Trends and area variations in Potentially Preventable Admissions for COPD in Spain (2002-2013): a significant decline and convergence between areas.

BACKGROUND: Potentially Preventable Hospitalizations (PPH) are hospital admissions for conditions which are preventable with timely and appropriate outpatient care being Chronic Obstructive Pulmonary Disease (COPD) admissions one of the most relevant PPH. We estimate the population age-sex standardized relative risk of admission for COPD-PPH by year and area of residence in the Spanish National Health System (sNHS) during the period 2002-2013. METHODS: The study was conducted in the 203 Hospital Service Areas of the sNHS, using the 2002 to 2013 hospital admissions for a COPD-PPH condition of patients aged 20 and over. We use conventional small area variation statistics and a Bayesian hierarchical approach to model the different risk structures of dependence in both space and time. RESULTS: COPD-PPH admissions declined from 24.5 to 15.5 per 10,000 persons-year (Men: from 40.6 to 25.1; Women: from 9.1 to 6.4). The relative risk declined from 1.19 (19 % above 2002-2013 average) in 2002 to 0.77 (30 % below average) in 2013. Both the starting point and the slope were different for the different regions. Variation among admission rates between extreme areas dropped from 6.7 times higher in 2002 to 4.6 times higher in 2013. CONCLUSIONS: COPD-PPH conditions in Spain have undergone a strong decline and a reduction in geographical variation in the last 12 years, suggesting a general improvement in health policies and health care over time. Variability among areas still remains, with a substantial room for improvement.

Análisis del exceso de consumo de recursos en pacientes con enfermedad tromboembólica tras cirugía, infección por uso de dispositivo vascular postoperatorio o sepsis post-quirúrgica en el Sistema Nacional de Salud / Analysis of excess resources in patients with catheter-related infection (bacteremia), postoperative pulmonary embolism or deep vein (DVT-PTE) or postoperative sepsis in the National Health System

Objetivo: Estimar el exceso de estancia atribuible a la presencia de eventos adversos en pacientes que han sido sometidos a una intervención quirúrgica en el mismo episodio. Población y métodos: Estudio observacional, transversal, sobre bases de datos clínico-administrativos al alta hospitalaria. Las altas elegidas fueron producidas en los años 2009 y 2010 en los centros hospitalarios de agudos de las 17 comunidades autónomas del SNS español, las cuales forman parte del proyecto Atlas de Variabilidad de la Práctica Médica en el Sistema Nacional de Salud (Atlas VPM). Resultados: El exceso de estancia fue de 28, 10 y 14 días en las altas con infección debida a uso de dispositivo vascular, altas con tromboembolismo o trombosis venosa profunda tras la cirugía y altas con sepsis post-quirúrgica, respectivamente. Las variables predictoras del paciente (edad, sexo, Elixhauser) influyen en el exceso de estancia. Conclusión: Los eventos adversos están asociados a un incremento significativo de exceso de estancia. El CMBD (Conjunto Mínimo Básico de Datos hospitalario) permite hacer una estimación del impacto que esto tiene en los hospitales españoles (AU)

Objective: To estimate the excess of length of stay (LOS) attributable to the presence of adverse events in patients who were operated. Methodology: Observational, cross-sectional study on the basis of clinical and administrative hospital discharge data. Discharge chosen were produced in 2009 and 2010 in acute hospitals of the 17 Spanish autonomous communities of the National Health System, which are part of the project Atlas of Variability in Medical Practice in the National Health System (Atlas VPM Group). Results: Excess of LOS was 28 days, 10 days and 14 days in the catheter-related infection (bacteremia), postoperative pulmonary embolism or deep vein (DVT-PTE) or postoperative sepsis stays. The predictor variables of the patient (age, sex and Elixhauser) influence in the excess of LOS. Conclusion: Adverse events are associated with a significant increase of excess of LOS. The discharge minimum basic dataset (CMBD) allows to estimate the impact of adverse events in the Spanish hospitals (AU)

[Incidence and cost of hospitalizations for bronchiolitis and respiratory syncytial virus infections in the autonomous community of Valencia in Spain (2001 and 2002)]. / Incidencia y costes de la hospitalización por bronquiolitis y de las infecciones por virus respiratorio sincitial en la Comunidad Valenciana. Añ 2001 y 2002.

OBJECTIVE: To assess the incidence and costs of hospitalizations for bronchiolitis and respiratory syncytial virus (RSV) infections the Autonomous Community of Valencia, Spain. METHODS: The minimum data set (MDS) of the Autonomous Community of Valencia was analyzed. Hospital discharges with the codes for bronchiolitis (with or without etiologic determination) and RSV infections occurring in 2001 and 2002 in children less than 2 years old were included. Second cases of bronchiolitis and RSV infections of possible nosocomial origin occurring during prolonged hospitalization were excluded. The average cost of hospitalization in a pediatric ward was estimated at euro 310.30 per day. To calculate the incidence, we assumed that 95 % of the hospitals reported to the MDS; the population used was that of the National Census, 2001. RESULTS: A total of 3,705 hospitalizations were obtained, of which 3,507 were coded as bronchiolitis and 42.2 % of these were RSV-positive. Virological assessment varied greatly among hospitals. Hospitalizations were most frequent between October and April, with no differences between the two years. The incidence of bronchiolitis hospitalization was 40.2 cases/1000 children < 1 year/year, with an average annual cost of 3,618 thousand Euros. CONCLUSIONS: The cost of bronchiolitis hospitalizations is high. Microbiological investigation is low in some hospitals, leading the economic impact of RSV on society to be underestimated.

Incidencia y costes de la hospitalización por bronquiolitis y de las infecciones / Incidence and cost of hospitalizations for bronchiolitis and respiratory syncytial virus infections in the Autonomous Community of Valencia in Spain (2001 and 2002)

Objetivo Analizar la incidencia y costes de las hospitalizaciones por bronquiolitis y de las infecciones por virus respiratorio sincitial (VRS) en la Comunidad Valenciana. Métodos Análisis de la base de datos de altas hospitalarias (Conjunto Mínimo Básico de Datos, CMBD) de la Comunidad Valenciana de los años 2001 y 2002. Se analizaron las altas hospitalarias con los códigos de bronquiolitis (con o sin determinación etiológica) y las infecciones por VRS ocurridas en niños menores de 2 años. Se eliminaron los casos con más de una hospitalización por bronquiolitis y aquellos casos de infecciones por VRS posiblemente nosocomiales ocurridas durante hospitalizaciones prolongadas. Se estimó un coste medio por día de hospitalización en una sala pediátrica de 310,30 euros. Para el cálculo de incidencia se asumió una cobertura poblacional del CMBD del 95 % y la población según el censo de 2001. Resultados Se obtuvieron 3.705 registros, de los cuales 3.507 fueron bronquiolitis, estando el 42,2 % filiadas como producidas por VRS. La investigación virológica fue diferente según el hospital de ingreso. La hospitalización fue más frecuente entre octubre y abril sin diferencias entre los 2 años. La incidencia de ingreso por bronquiolitis fue de 40,2 casos por 1.000 niños menores de un año y año, y presentó un coste anual medio de 3.618.000 euros. Conclusiones La bronquiolitis tiene un coste hospitalario elevado. La investigación etiológica es baja en algunos hospitales lo que lleva a infraestimar el impacto económico del VRS en la sociedad

Objective To assess the incidence and costs of hospitalizations for bronchiolitis and respiratory syncytial virus (RSV) infections the Autonomous Community of Valencia, Spain. Methods The minimum data set (MDS) of the Autonomous Community of Valencia was analyzed. Hospital discharges with the codes for bronchiolitis (with or without etiologic determination) and RSV infections occurring in 2001 and 2002 in children less than 2 years old were included. Second cases of bronchiolitis and RSV infections of possible nosocomial origin occurring during prolonged hospitalization were excluded. The average cost of hospitalization in a pediatric ward was estimated at euros 310.30 per day. To calculate the incidence, we assumed that 95 % of the hospitals reported to the MDS; the population used was that of the National Census, 2001. Results A total of 3,705 hospitalizations were obtained, of which 3,507 were coded as bronchiolitis and 42.2 % of these were RSV-positive. Virological assessment varied greatly among hospitals. Hospitalizations were most frequent between October and April, with no differences between the two years. The incidence of bronchiolitis hospitalization was 40.2 cases/1000 children < 1 year/year, with an average annual cost of 3,618 thousand euros. Conclusions The cost of bronchiolitis hospitalizations is high. Microbiological investigation is low in some hospitals, leading the economic impact of RSV on society to be underestimated

¿Rehabilitar en el hospital o en unidades básicas extrahospitalarias? Un análisis de minimización de costes / Rehabilitation at the hospital or at basic extrahospital units? An analysis of costs minimization

Introducción: La búsqueda de una mayor eficiencia en el sector sanitario público debe de tender a una descentralización en la provisión de servicios. Desde esta óptica un elemento destacado a analizar son las diferencias de costes que pueden existir entre las consultas externas hospitalarias y la asistencia ambulatoria. Objetivo: Análisis de minimización de costes de la asistencia ofertada por un Servicio de Rehabilitación hospitalaria frente a la ofertada en un centro de atención primaria. Material y método: El estudio se ha realizado en el área 9 de la Comunidad Valenciana, que cuenta con un centro de rehabilitación hospitalaria y dos unidades básicas de rehabilitación. Se ha realizado el cálculo de los costes directos de cada centro: sueldos y salarios, consumos de material, mantenimiento y amortizaciones. Se ha desestimado la incorporación de costes estructurales al no encontrarse implantado un sistema de contabilidad analítica en atención primaria y por la posible distorsión en cuanto a resultados que su inclusión produciría. Se han utilizado las unidades relativas de valor para ponderar las diferentes actividades asistenciales que son comunes a todos los centros. Resultados: El coste medio por consulta médica obtenido es del 6.502 pesetas en la atención hospitalaria y 4.806 pesetas en la unidad básica de rehabilitación. Por otro lado, el coste de la unidad relativa de valor de físioterapia se sitúa entre 940 pesetas en el centro hospitalario y 491 pesetas en la unidad básica de rehabilitación. Conclusiones: Los costes de las actividades asistenciales son significativamente inferiores en la UBR, aunque los resultados obtenidos pudieran no ser extrapolables a otras áreas con diferente sistema organizativo (AU)

[Nursing care in the home and in conventional hospitalization]. / Cuidados de enfermería en hospitalización a domicilio y hospitalización convencional.

BACKGROUND: Nursing care is of especial importance in hospital care in the home (HH). This is as due to the characteristics of the patient as it is to the transfer to the informal carers for the patient. The aim of this study is to analyse the quantity and type of nursing care administered and required by patients in HH and conventional hospitalisation (CH). METHODS: Project Research Nursing (PRN) was used to quantify the amount and types of nursing care administered and required in 2 groups of patients (HH: 148 patients, 1776 stays; CH: 148 patients, 1113 stays) having similar characteristics and treated in each way, together with how they evolved, analysing differences in terms of forms of attention and the characteristics of the patients. RESULTS: In terms of the care administered, those patients in HH (647.8 minutes/episode) received less care than those in CH (1030 minutes/episode). This difference was fundamentally due to the fact that they received less basic care (HH: 96.6 min./episode; CH: 464.3 min./episode) and diagnostic work (HH: 84.4 min./episode; CH: 177.3). On the other hand, patients in HH received a greater quantity of communicational care (238.8 min., as opposed to 107.4 in CH). No significant differences were found between the care administered and that which was required. CONCLUSIONS: Patients in HH received less nursing care than did those in CH, mainly due to the fact that they received less basic care from nurses, as this work was transferred to their careers. They also received less care associated with diagnostic tests (depending on styles of medical practice), although they received more care in the form of communication (health education). The lack of differences between the care that was actually administered and that which was required suggests that the quality of care provided is sufficient in both forms of hospitalisation.