La crisis sanitaria como una oportunidad de impulsar los procesos de comunicación / The health crisis as an opportunity to promote communication processes

La COVID-19 ha sido una crisis sanitaria, pero con una vertiente comunicativa muy importante. Una comunicación que ha formado parte de la propia gestión sanitaria como sujeto entanto a la importancia de la sensibilización e información servicio, pero que también ha sidoobjeto de un intenso seguimiento informativo por parte de medios de comunicación, redessociales, otras entidades que operan en un complejo ecosistema comunicativo, institucionaly social. En el centro del mismo se ha situado el gabinete del Departamento de Salud que, encolaboración con otras estructuras comunicativas del todo el Gobierno de Navarra, ha tenidoque atender diferentes frentes y niveles comunicativos, desde la comunicación interna comola externa, local y estatal, peticiones de medios y solicitudes de ciudadanía, ayuntamientospartidos políticos, actores sociales etc. El esfuerzo, que ha convivido con otras áreas temáticas ordinarias (aquí también han coexistido lo Covid y lo no Covid) se ha prolongado durantemás de dos años, obligando a los y las profesionales a realizar un esfuerzo continuado de adaptación y aprendizaje coherente con todo el del sistema sanitario del que forman parte. Esteartículo repasa las diferentes fases, protagonistas, herramientas y formatos utilizados duranteesta crisis sanitaria que ha sido una oportunidad comunicativa de la que también se extraenlecciones aprendidas. Entre ellas la necesidad de reforzar y estabilizar la estructura comunicativa del sistema sanitario hoy muy embrionaria, así como la constatación de la importancia dela comunicación en las políticas sanitarias, especialmente en las de salud pública.(AU)

Validez de las bases de datos administrativas para realizar ajustes de riesgo en el análisis de los efectos adversos producidos en pacientes quirúrgicos / Usefulness of administrative databases for risk adjustment of adverse events in surgical patients

OBJETIVO: Conocer la validez de las bases de datos clínico-administrativas para realizar ajustes de riesgo en el estudio de los efectos adversos que pueden sufrir los pacientes intervenidos quirúrgicamente. MÉTODOS: Se estudiaron 1.602 episodios de hospitalización de pacientes intervenidos quirúrgicamente durante los años 2008 y 2010 en un hospital terciario situado en el norte de España. Se analizaron 40 variables de comorbilidades que recoge el Colegio Americano de Cirujanos en el National Surgical Quality Improvement Program (NSQIP) a través de 2 fuentes de información: el conjunto mínimo básico de datos (CMBD) y los datos extraídos de la historia clínica completa (HC), considerada como patrón oro. Se catalogaron las variables en función de que los valores de sensibilidad (S), valor predictivo positivo (VPP) y kappa (K) fueran superiores a 0,6. RESULTADOS: La media de comorbilidades por paciente fue de 1,6 mediante la HC y de 0,95 a través del CMBD (p < 0,0001). El CMBD no detectó ningún caso en 13 comorbilidades (estas supusieron el 8% de las comorbilidades detectadas con la HC). De las 27 comorbilidades restantes, 5 cumplieron los 3 criterios establecidos (S, VPP y k > 0,6), 2 enfermedades cumplieron 2 criterios, 12 cumplieron al menos uno y 8 no cumplieron ninguno. CONCLUSIÓN: Las bases de datos clínico-administrativas detectaron comorbilidades como diabetes o hipertensión arterial pero no aportaron suficiente información para recoger las variables necesarias para hacer el ajuste de riesgo propuesto por el NSQIP para la medición de los efectos adversos en pacientes quirúrgicos

PURPOSE: The aim of this study was to assess the usefulness of clinical-administrative databases for the development of risk adjustment in the assessment of adverse events in surgical patients. METHODS: The study was conducted at the Hospital of Navarra, a tertiary teaching hospital in northern Spain. We studied 1602 hospitalizations of surgical patients from 2008 to 2010. We analysed 40 comorbidity variables included in the National Surgical Quality Improvement (NSQIP) Program of the American College of Surgeons using 2 sources of information: The clinical and administrative database (CADB) and the data extracted from the complete clinical records (CR), which was considered the gold standard. Variables were catalogued according to compliance with the established criteria: sensitivity, positive predictive value and kappa coefficient > 0.6. RESULTS: The average number of comorbidities per study participant was 1.6 using the CR and 0.95 based on CADB (p < .0001). Thirteen types of comorbidities (accounting for 8% of the comorbidities detected in the CR) were not identified when the CADB was the source of information. Five of the 27 remaining comorbidities complied with the 3 established criteria; 2 pathologies fulfilled 2 criteria, whereas 11 fulfilled 1, and 9 did not fulfil any criterion. CONCLUSION: CADB detected prevalent comorbidities such as comorbid hypertension and diabetes. However, the CABD did not provide enough information to assess the variables needed to perform the risk adjustment proposed by the NSQIP for the assessment of adverse events in surgical patients

Usefulness of administrative databases for risk adjustment of adverse events in surgical patients.

PURPOSE: The aim of this study was to assess the usefulness of clinical-administrative databases for the development of risk adjustment in the assessment of adverse events in surgical patients. METHODS: The study was conducted at the Hospital of Navarra, a tertiary teaching hospital in northern Spain. We studied 1602 hospitalizations of surgical patients from 2008 to 2010. We analysed 40 comorbidity variables included in the National Surgical Quality Improvement (NSQIP) Program of the American College of Surgeons using 2 sources of information: The clinical and administrative database (CADB) and the data extracted from the complete clinical records (CR), which was considered the gold standard. Variables were catalogued according to compliance with the established criteria: sensitivity, positive predictive value and kappa coefficient >0.6. RESULTS: The average number of comorbidities per study participant was 1.6 using the CR and 0.95 based on CADB (p<.0001). Thirteen types of comorbidities (accounting for 8% of the comorbidities detected in the CR) were not identified when the CADB was the source of information. Five of the 27 remaining comorbidities complied with the 3 established criteria; 2 pathologies fulfilled 2 criteria, whereas 11 fulfilled 1, and 9 did not fulfil any criterion. CONCLUSION: CADB detected prevalent comorbidities such as comorbid hypertension and diabetes. However, the CABD did not provide enough information to assess the variables needed to perform the risk adjustment proposed by the NSQIP for the assessment of adverse events in surgical patients.

Validity of the clinical and administrative databases in detecting post-operative adverse events.

OBJECTIVE: Patient safety has become a major public health concern and a priority for multiple institutions. Assessment of the adverse events is a key element for measuring the quality of healthcare organizations. The aim of this study was to measure the validity of the clinical and administrative database (CADB) as a source of information for the detection of post-operative adverse events. DESIGN: The study design was cross-sectional. SETTING: The study was carried out at the Hospital de Navarra (north of Spain). PARTICIPANTS: The sample consisted of 1602 episodes of surgical hospitalization from nine surgical departments. Two sources of information were used: data extracted from the complete clinical record (CR), the gold standard, vs. the CADB. MAIN OUTCOMES: Rate of adverse events, sensitivity, positive predictive value and κ index were analysed for 28 types of post-operative adverse event. Each index was considered acceptable if it had a value >0.6. RESULTS: The rate of adverse events using the CADB was 12.5 vs. 24% using CR within 30 days of surgery (P = 0.0001) and 13.9% using CR during a hospital stay (P > 0.05). The overall sensitivity of the CADB in the detection of adverse events was 0.18, and the positive predictive value was 0.34. Two adverse events (accounted for 6% of the total events detected) had moderate validity and the rest poor validity. Forty-two per cent of the adverse events took place after patient discharge. CONCLUSIONS: Although the use of CADB is appealing, the present study suggests that it is of very limited value in the detection of adverse events post-operatively.