La eficiencia de las organizaciones sanitarias a través del análisis envolvente de datos: las Comunidades Autónomas españolas en el 2000 / Healthcare organizations efficiency under the data envelopment analisis: the Spanish comunidades autónomas in 2000

Introducción: Uno de los indicadores de gestión más prácticos en los servicios sanitarios es la medición de la eficiencia de sus inversiones, entendida como el resultado de la productividad de los factores. Las comunidades autónomas (CCAA), aunque tienen un objetivo más social, también deben buscar la maximización de la eficiencia de sus inversiones. El objetivo del estudio es medir la eficiencia transversal de las CCAA españolas en el 2000 en materia sanitaria. Material y métodos: El estudio se hizo a partir datos de las memorias del Ministerio de Sanidad y las consejerías para el año 2000. Se realizó un estudio no paramétrico con el análisis envolvente de datos (AED) para analizar la eficiencia transversal de las CCAA españolas. Las variables incluidas como factores productivos fueron: número de camas por 1.000 habitantes, gasto sanitario por habitante (en euros), número de tomografías axiales computarizadas (TAC) por 100.000 habitantes, número de médicos por cada 1.000 habitantes y personal de enfermería por cada 1.000 habitantes. Como factores resultado se utilizaron: ingresos hospitalarios por cada 1.000 habitantes, total de intervenciones quirúrgicas, tasa de mortalidad general estandarizada y esperanza de vida. Resultados y conclusiones: La estadística paramétrica no acabó de identificar los factores utilizados como inputs o outputs. De la estadística no paramétrica mediante AED, cabe comentar que 8 CCAA tuvieron un nivel de eficiencia global del 100 por ciento, mientras que las restantes tuvieron menores valores de eficiencia. La eficiencia media por CCAA fue del 94 por ciento, lo que nos hace pensar que todas ellas tienen aún un recorrido de ganancias medias del 6 por ciento. Con la plena eficiencia benchmarkiana en el Sistema Nacional de Salud español para dicho año, se podría llegar a reducir un 21 por ciento de las camas y un 19 por ciento el gasto, fundamentalmente a expensas de una reducción del 32 por ciento del personal médico y, además, se debería poder incrementar los ingresos hospitalarios un 15 por ciento, con una reducción de la mortalidad del 12 por ciento, aunque con apenas repercusión en la esperanza de vida (AU)

Asistencia a extranjeros en urgencias. Hospital Virgen de la Arrixaca / Health care for foreigners in the emergency service. Hospital Virgen de la Arrixaca

En España se han superado los 40 millones de habitantes y como en el resto de Europa el crecimiento de la población se hubiera enlentecido a no ser por la incorporación de emigrantes. Según el INE la población española puede crecer hasta el año 2025, teniendo en cuenta la entrada de emigrantes en nuestro país. El 74 por ciento de los emigrantes que llegan a nuestra Región proceden de América del Sur y de manera especial de Ecuador. A gran distancia están los que proceden del continente africano (16 por ciento) con una alta representación de Marruecos. El incremento de población extranjera en la Región de Murcia provoca un cambio social y demográfico, con un fiel reflejo en la utilización de los servicios sanitarios. Los pacientes extranjeros atendidos han sido seleccionados teniendo en cuenta la cumplimentación, cuando ha existido, del campo país de nacimiento. Se han analizado 335.348 urgencias asistidas durante los años 2000 y 2001, extraídas de registros del Sistema de Información del Hospital Virgen de la Arrixaca de Murcia. De ellas, 11.602 han cumplido los requisitos para el estudio de urgencias, de las cuales el 19 por ciento ingresan. La evolución es ascendente y ha supuesto pasar de 4.674 pacientes en 2000 a 6.928 en 2001. En el desglose por meses de esta atención destaca la periodicidad casi simétrica en cada uno de los meses estudiados. En cuanto a días de la semana destaca el aumento de pacientes en urgencias los sábados, domingos y lunes. Al analizar el perfil del ciudadano inmigrante que acude a urgencias se detecta un gran impacto de las mujeres en edad fértil, que explicaría, posiblemente, el incremento de natalidad en la Región de Murcia (AU)

El análisis envolvente de datos como indicador de la eficiencia aplicado a hospitales de la Comunidad Valenciana / Data envelopment analysis as efficiency indicator of hospitals of Comunidad Valenciana

Introducción: Los estudios de eficiencia de los sistemas sanitarios intentan relacionar tanto los resultados logrados en un período de tiempo.(incrementos en salud de la población), como los recursos invertidos para conseguirlos. El objetivo del estudio es medir la eficiencia global, pura y de escala de los hospitales públicos de la Comunidad Valenciana (CV), incluyendo entre sus factores resultados el case-mix de los mismos. Material y métodos: El estudio se hizo a partir de todos los pacientes ingresados en hospitales públicos de la CV en el año 1997. Se utilizó el análisis envolvente de datos para analizar la eficiencia de los hospitales. Entre los factores productivos se han incluido número de camas, gasto total hospitalario, número de personal facultativo, personal de enfermería, resto de personal. Como factores resultado se utilizaron el número de ingresos hospitalarios, el índice de casemix (ICM), el total de intervenciones quirúrgicas, total de consultas externas y urgencias atendidas. Resultados: En relación al estudio de la eficiencia, 9 hospitales tuvieron un nivel de eficiencia total global del 100 por ciento, mientras que de los restantes, el hospital A5 con el 74 por ciento de eficiencia consiguió el menor valor de todos. En cuanto a la eficiencia técnica pura el hospital A5 también fue el hospital más ineficiente de todo el grupo de hospitales con dimensiones parecidas. De acuerdo con el estudio, en la CV se podría llegar a reducir un 5 por ciento del total de camas funcionantes y una reducción lineal de personal del 8 por ciento, y un 6 por ciento el gasto, mientras que se debería poder aumentar un 0,3 por ciento el número de ingresos aumentando el ICM en un 34 por ciento, mientras que las consultas, las intervenciones, y las urgencias deberían aumentar aproximadamente un 10 por ciento (AU)

Las premisas para la Gestión Clínica / The premises for the Clinical Administration

La gestión clínica se ha impuesto como una nueva herramienta para gestión de los servicios sanitarios, basada en la gestión de procesos, que garantizando la práctica clínica apropiada, centrando la gestión en los pacientes, aporta un mayor grado de participación y autonomía de los profesionales clínicos en la gestión de los recursos sanitarios. Sin embargo, a pesar de las bondades teóricas de la herramienta una serie de premisas se han de cumplir antes de su implantación, para poder garantizar unos correctos resultados. Desde el desarrollo de un correcto Plan de Salud, hasta una fuerte inversión en tecnologías de la información, hasta la modificación de esquemas organizativos de diferentes empresas proveedoras de servicios sanitarios, son premisas necesarias para la gestión clínica (AU)

[Analysis of avoidable mortality in Valencia Community hospitals]. / Análisis de la mortalidad evitable en los hospitales de la Comunidad Valenciana.

Using a list of avoidable mortality (AM) causes as indicators of medical care (IMC) according to the Holland classification, a study on AM was conducted in the Valencia Community hospitals during 1994 and 1995. A total of 617 patients out of 106,540 discharges with IMC criteria died (mortality rate: 0.58%). The most common causes of AM included hypertension and cerebrovascular disease, with 46% of avoidable deaths; maternalperinatal disease, with 36%, and tuberculosis, 7%. According to the logistic regression analysis, men had a higher risk of AM than women, the age groups at highest risk were those over 50 years and less than 18 years, and the presence of a higher number of diagnoses was associated with increased risk.

Análisis de la mortalidad evitable en los hospitales de la Comunidad Valenciana / Analysis of avoidable deaths in the Valencia Community hospitals

Utilizando el listado de causas de mortalidad evitable (ME) conocidas como indicadores de asistencia médica (IAM) según la clasificación de Holland se ha llevado a cabo un estudio de la ME ocurrida en los hospitales de la Comunidad Valenciana durante 1994 y 1995. De 106.540 altas con criterios de IAM, fallecieron 617 pacientes (letalidad: 0,58 por ciento). Las causas más frecuentes de ME fueron la enfermedad hipertensiva y cerebrovascular, con el 46 por ciento de los fallecimientos evitables; la maternoperinatal, con el 36 por ciento, y la tuberculosis, con el 7 por ciento. Según el análisis de regresión logística, los hombres presentaron mayor riesgo de ME que las mujeres; los grupos de edad con mayor riesgo fueron los de más de 50 años y los menores de 18 años, y la presencia de un mayor número de diagnósticos se asoció a un riesgo más elevado (AU)

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Características sociales y clínicas de un grupo de madres infectadas por VIH en Valencia: influencia de la drogadicción parenteral / Social and clinical characteristics of mothers with HIV infection: the influence of intravenous drug addiction

Objetivo: Al principio de conocerse la infección por el virus de la inmunodeficiencia humana (VIH), la causa más importante de su transmisión en las mujeres occidentales fue el consumo de drogas por vía parenteral. El objetivo de nuestro trabajo consistió en describir las principales características sociales y clínicas de un grupo de madres seropositivas, y en analizar su relación potencial con el uso intravenoso de drogas. Métodos: Realizamos un estudio observacional prospectivo con 220 mujeres infectadas por VIH que presentaban la particularidad de haber dado a luz niños con riesgo de infección. Se incluyeron todas las madres reclutadas en la Unidad VIH de un hospital de Valencia que tuviesen definido el diagnóstico de su infección durante el período de estudio comprendido entre el primer caso materno conocido en 1985 y 1993. El análisis de los datos se basó en un análisis univariado. Resultados: La transmisión del virus se produjo por mantener relaciones heterosexuales en un 27,7 por ciento de las mujeres estudiadas, y a través de la drogadicción parenteral en el 69,1 por ciento. Se detectó mayor número de madres que abortaron, con antecedentes penales y abandono domiciliario entre las usuarias de drogas por vía parenteral (UDVP), con odds ratio (OR) de 1,8 (p = 0,087), 8,95 (p = 0,012) y 15 (p = 0,000), al compararlas con las madres no UDVP. Además las UDVP presentaron mayor probabilidad de contraer la infección por hepatitis B o C (OR = 7,06, p = 0,000) y de tener asociados otros hábitos tóxicos como tabaquismo (OR = 6,19, p = 0,000) y alcoholismo (OR = 5,91, p = 0,117).Conclusiones: Muchas de las características analizadas en estas mujeres estaban más relacionadas con el consumo de droga inyectada que con la infección por VIH, tales como la mayor frecuencia de abortos electivos, antecedentes penales, abandono domiciliario, politoxicomanías y antecedentes patológicos como hepatitis B o C (AU)

[Social and clinical characteristics of a group of mothers infected with HIV in Valencia: influence of parenteral drug addiction]. / Características sociales y clínicas de un grupo de madres infectadas por VIH en Valencia: influencia de la drogadicción parenteral.

OBJECTIVE: In the first years after the finding of HIV-infection, the main was for its transmission among western women was the intravenous drug addiction. The objective of our work consisted in evaluating the main social and clinical characteristics of a group of seropositive mothers, and in analyzing their potential relationship with intravenous consumption of drugs. METHOD: We performed an observational prospective study in 220 HIV-infected women who had recently given birth to children with high risk for infection. We included every women at an HIV Unit of a hospital in Valencia who had been diagnosed of HIV infection at any moment between the first mother-child transmission reported in 1985 and 1993. The analysis was based on univariate analysis. RESULTS: The virus transmission was produced by heterosexual relations in a 27.7% of the study women and due to the parenteral drug addiction in 69.1%. We detected more women who had an abortion, with criminal antecedents and parental abandonment among those who were intravenous drug users (IVDU), with OR of 1.8 (p = 0.087), 8.95 (p = 0.012) and 15 (p = 0.000), when compared with those mothers non-IVDU. Besides, IVDU presented a higher probability for getting hepatitis B or C infection and for other toxic habits, as smoking (OR = 6.19, p = 0.000) or alcoholism (OR = 5.91, p = 0.017). CONCLUSION: Many of the analysed characteristics in these women were more related with the consumption of injected drug than with the HIV infection, such as the greater frequency of elective abortions, criminal antecedents, parental abandonment, multiple drug abuse and pathological precedents like hepatitis B or C.

[Geographic distribution of avoidable mortality in the community of Valencia (1975-1990)]. / Distribución geográfica de la mortalidad evitable en la Comunidad Valenciana (1975-1990).

BACKGROUND: Avoidable mortality (AM) has been proposed as the indicator of the quality and the efficacy of health care services and a parameter useful to distribute health care resources. The aim of this study was to analyze the size and geographic variability of AM in the Community of Valencia, Spain (1975-1990). METHODS: The causes of AM were analyzed by the classification of Holland divided into indicators of medical care (IMC) and indicators on national health care policy (INHCP) in addition to the causes of the Charlton classification. Standard rates for Spain and the European Community, the rate of masculinity and contribution to total mortality were calculated. Geographic distribution by areas and provinces was analyzed by the rate of standardized mortality. RESULTS: According to the Holland classification AM was 30% of the deaths from 5 to 64 years of age. Out of these cases, 18.5% corresponded to INHCP and 11.1% to IMC. According to the Charlton classification, this percentage was 3.6%. A considerable variation was observed among the 20 areas analyzed due to many causes. The geographic distribution by groups (IMC, INHCP and the Charlton classification) is quite homogeneous. The worse results corresponded to the city of Valencia and to the area 21 (area of the city of Alicante). CONCLUSIONS: A great variation was found in the results regarding geographic distribution for individual causes of death while the distribution was quite homogeneous for all of the groups of mortality with the worst results being observed in large urban centers.

[The trends in cancer mortality, especially lung cancer, in Spain compared with other developed countries]. / Tendencias de la mortalidad por cáncer en España, en especial del cáncer de pulmón, en comparación con otros países desarrollados.

In this paper we study the general mortality trends by cancer in Spain (1951-1987), and also by sex and age groups. We focus on lung cancer, establishing comparisons with USA, England and Wales. We appreciate on the general mortality trend that only young age groups show a higher decrease, while in other countries this decrease was also in old age groups. We observed a lower mortality trend in Spain by lung cancer than in the other countries, however increasing the rates in both sexes and more in males. That evolution could be related with the evolution of cancer risk factors and especially lung cancer. On concluded that the general mortality trend in Spain is the same than other developed countries but with some delay in the evolution, when comparing lung cancer. Spain is now in an increasing phase and USA, England and Wales have stabilized their rates and begin to decrease their trends.

[Antitubercular chemoprevention: hepatotoxicity and therapeutic compliance]. / Quimioprofilaxis antituberculosa: hepatotoxicidad y cumplimiento terapéutico.

We studied 142 patients who received antituberculous chemoprophylaxis with isoniacide. We evaluated the increase in GOT and PGT levels, observing higher than normal values in 10.56% and 21.83% of the cases, respectively. This increase was near the limit of the statistical significance with respect to sex and it was not related with previous episodes of hepatotoxicity, although it was related to age, with a lower number of hepatic disorders among the younger groups. The presence of hepatotoxicity forced us to discontinue the therapy in just 2.81% of the cases. The level of therapy compliance was 69.1% for women and 85.25% for men, being greatest in the age group below 13 years (86.89%).

[Survey of satisfaction among health center users]. / Encuesta de satisfacción a los usuarios de un centro de salud.

OBJECTIVES: To find out the satisfaction's level of the Nazaret (Valencia) Health Center's users; To detect the deficiencies in the areas under study; To find out whether or not there are differences with previous studies in primary care. DESIGN: Transversal study, results evaluation with no equivalent control group. SETTING: (site). Primary health care. Neighborhood of Valencia with 6749 people. With a regressive Sundbarg index, and the 42.6% of the population that are older than nine years are illiterate or with incomplete primary education, the income level index by neighborhood in 1986 is -5.6 (range: 13.4; -8.1). TARGET POPULATION: all the Nazaret Health Center users. The inclusion criteria were: 1. Eighteen years old (or older) users. 2. That had contacted previously for whatever reason (administrative or sanitary) with the health center at least in one occasion during the prior 6 months. The random sample was selected for a 5% maximum error, a 95.5% confidence level, and a p < or = 30% for the negative answers from the scale, its size was 323 patients, with a 20% increase for forecasted no cooperation/no answers (n = 388). INTERVENTION AND RESULTS: The average age of the interviewed was 42 years. The total adding score was 98.1 (theoretical range: 27-135). The score by areas (theoretical range 9-45) was: personal quality area 35.5 professional competence 32.4 and the relationship cost-comfort 30.5. A total (overall) satisfaction item had an average of 7.2 on a 1 to 10 scale, with P10 = 5, P50 = 7, P90 = 10. The analysis of variance shows that satisfaction increases with age, with the attachment to the same doctor, with feminine sex, with unemployment and, with low educational level, being more critic the young people and the people with educational level (not significative difference). CONCLUSION: We consider that users have a good degree of satisfaction, that the ratio cost-comfort should be improved, there is a significative improvement compared with previous studies done with the former primary health care model.

Correlation between mortality trends of ischaemic cardiopathy and some nutritional factors in Spain 1968-1986.

After describing the evolution of mortality from ischaemic cardiopathy (IC) in Spain from 1951 to 1986, which is tending to stabilize in some age groups, and from cerebrovascular accidents (CVA), which is clearly declining, an attempt is made to relate these developments to the prevalence of the main risk factors (hypertension, cholesterol, tobacco) associated with IC and CVA. Certain advances, though of a limited number, have been made in recent years in the control of arterial hypertension in Spain, although campaigns on a national scale as in other countries have not been carried out. Regarding alimentary factors, there is an obvious increase in the consumption of food rich in proteins and animal fats, abandoning to a great extent the traditional "Mediterranean diet", with health care action being limited to the improvement of nutrition education of the public. Furthermore, the consumption of tobacco has been increasing in Spain during the study period in spite of health legislation in force in recent years. It is therefore deduced that there is no obvious relationship between mortality due to IC and CVA and the prevalence of the main risk factors associated with these diseases, especially when taking into account that preventive actions on a public health level have been very limited.

Job absenteeism and arterial hypertension: results of a hypertension control program.

This study reports the findings of one of the stages of a programme for the detection and control of arterial hypertension, started in 1980 in an automobile company with a workforce of 9,782. In the initial screening, 522 hypertensive males were found using epidemiological criteria and 206 of these fulfilled the criteria of definite hypertension. The objective of this study consisted of evaluating, 9 years after the start of the program, the indirect cost in terms of the reduction in the morbidity indicator-temporary work incapacity (TWI). Analysis is based on a comparison of the prevalence of hypertension in the population when the program was begun (6%) and in 1989 (9.8%). It can be observed that the TWI rate of the hypertensive population was significantly higher than that of the rest of the workforce, and that this remained true for the reference group (RG) hypertensives a year after the study was initiated. In contrast, the intervention group (IG) showed significantly lower TWI levels, not only in comparison with the RG but also with the rest of the workers. The estimated reduction in TWI for 1989 was 4.500 days/year, which corresponds to an estimated saving of 76.500.000 pesetas/year.

[Environmental sanitation and typhoid-paratyphoid infection morbidity in Valencia]. / Saneamiento del medio ambiente y morbilidad por infecciones tifo-paratíficas en Valencia.

BACKGROUND: We intend to study the evolution of morbidity by typhoid-paratyphoid infections (TPI) in Spain and Valencia (1940-1990) as well as TPI morbidity and degree of sanitation in Valencia. METHODS: Data related to morbidity, as well as the sanitation basic data in Valencia, have been obtained from official sources. Morbidity rates belonging to Spain and Valencia have been calculated. RESULTS: It is found a decreasing trend of morbidity in Spain and Valencia. By Health Areas, a great decrease stands out in Valencia-City and, as a general rule, the highest rates belonged to the lowest automatic chlorination percentages. In general, there is an improvement in chlorination, sewers and sewage-depuration equipment. CONCLUSIONS: TPI morbidity in Spain shows a decreasing trend in both cases; it is more evident in Valencia when establishing a relation of TPI morbidity with the degree of hygiene by Health Areas of Valencia, an inverse relation appears and the highest rates belong to the interior Areas. The conclusion is that there is a remarkable improvement in the hygiene general situation in Valencia; in the city as well as in all the Health Areas.

[Hospital utilization and increasing old age in the user of care?]. / Utilización hospitalaria y ancianidad creciente en el usuario atendido?

Data are presented on hospital stay for the population 65 years-old and over, measured in percentage over the total for Spain, for the 1978 to 1988 period, by gender, for each province and autonomous region (Comunidad Autónoma). The country's total for the last available year was 35%. Except in Baleares and Murcia, the proportion of hospital stays increased in all Regions, especially in Navarra, where it increased from 23% to 51%. After adjusting for age, the increase in the proportion of hospital stays in the study population was due to an increase in utilization per person. The proportion, which was 13.3% in 1978, raised to 23.8% in 1988, with an adjusted value of 21.3%.

[Epidemiological course of rheumatic fever and rheumatic heart disease in Spain (1951-1986)]. / Evolución epidemiológica de la fiebre reumática y cardiopatía reumática en España (1951-1986).

A study has been made of the death rate due to Rheumatic Fever (R.F.) and Rheumatic Heart Disease (R.H.D.) in Spain (1951-1985) as well as the disease rate due to Rheumatic Fever (1951-1988). It has been found that the death rate due to R.F. and R.H.D. has clearly decreased over the past 20 years, whilst it is important to note that disease rate due to R.F' has shown a noticeable increase over the past 10 years. And on comparing the death rate due to R.F. in Spain and in the United States, one finds that the U.S. death rate began to drop prior to that in Spain, it currently being minimal in both countries. Stress is placed on the need to increase the control of streptococcus infections, specially throat infections, in our environment.

[Factors determining infant mortality in Spain]. / Algunos factores determinantes de la mortalidad infantil en España.

We introduce an ecological research for Spain between the 1975 and 1979, trying to explain the variation of childhood mortality. The social-economical factor had an important weight, as the disposable familiar rent (R2 = 0.44) and the per capita rent, while the health factors had a least important influence. From this last group, the health resources utilization were the most important, as the consultation per habitant (partial regression coefficient -0.15 and -0.14 in 1977 and 1978 respectively) and the surgery activities. Every this reflect a country in change.

[Comparison of mortality in Spain and France, following the method of "potential years of life lost"]. / Datos comparativos de la mortalidad en Espana y Francia, segun el metodo del "nivel potencial de anos de vida perdidos".

PIP: Mortality trends in Spain from 13 major causes of death are analyzed for the period 1972-1982 and compared with trends for the same period in France. Increases in mortality in Spain are noted for three causes--malignant tumors, cardiac diseases, and suicides and homicides--whereas significant declines in mortality are noted for pneumonia, influenza, chronic bronchitis, and asthma. Excess mortality for males is common to both countries. (SUMMARY IN ENG)^ieng