2010); y solo en el caso de las mujeres en 2010 hubo una reducción de la varianza debido a los factores contextuales (PCV=16.18%, RRM =1.12, RRI =1.32). Conclusiones: La variabilidad geográfica de la duración de la ITcc fue pequeña y explicada principalmente por los factores de nivel individual. El conocimiento de las diferencias geográficas en la duración de la ITcc es necesario para planificar programas e intervenciones específicas para reducir al mínimo estas diferencias (AU)

Assessment of the magnitude of geographical variations in the duration of non-work-related sickness absence by individual and contextual factors.

OBJECTIVE: To examine variation in the duration of non-work-related sickness absence (NWRSA) across geographical areas and the degree to which this variation can be explained by individual and/or contextual factors. METHODS: All first NWRSA episodes ending in 2007 and 2010 were analyzed. Individual (diagnosis, age, sex) and contextual factors (healthcare resources, socioeconomic factors) were analyzed to assess how much of the geographical variation was explained by these factors. Median NWRSA durations in quartiles were mapped by counties in Catalonia. Multilevel Cox proportional hazard regression models with episodes nested within counties were fitted to quantify the magnitude of this variation. The proportional change in variance (PCV), median hazard ratios (MHR) and interquartile hazard ratios (IHR) were calculated. RESULTS: We found a geographical pattern in the duration of NWRSA, with longer duration in northwestern Catalonia. There was a small, but statistically significant, geographical variation in the duration of NWRSA, which mostly decreased after adjustment for individual factors in both women (PCV=34.98%, MHR=1.09, IHR=1.13 in 2007; PCV=34.68%, MHR=1.11, IHR=1.28 in 2010) and men (PCV=39.88%, MHR=1.10, IHR=1.27 in 2007; PCV=45.93%, MHR=1.10, IHR=1.25 in 2010); only in the case of women in 2010 was there a reduction in county-level variance due to contextual covariates (PCV=16.18%, MHR=1.12, IHR=1.32). CONCLUSIONS: County-level variation in the duration of NWRSA was small and was explained more by individual than by contextual variables. Knowledge of geographic differences in NWRSA duration is needed to plan specific programs and interventions to minimize these differences.

[Accreditation model for acute hospital care in Catalonia, Spain]. / Modelo de acreditación de centros de atención hospitalaria aguda de Cataluña.

The implementation of an accreditation model for healthcare centres in Catalonia which was launched for acute care hospitals, leaving open the possibility of implementing it in the rest of lines of service (mental health and addiction, social health, and primary healthcare centres) is described. The model is based on the experience acquired over more tan 31 years of hospital accreditation and quality assessment linked to management. In January 2006 a model with accreditation methodology adapted to the European Foundation for Quality Management (EFQM) model was launched. 83 hospitals are accredited, with an average of 82.6% compliance with the standards required for accreditation. The number of active assessment bodies is 5, and the accreditation period is 3 years. A higher degree of compliance of the so-called "agent" criteria with respect to "outcome" criteria is obtained. Qualitative aspects for implementation to be stressed are: a strong commitment both from managers and staff in the centres, as well as a direct and fluent communication between the accreditation body (Ministry of Health of the Government of Catalonia) and accredited centres. Professionalism of audit bodies and an optimal communication between audit bodies and accredited centres is also added.

Modelo de acreditación de centros de atención hospitalaria aguda de Cataluña / Accreditation model for acute hospital care in Catalonia, Spain

Se describe la implantación de un modelo de acreditación para centros sanitarios de Catalunya que se inicia para hospitales de agudos y deja abierta la posibilidad de aplicación al resto de líneas de servicios: centros de salud mental y adicciones, sociosanitarios y atención primaria. El modelo se basa en la experiencia adquirida a lo largo de más de 31 años de acreditación de hospitales y de la evaluación de la calidad ligada a la gestión. En enero de 2006 se pone en marcha un modelo con metodología de acreditación, adaptado al modelo de la European Foundation for Quality Management (EFQM). Se acreditan 83 hospitales, con una media del 82,6% de cumplimiento de los estándares necesarios para acreditarse. El número de entidades evaluadoras en activo es de 5 y el período de acreditación es de 3 años. Se obtiene un mayor grado de cumplimiento de los denominados criterios "de agentes" respecto a los "de resultados". Como aspectos cualitativos, destacar en la implantación una gran implicación, tanto a nivel directivo como del personal de los centros, así como una comunicación directa y fluida entre órgano acreditador (Departament de Salut) y centros acreditados. Se añade también la profesionalidad de las entidades auditoras y una óptima comunicación entre entidades auditoras y centros acreditados (AU)

The implementation of an accreditation model for healthcare centres in Catalonia which was launched for acute care hospitals, leaving open the possibility of implementing it in the rest of lines of service (mental health and addiction, social health, and primary healthcare centres) is described. The model is based on the experience acquired over more tan 31 years of hospital accreditation and quality assessment linked to management. In January 2006 a model with accreditation methodology adapted to the European Foundation for Quality Management (EFQM) model was launched. 83 hospitals are accredited, with an average of 82.6% compliance with the standards required for accreditation. The number of active assessment bodies is 5, and the accreditation period is 3 years. A higher degree of compliance of the so-called "agent" criteria with respect to "outcome" criteria is obtained. Qualitative aspects for implementation to be stressed are: a strong commitment both from managers and staff in the centres, as well as a direct and fluent communication between the accreditation body (Ministry of Health of the Government of Catalonia) and accredited centres. Professionalism of audit bodies and an optimal communication between audit bodies and accredited centres is also added (AU)

Heterogeneity and event dependence in the analysis of sickness absence.

BACKGROUND: Sickness absence (SA) is an important social, economic and public health issue. Identifying and understanding the determinants, whether biological, regulatory or, health services-related, of variability in SA duration is essential for better management of SA. The conditional frailty model (CFM) is useful when repeated SA events occur within the same individual, as it allows simultaneous analysis of event dependence and heterogeneity due to unknown, unmeasured, or unmeasurable factors. However, its use may encounter computational limitations when applied to very large data sets, as may frequently occur in the analysis of SA duration. METHODS: To overcome the computational issue, we propose a Poisson-based conditional frailty model (CFPM) for repeated SA events that accounts for both event dependence and heterogeneity. To demonstrate the usefulness of the model proposed in the SA duration context, we used data from all non-work-related SA episodes that occurred in Catalonia (Spain) in 2007, initiated by either a diagnosis of neoplasm or mental and behavioral disorders. RESULTS: As expected, the CFPM results were very similar to those of the CFM for both diagnosis groups. The CPU time for the CFPM was substantially shorter than the CFM. CONCLUSIONS: The CFPM is an suitable alternative to the CFM in survival analysis with recurrent events, especially with large databases.

Distribución de la duración de la incapacidad temporal por contingencia comúnpor diagnóstico médico (Cataluna, 2006-2008) / Distribution of the duration of nonoccupational sick leave by medical diagnosis (Catalonia, Spain, 2006-2008)

Presentamos una herramienta sencilla y práctica que permite consultar la distribución habitual de laduración de la incapacidad temporal por contingencia común, según el diagnóstico médico. Para ello seanalizaron 2.646.352 episodios de incapacidad temporal ocurridos en Cataluna y seguidos hasta el alta, ˜entre 2006 y 2008, incorporados a un aplicativo. La duración mediana, dado que sigue una distribuciónasimétrica, fue de 9 días. Los trastornos musculoesqueléticos fueron el grupo diagnóstico más frecuente(22,5%) y las neoplasias tuvieron la duración mediana más larga (56 días). Los diagnósticos específicos máscomunes fueron la diarrea-gastroenteritis (8,2%;mediana: 3 días) y la rinofaringitis aguda (5,2%;mediana:4 días). La distribución de la duración de la incapacidad temporal en una población varía por diagnósticoy es asimétrica; la mayoría de los episodios duran mucho menos que la media. Esta información esimportante para una mejor gestión, tanto clínica como administrativa, de la incapacidad temporal (AU)

We present a simple and practical tool that allows the usual distribution of the duration of nonoccupational sick leave to be determined by medical diagnosis. A total of 2,646,352 episodes of medicallycertified sick leave, registered by the Catalan Institute of Medical Evaluations for the period 2006-2008,were followed to closure and were entered into a spreadsheet. Given its asymmetric distribution, themedian duration of sick leave was 9 days. Musculoskeletal disorders were the most frequent diagnosticgroup (22.5%), while neoplasms had the longest median duration (56 days). The most common specific diagnoses were diarrhea-gastroenteritis (8.2%; median: 3 days) and acute rhinopharyngitis (5.2%;median: 4 days). The distribution of the duration of sick leave in a population varies by diagnosis and isasymmetric, with most episodes being much shorter than the mean duration. This finding is importantfor better clinical and administrative management of sick leave episodes (AU)

[Distribution of the duration of nonoccupational sick leave by medical diagnosis (Catalonia, Spain, 2006-2008)]. / Distribución de la duración de la incapacidad temporal por contingencia común por diagnóstico médico (Cataluña, 2006-2008).

We present a simple and practical tool that allows the usual distribution of the duration of non-occupational sick leave to be determined by medical diagnosis. A total of 2,646,352 episodes of medically certified sick leave, registered by the Catalan Institute of Medical Evaluations for the period 2006-2008, were followed to closure and were entered into a spreadsheet. Given its asymmetric distribution, the median duration of sick leave was 9 days. Musculoskeletal disorders were the most frequent diagnostic group (22.5%), while neoplasms had the longest median duration (56 days). The most common specific diagnoses were diarrhea-gastroenteritis (8.2%; median: 3 days) and acute rhinopharyngitis (5.2%; median: 4 days). The distribution of the duration of sick leave in a population varies by diagnosis and is asymmetric, with most episodes being much shorter than the mean duration. This finding is important for better clinical and administrative management of sick leave episodes.

Incapacidad temporal por enfermedad común y accidente no laboral en Cataluña, 2007-2010 / Nonoccupational temporary sickness absence in Catalonia, 2007-2010

Objetivos: Describir los episodios de incapacidad temporal por enfermedad común y accidente no laboral (ITcc) registrados en Cataluña entre 2007 y 2010. Métodos: Se analizaron 4.273.601 procesos de ITcc certificados en los Centros de Atención Primaria de Cataluña con alta entre 2007 y 2010. Se estimó para cada año la incidencia de episodios de ITcc por cada 100 afiliados en la Seguridad Social, la duración mediana y la duración media de días de baja por afiliado según el sexo, la edad, la provincia, el régimen de la seguridad social y la familia diagnóstica de la CIE-10.Resultados: Se observa una tendencia consistente en descenso de la duración media de días de baja por afiliado (de12,2 días en 2007 a 10,8 en 2010) y de la incidencia (de 34,4 a 30,4 casos por 100 afiliados). Este patrón se observa tanto en hombres como en mujeres, aunque los hombres presentan una incidencia, duración mediana y días de baja por afiliado menor que las mujeres. La mayoría de los diagnósticos fueron por enfermedades respiratorias (alrededor de 7 episodios porcada 100 afiliados), osteomusculares (que desciende de 6,9 a 3,2 en el periodo de estudio) e infeccionas (alrededor de 4). En cuanto a la duración mediana de los episodios destacan las enfermedades tumorales (sobre 50 días), mentales (sobre 30 días)y cardiovasculares (entre 20 y 30 días). Conclusiones: Las tendencias mostradas pueden servir como valores de referencia para la planificación y evaluación delas políticas de gestión de la ITcc(AU)

Objectives: To describe nonoccupational temporary sickness absence episodes registered in Catalonia between 2007and 2010.Methods: We analysed 4,273,601 sickness absence episodes (SA) that came to closure between 2007 and 2010, registered through Catalonian Primary Health centers. Annual incidence rates per 100 workers, and median and mean duration of days lost per worker were examined by gender, age, province, social security scheme, and major ICD-10 diagnostic groups. Results: There was a consistent downward trend in mean duration of days lost per worker (from 12.2 days in 2007 to10.8 in 2010), and in incidence rates (from 34.4 to 30.4 cases per 100 workers). This pattern was observed in both men and women, although overall men had a lower incidence, median duration and mean days lost per worker than women. The most frequent diagnostic groups were respiratory diseases (about 7 episodes per 100 workers), musculoskeletal disorders (decreasing from 6.9 to 3.2 over the study period), and infections (about 4 episodes per 100 workers). The longest median durations were those associated with neoplasms (about 50 days), mental disorders (30 days) and cardiovascular diseases (between 20and 30 days)(AU)

[Non-occupational temporary sickness absence in Catalonia, 2007-2010]. / Incapacidad temporal por enfermedad común y accidente no laboral en Cataluña, 2007-2010.

OBJECTIVES: To describe nonoccupational temporary sickness absence episodes registered in Catalonia between 2007 and 2010. METHODS: We analysed 4,273,601 sickness absence episodes (SA) that came to closure between 2007 and 2010, registered through Catalonian Primary Health centers. Annual incidence rates per 100 workers, and median and mean duration of days lost per worker were examined by gender, age, province, social security scheme, and major ICD-10 diagnostic groups. RESULTS: There was a consistent downward trend in mean duration of days lost per worker (from 12.2 days in 2007 to 10.8 in 2010), and in incidence rates (from 34.4 to 30.4 cases per 100 workers). This pattern was observed in both men and women, although overall men had a lower incidence, median duration and mean days lost per worker than women. The most frequent diagnostic groups were respiratory diseases (about 7 episodes per 100 workers), musculoskeletal disorders (decreasing from 6.9 to 3.2 over the study period), and infections (about 4 episodes per 100 workers). The longest median durations were those associated with neoplasms (about 50 days), mental disorders (30 days) and cardiovascular diseases (between 20 and 30 days). CONCLUSIONS: These trends may serve as a baseline for planning and evaluating policies directed at better management of sickness absence in Spain.

OBJETIVOS: Describir los episodios de incapacidad temporal por enfermedad común y accidente no laboral (ITcc) registrados en Cataluña entre 2007 y 2010. MÉTODOS: Se analizaron 4.273.601 procesos de ITcc certificados en los Centros de Atención Primaria de Cataluña con alta entre 2007 y 2010. Se estimó para cada año la incidencia de episodios de ITcc por cada 100 afiliados en la Seguridad Social, la duración mediana y la duración media de días de baja por afiliado según el sexo, la edad, la provincia, el régimen de la seguridad social y la familia diagnóstica de la CIE-10. RESULTADOS: Se observa una tendencia consistente en descenso de la duración media de días de baja por afiliado (de 12,2 días en 2007 a 10,8 en 2010) y de la incidencia (de 34,4 a 30,4 casos por 100 afiliados). Este patrón se observa tanto en hombres como en mujeres, aunque los hombres presentan una incidencia, duración mediana y días de baja por afiliado menor que las mujeres. La mayoría de los diagnósticos fueron por enfermedades respiratorias (alrededor de 7 episodios por cada 100 afiliados), osteomusculares (que desciende de 6,9 a 3,2 en el periodo de estudio) e infeccionas (alrededor de 4). En cuanto a la duración mediana de los episodios destacan las enfermedades tumorales (sobre 50 días), mentales (sobre 30 días) y cardiovasculares (entre 20 y 30 días). CONCLUSIONES: Las tendencias mostradas pueden servir como valores de referencia para la planificación y evaluación de las políticas de gestión de la ITcc.