Analysis of the implementation of a personalized care model in diabetes mellitus as an example of chronic disease with information and communication technology support.

INTRODUCTION: Diabetes mellitus affects 13.8% of the adult population in Spain, representing some 8.2% of total Spanish health spending, which may be reduced by optimizing treatment and disease monitoring. Areas covered: This perspective article aims to evaluate the possible clinical and economic outcomes of implementing a theoretical personalized care model in diabetes supported by information and communications technology in Spain vs. conventional care. Moreover, we assessed the value of emminens® eConecta, a solution designed to support the operational implementation of this model, which enables the connection and participation of patients and health professionals, facilitates patient education, decision-making, access to information, and data analysis. We carried out a review of the available evidence, consultations with experts and a clinical and cost estimation. Expert commentary: The experts consulted considered that the proposed model is consistent with Spanish strategies on chronicity, supports the management of chronicity/diabetes, and may improve the most important aspects of disease management. In the literature, this type of care models improved or provided equal disease control compared with conventional care, potentiated self-management strategies and reduced the high use of resources. Cost estimation showed a reduction of -12% in total direct costs and around -34% in the costs of outpatient visits.

La cohesión del Sistema Nacional de Salud / No disponible

En este artículo se exponen cuáles han sido las principales aportaciones que la Ley 16/2003, de 28 de mayo, de Cohesión y Calidad del Sistema Nacional de Salud, ha supuesto para la coordinación del sistema sanitario español; en concreto, respecto a las actuaciones que las administraciones central y autonómicas deben realizar y en cuanto a la mejora de la calidad de dicho sistema (AU)

This article presents the main contributions of Law 16/2003 dated May 28, 2003, entitled Cohesion and Quality of the National Health System, to the coordination of the Spanish health care system. It focuses specifically on the measures to be taken by the central and autonomic administrations in order to improve the quality of that system (AU)

Methods for external evaluation of health care institutions.

OBJECTIVE: To compare the methods used by external evaluators of health care institutions in Europe. METHODS: A common framework for analysis was designed by the authors and shared among the members of the ExPeRT Project. Each member prepared a description of a model and the results were compared in two workshops. RESULTS: Programmes share similarities in the methods used, but they differ in the focus and purpose of the evaluation. Differences in focus included whether a part or the whole of the institution is analysed and whether the review is patient or system centred. Different purposes of the programmes are reflected in the emphasis and use of the methodological tools: for instance, the appeal system is used only in the programmes that provide a certificate to the institution audited.

[Health expenditures in Spain at the dawn of the 3d millennium]. / Les dépenses de santé en Espagne à l'aube du troisième millénaire.

In 1997, per capita health expenditures reached in Spain 805 Euros as compared to 1146 Euros in the entire European Union. In terms of percent GDP, Spanish health expenditures amounted to 7.4 percent, as compared to 7.9 in the European Union. About 80% of Spanish health expenditures are public-funded. Since 1993 onwards, there is a political consensus for keeping at the same pace health expenditures increase and GDP growth. However it is not certain that such a consensus can be maintained, as trade unions are increasingly voicy for a strong growth of salaries in the public sector. There will be also pressure on the demand side, both in the short term (the Spanish people are increasingly expecting to raise their consumption of health services to the level of other European countries) and in the long run (impact of population aging).

Accreditation across borders: the introduction of Joint Commission accreditation in Spain.

BACKGROUND: Introducing accreditation as conducted by the Joint Commission on Accreditation of Healthcare Organizations (Oakbrook Terrace, III) into Spain has raised many issues regarding the internationalization of accreditation. CHARACTERISTICS OF ACCREDITATION: In recent years more and more countries have considered accreditation a useful tool for the improvement of health care quality. In spite of the differences in the health care systems of the countries where accreditation has been introduced, many of the original characteristics of accreditation as seen in the United States largely remain: peer review evaluation, support of professional associations, voluntary participation, and a national approach. These similarities reflect the fact that the majority of the programs are based on models created by the Joint Commission. THE EXPERIENCE OF THE AVEDIS DONABEDIAN FOUNDATION: In 1994 the Avedis Donabedian Foundation (FAD), a nonprofit organization founded in Barcelona in 1988, broadened its scope to include accreditation. Having rejected the idea of creating de novo its own standards and accreditation program, FAD worked out an agreement with the Joint Commission whereby FAD would become a Spanish accrediting body to accredit Spanish hospitals but would collaborate with Joint Commission International to adopt the Joint Commission's accreditation standards and processes. DISCUSSION: The development of accreditation continues. As of spring 1998, seven hospitals and two ambulatory care centers are preparing for accreditation. FAD's experience with adapting the Joint Commission model of accreditation should be instructive to other countries considering health care accreditation.

A comparative analysis of surveyors from six hospital accreditation programmes and a consideration of the related management issues.

PURPOSE: To gather data on how accreditors manage surveyors, to compare these data and to offer them to the accreditors for improvement and to the scientific community for knowledge of the accreditation process and reinforcement of the credibility of these processes. DATA SOURCE: The data were gathered with the aid of a questionnaire sent to all accreditors participating in the study. RESULTS: An important finding in this comparative study is the different contractual relationships that exist between the accreditors and their surveyors. CONCLUSION: Surveyors around the world share many common features in terms of careers, training, work history and expectations. These similarities probably arise from the objectives of the accreditors who try to provide a developmental process to their clients rather than an 'inspection'.

Accreditation programs for hospitals: funding and operation.

Accreditation is a formal process by which an authorized body assesses and recognizes an individual, an organization (like a hospital), a program, or a group as complying with requirements such as standards or criteria. This article analyses and compares the activity and funding of six health care accrediting bodies which operate in five different countries, and which in 1994, accredited over 5000 health centres. The data included in this article could be useful for other institutions who wish to commence accreditation programmes for health care organizations.

Hospital accreditation in Catalunya: an assessment of the performance in quality of hospitals.

Information about a hospital accreditation program generally goes unpublished, and when published, it is seldom used to analyse the quality performance in a group of hospitals. This article uses the information derived from the Accreditation Program of Hospitals in Catalunya to assess the quality of the performance of hospitals in this region. Catalunya's accreditation program is publicly administered, and the advantages and disadvantages of such a model in comparison to others will also be analysed.

An analysis of the factors affecting the average length of stay in the otolaryngology unit.

Specific factors which have an influence on the average length of stay in the otolaryngology unit of a University Hospital are studied; the patients are covered by some type of insurance and have no out-of-pocket expenses. The effect of the following variables on the average length of stay is evaluated: age, sex and type of pathology. The periods of hospitalisation are significantly longer (Mann-Whitney test) in males (p < 0.0001), in older patients (p < 0.008) and in the case of tumours, which prolong the period of stay especially of males (p < 0.0001). It is suggested that the shorter stay in the case of females may be conditioned by social and family factors.

The implementation of a quality assurance programme in the Hospital de la Santa Creu i Sant Pau in Barcelona.

The goal of quality assurance is to guarantee quality in medical care through the detection of problems with their subsequent evaluation and study, and through the implementation of corrective measures, when necessary. This article describes the criteria, methods, and results of a programme of quality assurance introduced in the Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, in 1981. The programme covered the following aspects: evaluation of medical care services; process and outcome of medical care; use of available resources; and patient satisfaction. The results obtained over the last two years showed a substantial improvement in those areas which had been influenced by the programme, as well as the development of collective responsibility of the medical staff when faced with the problems of quality that have been detected.