A Semiautomated Classification System for Producing Service Directories in Social and Health Care (DESDE-AND): Maturity Assessment Study.

BACKGROUND: DESDE-LTC (Description and Evaluation of Services and DirectoriEs for Long-Term Care) is an international classification system that allows standardized coding and comparisons between different territories and care sectors, such as health and social care, in defined geographic areas. We adapted DESDE-LTC into a computer tool (DESDE-AND) for compiling a directory of care services in Andalucia, Spain. OBJECTIVE: The aim of this study was to evaluate the maturity of DESDE-AND. A secondary objective of this study is to show the practicality of a new combined set of standard evaluation tools for measuring the maturity of health technology products. METHODS: A system for semiautomated coding of service provision has been co-designed. A panel of 23 domain experts and a group of 68 end users participated in its maturity assessment that included its technology readiness level (TRL), usability, validity, adoption (Adoption Impact Ladder [AIL]), and overall degree of maturity [implementation maturity model [IMM]). We piloted the prototype in an urban environment (Seville, Spain). RESULTS: The prototype was demonstrated in an operational environment (TRL 7). Sixty-eight different care services were coded, generating fact sheets for each service and its geolocation map. The observed agreement was 90%, with moderate reliability. The tool was partially adopted by the regional government of Andalucia (Spain), reaching a level 5 in adoption (AIL) and a level 4 in maturity (IMM) and is ready for full implementation. CONCLUSIONS: DESDE-AND is a usable and manageable system for coding and compiling service directories and it can be used as a core module of decision support systems to guide planning in complex cross-sectoral areas such as combined social and health care.

Evaluación del impacto de un plan multisectorial de promoción de la salud y el bienestar social en Andalucía / Impact assessment of a multisectoral plan for the promotion of health and social wellbeing in Andalusia (Spain)

OBJETIVO: Evaluar el impacto del Plan de Promoción de la Autonomía Personal y Prevención de la Dependencia de Andalucía (2016-2020) en 13 organismos públicos participantes tras su primer año, y analizar la usabilidad y la fiabilidad de la escala de evaluación del impacto que se ha empleado. MÉTODO: El Plan aborda la promoción de la autonomía personal y la prevención de la discapacidad y la dependencia con un enfoque multisectorial. Se estructura en líneas, objetivos y actuaciones que han sido evaluadas mediante la escala Adoption Impact Ladder (AIL). El análisis de la validez simple, la viabilidad y la fiabilidad de la escala se ha realizado en 30 actuaciones evaluadas por 20 expertos de la Administración pública y un evaluador externo independiente. RESULTADOS: En 2017 se pusieron en marcha 176 actuaciones y programas del Plan. Se han implementado el 67,2% de las actuaciones propuestas y solo uno de los 16 objetivos no se ha asociado a actuaciones ejecutadas en el primer año. Siete de los 15 objetivos ejecutados fueron enteramente multisectoriales, involucrando a tres o más consejerías. La validez simple, la viabilidad y la fiabilidad interexaminadores de la escala AIL fueron buenas (κ: 0,72). CONCLUSIONES: El Plan ha proporcionado un marco novedoso para coordinar un amplio rango de políticas y actuaciones en la Administración pública de Andalucía. Por primera vez se presenta un análisis del impacto multisectorial que proporciona una guía efectiva para el seguimiento, la planificación y el establecimiento de prioridades públicas en salud, servicios sociales y atención a personas mayores y personas con discapacidad

OBJECTIVE: To evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used. METHOD: The Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater. RESULTS: 176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72). CONCLUSIONS: This Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities

[Impact assessment of a multisectoral plan for the promotion of health and social wellbeing in Andalusia (Spain)]. / Evaluación del impacto de un plan multisectorial de promoción de la salud y el bienestar social en Andalucía.

OBJECTIVE: To evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used. METHOD: The Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater. RESULTS: 176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72). CONCLUSIONS: This Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities.

Experiencias, modelos y claves para la coordinación e integración de servicios sociales y sanitarios / Experiences, models and key factors for the coordination and integration of social and health services

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¿Es necesaria una estrategia integrada de biosocioética? / Is a strategy of bio-socio-ethic necessary?

OBJETIVO: El presente artículo reflexiona sobre la necesidad de apostar por la articulación de una estrategia de ética que incluya 2 de los pilares básicos que afectan al bienestar de las personas, la atención de los servicios sanitarios y de los servicios sociales. El objetivo es realizar un acercamiento a la percepción de profesionales de los servicios sociales y sanitarios en Andalucía acerca de la necesidad de desarrollar un espacio de encuentro entre la bioética y la ética de la intervención social. MÉTODO: Estudio observacional, transversal y descriptivo, mediante encuesta a profesionales de los servicios sociales y sanitarios. Se utilizó una técnica de muestreo intencional. El cuestionario constaba de 10 preguntas sobre conflictos éticos en la práctica profesional social y sanitaria, y la percepción de desarrollo de un espacio compartido para la bioética y la ética de la intervención social. RESULTADOS: La muestra constó de 124 profesionales, un 56% del sector sanitario y un 44% del sector de servicios sociales. Alrededor del 90% de las personas encuestadas se habían enfrentado a decisiones éticas difíciles de abordar en su práctica profesional y valoraron positivamente un abordaje común social y sanitario. El 75% afirmaron que los conflictos se presentan en los 2 ámbitos simultáneamente más que por separado. La gestión de los asuntos éticos se realizaba preferentemente de manera individual y de forma independiente. CONCLUSIONES: El social y el sanitario son sistemas que poseen identidad y características diferenciadas, pero tienen una afinidad especial pues comparten saberes, espacios y valores comunes, que requieren de una profunda y comprometida reflexión, en aras a crear metodologías conjuntas de actuación, gestión y deliberación ética

AIM: The aim of this paper is to assess the need for a common ethics strategy shared by 2 of the cornerstones of human welfare: the healthcare and social services sectors. Method: An observational cross-sectional descriptive study was performed by surveying social services and healthcare professionals. A purposive sampling technique was used. The questionnaire consisted of 10 questions about ethical conflicts in professional practice and respondents' views on a proposed shared approach to bioethics and ethics in social intervention. RESULTS: 124 professionals completed the questionnaire, 56% of the health sector and 44% of the social services sector. About 90% professionals surveyed had had to make difficult ethical decisions in their work and would welcome a common approach to ethics in the social services and healthcare sectors.75% said that conflicts are occurring more frequently in both sectors simultaneously and that they were resolved preferably individually and independently. CONCLUSIONS: The survey respondents believe that a common approach to tackling ethical conflicts in professional practice is required. Nevertheless, it is still rare for ethics committees to intervene in the conflict resolution process and for decision-making support and evaluation tools to be used

Factores predictores de la institucionalización de personas mayores en situación de dependencia en Andalucía / Predictors of institutionalization of elderly persons in dependency situation in Andalusia

OBJETIVO: Identificar las preferencias acerca del recurso asistencial y los factores de riesgo de institucionalización de personas mayores en situación de dependencia en Andalucía. MÉTODO: Se analizaron datos de 200.039 personas registradas en el Sistema para la Autonomía y Atención a la Dependencia, en el período 2007-2012. Se describió en la población: la edad, situación de dependencia, preferencias, red de apoyo y factores clínicos a la entrada en el estudio. El análisis se realizó por separado para hombres y mujeres. Se diseñó un modelo de regresión logística para determinar los factores de riesgo de institucionalización para cada sexo. RESULTADOS: El 87,4% de las mujeres y el 85,9% de los hombres manifestaron su deseo de recibir los cuidados en su domicilio particular. Los hombres tienen 3 veces más riesgo de institucionalización que las mujeres. En mujeres los factores de riesgo de institucionalización son: el nivel de dependencia, desear vivir en residencia, una consistencia y una fragilidad medias de la red de apoyo y tener un diagnóstico de demencia. En hombres: desear vivir en una residencia y una consistencia baja o media de la red de apoyo. CONCLUSIONES: El cuidado en el domicilio es la alternativa de preferencia para las personas mayores en situación de dependencia. El riesgo de institucionalización está condicionado por las preferencias de la persona y su familia y las características de la red de apoyo, más que por las condiciones clínicas del individuo

OBJECTIVE: Identifying preferences regarding type of care and risk factors for institutionalization of elderly persons in dependency situations in Andalusia. METHODS: The data on 200,039 persons registered in the System for Autonomy and Dependency Care over the period 2007-2012 were analysed. The study population was described in terms of: age, dependency situation, preferences, support network and clinical factors at the time of inclusion in the study. Separate analysis was made for men and women. A logistic regression model was designed to determine the risk factors for institutionalization for each sex. RESULTS: 87,4% of women and 85,9% of men expressed their wish to receive care in their own home. The risk of institutionalization is three times higher among men than among women. Among women, the risks of institutionalization are: level of dependency, wishing to move into a residential care home, medium consistency and fragility of support network and being diagnosed with dementia. Among men, the risks are: wishing to move into a residential care home and low or medium consistency of support network. CONCLUSIONS: Care in the home is the preferred alternative for elderly persons in dependency situations. The risk of institutionalization is conditioned more by the preferences of the person and their family and the characteristics of the support network than by individual's clinical condition

[Predictors of institutionalization of elderly persons in dependency situation in Andalusia]. / Factores predictores de la institucionalización de personas mayores en situación de dependencia en Andalucía.

OBJECTIVE: Identifying preferences regarding type of care and risk factors for institutionalization of elderly persons in dependency situations in Andalusia. METHODS: The data on 200,039 persons registered in the System for Autonomy and Dependency Care over the period 2007-2012 were analysed. The study population was described in terms of: age, dependency situation, preferences, support network and clinical factors at the time of inclusion in the study. Separate analysis was made for men and women. A logistic regression model was designed to determine the risk factors for institutionalization for each sex. RESULTS: 87,4% of women and 85,9% of men expressed their wish to receive care in their own home. The risk of institutionalization is three times higher among men than among women. Among women, the risks of institutionalization are: level of dependency, wishing to move into a residential care home, medium consistency and fragility of support network and being diagnosed with dementia. Among men, the risks are: wishing to move into a residential care home and low or medium consistency of support network. CONCLUSIONS: Care in the home is the preferred alternative for elderly persons in dependency situations. The risk of institutionalization is conditioned more by the preferences of the person and their family and the characteristics of the support network than by individual's clinical condition.

[Is a strategy of bio-socio-ethic necessary?]. / ¿Es necesaria una estrategia integrada de biosocioética?

AIM: The aim of this paper is to assess the need for a common ethics strategy shared by 2 of the cornerstones of human welfare: the healthcare and social services sectors. METHOD: An observational cross-sectional descriptive study was performed by surveying social services and healthcare professionals. A purposive sampling technique was used. The questionnaire consisted of 10 questions about ethical conflicts in professional practice and respondents' views on a proposed shared approach to bioethics and ethics in social intervention. RESULTS: 124 professionals completed the questionnaire, 56% of the health sector and 44% of the social services sector. About 90% professionals surveyed had had to make difficult ethical decisions in their work and would welcome a common approach to ethics in the social services and healthcare sectors. 75% said that conflicts are occurring more frequently in both sectors simultaneously and that they were resolved preferably individually and independently. CONCLUSIONS: The survey respondents believe that a common approach to tackling ethical conflicts in professional practice is required. Nevertheless, it is still rare for ethics committees to intervene in the conflict resolution process and for decision-making support and evaluation tools to be used.