Proceso de evaluación y variabilidad en los congresos de la Sociedad Española de Calidad Asistencial / The assessment process and variability in the conferences of Spanish Society of Quality in Healthcare

Objetivo. Describir el proceso de evaluación de comunicaciones al Congreso de la Sociedad Española de Calidad Asistencial 2011, con énfasis en el procedimiento para controlar la variabilidad interevaluador. Material y método. Proceso descrito mediante IDEF0. Estudio de intervención en ciego para conocer y controlar la variabilidad de los evaluadores. Cinco comunicaciones fueron valoradas por los 27 evaluadores del congreso utilizando 4 criterios explícitos. La suma de puntuaciones fue utilizada para calcular la variabilidad. La razón de variabilidad (RV) de cada evaluador, obtenida al dividir la media de puntuaciones por su puntuación, se empleó para controlar la variabilidad ajustando las puntuaciones brutas. Resultados. Misión del proceso: «evaluar de forma ágil, transparente y equitativa las comunicaciones recibidas al congreso de la SECA». Se identificó como clientes y se exploraron necesidades y expectativas de congresistas, autores y SECA. Se desarrolló diagramado IDEF0. Variabilidad: puntuación máxima 170, mínima 37, media 115,4, coeficientes: variación 23%, asimetría −0,7, curtosis 2,1. RV máxima 3,12, mínima: 0,68. Conclusiones. IDEF0 puede servir para avanzar en la mejora del proceso de evaluación y facilitar el trabajo de futuros comités. La variabilidad entre evaluadores es alta. RV es una herramienta fácil de obtener y sencilla de aplicar que produce puntuaciones ajustadas para controlar la variabilidad interevaluador (AU)

Objective. To describe the abstracts assessment process in the 2011 Conference of the Spanish Society for Quality in Health Care, focusing on the procedures adopted to control the interobserver variability. Material and methods. Process described using the IDEF0 model. An interventional blinded study is designed to know and control the interobserver variability of the 27 Conference appraisers, who scored 5 submitted abstracts using 4 explicit criteria. The sum of these scores is used to estimate the variability. The variability ratio (VR) of every appraiser is obtained dividing the average score by his total score, and used to control the variability adjusting the gross score of every abstract. Results. Process mission: “to assess the abstracts submitted to Conference in an easy, open and fair way”. Attendants to the conference, abstract authors and the Society have been identified as clients, their needs and explored expectations. Variability scores: maximum 170, minimum 37, average 115.4. Coefficients: variation 23%, asymmetry −.7, kurtosis 2.1. VR: maximum 3.12, minimum .68. Conclusions. IDEF0 diagrams could be useful to improve the evaluation process and facilitate the work of future scientific committees. The appraisers’ variability was too important to be omitted. VR is an easy to get and simple to use tool that produces adjusted scores to control this (AU)

[The assessment process and variability in the conferences of Spanish Society of Quality in Healthcare]. / Proceso de evaluación y variabilidad en los congresos de la Sociedad Española de Calidad Asistencial.

OBJECTIVE: To describe the abstracts assessment process in the 2011 Conference of the Spanish Society for Quality in Health Care, focusing on the procedures adopted to control the interobserver variability. MATERIAL AND METHODS: Process described using the IDEF0 model. An interventional blinded study is designed to know and control the interobserver variability of the 27 Conference appraisers, who scored 5 submitted abstracts using 4 explicit criteria. The sum of these scores is used to estimate the variability. The variability ratio (VR) of every appraiser is obtained dividing the average score by his total score, and used to control the variability adjusting the gross score of every abstract. RESULTS: Process mission: "to assess the abstracts submitted to Conference in an easy, open and fair way". Attendants to the conference, abstract authors and the Society have been identified as clients, their needs and explored expectations. Variability scores: maximum 170, minimum 37, average 115.4. Coefficients: variation 23%, asymmetry -.7, kurtosis 2.1. VR: maximum 3.12, minimum .68. CONCLUSIONS: IDEF0 diagrams could be useful to improve the evaluation process and facilitate the work of future scientific committees. The appraisers' variability was too important to be omitted. VR is an easy to get and simple to use tool that produces adjusted scores to control this.

Lactancia materna en la Región de Murcia. ¿Seguimos con el problema? / Maternal breastfeeding in the Region of Murcia, does the

Objetivo: Conocer la prevalencia y la duración de la lactancia materna (LM) en la Región de Murcia. Método: Estudio transversal (junio de 2007), mediante encuestas a madres de niños menores de 24 meses realizadas en centros de vacunación. El ámbito de estudio estuvo comprendido por 77 zonas de salud de 6 áreas sanitarias de la región, y el muestreo fue proporcional al número de niños nacidos en el área. Se recogieron datos sociosanitarios del niño, de la madre y de la alimentación del niño. Se calculó la prevalencia de LM según las categorías definidas por la Organización Mundial de Salud (OMS) y se estudiaron los motivos de no iniciar y de abandonar la LM. Resultados: Se obtuvieron datos de 1.836 niños, con una tasa de respuesta del 95,2%. Al alta del hospital, un total de 1.643 niños (89,7%) fueron alimentados con LM; de éstos, el 76,7% (n= 1.405) lo hicieron sin suplementos nutritivos. Al tercer mes mantenían la LM completa el 44,4% y al sexto mes el 36,3%. La mediana de duración de LM exclusiva fue de 75 días y para la LM parcial de 129 días. Los motivos de no alimentar con LM fueron: enfermedad/ingreso (46,7%), falta de leche (28,6%) y decisión de la madre (19,3%). Entre las causas de abandono, cabe citar las siguientes: hipogalactia e insaciabilidad (29,3%) y escasa ganancia de peso (11%). Las variables que mostraron una asociación estadísticamente significativa (p <0,05) con la LM fueron el peso del niño, el tipo de parto y el área sanitaria, y, en relación con la madre, la edad, la paridad, la actividad laboral, el lugar de procedencia y el nivel de estudios. Conclusiones: Las cifras de LM en la Región de Murcia son similares a las de nuestro entorno, pero se alejan de las recomendadas por la OMS (AU)

Title: Maternal breastfeeding in the Region of Murcia, does the problem persist? Objective: To study the prevalence and duration of maternal breastfeeding (MB) in the Region of Murcia. Methods: Cross-sectional study (June, 2007). Mothers of infants under 24 months old were surveyed in immunization centers. The study was conducted through the 77 health zones of the 6 health areas of the Region. The sample size was proportion alto the number of newborns in these areas. Breast-fed baby, mother and child feeding social and health data were collected. The MB prevalence was calculated in accordance with the categories defined by the World Health Organization (WHO) and the reasons for not starting and for stopping MB were studied. Results: Data from 1,836 infants (response rate of 95.2%) has been obtained. Upon hospital discharge, the percentage of children fed with MB was of 89.7% (1,643), 76.7% (1,405) of which were breastfed without nourishing supplements. 44.4%of infants exclusively MB at 3 months and 36.3% at 6 months. The median duration of exclusive MB was of 75 days and of129 days for partial MB. The reasons for not being fed by MB were: disease/admission (46.7%), lack of milk (28.6%), and mother’s decision (19.3%). The reasons for discontinuing breastfeeding were: hypogalactia and insatiable appetite (29.3%), and not to put on weight (11%). The variables that showed statistically significant association (p < 0.05) regarding MB were child weight, type of childbirth, and health area, and, regarding the mother, age, parity, occupation, place of origin, and education. Conclusions: The MB figures in the Region of Murcia are similar to those in our environment, but are far from those recommended by the WHO (AU)

[Malama project in the Region of Murcia (Spain): environment and breastfeeding]. / Proyecto Malama en la Región de Murcia (España): medio ambiente y lactancia materna.

OBJECTIVES: To identify protective factors and risk factors for the initiation and length of breastfeeding and full breastfeeding, in the Region of Murcia (Spain). PATIENTS AND METHODS: The Malama study (Medio Ambiente y Lactancia Materna) is a follow up study from birth up to years of 1,000 mother-child pairs. A description of breastfeeding practices are presented here, the survival curve of breastfeeding and a Cox regression model of the pilot study that includes 101 mother-child pairs and 6 months of follow-up. RESULTS: After six months the prevalence of breastfeeding was 35 %. The mean duration of full breastfeeding was 63 days (median 45 days) with six months prevalence of 8 %. Hazard ratios (HR) for full breastfeeding were, to be a smoker (1.89; 95 % CI: 1.18-3.02), older than 35 years of age (2.04; 95 % CI: 1.22-3.42), caesarean birth (1.63; 95 % CI: 1.00-2.66). As well as those previously mentioned risks for breastfeeding, there were also hazard ratios for primary school education or less (1.63; 95 % CI: 0.98-2.82); to have breastfed an earlier child for at least 16 weeks (0.33; 95 % CI: 0.13-0.79), and to be the first birth (0.50; 95 % CI: 0.27-0.95). The length of both breastfeeding and full breastfeeding increased with the length of the maternal leave (0.96; 95 % CI: 0.94-0.99). Pregestational occupational exposure to endocrine disruptors did not seem to interfere with the duration of breastfeeding. CONCLUSIONS: In order to improve quality and duration of breastfeeding programmes, paediatric research and training on breastfeeding practice should be encouraged, to reduce unnecessary caesarean sections, promote tobacco cessation, focus human and economic resources to women with less education, and include legal mechanisms to ensure longer maternal leave.

Proyecto Malama en la Región de Murcia (España): medio ambiente y lactancia materna / Malama project in the Region of Murcia (Spain): environment and breastfeeding

Objetivo: Estudiar los factores protectores y de riesgo de la calidad y duración de la lactancia materna completa (LMC) y total (LMT) en la Región de Murcia. Pacientes y métodos: El estudio Malama (medio ambiente y lactancia materna) realiza un seguimiento de 1.000 parejas madre-hijo desde el nacimiento hasta los 2 años. Aquí presentamos la descripción, supervivencia de la lactancia y regresión de Cox del estudio piloto con 101 parejas y 6 meses de seguimiento. Resultados: La duración media de la LMC fue de 63 días (mediana de 45) y prevalencia a los 6 meses del 8 %. La prevalencia de LMT fue del 35 %. Riesgo relativo (RR) para LMC eran ser madre fumadora (1,89; intervalo de confianza del 95 % [IC 95 %]: 1,18-3,02), mayor de 35 años (2,04; IC 95 %: 1,22-3,42), con parto por cesárea (1,63; IC 95 %: 1,00-2,66); y para LMT, además de las anteriores el tener sólo estudios primarios (1,63; IC 95 %: 0,98-2,82); haber lactado antes al menos 16 semanas (0,33; IC 95 %: 0,13-0,79); primer hijo/a (0,50; IC 95 %: 0,27-0,95). La duración de LMC y LMT crecían con la mayor duración de la baja maternal (0,96; IC 95 %: 0,94-0,99). La exposición laboral pregestacional a disruptores endocrinos no parece interferir con la duración de la lactancia. Conclusiones: Los programas de protección-promoción de la LM deberían aumentar la investigación y formación pediátrica en LM, disminuir las cesáreas innecesarias, fomentar la deshabituación tabáquica, dedicar más recursos a las mujeres con menos estudios e incluir mecanismos legales que prolonguen la baja por maternidad para conseguir una lactancia más duradera y de mejor calidad (AU)

Objectives: To identify protective factors and risk factors for the initiation and length of breastfeeding and full breastfeeding, in the Region of Murcia (Spain). Patients and methods: The Malama study (Medio Ambiente y Lactancia Materna) is a follow up study from birth up to years of 1,000 mother-child pairs. A description of breastfeeding practices are presented here, the survival curve of breastfeeding and a Cox regression model of the pilot study that includes 101 mother-child pairs and 6 months of follow-up. Results: After six months the prevalence of breastfeeding was 35 %. The mean duration of full breastfeeding was 63 days (median 45 days) with six months prevalence of 8 %. Hazard ratios (HR) for full breastfeeding were, to be a smoker (1.89; 95 % CI: 1.18-3.02), older than 35 years of age (2.04; 95 % CI: 1.22-3.42), caesarean birth (1.63; 95 % CI: 1.00-2.66). As well as those previously mentioned risks for breastfeeding, there were also hazard ratios for primary school education or less (1.63; 95 % CI: 0.98-2.82); to have breastfed an earlier child for at least 16 weeks (0.33; 95 % CI: 0.13-0.79), and to be the first birth (0.50; 95 % CI: 0.27-0.95). The length of both breastfeeding and full breastfeeding increased with the length of the maternal leave (0.96; 95 % CI: 0.94-0.99). Pregestational occupational exposure to endocrine disruptors did not seem to interfere with the duration of breastfeeding. Conclusions: In order to improve quality and duration of breastfeeding programmes, paediatric research and training on breastfeeding practice should be encouraged, to reduce unnecessary caesarean sections, promote tobacco cessation, focus human and economic resources to women with less education, and include legal mechanisms to ensure longer maternal leave (AU)

Non-compliance with appointments amongst patients attending an Allergology Clinic, after implementation of an improvement plan.

BACKGROUND: Non-compliance is a common cause of failed medical action, contributing to absence of regular check-ups. Our group has already published studies that analyse the level of non-compliance with appointments amongst patients attending our Allergology clinic, and we have made proposals for improvement. OBJECTIVE: This article evaluates the results obtained three years after setting up and launching telephone reminders for patients' first appointments. METHODS: All patients who were given appointments for first and subsequent visits during 2005 were included. A total of 18215 appointments were studied (3115 first appointments and 15100 subsequent ones). Of these, there were 2479 missed appointments (438 first appointments and 2041 subsequent ones), corresponding to 2215 patients (412 first visits and 1803 subsequent ones), with a mean of 1.12 appointments/patient/year. RESULTS: The non-compliance rate was 13.61%. The most common non-compliers were men (14.11% missed appointments against 13.24% missed appointments in women) and in the age range 20-29 years and 30-39 years (16.46% and 15.28% non-compliance, respectively). The mean age of non-compliers was 34.55 +/- 14.73 years. We observed a significant number of patients who missed more than one appointment (5.12% of all non-compliers and 0.7% of all patients). Differences were found in the degree of non-compliance depending on the type of appointment (14.06% non-compliance with first visits and 13.52% with subsequent visits). We observed a significant increase in missed appointments during the Summer holidays; July and August showed the highest percentage of missed appointments for both the first visit (20.62% in July and 23.59% in August) and subsequent visits alike (16.14% in July and 14.23% in August). CONCLUSIONS: A slight reduction in non-compliance was observed after implementing the proposals made in our previous study. In view of the high costs incurred from missed appointments, the government should finance studies to reduce this problem. The causes of non-compliance may be difficult to control, including present access to the public health service. We must be alert to and/or take preventive measures in young patients and cases of previous non-compliance. The degree of non-compliance is a quality indicator, because it reduces the yield of appointments, and it evidences a lack of cohesion of patients with Primary Health Care Units for first appointments, and with Specialist Care Units for subsequent appointments. Once certain levels of attendance have been attained, it is difficult to achieve an effect on this point in order to improve attendance rates.

Non-compliance with appointments amongst patients attending an Allergology Clinic, after implementation of an improvement plan / Incumplimiento de citas concertadas en los pacientes de una consulta de alergología, tras la implantación de un ciclo de mejora

Background: Non-compliance is a common cause of failed medical action, contributing to absence of regular check-ups. Our group has already published studies that analyse the level of non-compliance with appointments amongst patients attending our Allergology clinic, and we have made proposals for improvement. Objective: This article evaluates the results obtained three years after setting up and launching telephone reminders for patients' first appointments. Methods: All patients who were given appointments for first and subsequent visits during 2005 were included. A total of 18215 appointments were studied (3115 first appointments and 15100 subsequent ones). Of these, there were 2479 missed appointments (438 first appointments and 2041 subsequent ones), corresponding to 2215 patients (412 first visits and 1803 subsequent ones), with a mean of 1.12 appointments/patient/year. Results: The non-compliance rate was 13.61 %. The most common non-compliers were men (14.11 % missed appointments against 13.24 % missed appointments in women) and in the age range 20-29 years and 30-39 years (16.46 % and 15.28 % non-compliance, respectively). The mean age of non-compliers was 34.55 ± 14.73 years. We observed a significant number of patients who missed more than one appointment (5.12 % of all non-compliers and 0.7 % of all patients). Differences were found in the degree of non-compliance depending on the type of appointment (14.06 % non-compliance with first visits and 13.52 % with subsequent visits). We observed a significant increase in missed appointments during the Summer holidays; July and August showed the highest percentage of missed appointments for both the first visit (20.62 % in July and 23.59 % in August) and subsequent visits alike (16.14 % in July and 14.23 % in August). Conclusions: A slight reduction in non-compliance was observed after implementing the proposals made in our previous study. In view of the high costs incurred from missed appointments, the government should finance studies to reduce this problem. The causes of non-compliance may be difficult to control, including present access to the public health service. We must be alert to and/or take preventive measures in young patients and cases of previous non-compliance. The degree of non-compliance is a quality indicator, because it reduces the yield of appointments, and it evidences a lack of cohesion of patients with Primary Health Care Units for first appointments, and with Specialist Care Units for subsequent appointments. Once certain levels of attendance have been attained, it is difficult to achieve an effect on this point in order to improve attendance rates

Fundamento: El incumplimiento es una causa frecuente de fracaso de las actuaciones médicas, contribuyendo a ello la ausencia a los controles periódicos. Nuestro grupo con anterioridad ha publicado estudios en los que se analizaba el grado de incumplimiento a citas concertadas, de los pacientes citados en nuestra consulta de Alergología y se realizaban propuestas de mejora. Objetivo: En el presente artículo se evalúan los resultados obtenidos tras tres años desde su puesta en marcha, e introducción de recordar telefónicamente la fecha de la cita a los pacientes de primera vez. Métodos: Se incluyeron los pacientes citados en consulta que acudían por primera vez o a una visita sucesiva, durante todo el año 2005. Fueron objeto del estudio un total de 2.479 citaciones (438 por primera vez y 2.041 sucesivas) que no acudieron a la consulta, correspondientes a 2.215 pacientes (412 de primera visita y 1803 sucesivas), con una media de 1,12 citas/paciente/año. Eran 1391 (56,11%) mujeres y 1088 (43,89%) hombres, con una edad media de 34,55 ± 14.73 años. Resultados: Existió incumplimiento al 13,61% de las consultas. Los pacientes que incurrieron en el incumplimiento con más frecuencia fueron los hombres (14,11% de los citados frente al 13,24%) y las franjas de edades de los 20 a 30 años y de 30 a 40 años (16,46% y 15,28% de incumplimiento respectivamente). Encontramos un número importante de pacientes reincidentes en el incumplimiento (5,12% del total de pacientes incumplidores y 0,7% del total de pacientes citados). Se evidenciaron diferencias en el grado de incumplimiento de las citas en función de la consulta (14.06% incumplimiento en la primera consulta y 13.52% en las consultas sucesivas). Hemos encontrado un aumento significativo de las ausencias en la consulta durante el período vacacional estival, siendo los meses de julio y de agosto los que registraron mayor porcentaje de ausencias, tanto los de primera visita (20,62% en julio y 23,59% en agosto) como los de visitas sucesivas (16,14% en julio y 14,23% en agosto). Conclusiones: Se evidenció un discreto descenso en el incumplimiento, tras poner en marcha las medidas propuestas a raíz de nuestro anterior estudio. Debido a los elevados costes que las inasistencias suponen, es necesario que la administración financie estudios que permitan la disminución de las mismas. Quizá en las inasistencias jueguen papel motivos de difícil control, entre los que cabe barajar la actual accesibilidad a los servicios sanitarios públicos. Es preciso estar alerta y/o tomar medidas anticipatorias en pacientes jóvenes y con incumplimientos previos. El nivel de incumplimiento es un indicador de calidad, al disminuir el rendimiento de las consultas, y poner en evidencia una falta de adherencia de los ciudadanos con los Equipos de Atención Primaria para las primeras consultas, y para la Atención Especializada en las consultas sucesivas. Sobre él, es difícil incidir con el fin de mejorar los índices, una vez obtenidas determinadas cuotas

Proposal for relative units of value (RUV) for use in allergy examinations.

Health resources are limited and consequently real cost generators must be identified to optimize resources. In the present article, we describe the structure of the Homogeneous Functional Groups (HFG) for Diagnostic Techniques in the Allergy Department of the Virgen de la Arrixaca University Hospital in Murcia (Spain) and the healthcare products generated. Based on the 2005 budget, variable costing was used to calculate the costs of the healthcare products generated (skin tests, investigation of drug allergies, etc.) by one of the three HFG (the HFG for complementary investigations). On the basis of these costs, and taking as the unit the cost of one skin prick test, we assigned relative units of value (RUV) to each of the products in our services portfolio. The following conclusions can be drawn: 1) the current system of variable costing provides information, which should be useful to health professionals; 2) the real cost generators in the microcosm of daily clinical practice should be identified to allow resource reallocation; 3) the costing system used enables modifications to be made that allow decision making on optimal use of the budget; 4) to take the decisions required to optimize resources, clinical management and complementary tests should go hand-in-hand.

Proposal for relative units of value (RUV) for use in allergy examinations / Propuesta de unidades relativas de valor para uso en los exámenes alergológicos

Health resources are limited and consequently real cost generators must be identified to optimize resources. In the present article, we describe the structure of the Homogeneous Functional Groups (HFG) for Diagnostic Techniques in the Allergy Department of the Virgen de la Arrixaca University Hospital in Murcia (Spain) and the healthcare products generated. Based on the 2005 budget, variable costing was used to calculate the costs of the healthcare products generated (skin tests, investigation of drug allergies, etc.) by one of the three HFG (the HFG for complementary investigations). On the basis of these costs, and taking as the unit the cost of one skin prick test, we assigned relative units of value (RUV) to each of the products in our services portfolio. The following conclusions can be drawn: 1) the current system of variable costing provides information, which should be useful to health professionals; 2) the real cost generators in the microcosm of daily clinical practice should be identified to allow resource reallocation; 3) the costing system used enables modifications to be made that allow decision making on optimal use of the budget; 4) to take the decisions required to optimize resources, clinical management and complementary tests should go hand-in-hand

Los recursos sanitarios son limitados, por lo que es preciso identificar los auténticos generadores del gasto, con el fin de poder optimizar los recursos. En la presente publicación se describe la estructura de los Grupos Funcionales Homogéneos (GFH) de Técnicas Diagnósticas del Servicio de Alergología del Hospital Universitario “Virgen de la Arrixaca” de Murcia (España), y los productos sanitarios que genera. Partiendo del presupuesto ejecutado durante el año 2005, y utilizando la contabilidad analítica, se calculan los costes de los productos sanitarios generados (pruebas cutáneas, estudios de alergia a medicamentos, etc.), producidos por uno de los GFH de los tres que la componen, a saber, el GFH de Exploraciones Complementarias. A partir de estos costes, tomando como unidad el coste del prick-test, asignamos unidades relativas de valor (URV), a cada uno de los productos de nuestra Cartera de Servicios. Como conclusiones cabe destacar que el actual sistema de gestión analítica: 1) Proporciona información y ésta debe de tener validez para el clínico. 2) Es necesario identificar verdaderos generadores de gastos en el microcosmos de la clínica diaria que permitan la reasignación de recursos. 3) Hace posible correcciones que permitan tomar decisiones para ejecutar de forma óptima el presupuesto. 4) La gestión clínica y la analítica deben de caminar al unísono, con el fin de poder tomar las medidas necesarias tendentes a optimizar los recursos

Direct patient treatment costs in the Allergology Service of a University Hospital.

Health resources are limited and consequently real cost generators must be identified to optimize resources. In the present article, we describe the structure of the Allergy Unit of the University Hospital Virgen de la Arrixaca in Murcia (Spain), the health area in which allergic patients are attended, and the final healthcare products generated. Based on the 2004-2005 budget, variable costing was used to calculate the costs of the healthcare products generated (first visits, subsequent visits, and diverse laboratory tests) by two of the three homogeneous functional groups (HFG), i.e., HFG of the ambulatory service and HFG of complementary tests. The following conclusions can be drawn: 1) the current system of variable costing provides information, which should be useful to health professionals; 2) the real cost generators in the microcosm of daily clinical practice should be identified to allow resource reallocation; 3) the costing system used enables modifications to be made that allow decision making on optimal use of the budget; 4) clinical management and complementary tests should go hand in hand with a view to optimizing resources.

Direct patient treatment costs in the Allergology Service of a University Hospital / Costes directos del tratmiento de los pacientres en el servicio de alergología de un hospital universitario

Health resources are limited and consequently real cost generators must be identified to optimize resources. In the present article, we describe the structure of the Allergy Unit of the University Hospital Virgen de la Arrixaca in Murcia (Spain), the health area in which allergic patients are attended, and the final healthcare products generated. Based on the 2004-2005 budget, variable costing was used to calculate the costs of the healthcare products generated (first visits, subsequent visits, and diverse laboratory tests) by two of the three homogeneous functional groups (HFG), i.e., HFG of the ambulatory service and HFG of complementary tests. The following conclusions can be drawn: 1) the current system of variable costing provides information, which should be useful to health professionals; 2) the real cost generators in the microcosm of daily clinical practice should be identified to allow resource reallocation; 3) the costing system used enables modifications to be made that allow decision making on optimal use of the budget; 4) clinical management and complementary tests should go hand in hand with a view to optimizing resources

Los recursos sanitarios son limitados, por lo que es preciso identificar los auténticos generadores del gasto, con el fin de poder optimizar los recursos. En la presente publicación se describe la estructura de la Unidad de Alergología del Hospital Universitario “Virgen de la Arrixaca” de Murcia (España), el área sanitaria en la que son atendidos los pacientes alérgicos, y los productos sanitarios finalistas que genera. Partiendo del presupuesto ejecutado durante los años 2004 y 2005, y utilizando la contabilidad analítica, se calculan los costes de los productos sanitarios generados (primeras visitas, sucesivas y diversas determinaciones analíticas), por dos de los Grupos Funcionales Homogéneos (GFH) de los tres que la componen, a saber, el GFH de Consultas Externas y el GFH de Exploraciones Complementarias. Como conclusiones cabe destacar que el actual sistema de gestión analítica: 1) Proporciona información y ésta debe de tener validez para el clínico. 2) Es necesario identificar verdaderos generadores de gastos en el microcosmos de la clínica diaria que permitan la reasignación de recursos. 3) Hace posible correcciones que permitan tomar decisiones para ejecutar de forma óptima el presupuesto. 4) La gestión clínica y la analítica deben de caminar al unísono, con el fin de poder tomar las medidas necesarias tendentes a optimizar los recursos

[Prevalence of iron deficiency and iron deficiency anemia in infancy and related factors in a community of the Murcia region]. / Prevalencia de ferropenia y anemia ferropénica en la primera infancia y factores relacionados en una comarca de la región de Murcia.

In this study of 98 children, we determined hematological values and serum iron concentrations. A nutritional investigation was also done. We found that 25.5% of the children were iron deficient and 12.2% were anemic. In the group of children with iron deficiency, the introduction of meat and cereals was significantly late (p less than 0.01 and p less than 0.05, respectively). In this same group of children the introduction of whole cow milk was earlier, although not significant (NS). The age of maximal prevalence was between 13 and 24 months. These results indicate a need to screen for iron deficiency during the second year of life, to delay the introduction of whole cow milk and not to delay the introduction of meat and cereals.