Análisis de la influencia del proceso asistencial de la atención primaria de salud sobre la ocurrencia de hospitalizaciones evitables por insuficiencia cardíaca / Analysis of the influence of the process of care in primary health care on avoidable hospitalizations for heart failure

Objetivo: Comprobar si el proceso asistencial en Atención Primaria de Salud (APS), definido por 7 criterios de correcta atención, influye en el riesgo de hospitalizaciones evitables por Ambulatory Care Sensitive Conditions (ACSH) por insuficiencia cardíaca (IC). Diseño: Estudio de casos y controles que analizó el riesgo de hospitalización por IC. Factor de exposición: proceso asistencial de APS. Emplazamiento: Área sanitaria de la Comunidad de Madrid (n = 466.901). Participantes: Pacientes mayores de 14 años con el registro del diagnóstico de IC en la historia clínica electrónica de APS (n = 3.277) antes del 1 de enero de 2007. Los casos fueron pacientes que ingresaron en el hospital de referencia por IC durante 2007. Los controles no requirieron ingreso. Mediciones principales: Riesgo de ACSH por IC relacionado con el proceso asistencial considerado tanto de forma conjunta como por cada uno de los criterios. Diferencias en complejidad clínica mediante Adjusted Clinical Group(ACG). Resultados: Doscientos veintisiete ingresos por IC frente a un grupo control de 3.050 pacientes. El peso medio de ACG fue mayor en los casos. Los controles tuvieron mayor cumplimentación de criterios, pero ninguno cumplió los 7. Solo en 2 de los criterios se observó menor riesgo de ACSH. A medida que no se cumplimentaba progresivamente cada criterio, el riesgo de ingresar aumentó (OR = 1,33; IC 95%: 1,19-1,49). Conclusión: La calidad del proceso asistencial en APS influyó en el riesgo de ingreso por IC (AU)

Objective: To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). Design: Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. Location: Health area of the region of Madrid (n=466.901). Participants: There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n = 3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. Main measurements: risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. Results: 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). Conclusion: Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF (AU)

[Analysis of the influence of the process of care in primary health care on avoidable hospitalizations for heart failure]. / Análisis de la influencia del proceso asistencial de la atención primaria de salud sobre la ocurrencia de hospitalizaciones evitables por insuficiencia cardíaca.

OBJECTIVE: To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). DESIGN: Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. LOCATION: Health area of the region of Madrid (n=466.901). PARTICIPANTS: There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. MAIN MEASUREMENTS: risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. RESULTS: 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). CONCLUSION: Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF.