Repercusión de las auditorías de historias clínicas en la calidad asistencial recibida por los pacientes que ingresan por una agudización de EPOC / Repercussions from the clinical history audit regarding the quality of the healthcare received by patients in hospital due to worsened COPD

OBJETIVO: el objetivo de este trabajo es la valoración comparativa de dos auditorías clínicas, realizadas en centros públicos de Andalucía y Extremadura, en cuanto a variables relacionadas con la calidad asistencial recibida por el paciente que ingresa con una agudización de su EPOC. Se pretende valorar el posible impacto de una auditoría sobre la práctica clínica asistencial y la calidad de la asistencia sanitaria prestada a estos pacientes. MÉTODO: se recopilaron datos clínicos y demográficos de la auditoría realizada en estos centros en 2008 (dentro del programa AUDIPOC España) y de la del 2011 (dentro de COPD ERS Audit) y, además, se han comparado los resultados de cumplimentación de las normativas GOLD en lo que respecta a las medidas diagnósticas y terapéuticas recibidas por los pacientes ingresados por una EPOC agudizada. RESULTADOS: quince hospitales (12 de Andalucía y 3 de Extremadura) participaron en ambas auditorías clínicas. Se analizaron un total de 1.016 ingresos en ambas auditorías (397 en la auditoría 1 y 619 en la auditoría 2). Los pacientes eran, mayoritariamente, varones en la 8ª década de la vida, con un porcentaje considerable de fumadores activos. La adherencia a la guía GOLD es cercana al 90% en numerosos parámetros terapéuticos medidos, siendo más baja en los parámetros diagnósticos. Algunos parámetros evaluados mejoraron en la segunda auditoría, fundamentalmente parámetros terapéuticos, como son reducción del uso inadecuado de metilxantinas (de un 10,6% a un 3,1% ) y aumento del uso de broncodilatadores de acción corta (del 69,3% al 72,5%). CONCLUSIONES: tras los resultados obtenidos, puede concluirse que la adherencia a la guía GOLD es bastante aceptable y que a pesar de haberse evidenciado algunos cambios de pequeña magnitud, son necesarias estrategias de implementación de la mejora asistencial tras haber realizado una auditoría para obtener un futuro impacto clínico relevante en nuestros pacientes

OBJECTIVE: the objective of this work is to perform a comparative assessment of two clinical audits. These audits were carried out at public healthcare centers in the regions of Andalusia and Extremadura (Spain). This comparison included variables regarding the quality of the healthcare received by the patient upon admission to hospital due to the worsening of his/her COPD. The objective was to assess the possible impact of an audit regarding clinical healthcare and the quality of the healthcare provided. METHOD: clinical and demographic data was collected for the audit, carried out in 2008 (with the program AUDIPOC España) and again in 2011 (within the scope of COPD ERS Audit). Also, the compliance results based on GOLD COPD Guidelines regarding the diagnostic and therapeutic measures received by the patients admitted to hospital due to acute COPD were also compared. RESULTS: if teen hospitals (12 in Andalusia and 3 in Extremadura) participated in both clinical audits. A total of 1016 patients admitted to hospital were included in both audits (397 in audit 1 and 619 in audit 2). For the most part, the patients were males, in their 80s, with a considerable percentage being active smokers. Adherence to the GOLD guidelines was almost 90% for the many therapeutic parameters measured, with the diagnostic parameters being the lowest. Some parameters improved by the second audit; essentially therapeutic parameters, such as the reduced use of methylxanthines (down from 10.6% to 3.1%) and an increase in the use of short-acting bronchodilators (up from 69.3% to 72.5%). CONCLUSIONS: based on the results obtained, it may be concluded that adherence to the GOLD COPD guidelines is quite acceptable. Despite some slight changes, strategies need to be implemented to improve healthcare after having performed an audit to obtain a future clinical impact that is relevant in our patients

Determinants of between-hospital variations in outcomes for patients admitted with COPD exacerbations: findings from a nationwide clinical audit (AUDIPOC) in Spain.

BACKGROUND: Previous studies have demonstrated significant variability in the processes of care and outcomes of chronic obstructive pulmonary disease (COPD) exacerbations. The AUDIPOC is a Spanish nationwide clinical audit that identified large between-hospital variations in care and clinical outcomes. Here, we test the hypothesis that these variations can be attributed to either patient characteristics, hospital characteristics and/or the so-called hospital-clustering effect, which indicates that patients with similar characteristics may experience different processes of care and outcomes depending on the hospital to which they are admitted. METHODS: A clinical audit of 5178 COPD patients consecutively admitted to 129 Spanish public hospitals was performed, with a 90-day follow-up. Multilevel regression analysis was conducted to model the probability of patients experiencing adverse outcomes. For each outcome, an empty model (with no independent variables) was fitted to assess the clustering effect, followed by a model adjusted for the patient- and hospital-level covariables. The hospital-clustering effect was estimated using the intracluster correlation coefficient (ICC); the cluster heterogeneity was estimated with the median odds ratio (MOR), and the coefficients of predictors were estimated with the odds ratio (OR). RESULTS: In the empty models, the ICC (MOR) for inpatient mortality and the follow-up mortality and readmission were 0.10 (1.80), 0.08 (1.65) and 0.01 (1.24), respectively. In the adjusted models, the variables that most represented the patients' clinical conditions and interventions were identified as outcome predictors and further reduced the hospital variations. By contrast, the resource factors were primarily unrelated with outcomes. CONCLUSIONS: This study demonstrates a noteworthy reduction in the observed crude between-hospital variation in outcomes after accounting for the hospital-cluster effect and the variables representing patient's clinical conditions. This emphasises the predictor importance of the patients' clinical conditions and interventions, and understates the impacts of hospital resources and organisational factors.

Síntomas respiratorios persistentes en los limpiadores cinco años después del vertido de petróleo del Prestige / Persistent respiratory symptoms in clean-up workers 5 years after the Prestige oil spill

Objetivos. Los pescadores que participaron en las actividades de limpieza del vertido del Prestige mostraban un aumento del riesgo de padecer síntomas respiratorios pasados entre uno y dos años después de la catástrofe; sin embargo, la persistencia a largo plazo de estos efectos sobre la salud permanecía incierta. El objetivo del presente estudio ha sido evaluar la persistencia de estos síntomas respiratorios cinco años después de los trabajos de limpieza. Métodos. Subgrupos de 501 pescadores que habían estado expuestos a los trabajos de limpieza y 177 pescadores no expuestos fueron re-entrevistados por teléfono en el 2008, incluyendo las mismas preguntas utilizadas en la encuesta inicial. Las asociaciones entre la participación en los trabajos de limpieza y la presencia de síntomas respiratorios se evaluaron mediante análisis de regresión log-binomial y multinomial, ajustado por sexo, edad y tabaquismo. Resultados. Se obtuvo información de 466 (93%) pescadores expuestos y de 156 (88%) no expuestos. La prevalencia de síntomas del tracto respiratorio bajo (incluyendo sibilancias, falta de aire, tos y flema) disminuyó ligeramente en ambos grupos, pero permaneció más alta entre los expuestos (RR 1,4, IC 95%: 1,1-1,9) El riesgo de tener síntomas respiratorios persistentes(referidos tanto al inicio como durante el seguimiento) aumentó con el nivel de exposición: RR 1,7(IC 95%: 0,9-3,1) y 3,3 (IC 95%: 1,8-6,2) para los moderada y altamente expuestos, respectivamente. El riesgo en relación con la presencia de síntomas nasales y para el uso de medicación respiratoria fue de un orden similar. Conclusiones. La participación en las actividades de limpieza de los derrames de petróleo puede dar lugar a síntomas respiratorios que persisten hasta cinco años después de la exposición. Sería necesario disponer de protocolos para llevar a cabo las medidas preventivas oportunas, así como una continua vigilancia de la salud de los trabajadores que participen en actividades de limpieza en este tipo de accidentes ( AU)

Objectives. Fishermen who had participated in clean-up activities of the Prestige oil spill showed an excess risk of respiratory symptoms 1-2 years later, but the long-term persistence of these health effects is unclear. The aim of this study was to evaluate the persistence of these respiratory symptoms 5 years after clean-up work. Methods. Subgroups of 501 fishermen who had been exposed to clean-up work and 177 non-exposed individuals were re-interviewed by telephone in 2008, including the same symptom questions as in the initial survey. Associations between participation in clean-up work and respiratory symptoms were assessed using log-binomial and multinomial regression analyses adjusting for sex, age and smoking. Results. Information from 466 exposed (93%) and 156 non-exposed (88%) fishermen was obtained. The prevalence of lower respiratory tract symptoms (including wheeze, shortness of breath, cough and phlegm) had slightly decreased in both groups, but remained higher among the exposed (RR 1.4, 95% CI 1.1 to 1.9). The risk of having persistent respiratory symptoms(reported both at baseline and at follow-up) increased with the degree of exposure: RR ratio 1.7 (95% CI 0.9 to 3.1)and 3.3 (95% CI 1.8 to 6.2) for moderately and highly exposed, respectively, when compared with those without any symptoms. Findings for nasal symptoms and for respiratory medication usage were similar. Conclusions. Participation in clean-up activities of oil spills may result in respiratory symptoms that persist up to 5years after exposure. Guidelines for preventive measures and a continued surveillance of clean-up workers of oil spills are necessary(AU)

Factors associated with pathogenicity of oils related to the toxic oil syndrome epidemic in Spain.

The toxic oil syndrome (TOS), which affected over 20,000 persons in Spain in 1981, has been linked to the consumption of aniline-denatured rapeseed oil, but the precise etiologic agent is still unknown. We attempted to validate the use of high concentrations of oleyl anilide as a marker for oils that contain (or contained) the causal agent. We compared the chemical compositions of oils obtained from ill (N = 59) and unaffected (N = 70) families in 1981. Case oils had higher concentrations of fatty acids and sterols in which rapeseed oil is particularly rich. In addition, case oils had more frequent and extensive contamination with oleyl anilide and other fatty acid anilides. We observed a dose-response effect; risk increased sharply with increasing concentrations of oleyl anilide, and no control oil had more than about 825 micrograms per liter of that compound. We conclude that high concentrations of oleyl anilide specifically mark oils that contain (or used to contain) the TOS etiologic agent.