Diseño y validación del Índice de Evaluación de Casos Complejos (IECC), un instrumento para identificar pacientes complejos / Design and validation of the Complex Case Evaluation Index, an instrument to identify complex patients

Fundamento: Desarrollar y validar un instrumento específico de identificación de pacientes complejos, elÍndice de Evaluación de Casos Complejos (IECC). Métodos: Estudio instrumental con dos fases: 1) Elaboración del instrumento: se definieron y operacionalizaronlas variables extraídas de la literatura que, posteriormente, fueron sometidas al juicio de expertos. El IECCincluyó catorce variables divididas en dos dimensiones:complejidad del manejo clínico y complejidad del manejo comunitario. 2) Estudio psicométrico: evaluaciónde la fiabilidad por equivalencia entre observadores (rPearson), de la validez de criterio respecto al sistema declasificación Clinical Risk Groups (CRG) y de la validezde constructo a través de grupos conocidos y a travésdel estudio de conglomerados jerárquicos. Los análisisse realizaron con el paquete estadístico SPSS.v.17. Resultados: La fiabilidad entre observadores para lasubescala clínica fue r = 0,97, para la subescala comunitaria r = 0,74 y para la puntuación total r = 0,89. El 88,4%(n = 458) de los 518 casos identificados como complejospor el IECC fueron categorizados por el sistema CRG enlas categorías de más complejidad clínica (niveles 6 a9). Los resultados sustentan la validez de constructode la escala. El análisis de conglomerados mostró dosclusters diferentes, aunque relacionados. Conclusión: El IECC es un índice breve y de fácil aplicación, con una buena adecuación conceptual y evidencias de su fiabilidad y validez dirigido a la detección depacientes con necesidades complejas.(AU)

Background: The aim was to develop and validate theComplex Case Assessment Index (CCAI), a specific instrument to identify complex patients. Methods: Instrumental study in two phases: 1) Development of the scale: the variables extracted from theliterature were firstly defined and operationalized, andthen submitted for expert judgment. The CCAI included14 variables divided into two dimensions: complexity ofclinical management and complexity of community management. 2) Psychometric study: evaluation of the reliability and validity of the scale by equivalence betweenobservers (Pearson’s r), criterion validity with respect tothe Clinical Risk Groups (CRG) classification system, andconstruct validity through known groups and study ofhierarchical clusters were examined. The analyses werecarried out with the SPSS version 17 statistical package. Results: Reliability by equivalence between observers was r = 0.97 for the clinical subscale, r = 0.74 for thecommunity subscale, and r = 0.89 for the total score.The CCAI identified 518 cases as complex; 458 of them(88.4%) were categorized by the CRG system in the categories of greatest clinical complexity (levels 6 to 9).The results support the construct validity of the scale.The cluster analysis showed two different, although related, clusters. Conclusion: The CCAI is a fast and easy-to-use index,with good conceptual adequacy and evidence of reliability and validity for screening patients with complexneeds.(AU)

[Design and validation of a complex case evaluation index].

BACKGROUND: The aim was to develop and validate the Complex Case Assessment Index (CCAI), a specific instrument to identify complex patients. METHODS: Instrumental study in two phases: 1) Development of the scale: the variables extracted from the literature were firstly defined and operationalized, and then submitted for expert judgment. The CCAI included 14 variables divided into two dimensions: complexity of clinical management and complexity of community management. 2) Psychometric study: evaluation of the reliability and validity of the scale by equivalence between observers (Pearson's r), criterion validity with respect to the Clinical Risk Groups (CRG) classification system, and construct validity through known groups and study of hierarchical clusters were examined. The analyses were carried out with the SPSS version 17 statistical package. RESULTS: Reliability by equivalence between observers was r?=?0.97 for the clinical subscale, r?=?0.74 for the community subscale, and r?=?0.89 for the total score. The CCAI identified 518 cases as complex; 458 of them (88.4%) were categorized by the CRG system in the categories of greatest clinical complexity (levels 6 to 9). The results support the construct validi-ty of the scale. The cluster analysis showed two different, although related, clusters. CONCLUSION: The CCAI is a fast and easy-to-use index, with good conceptual adequacy and evidence of reliability and validity for screening patients with complex needs.

Sedoanalgesia realizada por intensivistas en pacientes no críticos / No disponible

No disponible

[Quality of life in homebound elderly people in a district of Alicante (Spain)]. / Estudio de la calidad de vida en las personas mayores confinadas en el domicilio en un barrio de Alicante.

OBJECTIVE: To measure health-related quality of life (HRQoL) in homebound elderly individuals in the District of San Blas (Alicante, Spain). METHOD: The sample was composed of 107 people aged more than 75 years old included in the home care program. As a measurement instrument, the Spanish version of COOP/WONCA charts in their complete version were used. RESULTS: The mean age was 83.18 years. Distribution by sex was 76 (71%) women and 31 (29%) men. The mean overall score was 29.7 points with a standard deviation of 5.04. The association between age and total score was 0.19, which was statistically significant (p = 0.045). Comparison of these two means with Student's t-test for independent samples showed no statistically significant differences (t = -580; p > 0.05). When differences between men and women in each of the items of the scale were analyzed, only "social activities" showed a statistically significant difference (t = -2.959; p = 0.04). The time taken to administer the questionnaire was 30 +/- 5 min. CONCLUSIONS: HRQoL in our population is worse than that in other studied populations. Due to the ceiling-floor effect of some of the variables, further studies in this type of population are required. The time used in this type of population to complete the questionnaire was five times greater than that used in other populations.

Estudio de la calidad de vida en las personas mayores confinadas en el domicilio en un barrio de Alicante / Quality of life in homebound elderly people in a district of Alicante (Spain)

Objetivo. Medir la calidad de vida relacionada con la salud en personas mayores confinadas en el domicilio en el Barrio de San Blas de Alicante. Método. La muestra estuvo compuesta por 107 personas mayores de 75 años incluidas en el programa de atención domiciliaria. Como instrumento de medida se utilizó la versión española de las láminas COOP/WONCA en su versión completa. Resultados. La edad media fue de 83,18 años. La distribución por sexo fue de 76 (71%) mujeres y 31 (29%) varones. La puntuación global media fue de 29,7 con una desviación estándar de 5,04. La asociación entre la edad y la puntuación total fue de 0,19, estadísticamente significativa (p = 0,045). Al comparar estas 2 medias con la prueba t de Student de muestras independientes no resultaron estadísticamente significativas (t = ­580; p > 0,05). En cuanto a la diferencia de varones y mujeres en cada uno de los ítems de la escala tan sólo las "actividades sociales" mostraron diferencia estadísticamente significativa entre varones y mujeres (t = ­2,959; p = 0,04). El tiempo empleado para realizar la encuesta fue de 30 ± 5 min. Conclusiones. La calidad de vida de nuestra población es peor que la de otras poblaciones estudiadas. Debido al efecto suelo-techo de algunas de las variables sería necesario realizar más estudios en este tipo de población. El tiempo empleado en este tipo de población para cumplimentar el cuestionario ha sido 5 veces superior que el empleado en otras poblaciones

Objective. To measure health-related quality of life (HRQoL) in homebound elderly individuals in the District of San Blas (Alicante, Spain). Method. The sample was composed of 107 people aged more than 75 years old included in the home care program. As a measurement instrument, the Spanish version of COOP/WONCA charts in their complete version were used. Results. The mean age was 83.18 years. Distribution by sex was 76 (71%) women and 31 (29%) men. The mean overall score was 29.7 points with a standard deviation of 5.04. The association between age and total score was 0.19, which was statistically significant (p = 0.045). Comparison of these two means with Student's t-test for independent samples showed no statistically significant differences (t = ­580; p > 0.05). When differences between men and women in each of the items of the scale were analyzed, only "social activities" showed a statistically significant difference (t = ­2.959; p = 0.04). The time taken to administer the questionnaire was 30 ± 5 min. Conclusions. HRQoL in our population is worse than that in other studied populations. Due to the ceiling-floor effect of some of the variables, further studies in this type of population are required. The time used in this type of population to complete the questionnaire was five times greater than that used in other populations